Alcoholism, also known as alcohol use disorder (AUD), is a broad term
for any drinking of alcohol that results in mental or physical health
problems. The disorder was previously divided into two types:
alcohol abuse and alcohol dependence. In a medical context,
alcoholism is said to exist when two or more of the following
conditions is present: a person drinks large amounts over a long time
period, has difficulty cutting down, acquiring and drinking alcohol
takes up a great deal of time, alcohol is strongly desired, usage
results in not fulfilling responsibilities, usage results in social
problems, usage results in health problems, usage results in risky
situations, withdrawal occurs when stopping, and alcohol tolerance has
occurred with use. Risky situations include drinking and driving or
having unsafe sex, among other things. Alcohol use can affect all
parts of the body, but it particularly affects the brain, heart,
liver, pancreas, and immune system. This can result in mental
illness, Wernicke–Korsakoff syndrome, an irregular heartbeat,
cirrhosis of the liver, and an increase in the risk of cancer, among
other diseases. Drinking during pregnancy can cause damage to
the baby resulting in fetal alcohol spectrum disorders. Women are
generally more sensitive than men to the harmful physical and mental
effects of alcohol.
Environmental factors and genetics are two components that are
associated with alcoholism, with about half the risk attributed to
each. A person with a parent or sibling with alcoholism is three to
four times more likely to become an alcoholic themselves.
Environmental factors include social, cultural, and behavioral
influences. High stress levels, anxiety, as well as inexpensive
cost and easy accessibility to alcohol increase the risk. People
may continue to drink partly to prevent or improve symptoms of
withdrawal. After a person stops drinking alcohol, they may
experience a low level of withdrawal lasting for months. Medically,
alcoholism is considered both a physical and mental illness.
Questionnaires and certain blood tests may both detect people with
possible alcoholism. Further information is then collected to
confirm the diagnosis.
Prevention of alcoholism may be attempted by regulating and limiting
the sale of alcohol, taxing alcohol to increase its cost, and
providing inexpensive treatment. Treatment may take several
steps. Due to medical problems that can occur during withdrawal,
alcohol detoxification should be carefully controlled. One common
method involves the use of benzodiazepine medications, such as
diazepam. This can be either given while admitted to a health care
institution or occasionally while a person remains in the community
with close supervision.
Mental illness or other addictions may
complicate treatment. After detoxification support such as group
therapy or support groups are used to help keep a person from
returning to drinking. One commonly used form of support is the
group Alcoholics Anonymous. The medications acamprosate,
disulfiram, or naltrexone may also be used to help prevent further
World Health Organization
World Health Organization estimates that as of 2010 there were 208
million people with alcoholism worldwide (4.1% of the population over
15 years of age). In the United States about 17 million (7%) of
adults and 0.7 million (2.8%) of those age 12 to 17 years of age are
affected. It is more common among males and young adults, becoming
less common in middle and old age. It is the least common in Africa
at 1.1% and has the highest rates in
Eastern Europe at 11%.
Alcoholism directly resulted in 139,000 deaths in 2013, up from
112,000 deaths in 1990. A total of 3.3 million deaths (5.9% of all
deaths) are believed to be due to alcohol. It often reduces a
person's life expectancy by around ten years. In the United States
it resulted in economic costs of $224 billion USD in 2006. Many
terms, some insulting and others informal, have been used to refer to
people affected by alcoholism; the expressions include tippler,
drunkard, dipsomaniac, and souse. In 1979, the World Health
Organization discouraged the use of "alcoholism" due to its inexact
meaning, preferring "alcohol dependence syndrome".
1 Signs and symptoms
1.1 Early signs
1.2 Long-term misuse
1.3 Warning signs
220.127.116.11 Short-term effects
18.104.22.168 Long-term effects
1.3.3 Social effects
1.4 Alcohol withdrawal
2.2 Gender difference
2.3 Genetic variation
3.1.2 Johnson's typologies
3.1.3 Milam & Ketcham's physical deterioration stages
3.1.4 DSM and ICD
3.2 Social barriers
3.4 Genetic predisposition testing
3.5 Urine and blood tests
5.4 Dual addictions and dependences
9 Society and culture
11 See also
13 External links
Signs and symptoms
Effects of alcohol on the body
The risk of alcohol dependence begins at low levels of drinking and
increases directly with both the volume of alcohol consumed and a
pattern of drinking larger amounts on an occasion, to the point of
intoxication, which is sometimes called "binge drinking". Young adults
are particularly at risk of engaging in binge drinking.[citation
Some of the possible long-term effects of ethanol an individual may
develop. Additionally, in pregnant women, alcohol can cause fetal
Alcoholism is characterised by an increased tolerance to
alcohol–which means that an individual can consume more
alcohol–and physical dependence on alcohol, which makes it hard for
an individual to control their consumption. The physical dependency
caused by alcohol can lead to an affected individual having a very
strong urge to drink alcohol. These characteristics play a role
decreasing an alcoholic's ability to stop drinking.
have adverse effects on mental health, causing psychiatric disorders
and increasing the risk of suicide. A depressed mood is a common
symptom of heavy alcohol drinkers.
