Alcohol Abuse

What is alcohol abuse?

Many people enjoy drinking alcohol in social settings or to relax. But sometimes people may find they're drinking too much. And when heavy drinking leads to health, work, or relationship problems, it's a form of alcohol abuse. Experts say that alcohol abuse is marked by one or more of the following problems: continuing to drink despite alcohol-related problems; indulging in hazardous behavior such as drinking and driving; or failing to fulfill work, school, or home obligations because of heavy drinking.

What are the symptoms of alcohol abuse?

The most prominent signs of alcohol abuse are the following:

• Mood swings. Someone who abuses alcohol may have an explosive temper or become unusually aggressive.
• Drinking as a crutch. If someone is drinking more frequently in order to relax, to escape problems, or to feel "normal," these may be signs of alcohol abuse.
• Lack of control. Alcohol abusers will keep drinking until they become very drunk. Often, drinking bouts result in temporary blackouts and an inability to remember events that happened while drinking.
• Problems at work, school, or home.

It is common for alcohol abusers to drink to the point of becoming unruly and irresponsible. They often drive while drunk, become drunk in public, and miss work or have problems doing their job when they are at work. Friendships and family relationships are likely to suffer, and although the drinkers may know it, they continue to drink anyway.

How does alcohol abuse differ from alcoholism?

The two disorders have many symptoms in common (see Alcoholism), so the line is difficult to draw. However, most experts agree that alcoholism is a disease marked by a physical dependence on alcohol. Alcoholics have a greater tolerance for alcohol than other people and must consume more to get high as the disease progresses; they eventually develop a physical craving for alcohol and suffer withdrawal symptoms such as nausea, sweating, shakiness, and anxiety when they stop drinking.

Alcohol abuse, in contrast, is considered more of a psychological phenomenon. Not all alcohol abusers are alcoholics by any means, but in some cases alcohol abuse eventually progresses to alcoholism.

How do I know if I'm abusing alcohol?

Not everyone who drinks has an alcohol problem. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) offers some guidelines to help determine whether you or someone you care about may be abusing alcohol.

You might want to get help if you:

• Drink to calm your nerves, forget your worries, or reduce depression
• Gulp your drinks down too fast
• Frequently have more than one drink a day
• Lie or try to hide your drinking habits
• Hurt yourself, or someone else, while drinking
• Need more alcohol to get "high"
• Feel irritable, resentful, or unreasonable when not drinking
• Have medical, social or financial problems caused by drinking

Another set of questions that help determine if you have an alcohol problem is the CAGE test:

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning (eye opener) to steady your nerves or get rid of a hangover?

Answering "yes" to two or more of these questions may indicate a drinking problem.

What causes alcohol abuse?

Although it's considered largely a psychological problem, alcohol abuse is more common among children of problem drinkers, which suggests that there may be a genetic predisposition to abuse alcohol. Environmental factors, such as growing up in a household of heavy drinkers, may also dispose someone to alcohol abuse.

In addition, your personality and life experiences play a large role in predicting whether you abuse alcohol or not. If you're unhappy, have an addictive personality, or are going through a stressful or depressing time in your life, you may be more likely to turn to alcohol to change your mood or escape your troubles. People suffering from clinical depression or certain mental illnesses may also be more prone to abuse alcohol than others.

What are the dangers of abusing alcohol?

The health consequences of alcohol abuse are serious and can be life-threatening in many cases. Heavy drinking can increase the risk for all of these conditions:

• Cancer, particularly liver, esophagus, throat, and larynx (voice box) cancer.
• Liver cirrhosis, an irreversible liver disease.
• Immune system problems and central nervous system disorders, such as dementia and short-term memory loss.
• Fetal Alcohol Syndrome. Women who drink heavily while pregnant may cause permanent, severe brain damage to their unborn babies. Even light social drinking while pregnant may cause learning disabilities in women's offspring, according to recent research.
• Serious social problems. Problem drinking has been shown to increase the incidence of domestic violence, fights, job loss, and damaged or ruined relationships. The risk of death from car and on-the-job accidents, drowning, homicide, and suicide is also significantly higher for alcohol abusers.

