Alcohol Abuse and Alcoholism

What are alcohol abuse and alcoholism?
Alcohol abuse means drinking more alcohol than is socially, psychologically or physically healthy. Alcoholism is a more serious condition and is characterised by dependence, both psychological and physical, on alcohol. Alcoholism is a long-term condition in which uncontrolled drinking damages the sufferer's health, social and family life, and career. In practice, the distinction between alcohol abuse and alcoholism is not always clear-cut. Alcohol abuse and alcoholism are already common problems and are increasing, especially among young people. Alcoholism is about four times more common in men than in women.
Occasional, moderate consumption of alcohol poses little risk to health. Indeed, scientific trials have shown that a small, regular intake of red wine can reduce the risk of heart disease. However, women should drink only very little, if any, alcohol while pregnant because even moderate alcohol consumption can cause birth defects or 'foetal alcohol syndrome'.
What causes alcohol abuse and alcoholism, and who is at risk?
The cause of alcohol abuse and alcoholism is unknown but it is not simply related to drinking, because only about 10 per cent of people who drink alcohol become alcoholics. There is probably a genetic factor because the biological children of people with alcoholism are much more likely to develop alcoholism than are children who are adopted into a family with a history of alcoholism.
Even so, social factors such as an unhappy home life, a need to control anxiety, problems with relationships, low self-esteem, peer group pressure and stress probably also play a large part, most likely as 'triggers' leading to alcohol abuse and alcoholism.
However, even though many alcoholics are lonely and depressed and exhibit self-destructive behaviour, alcohol abuse and alcoholism are so common that no one personality type is clearly associated with these conditions.
What are the symptoms and complications of alcohol abuse and alcoholism?
The symptoms of alcohol abuse include: 
  • missing work because of drinking,
  • finding it hard to stop drinking,
  • feeling angry about drinking,
  • neglecting personal appearance, and
  • becoming irritable, violent or subject to mood swings.
Alcohol abuse is often a factor in accidental deaths, road traffic accidents, acts of violence, vandalism and suicide.
'Binge drinking' is another major problem. The drinker may abstain from alcohol for weeks or even months and then go on a binge, becoming completely drunk for as long as several days. This sort of problem drinking is often, but not invariably, a form of alcoholism.
A person with alcoholism may display the above symptoms as well as the following: 
  • an ability to drink increasing amounts of alcohol before getting drunk,
  • a need to drink frequently to 'get through the day',
  • an inability to stop drinking or cut down,
  • drinking alone,
  • making excuses to drink,
  • lying about drinking or hiding it,
  • confusion,
  • having memory blackouts (forgetting what happened during drinking bouts),
  • abdominal cramps or pain,
  • nausea and vomiting,
  • shaking in the morning,
  • dizziness,
  • numbness or tingling in parts of the body,
  • facial redness or spidery veins on the face, especially the nose,
  • loss of appetite or poor diet.
Prolonged misuse of alcohol can have serious effects on health by affecting certain organs of the body:
Liver and digestion - 
  • inflamed pancreas,
  • cirrhosis (scarring) of the liver,
  • ulcers in the stomach or intestine.
Heart and circulation - 
  • high blood pressure,
  • high fat levels in the blood,
  • disease of the coronary arteries, and
  • damage to the heart muscle.
Brain and nervous system - 
  • nerve damage,
  • dementia,
  • depression, and
  • sleeplessness.
Nutrition - 
  • anaemia (due to iron and folic acid deficiency), and
  • skin damage, diarrhoea and depression (due to vitamin B deficiency).
Deficiency of vitamin B1 (thiamine) produces some of the most serious effects of alcoholism. It causes loss of memory of recent events, confusion and abnormal co-ordination. It can be fatal if it is not promptly treated.
Alcohol withdrawal syndrome can occur about 12-48 hours after a person with alcoholism abruptly stops drinking. The symptoms include nausea, sweating, tremor ('the shakes'), weakness and sometimes epileptic fits. If it is severe, hallucinations may develop. If alcohol withdrawal syndrome is not treated, delirium tremens ('the DTs') can develop 2-10 days after stopping drinking. This can cause confusion, depression, anxiety, terrifying hallucinations and possibly death.
If the liver has become so damaged that it can no longer perform its function of ridding the body of various toxic substances in the blood, the brain can be affected. The result is that the person becomes drowsy and confused, and eventually sinks into a coma. This is a life-threatening condition and requires emergency treatment.
How do doctors recognise alcohol abuse and alcoholism?
A person is abusing alcohol if, during the past year, three or more of the following apply: 
  • falling behind with work because of drinking,
  • drinking in dangerous or inappropriate situations,
  • having alcohol-related legal problems,
  • allowing alcohol to make personal problems worse,
  • becoming violent when drinking.
A person may have alcoholism if, during the past year, three or more of the following apply: 
  • feeling a strong compulsion to drink,
  • being able to drink increasing amounts without getting drunk, indicating a tolerance to alcohol,
  • feeling unpleasant withdrawal effects on stopping drinking,
  • drinking more, or for longer, than intended,
  • being unable to cut down or control drinking,
  • putting aside work or other important matters in favour of drinking,
  • spending time recovering from drinking,
  • ignoring health warnings or accepting serious risks to health,
  • lying about, disguising or hiding drinking.
A physical examination may reveal health problems related to alcohol, and blood tests may reveal liver damage.
What is the treatment for alcohol abuse and alcoholism?
Self-care action plan
The most important part of treatment is for people with alcohol problems to admit it to themselves and to stop drinking completely. Other treatment includes detoxification programmes and support groups.
After alcohol is withdrawn, people with alcohol problems must learn to modify their behaviour and to avoid alcohol, situations where alcohol is freely available and situations that trigger alcohol consumption.
Stopping drinking is very difficult for a person with alcoholism and the help of friends, family and support groups such as Alcoholics Anonymous is usually essential.
Medicines
Medication is sometimes used to treat alcoholism. Often a medicine such as valium will be temporarily prescribed to treat anxiety. In more serious withdrawal cases, hospitalisation may be necessary and large doses of vitamin B and fluids are given into a vein. Anti-psychotic drugs and sedatives may also be given if there are hallucinations, confusion and agitation.
Some drugs (such as 'Antabuse') produce nausea and vomiting if even a small amount of alcohol is consumed. However, the person being treated must take the medication for it to work. Other drugs block the effects of alcohol, thus reducing the desire to drink.
What is the outcome of alcohol abuse and alcoholism?
Stopping drinking is the easiest part of treatment for alcoholism. Staying sober is the most difficult. Organisations such as Alcoholics Anonymous can be crucial in providing a social environment free of alcohol where people recovering from alcohol problems can regain self-esteem and confidence. The withdrawal of alcohol will prevent the development of severe health problems.
If you have a problem with alcohol, it is important to face up to this because there are many people equipped to help you make a full and healthy recovery.
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