Warning signs of alcoholism include the consumption of increasing
amounts of alcohol and frequent intoxication, preoccupation with
drinking to the exclusion of other activities, promises to quit
drinking and failure to keep those promises, the inability to remember
what was said or done while drinking (colloquially known as
"blackouts"), personality changes associated with drinking, denial or
the making of excuses for drinking, the refusal to admit excessive
drinking, dysfunction or other problems at work or school, the loss of
interest in personal appearance or hygiene, marital and economic
problems, and the complaint of poor health, with loss of appetite,
respiratory infections, or increased anxiety.
Main article: Short-term effects of alcohol
Drinking enough to cause a blood alcohol concentration (BAC) of
0.03–0.12% typically causes an overall improvement in mood and
possible euphoria (a "happy" feeling), increased self-confidence and
sociability, decreased anxiety, a flushed, red appearance in the face
and impaired judgment and fine muscle coordination. A BAC of 0.09% to
0.25% causes lethargy, sedation, balance problems and blurred vision.
A BAC of 0.18% to 0.30% causes profound confusion, impaired speech
(e.g. slurred speech), staggering, dizziness and vomiting. A BAC from
0.25% to 0.40% causes stupor, unconsciousness, anterograde amnesia,
vomiting (death may occur due to inhalation of vomit (pulmonary
aspiration) while unconscious and respiratory depression (potentially
life-threatening). A BAC from 0.35% to 0.80% causes a coma
(unconsciousness), life-threatening respiratory depression and
possibly fatal alcohol poisoning. With all alcoholic beverages,
drinking while driving, operating an aircraft or heavy machinery
increases the risk of an accident; many countries have penalties for
See also: Long-term effects of alcohol consumption
Having more than one drink a day for women or two drinks for men
increases the risk of heart disease, high blood pressure, atrial
fibrillation, and stroke. Risk is greater in younger people due to
binge drinking, which may result in violence or accidents. About
3.3 million deaths (5.9% of all deaths) are believed to be due to
alcohol each year.
Alcoholism reduces a person's life expectancy
by around ten years and alcohol use is the third leading cause of
early death in the United States. No professional medical
association recommends that people who are nondrinkers should start
drinking wine. Long-term alcohol abuse can cause a number of
physical symptoms, including cirrhosis of the liver, pancreatitis,
epilepsy, polyneuropathy, alcoholic dementia, heart disease,
nutritional deficiencies, peptic ulcers and sexual dysfunction,
and can eventually be fatal. Other physical effects include an
increased risk of developing cardiovascular disease, malabsorption,
alcoholic liver disease, and several cancers. Damage to the central
nervous system and peripheral nervous system can occur from sustained
alcohol consumption. A wide range of immunologic defects can
result and there may be a generalized skeletal fragility, in addition
to a recognized tendency to accidental injury, resulting a propensity
to bone fractures.
Women develop long-term complications of alcohol dependence more
rapidly than do men. Additionally, women have a higher mortality rate
from alcoholism than men. Examples of long-term complications
include brain, heart, and liver damage and an increased risk of
breast cancer. Additionally, heavy drinking over time has been found
to have a negative effect on reproductive functioning in women. This
results in reproductive dysfunction such as anovulation, decreased
ovarian mass, problems or irregularity of the menstrual cycle, and
early menopause. Alcoholic ketoacidosis can occur in individuals
who chronically abuse alcohol and have a recent history of binge
drinking. The amount of alcohol that can be biologically
processed and its effects differ between sexes. Equal dosages of
alcohol consumed by men and women generally result in women having
higher blood alcohol concentrations (BACs), since women generally have
a higher percentage of body fat and therefore a lower volume of
distribution for alcohol than men, and because the stomachs of men
tend to metabolize alcohol more quickly.
Long-term misuse of alcohol can cause a wide range of mental health
problems. Severe cognitive problems are common; approximately 10
percent of all dementia cases are related to alcohol consumption,
making it the second leading cause of dementia. Excessive alcohol
use causes damage to brain function, and psychological health can be
increasingly affected over time.
