Alcoholism

Introduction:

Alcoholism is a chronic, often progressive disease in which a person craves alcohol and drinks despite repeated alcohol related problems (like losing a job or a relationship). Alcoholism involves a physical dependence on alcohol, but other factors include genetic, psychological, and cultural influences.

Becoming addicted to alcohol is a gradual process that happens as alcohol changes the level of chemicals in your brain, especially gamma-aminobutyric acid or GABA (which stops you from being impulsive) and dopamine (which is linked with pleasurable feelings). As the levels of these chemicals change, you crave alcohol to make yourself feel good again.

About 18 million people in the United States abuse alcohol, and estimates suggest that more than 70 million Americans have dealt with alcoholism in their family. Alcohol is involved in almost half or all traffic deaths in the U.S.

Alcoholism is characterized by craving alcohol and losing control over drinking, along with a physical dependence (meaning that the person experiences withdrawal symptoms when not drinking) and a tolerance for alcohol (meaning the person needs to drink greater amounts to feel “good”). Before entering recovery, most alcoholics will deny they have a problem. People who abuse alcohol but are not dependent on it may have similar symptoms, but they don' t feel the same craving to drink and usually don' t experience withdrawal symptoms.

Signs and Symptoms:

Symptoms of alcoholism include:

• Drinking by yourself or in secret
• Craving alcohol
• Not being able to control the amount you drink
• Blackouts (not remembering events or conversations)
• Becoming irritable when you can' t get a drink at your regular time
• Having legal problems or an inability to sustain a relationship or a job
• Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when you stop drinking
• Needing more alcohol to feel its effects
• Liver disease

Risk Factors:

If you have a family history of alcohol abuse, you are more likely to develop the condition than someone without a family history. Other factors that may increase your risk include:

• Having 2 or more adverse events during childhood
• Beginning to drink early, by age 16 or sooner
• Drinking more than 1 - 2 drinks per day
• Smoking cigarettes (particularly teenagers)
• Being under a lot of stress
• Having a pre-existing psychiatric disorder (such as depression or anxiety)
• Men have higher rates of alcoholism than women
• Broken homes

Diagnosis:

If you are experiencing symptoms associated with alcoholism, you should see your doctor. He or she can help make a diagnosis and guide you in determining which treatment or combination of therapies will work best. You should know that, because most alcoholics deny they have a problem, they are often unlikely to seek treatment by themselves. Friends and family members may have to convince them to seek help.

Your doctor will take a history and do a physical exam. Questions that he or she may ask include:

• Have you ever thought that you needed to cut back on the amount of alcohol you drink?
• Has a spouse, friend or coworker ever annoyed you by asking you to drink less?
• Do you ever feel guilty about the amount that you drink?
• Do you ever drink in the morning or early in the day to soothe a hangover, get the day started, or get rid of the shakes?

Blood tests generally aren' t helpful because they only show recent alcohol consumption. But your doctor may order liver function tests to see if there has been damage to your liver from alcohol.

Preventive Care:

If you drink, do so only in moderation -- no more than 2 drinks per day if you are a man and no more than 1 drink per day if you are a woman.

Early intervention is key, especially with teenagers. To prevent teen drinking, consider the following:

• Stay involved and interested in your teenager's life.
• Talk openly to your children, especially pre-teens and teens, about the widespread presence and dangers of alcohol and drugs.
• Have clear, non-negotiable rules about not using alcohol and drugs.
• Act as a role model -- don' t drink excessively, use other drugs, or smoke.
• Strongly urge your children to not smoke.
• Encourage your children to become active in sports, music, the arts, or other activities.
• Know where your children and teens are at all times and make sure they always have adult supervision.
• Monitor your teenager for aggressive behavior, feelings of anger or depression, and poor school performance. If any of these develop, consider whether alcohol may be a reason.
• Never drink and drive or allow your teenager to be driven in the car by someone who has been drinking.

Treatment Approach:

The first and most important step in getting treatment for alcoholism is recognizing that you have a problem. Often, family members and close friends may urge treatment for the person with the addiction.

Treatment and ongoing recovery must address both physical and psychological addiction and may include inpatient treatment and/or Alcoholics Anonymous (AA). In an inpatient or residential program, the person generally stays in a hospital or center for 28 days, undergoing first detoxification (usually 4 - 7 days) and then individual and group therapy emphasizing abstinence. Talk to a doctor about what is best for you or your loved one.

Lifestyle

• Attend Alcoholics Anonymous.
• Family members should attend Al-Anon to learn how to help the person with the addiction and to get help and support themselves.
• Exercise regularly to help reduce cravings.

Medications

Your provider may prescribe the following medications:

For alcohol withdrawal

Benzodiazepines -- tranquilizers used during the first few days of treatment to help you withdraw safely from alcohol. These drugs include:

• Diazepam (Valium)
• Chlordiazepoxid (Librium)
• Lorazepam (Ativan)
• Oxazepam (Serax)

Anticonvulsants -- may also help with withdrawal symptoms and don' t have the potential for abuse (as benzodiazepines do). They include:

• Carbamazepine (Tegretol)
• Valprioc acid (Depakote)
• Phenytoin (Dilantin)
• Gabapentn (Neurontin)

To prevent relapse

Naltrexone (Revia, Vivitrol) -- used in combination with counseling, may lessen the craving for alcohol and help prevent a return to drinking. Taking Revia or Vivitrol blocks receptors in your brain so that you don' t get “high” from drinking. It is only used after detoxification -- that is, once you are no longer physically addicted to alcohol.

