Alcoholism is thought to arise from a combination of a wide range of
physiological, psychological, social, and genetic factors. It is
characterized by an emotional and often physical dependence on alcohol,
and it frequently leads to brain damage or early death.
Some 10 percent of the adult drinkers in the United States are
considered alcoholics or at least they experience drinking problems to
some degree. More males than females are affected, but drinking among
the young and among women is increasing. Consumption of alcohol is
apparently on the rise in the United States, countries of the former
Union of Soviet Socialist Republics, and many European nations. This is
paralleled by growing evidence of increasing numbers of alcohol-related
problems in other nations, including the Third World.
Alcoholism, as opposed to merely excessive or irresponsible
drinking, has been variously thought of as a symptom of psychological or
social stress or as a learned, maladaptive coping behavior. More
recently, and probably more accurately, it has come to be viewed as a
complex disease entity in its own right. Alcoholism usually develops
over a period of years. Early and subtle symptoms include placing
excessive importance on the availability of alcohol. Ensuring this
availability strongly influences the person’s choice of associates or
activities. Alcohol comes to be used more as a mood-changing drug than
as a foodstuff or beverage served as a part of social custom or
Initially, the alcoholic may demonstrate a high tolerance to alcohol,
consuming more and showing less adverse effects than others.
Subsequently, however, the person begins to drink against his or her own
best interests, as alcohol comes to assume more importance than personal
relationships, work, reputation, or even physical health. The person
commonly loses control over drinking and is increasingly unable to
predict how much alcohol will be consumed on a given occasion or, if the
person is currently abstaining, when the drinking will resume again.
Physical addiction to the drug may occur, sometimes eventually leading
to drinking around the clock to avoid withdrawal symptoms.
Alcohol has direct toxic as well as sedative effects on the body,
and failure to take care of nutritional and other physical needs during
prolonged periods of excessive drinking may further complicate matters.
Advanced cases often require hospitalization. The effects on major organ
systems are cumulative and include a wide range of digestive-system
disorders such as ulcers, inflammation of the pancreas, and cirrhosis of
the liver. The central and peripheral nervous systems can be permanently
damaged. Blackouts, hallucinations, and extreme tremors may occur. The
latter symptoms are involved in the most serious alcohol withdrawal
syndrome, delirium tremens, which can prove fatal despite prompt
treatment. This is in contrast to withdrawal from narcotic drugs such as
heroin, which, although distressful, rarely results in death. Recent
evidence has shown that heavy—and even moderate—drinking during
pregnancy can cause serious damage to the unborn child: physical or
mental retardation or both; a rare but severe expression of this damage
is known as fetal alcohol syndrome.
Treatment of the illness increasingly recognizes alcoholism itself
as the primary problem needing attention, rather than regarding it as
always secondary to another, underlying problem. Specialized residential
treatment facilities and separate units within general or psychiatric
hospitals are rapidly increasing in number. As the public becomes more
aware of the nature of alcoholism, the social stigma attached to it
decreases, alcoholics and their families tend to conceal it less, and
diagnosis is not delayed as long. Earlier and better treatment has led
to encouragingly high recovery rates.
In addition to managing physical complications and withdrawal states,
treatment involves individual counseling and group therapy techniques
aimed at complete and comfortable abstinence from alcohol and other
mood-changing drugs of addiction. Such abstinence, according to the best
current evidence, is the desired goal, despite some highly controversial
suggestions that a safe return to social drinking is possible. Addiction
to other drugs, particularly to other tranquilizers and sedatives, poses
a major hazard to alcoholics. Antabuse, a drug that produces a violent
intolerance for alcohol as long as the substance remains in the body, is
sometimes used after withdrawal. Alcoholics Anonymous, a support group
commonly used for those undergoing other treatment, in many cases helps
alcoholics to recover without recourse to formal treatment.
Despite these encouraging signs, estimates of the annual number of
deaths related to excessive drinking exceed 97,000 in the United States
alone. Economic costs related to alcoholism are at least $100 billion a
year. Additional data are needed on various societal costs of alcoholism
as well as on the costs of various modes of treatment compared with
their actual results.
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