Social skills are significantly
impaired in people suffering from alcoholism due to the neurotoxic
effects of alcohol on the brain, especially the prefrontal cortex area
of the brain. The social skills that are impaired by alcohol abuse
include impairments in perceiving facial emotions, prosody perception
problems and theory of mind deficits; the ability to understand humour
is also impaired in alcohol abusers. Psychiatric disorders are
common in alcoholics, with as many as 25 percent suffering severe
psychiatric disturbances. The most prevalent psychiatric symptoms are
anxiety and depression disorders. Psychiatric symptoms usually
initially worsen during alcohol withdrawal, but typically improve or
disappear with continued abstinence. Psychosis, confusion, and
organic brain syndrome may be caused by alcohol misuse, which can lead
to a misdiagnosis such as schizophrenia.
Panic disorder can
develop or worsen as a direct result of long-term alcohol
The co-occurrence of major depressive disorder and alcoholism is well
documented. Among those with comorbid occurrences, a
distinction is commonly made between depressive episodes that remit
with alcohol abstinence ("substance-induced"), and depressive episodes
that are primary and do not remit with abstinence ("independent"
episodes). Additional use of other drugs may increase the
risk of depression. Psychiatric disorders differ depending on
gender. Women who have alcohol-use disorders often have a co-occurring
psychiatric diagnosis such as major depression, anxiety, panic
disorder, bulimia, post-traumatic stress disorder (PTSD), or
borderline personality disorder. Men with alcohol-use disorders more
often have a co-occurring diagnosis of narcissistic or antisocial
personality disorder, bipolar disorder, schizophrenia, impulse
disorders or attention deficit/hyperactivity disorder (ADHD).
Women with alcoholism are more likely to experience physical or sexual
assault, abuse and domestic violence than women in the general
population, which can lead to higher instances of psychiatric
disorders and greater dependence on alcohol.
See also: Drug-related crime
Serious social problems arise from alcoholism; these dilemmas are
caused by the pathological changes in the brain and the intoxicating
effects of alcohol.
Alcohol abuse is associated with an
increased risk of committing criminal offences, including child abuse,
domestic violence, rape, burglary and assault.
associated with loss of employment, which can lead to financial
problems. Drinking at inappropriate times and behavior caused by
reduced judgment can lead to legal consequences, such as criminal
charges for drunk driving or public disorder, or civil penalties
for tortious behavior, and may lead to a criminal sentence. An
alcoholic's behavior and mental impairment while drunk can profoundly
affect those surrounding him and lead to isolation from family and
friends. This isolation can lead to marital conflict and divorce, or
contribute to domestic violence.
Alcoholism can also lead to child
neglect, with subsequent lasting damage to the emotional development
of the alcoholic's children. For this reason, children of
alcoholic parents can develop a number of emotional problems. For
example, they can become afraid of their parents, because of their
unstable mood behaviors. In addition, they can develop considerable
amount of shame over their inadequacy to liberate their parents from
alcoholism. As a result of this failure, they develop wretched
self-images, which can lead to depression.
Main article: Alcohol withdrawal syndrome
See also: Kindling (sedative-hypnotic withdrawal)
A French temperance poster from the Union des Françaises contre
l'Alcool (this translates as "Union of French Women Against Alcohol").
The poster states "Ah! Quand supprimera-t'on l'alcool?", which
translates as "Ah! When will we [the nation] abolish alcohol?"
