Understanding Alcohol Abuse and Alcoholism

Many of us may be drinking too much alcohol without realizing that the amount we consume is a risk to our health and well-being. And, according to reports from the Centers for Disease Control and Prevention (CDC, cdc.gov), most of us aren’t discussing our alcohol use with healthcare providers, putting us at even great risk for problems associated with heavy drinking.

We tend to be aware of the dangers of alcoholism (a disease that includes problems controlling drinking and physical dependence on alcohol), but we’re less likely to understand that excessive and binge drinking are also significant health concerns. Because we’re not aware of these dangers—and maybe because we’re embarrassed about our drinking—we’re not telling our doctors about our excessive drinking; and our healthcare providers don’t tend to ask about it. This means that they can’t look for warning signs of alcohol-related problems or help us cut back.

According to the CDC, at least 38 million U.S. adults drink what’s considered “too much.” This includes binge drinking (for men, five or more alcoholic drinks in about two or three hours; for women, four or more in two or three hours), high weekly use (an average of more than 15 drinks per week for men and eight for women), and any alcohol use by pregnant women or those under age 21.

But even with 38 million U.S. adults drinking too much, the CDC reports that only one in six adults is discussing their alcohol use with a healthcare provider.

As a result, we’re missing out on some significant benefits: Studies suggest that among people who drink too much, alcohol screening and brief counseling can reduce consumption on an occasion by 25 percent. So if you tend to binge at five drinks on an outing, once you’ve had a chat about drinking with your healthcare provider, you may be more inclined to stop at fewer than one and a half.

Sensible choices when it comes to alcohol use can have a real impact. Not only is excessive drinking responsible for around 88,000 deaths in the United State each year and about $224 billion in expenses, it can lead to heart disease, breast cancer, sexually transmitted diseases, unintended pregnancy, fetal alcohol spectrum disorders, sudden infant death syndrome, motor-vehicle crashes, and violence. Each person who cuts back on alcohol can help reduce the incidence of these issues.

It’s easy to understand that as patients and healthcare providers, we can’t afford not to discuss alcohol use with our healthcare providers. We hope that our doctors, nurses, and others will act on the need to ask us. But we can also do our part as healthcare consumers by starting the conversation, being honest about our drinking, and seeking help if we think we’re drinking too much.

Drinking raises your risk of liver disorders because drinking can cause inflammation of the liver, called alcoholic hepatitis. Over time, this inflammation can lead to scarring of the liver, also known as cirrhosis.
Alcohol can contribute to digestive problems by causing inflammation of the lining of the stomach and thus interfering with nutrient absorption. The pancreas may also become damaged, leading to problems with metabolism and digestion of fats, proteins, and carbohydrates.
You may be at an increased risk for cancer, as alcohol abuse has been linked with the development of cancers such as mouth, throat, liver, colon, and breast cancer.

What Is Alcohol Abuse?

Alcohol abuse is a condition where you drink too much and your drinking has become disruptive in many areas of your life, but you aren’t dependent on alcohol. The Centers for Disease Control and Prevention (CDC) defines “excessive” alcohol use as drinking an average of more than two drinks per day for men and more than one drink per day for women. Even without dependence, you may have some of the symptoms of alcohol dependence, or alcoholism, which are described in the next section. You may have trouble cutting back on your drinking or quitting without help. The same resources available to people with alcoholism (counseling and self-help groups, for example) can also help people who abuse alcohol but are not dependent. Learn more about treatment in “How Is Alcohol Dependence Treated?”

Signs that you may be abusing alcohol include:

Trouble fulfilling responsibilities at work, school, or home
Drinking in dangerous situations, such as when driving or operating machinery
Having legal problems related to drinking, such as being arrested for driving under the influence or for alcohol-related violent behavior
Continuing to drink even though you know it is harming your personal relationships and health

What Is Alcohol Dependence?

Alcohol dependence, also known as alcoholism, is considered a chronic disease. If you have alcoholism, your body has become dependent on alcohol, and you lose control over your drinking—when you drink and how much. You’re aware that drinking may cause health problems and is disrupting your relationships, work life, and may be negatively impacting your finances, but you continue to drink anyway.

Some factors can increase the risk that your drinking will turn into alcoholism. These include:

Drinking too much over an extended period, which can lead to physical dependence on alcohol
Beginning drinking at an early age
Gender—with men more likely to become dependent on alcohol than women
A family history of alcoholism or alcohol abuse
Having depression and other mental health problems
Having people around you who drink heavily or abuse alcohol

How Do I Know if I’m Addicted to Alcohol?

If you worry that you may be addicted to, or dependent on, alcohol, consider the following questions. If you answer “yes” to even one of them, you may be abusing or dependent on alcohol and should seek help (learn more about treating drinking problems in “How Is Alcohol Dependence Treated?”).

If you’re a man, do you ever have five or more drinks in one day? Or, if you’re a woman, do you ever have four or more drinks in a day?
Do you have strong cravings for alcohol?
Do you continue to drink even though you know it is causing physical and emotional problems and conflict in your relationships?
Do you need a drink when you wake up in the morning?
Do you feel guilty about your drinking?
Do you think you need to cut back on how much you drink but can’t make yourself limit your intake?
Are you annoyed if other people criticize your drinking habits?
Do you experience withdrawal symptoms (nausea, sweating, shakiness, anxiety) if your stop drinking after a period of heavy drinking?