Acamprosate (Campral) -- may help restore the chemical balance in the brain. It is best used in combination with counseling.

Disulfiram (Antabuse) -- an older medication that discourages drinking by causing nausea, vomiting, and other unpleasant physical reactions when alcohol is used.

Nutrition and Dietary Supplements

Because chronic use of alcohol decreases your appetite and keeps your body from absorbing vital nutrients, you may be deficient in a number of vitamins and minerals. Your doctor may tell you to take supplements while you are regaining your health. Beneficial supplements may include vitamin B complex, vitamin C, selenium, magnesium, and zinc. A combination of amino acids -- carnitine, glutamine, and glutathione -- may help reduce cravings, blood sugar fluctuations, and stress related to alcohol use.

Thiamine (vitamin B1) -- Your doctor may prescribe a thiamine supplement during withdrawal. Heavy use of alcohol causes thiamine deficiency, which can lead to a serious brain disorder called Wernicke-Korsakoff syndrome.

People who abuse alcohol are often deficient in vitamin A, but should take extra supplements (beyond the recommended daily allowance) only under their doctor' s supervision. High doses of vitamin A can damage the liver and may causes alcoholic liver disease to develop more quickly in people who drink heavily.

Herbs

The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner. However, herbs alone should not be used to treat alcoholism; counseling and peer groups such as AA are also needed.

• Milk thistle (Silybum marianum) -- Milk thistle is often used to treat liver problems, and some studies looking at milk thistle to treat alcoholic liver disease have found significant improvements in liver function. People with the mildest form of alcohol related liver damage seem to improve the most. Milk thistle is less effective for those with severe liver disease such as cirrhosis, which is characterized by scarring and permanent, irreversible damage to the liver. However, there are no studies looking at whether milk thistle is useful for alcohol withdrawal.
• Kudzu (Pueraria lobata) -- Animal studies suggest that kudzu, used in traditional Chinese medicine to treat alcohol abuse, might help reduce cravings. However, one study in humans failed to show any benefit.
• Dandelion (Taraxacum officinale) -- Dandelion is used traditionally for liver related problems, although there is evidence that it helps alcohol withdrawal symptoms. It is often combined with milk thistle.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend a treatment for alcoholism based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Homeopathy alone should not be used to treat alcoholism, but can be a supportive therapy along with counseling and groups such as AA. The following are a few examples of remedies that an experienced homeopath might consider for symptoms related to alcohol abuse or withdrawal:

Arsenicum album -- for anxiety and compulsiveness, with nausea, vomiting, and diarrhea

Nux vomica -- for irritability and compulsiveness with constipation, nausea, and vomiting

Lachesis -- for cravings for alcohol, headaches, and difficulty swallowing

Staphysagria -- for angry individuals who tend to suppress their emotions and may have been abused physically, sexually, or psychologically in the past

Mind/Body Medicine

Cognitive behavioral therapy with a psychologist or psychiatrist is a very effective treatment approach for alcohol addiction. This type of therapy, which is geared toward changing your beliefs and thought process about drinking, can help you cope with stress and control your behavior. Talk to your doctor about finding a qualified cognitive behavioral therapist.

Acupuncture

In some cases, acupuncture may be a useful supportive therapy for addiction. Some but not all studies of acupuncture for the treatment of alcohol abuse have shown that it can reduce cravings and symptoms of withdrawal. However, acupuncture alone should not be used to treat alcohol addiction, but in combination with counseling and groups such as AA.

Other Considerations:

Pregnancy

Drinking alcohol while pregnant can seriously damage the baby, causing a condition known as fetal alcohol syndrome. Fetal alcohol syndrome causes irreversible physical and mental disabilities. The only safe way to protect against damage to the baby is not to drink during pregnancy or even if you are trying to become pregnant.

Prognosis and Complications

Possible complications associated with heavy alcohol use include:

• Mental confusion or delirium
• Severe amnesia
• An unsteady gait
• Loss of sperm cells
• Repeated vomiting, ulcers, gastrointestinal bleeding
• Pancreatitis

In addition, long-term use of alcohol decreases life expectancy by about 15 years and puts you at significant risk for:

• Liver damage, even liver failure (called cirrhosis)
• High blood pressure, heart disease, and heart failure
• Brain and nerve damage
• Certain types of cancer including mouth, throat, laryngeal (voice box), esophageal, and breast
• Osteoporosis
• Nutritional deficiencies
• Infections, including pneumonia and tuberculosis
• Low bone mineral density and osteoporosis

The good news is, however, that even though alcohol abuse is a serious condition with potentially dire consequences, it is treatable. If you or someone you love has a problem, seek the help and advice of a health care professional as early as possible.

• Reviewed last on: 11/20/2009
• Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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