As with similar substances with a sedative-hypnotic mechanism, such as
barbiturates and benzodiazepines, withdrawal from alcohol dependence
can be fatal if it is not properly managed. Alcohol's primary
effect is the increase in stimulation of the GABAA receptor, promoting
central nervous system depression. With repeated heavy consumption of
alcohol, these receptors are desensitized and reduced in number,
resulting in tolerance and physical dependence. When alcohol
consumption is stopped too abruptly, the person's nervous system
suffers from uncontrolled synapse firing. This can result in symptoms
that include anxiety, life-threatening seizures, delirium tremens,
hallucinations, shakes and possible heart failure. Other
neurotransmitter systems are also involved, especially dopamine, NMDA
Severe acute withdrawal symptoms such as delirium tremens and seizures
rarely occur after 1-week post cessation of alcohol. The acute
withdrawal phase can be defined as lasting between one and three
weeks. In the period of 3–6 weeks following cessation increased
anxiety, depression, as well as sleep disturbance, is common;
fatigue and tension can persist for up to 5 weeks as part of the
post-acute withdrawal syndrome; about a quarter of alcoholics
experience anxiety and depression for up to 2 years. These post-acute
withdrawal symptoms have also been demonstrated in animal models of
alcohol dependence and withdrawal. A kindling effect also occurs
in alcoholics whereby each subsequent withdrawal syndrome is more
severe than the previous withdrawal episode; this is due to
neuroadaptations which occur as a result of periods of abstinence
followed by re-exposure to alcohol. Individuals who have had multiple
withdrawal episodes are more likely to develop seizures and experience
more severe anxiety during withdrawal from alcohol than
alcohol-dependent individuals without a history of past alcohol
withdrawal episodes. The kindling effect leads to persistent
functional changes in brain neural circuits as well as to gene
expression. Kindling also results in the intensification of
psychological symptoms of alcohol withdrawal. There are decision
tools and questionnaires which help guide physicians in evaluating
alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol
withdrawal symptoms in order to guide therapy decisions which allows
for an efficient interview while at the same time retaining clinical
usefulness, validity, and reliability, ensuring proper care for
withdrawal patients, who can be in danger of death.
William Hogarth's Gin Lane, 1751
A complex mixture of genetic and environmental factors influences the
risk of the development of alcoholism. Genes that influence the
metabolism of alcohol also influence the risk of alcoholism, and may
be indicated by a family history of alcoholism. One paper has
found that alcohol use at an early age may influence the expression of
genes which increase the risk of alcohol dependence. Individuals
who have a genetic disposition to alcoholism are also more likely to
begin drinking at an earlier age than average. Also, a younger age
of onset of drinking is associated with an increased risk of the
development of alcoholism, and about 40 percent of alcoholics will
drink excessively by their late adolescence. It is not entirely clear
whether this association is causal, and some researchers have been
known to disagree with this view.
Severe childhood trauma is also associated with a general increase in
the risk of drug dependency. Lack of peer and family support is
associated with an increased risk of alcoholism developing.
Genetics and adolescence are associated with an increased sensitivity
to the neurotoxic effects of chronic alcohol abuse. Cortical
degeneration due to the neurotoxic effects increases impulsive
behaviour, which may contribute to the development, persistence and
severity of alcohol use disorders. There is evidence that with
abstinence, there is a reversal of at least some of the alcohol
induced central nervous system damage. The use of cannabis was
associated with later problems with alcohol use. Alcohol use was
associated with an increased probability of later use of tobacco,
cannabis, and other illegal drugs.
Alcohol is the most available, widely consumed, and widely abused
Beer alone is the world's most widely consumed
alcoholic beverage; it is the third-most popular drink overall, after
water and tea. It is thought by some to be the oldest fermented
Based on combined data from SAMHSA's 2004–2005 National Surveys on
Drug Use & Health, the rate of past-year alcohol dependence or
abuse among persons aged 12 or older varied by level of alcohol use:
44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past
month non-binge drinkers, and 1.3% of those who did not drink alcohol
in the past month met the criteria for alcohol dependence or abuse in
the past year. Males had higher rates than females for all measures of
drinking in the past month: any alcohol use (57.5% vs. 45%), binge
drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%),
and males were twice as likely as females to have met the criteria for
alcohol dependence or abuse in the past year (10.5% vs. 5.1%).
See also: Human genetic variation
Genetic differences that exist between different racial groups affect
the risk of developing alcohol dependence. For example, there are
differences between African, East Asian and Indo-racial groups in how
they metabolize alcohol. These genetic factors partially explain the
differing rates of alcohol dependence among racial groups. The
alcohol dehydrogenase allele ADH1 B*3 causes a more rapid metabolism
of alcohol. The allele ADH1 B*3 is only found in those of African
descent and certain Native American tribes. African Americans and
Native Americans with this allele have a reduced risk of developing
alcoholism. Native Americans, however, have a significantly higher
rate of alcoholism than average; it is unclear why this is the
case. Other risk factors such as cultural environmental effects
e.g. trauma have been proposed to explain the higher rates of
alcoholism among Native Americans compared to alcoholism levels in
A genome-wide association study of more than 100,000 human individuals
identified variants of the gene KLB, which encodes the transmembrane
protein β-Klotho, as highly associated with alcohol consumption. The
protein β-Klotho is an essential element in cell surface receptors
for hormones involved in modulation of appetites for simple sugars and
A picture of a man drinking from a bottle of liquor while sitting on a
boardwalk, ca. 1905–1914. Picture by Austrian photographer Emil
Misuse, problem use, abuse, and heavy use of alcohol refer to improper
use of alcohol, which may cause physical, social, or moral harm to the
drinker. The Dietary Guidelines for Americans defines "moderate
use" as no more than two alcoholic beverages a day for men and no more
than one alcoholic beverage a day for women. Some drinkers may
drink more than 600 ml of alcohol per day during a heavy drinking
period. The National Institute on Alcohol Abuse and Alcoholism
(NIAAA) defines binge drinking as the amount of alcohol leading to a
blood alcohol content (BAC) of 0.08, which, for most adults, would be
reached by consuming five drinks for men or four for women over a
two-hour period. According to the NIAAA, men may be at risk for
alcohol-related problems if their alcohol consumption exceeds 14
standard drinks per week or 4 drinks per day, and women may be at risk
if they have more than 7 standard drinks per week or 3 drinks per day.