But isn't it healthy to drink moderately?

The advice to drink a glass of red wine each day has become popular in recent years. Although some studies show that up to a drink a day may help reduce heart disease rates, drinking much more than that may cause health problems.

And the definition of moderate drinking may be stricter than many people think. The federal government defines moderate drinking as up to one drink a day for women and up to two drinks a day for men (women's bodies metabolize, or break down, alcohol differently than men's do).

Because the liver takes about an hour to break down the alcohol in one drink, physicians also recommend consuming no more than one drink in that amount of time. A drink is defined as a beverage containing one-half ounce of ethanol -- the amount contained in a 12-ounce serving of regular beer, five ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

How can I cut down on my drinking?

The National Institute on Alcohol Abuse and Alcoholism recommends that you start by writing down the reasons you would like to stop or cut down on your drinking. Then set a drinking limit for yourself, perhaps one or two drinks per day to start. For three weeks, keep a diary of how much you drink, when, and under what circumstances to get an idea of the kind of situations that cause you to drink too much.

Here are some other tips:

• When you're ready to stop drinking or cut down, reduce the amount of alcohol you keep in the house or stop buying it entirely.
• Drink slowly.
• Try to develop an alternative drinking ritual by substituting, say, a cup or two of hot non-caffeine tea before bed.
• Don't consume more than one drink in an hour.
• Try not to drink just because other people are doing so. Stay active and learn to spend the time and money you once spent drinking doing something else you enjoy.
• Join a support group that can help you stay sober. You may want to talk with your doctor, a counselor, or a spiritual advisor about your drinking. Often, alcohol abuse has underlying emotional or psychological causes, and it may help to discuss those issues with someone.

Where can I get help and information about alcohol abuse or alcoholism?

• The National Council on Alcoholism and Drug Dependence (NCADD) is an independent volunteer organization that provides free information and referrals for counseling and support; 244 East 58th Street, Fourth Floor, New York, NY 10022. Call the group's 24-hour "hope-line" at 800/622-2255 to be referred to a local NCADD affiliate, or visit their Web site at http://www.ncadd.org.
• Alcoholics Anonymous (AA) has over 100,000 chapters worldwide. Check their Web site or your local phone book, or call 212/870-3400 to find a group near you; P.O. Box 459, Grand Central Station; New York, NY 10163; http://www.alcoholics-anonymous.org.
• Rational Recovery Systems also provides nonreligious support for people who want to be sober; Box 800 Lotus, CA 95651; 530/621-4374; http://www.rational.org.
• The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is a public institute within the US Department of Health and Human Services. Its Web site features links to the latest research, government publications, and answers to frequently asked questions about alcohol and alcohol abuse; 5635 Fishers Lane, MSC 9304, Bethesda, MD 20892; 301/443-3860; http://www.niaaa.nih.gov.
• Secular Organizations for Sobriety (SOS) provides support groups and information for people who are dependent on alcohol and/or drugs and want to become sober. SOS National Clearinghouse; 4773 Hollywood Blvd.; Hollywood, CA 90027; 323/666-4295; http://www.sossobriety.org.
• Al-Anon and Alateen (for teenagers) provide support programs for families and friends of alcohol abusers, using the same approach as Alcoholics Anonymous. Check their Web site at http://www.al-anon.alateen.org or your local phone book, or call 888/425-2666 to find a group near you. Al-Anon Family Groups Headquarters Inc.; 1600 Corporate Landing Parkway; Virginia Beach, Virginia, 23454.

References

Good and Evil: Alcohol and Health. Harvard Men's Health Watch.

Spies CD, et al. Effects of alcohol on the heart. Curr Opin Crit Care; ;7(5):337-43.

National Institute on Alcohol Abuse and Alcoholism. Alcohol Use and Abuse. http://www.niaaa.nih.gov