Symptoms and Effects of Alcohol Dependence

Symptoms of alcoholism, which may also occur with alcohol abuse, include:

Not being able to limit the amount of alcohol you drink
Feeling a strong need or compulsion to drink
Having developed a high tolerance for alcohol so that you must consume more before feeling its effects
Drinking-related legal problems or problems with relationships, employment, or finances
Drinking alone or in secret
Physical withdrawal symptoms when you don’t drink (such as nausea, sweating, and shaking)
“Blacking out” (not remembering conversations or commitments) due to drinking
Losing interest in activities that you once enjoyed
Keeping alcohol readily available by stashing it in unlikely places (such as places at home, at work, and in your car)

Alcohol dependence and abuse can cause problems in a various areas or your life, from behavior to serious health complications. The CDC estimates that from 2001-2005, there were approximately 79,000 deaths attributable to excessive drinking.

Impact on behavior:

Driving while intoxicated puts you at greater risk for car accidents. And being under the influence raises your risk of any type of accident.
Drinking may lead to poor judgment and lowered inhibitions; both can result in dangerous or regrettable situations and behaviors.
Drinking may contribute to conflict with family and in personal relationships.
Your performance at work or at school may suffer as a result of your drinking.
People who drink heavily may be more likely to become violent.

In Addition to its Impact on the GI System Alcohol is associated with other health conditions:

You may be at greater risk of heart problems, as heavy drinking can raise your blood pressure.
If you have diabetes, drinking can put you at risk of dangerously low blood sugar, or hypoglycemia.
Men can experience erectile dysfunction as a result of excessive drinking.
In women, heavy drinking can interrupt menstruation.
Women who drink during pregnancy put their baby at risk of birth defects such as fetal alcohol syndrome, which involves both physical and mental problems.
Alcohol can contribute to osteoporosis, or thinning of the bones, a condition that increases your risk of fracture.
Excessive drinking may lead to neurological complications, such as numbness in your hands and feet, disordered thinking, dementia, and short-term memory loss..

How Is Alcohol Dependence Treated?

If you think you might be dependent on alcohol or that you don’t have control over your drinking, it’s time to talk to your doctor. Your first step may be to visit your family doctor, or you may wish to talk with a mental health provider or attend a support group such as Alcoholics Anonymous, or AA (www.aa.org).

Be aware that denial is common among people with alcoholism and alcohol abuse. So, even if you don’t believe you have a problem, but other people are concerned about your drinking habits, consider treatment.

Treatment of alcoholism will be different for each individual. Factors that may affect the course that you and your healthcare providers choose include your personal preferences, other health concerns, and various characteristics of your dependence (your doctor will likely ask you detailed questions to determine what these are). Some of the phases of treatment may include:

Detoxification and withdrawal. If your body has become dependent on alcohol, your treatment will begin with several days of detoxification, commonly called “detox.” The detox process can cause shaking, confusion, and hallucinations, which can all be managed with medication. Most people stay at a hospital or inpatient treatment center during detox.
Creating a treatment plan. An alcohol abuse specialist can help you plan your treatment. He or she will work with you to establish goals, learn coping skills, change behaviors associated with drinking, and help you find resources like self-help manuals, counseling, and treatment centers. Depending on the severity of the alcohol problem, some people undergo treatment at residential facilities, whereas others are treated on an outpatient basis.
Psychological counseling. Alcoholism may impact your emotional well-being and your relationships. Individual, couples, or family counseling can help you work through these issues.
There are several oral medications available to help people with alcoholism quit drinking. Antabuse® (disulfiram) causes a bad reaction to alcohol (nausea and vomiting), ReVia® (naltrexone) blocks the good feeling that alcohol can produce and thus reduces the urge to drink; and Campral® (acamprosate) can help reduce cravings for alcohol. Naltrexone (ReVia in pill form) can also be received by injection under the name Vivitrol®.
Medical treatment for other conditions. Alcoholism is often related to medical problems including high blood pressure, increased blood sugar, and liver and heart disease. If you’re being treated for alcoholism, it’s also important that you’re screened and, if needed, treated for other conditions.
Ongoing support. Recovery from alcoholism can be a long and complex process. Challenges may include lifestyle changes, relapses, and psychological issues. These challenges are best met with ongoing support. Look to programs and support groups such as AA.

Professional help is vital to successful recovery from alcoholism, but there are also measures you can personally take to support your recovery. Changes to your lifestyle, habits, and social life can help you quit drinking and avoid a relapse. Make sure your friends and family know that you are not drinking; if you find that some people aren’t supportive of your recovery, you may need to avoid them as well as situations where it’s hard not to drink. Find ways to make your lifestyle healthier: exercise, eat well, and get plenty of sleep. Find new hobbies and interests to replace activities that involve drinking—you’ll likely discover some things that you really enjoy!