It defines a standard drink as one 12-ounce bottle of beer, one
5-ounce glass of wine, or 1.5 ounces of distilled spirits.
Despite this risk, a 2014 report in the National Survey on Drug Use
and Health found that only 10% of either "heavy drinkers" or "binge
drinkers" defined according to the above criteria also met the
criteria for alcohol dependence, while only 1.3% of non-binge drinkers
met the criteria. An inference drawn from this study is that
evidence-based policy strategies and clinical preventive services may
effectively reduce binge drinking without requiring addiction
treatment in most cases.
The term alcoholism is commonly used amongst laypeople, but the word
is poorly defined. The WHO calls alcoholism "a term of long-standing
use and variable meaning", and use of the term was disfavored by a
1979 WHO expert committee. The Big Book (from Alcoholics Anonymous)
states that once a person is an alcoholic, they are always an
alcoholic, but does not define what is meant by the term alcoholic in
this context. In 1960, Bill W., co-founder of Alcoholics Anonymous
We have never called alcoholism a disease because, technically
speaking, it is not a disease entity. For example, there is no such
thing as heart disease. Instead there are many separate heart
ailments, or combinations of them. It is something like that with
alcoholism. We did not wish to get in wrong with the medical
profession by pronouncing alcoholism a disease entity. We always
called it an illness, or a malady—a far safer term for us to
use. In professional and research contexts, the term "alcoholism"
sometimes encompasses both alcohol abuse and alcohol dependence,
and sometimes is considered equivalent to alcohol dependence. Talbot
(1989) observes that alcoholism in the classical disease model follows
a progressive course: if a person continues to drink, their condition
will worsen. This will lead to harmful consequences in their life,
physically, mentally, emotionally and socially.
Johnson (1980) explores the emotional progression of the addict’s
response to alcohol. He looks at this in four phases. The first two
are considered "normal" drinking and the last two are viewed as
"typical" alcoholic drinking. Johnson's four phases consist
Learning the mood swing. A person is introduced to alcohol (in some
cultures this can happen at a relatively young age), and the person
enjoys the happy feeling it produces. At this stage, there is no
Seeking the mood swing. A person will drink to regain that feeling of
euphoria experienced in phase 1; the drinking will increase as more
intoxication is required to achieve the same effect. Again at this
stage, there are no significant consequences.
At the third stage there are physical and social consequences, i.e.,
hangovers, family problems, work problems, etc. A person will continue
to drink excessively, disregarding the problems.
The fourth stage can be detrimental, as Johnson cites it as a risk for
premature death. As a person now drinks to feel normal, they block out
the feelings of overwhelming guilt, remorse, anxiety, and shame they
experience when sober.
Milam & Ketcham's physical deterioration stages
Other theorists such as Milam & Ketcham (1983) focus on the
physical deterioration that alcohol consumption causes. They describe
the process in three stages:
Adaptive stage – The person will not experience any negative
symptoms, and they believe they have the capacity for drinking alcohol
without problems. Physiological changes are happening with the
increase in tolerance, but this will not be noticeable to the drinker
Dependent stage – At this stage, symptoms build up gradually.
Hangover symptoms from excessive drinking may be confused with
withdrawal symptoms. Many addicts will maintain their drinking to
avoid withdrawal sickness, drinking small amounts frequently. They
will try to hide their drinking problem from others and will avoid
Deterioration stage – Various organs are damaged due to long-term
drinking. Medical treatment in a rehabilitation center will be
required; otherwise, the pathological changes will cause death.
DSM and ICD
In psychology and psychiatry, the DSM is the most common global
standard, while in medicine, the standard is ICD. The terms they
recommend are similar but not identical.
"alcohol abuse" and "alcohol dependence"
alcohol abuse = repeated use despite recurrent adverse
alcohol dependence = alcohol abuse combined with tolerance,
withdrawal, and an uncontrollable drive to drink. The term
"alcoholism" was split into "alcohol abuse" and "alcohol dependence"
in 1980's DSM-III, and in 1987's DSM-III-R behavioral symptoms were
moved from "abuse" to "dependence". It has been suggested that
DSM-V merge alcohol abuse and alcohol dependence into a single new
entry, named "alcohol-use disorder".
"alcohol harmful use" and "alcohol dependence syndrome"
Definitions are similar to that of the DSM-IV. The World Health
Organisation uses the term "alcohol dependence syndrome" rather than
alcoholism. The concept of "harmful use" (as opposed to "abuse")
was introduced in 1992's
ICD-10 to minimize underreporting of damage
in the absence of dependence. The term "alcoholism" was removed
from ICD between ICD-8/ICDA-8 and ICD-9.
DSM-IV diagnosis of alcohol dependence represents one approach to
the definition of alcoholism. In part, this is to assist in the
development of research protocols in which findings can be compared to
one another. According to the DSM-IV, an alcohol dependence diagnosis
is: "maladaptive alcohol use with clinically significant impairment as
manifested by at least three of the following within any one-year
period: tolerance; withdrawal; taken in greater amounts or over longer
time course than intended; desire or unsuccessful attempts to cut down
or control use; great deal of time spent obtaining, using, or
recovering from use; social, occupational, or recreational activities
given up or reduced; continued use despite knowledge of physical or
psychological sequelae." Despite the imprecision inherent in the
term, there have been attempts to define how the word alcoholism
should be interpreted when encountered. In 1992, it was defined by the
National Council on Alcoholism and Drug Dependence (NCADD) and ASAM as
"a primary, chronic disease characterized by impaired control over
drinking, preoccupation with the drug alcohol, use of alcohol despite
adverse consequences, and distortions in thinking."
MeSH has had
an entry for "alcoholism" since 1999, and references the 1992
AA describes alcoholism as an illness that involves a physical
allergy:28 (where "allergy" has a different meaning than that
used in modern medicine.) and a mental obsession.:23
The doctor and addiction specialist Dr. William D. Silkworth M.D.
writes on behalf of AA that "Alcoholics suffer from a "(physical)
craving beyond mental control".:XXVI A 1960 study by E. Morton
Jellinek is considered the foundation of the modern disease theory of
alcoholism. Jellinek's definition restricted the use of the word
alcoholism to those showing a particular natural history. The modern
medical definition of alcoholism has been revised numerous times since
American Medical Association
American Medical Association uses the word alcoholism to
refer to a particular chronic primary disease.
Attitudes and social stereotypes can create barriers to the detection
and treatment of alcohol abuse. This is more of a barrier for women
than men. Fear of stigmatization may lead women to deny that they are
suffering from a medical condition, to hide their drinking, and to
drink alone. This pattern, in turn, leads family, physicians, and
others to be less likely to suspect that a woman they know is an
alcoholic. In contrast, reduced fear of stigma may lead men to
admit that they are suffering from a medical condition, to display
their drinking publicly, and to drink in groups. This pattern, in
turn, leads family, physicians, and others to be more likely to
suspect that a man they know is an alcoholic.
Several tools may be used to detect a loss of control of alcohol use.
These tools are mostly self-reports in questionnaire form. Another
common theme is a score or tally that sums up the general severity of
The CAGE questionnaire, named for its four questions, is one such
example that may be used to screen patients quickly in a doctor's
Two "yes" responses indicate that the respondent should be
The questionnaire asks the following questions:
Have you ever felt you needed to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
Have you ever felt you needed a drink first thing in the morning
(Eye-opener) to steady your nerves or to get rid of a
CAGE questionnaire has demonstrated a high effectiveness in
detecting alcohol-related problems; however, it has limitations in
people with less severe alcohol-related problems, white women and
Other tests are sometimes used for the detection of alcohol
dependence, such as the Alcohol Dependence Data Questionnaire, which
is a more sensitive diagnostic test than the CAGE questionnaire. It
helps distinguish a diagnosis of alcohol dependence from one of heavy
alcohol use. The
Michigan Alcohol Screening Test (MAST) is a
screening tool for alcoholism widely used by courts to determine the
appropriate sentencing for people convicted of alcohol-related
offenses, driving under the influence being the most common. The
Alcohol Use Disorders Identification Test
Alcohol Use Disorders Identification Test (AUDIT), a screening
questionnaire developed by the World Health Organization, is unique in
that it has been validated in six countries and is used
internationally. Like the CAGE questionnaire, it uses a simple set of
questions – a high score earning a deeper investigation. The
Paddington Alcohol Test (PAT) was designed to screen for
alcohol-related problems amongst those attending Accident and
Emergency departments. It concords well with the AUDIT questionnaire
but is administered in a fifth of the time. Certain blood tests
may also indicate possible alcoholism.
Genetic predisposition testing
Psychiatric geneticists John I. Nurnberger, Jr., and Laura Jean Bierut
suggest that alcoholism does not have a single cause—including
genetic—but that genes do play an important role "by affecting
processes in the body and brain that interact with one another and
with an individual's life experiences to produce protection or
susceptibility". They also report that fewer than a dozen
alcoholism-related genes have been identified, but that more likely
await discovery. At least one genetic test exists for an allele
that is correlated to alcoholism and opiate addiction. Human
dopamine receptor genes have a detectable variation referred to as the
DRD2 TaqI polymorphism. Those who possess the A1 allele (variation) of
this polymorphism have a small but significant tendency towards
addiction to opiates and endorphin-releasing drugs like alcohol.
Although this allele is slightly more common in alcoholics and opiate
addicts, it is not by itself an adequate predictor of alcoholism, and
some researchers argue that evidence for DRD2 is contradictory.
Urine and blood tests
There are reliable tests for the actual use of alcohol, one common
test being that of blood alcohol content (BAC). These tests do
not differentiate alcoholics from non-alcoholics; however, long-term
heavy drinking does have a few recognizable effects on the body,
Macrocytosis (enlarged MCV)
Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1
High carbohydrate deficient transferrin (CDT)
With regard to alcoholism, BAC is useful to judge alcohol tolerance,
which in turn is a sign of alcoholism.
However, none of these blood tests for biological markers is as
sensitive as screening questionnaires.
The World Health Organization, the
European Union and other regional
bodies, national governments and parliaments have formed alcohol
policies in order to reduce the harm of alcoholism.
Targeting adolescents and young adults is regarded as an important
step to reduce the harm of alcohol abuse. Increasing the age at which
licit drugs of abuse such as alcohol can be purchased, the banning or
restricting advertising of alcohol has been recommended as additional
ways of reducing the harm of alcohol dependence and abuse. Credible,
evidence based educational campaigns in the mass media about the
consequences of alcohol abuse have been recommended. Guidelines for
parents to prevent alcohol abuse amongst adolescents, and for helping
young people with mental health problems have also been
Treatments are varied because there are multiple perspectives of
alcoholism. Those who approach alcoholism as a medical condition or
disease recommend differing treatments from, for instance, those who
approach the condition as one of social choice. Most treatments focus
on helping people discontinue their alcohol intake, followed up with
life training and/or social support to help them resist a return to
alcohol use. Since alcoholism involves multiple factors which
encourage a person to continue drinking, they must all be addressed to
successfully prevent a relapse. An example of this kind of treatment
is detoxification followed by a combination of supportive therapy,
attendance at self-help groups, and ongoing development of coping
mechanisms. The treatment community for alcoholism typically supports
an abstinence-based zero tolerance approach; however, some prefer a
Main article: Alcohol detoxification
Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of
alcohol drinking coupled with the substitution of drugs, such as
benzodiazepines, that have similar effects to prevent alcohol
withdrawal. Individuals who are only at risk of mild to moderate
withdrawal symptoms can be detoxified as outpatients. Individuals at
risk of a severe withdrawal syndrome as well as those who have
significant or acute comorbid conditions are generally treated as
inpatients. Detoxification does not actually treat alcoholism, and it
is necessary to follow up detoxification with an appropriate treatment
program for alcohol dependence or abuse to reduce the risk of
relapse. Some symptoms of alcohol withdrawal such as depressed mood
and anxiety typically take weeks or months to abate while other
symptoms persist longer due to persisting neuroadaptations.
Alcoholism has serious adverse effects on brain function; on average
it takes one year of abstinence to recover from the cognitive deficits
incurred by chronic alcohol abuse.
A regional service center for Alcoholics Anonymous.
Various forms of group therapy or psychotherapy can be used to deal
with underlying psychological issues that are related to alcohol
addiction, as well as provide relapse prevention skills. The
mutual-help group-counseling approach is one of the most common ways
of helping alcoholics maintain sobriety.
Alcoholics Anonymous was
one of the first organizations formed to provide mutual,
nonprofessional counseling, and it is still the largest. Others
include LifeRing Secular Recovery, SMART Recovery, Women For Sobriety,
and Secular Organizations for Sobriety. Rationing and moderation
programs such as
Moderation Management and DrinkWise do not mandate
complete abstinence. While most alcoholics are unable to limit their
drinking in this way, some return to moderate drinking. A 2002 US
study by the National Institute on Alcohol Abuse and Alcoholism
(NIAAA) showed that 17.7 percent of individuals diagnosed as alcohol
dependent more than one year prior returned to low-risk drinking. This
group, however, showed fewer initial symptoms of dependency. A
follow-up study, using the same subjects that were judged to be in
remission in 2001–2002, examined the rates of return to problem
drinking in 2004–2005. The study found abstinence from alcohol was
the most stable form of remission for recovering alcoholics. A
long-term (60 year) follow-up of two groups of alcoholic men concluded
that "return to controlled drinking rarely persisted for much more
than a decade without relapse or evolution into abstinence."
In the United States there are four approved medications for
alcoholism: disulfiram, two forms of naltrexone, and acamprosate.
Several other drugs are also used and many are under investigation.
Benzodiazepines, while useful in the management of acute alcohol
withdrawal, if used long-term can cause a worse outcome in alcoholism.
Alcoholics on chronic benzodiazepines have a lower rate of achieving
abstinence from alcohol than those not taking benzodiazepines. This
class of drugs is commonly prescribed to alcoholics for insomnia or
anxiety management. Initiating prescriptions of benzodiazepines
or sedative-hypnotics in individuals in recovery has a high rate of
relapse with one author reporting more than a quarter of people
relapsed after being prescribed sedative-hypnotics. Those who are
long-term users of benzodiazepines should not be withdrawn rapidly, as
severe anxiety and panic may develop, which are known risk factors for
relapse into alcohol abuse. Taper regimes of 6–12 months have been
found to be the most successful, with reduced intensity of
Acamprosate may stabilise the brain chemistry that is altered due to
alcohol dependence via antagonising the actions of glutamate, a
neurotransmitter which is hyperactive in the post-withdrawal
phase. By reducing excessive
NMDA activity which occurs at the
onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol
withdrawal related neurotoxicity.
Acamprosate reduces the risk of
relapse amongst alcohol dependent persons.
Disulfiram (Antabuse) prevents the elimination of acetaldehyde, a
chemical the body produces when breaking down ethanol. Acetaldehyde
itself is the cause of many hangover symptoms from alcohol use. The
overall effect is severe discomfort when alcohol is ingested: an
extremely fast-acting and long-lasting uncomfortable hangover. This
discourages an alcoholic from drinking in significant amounts while
they take the medicine.
Naltrexone is a competitive antagonist for opioid receptors,
effectively blocking the effects of endorphins and opioids. Naltrexone
is used to decrease cravings for alcohol and encourage abstinence.
Alcohol causes the body to release endorphins, which in turn release
dopamine and activate the reward pathways; hence when naltrexone is in
the body there is a reduction in the pleasurable effects from
consuming alcohol. Evidence supports a reduced risk of relapse
among alcohol dependent persons and a decrease in excessive
Nalmefene also appears effective and works by a similar
Calcium carbimide works in the same way as disulfiram; it has an
advantage in that the occasional adverse effects of disulfiram,
hepatotoxicity and drowsiness, do not occur with calcium
The Sinclair method is a method of using naltrexone or another opioid
antagonists to treat alcoholism by having the person take the
medication about an hour before they drink alcohol, and only
then. The medication blocks the positive reinforcement
effects of ethanol and hopefully allows the person to stop drinking or
Evidence does not support the use of selective serotonin reuptake
inhibitors (SSRIs), tricyclic antidepressants (TCAs), antipsychotics,
Dual addictions and dependences
Alcoholics may also require treatment for other psychotropic drug
addictions and drug dependences. The most common dual dependence
syndrome with alcohol dependence is benzodiazepine dependence, with
studies showing 10–20 percent of alcohol-dependent individuals had
problems of dependence and/or misuse problems of benzodiazepine drugs
such as valium or clonazopam. These drugs are, like alcohol,
Benzodiazepines may be used legally, if they are
prescribed by doctors for anxiety problems or other mood disorders, or
they may be purchased as illegal drugs "on the street" through illicit
Benzodiazepine use increases cravings for alcohol and the
volume of alcohol consumed by problem drinkers. Benzodiazepine
dependency requires careful reduction in dosage to avoid
benzodiazepine withdrawal syndrome and other health consequences.
Dependence on other sedative-hypnotics such as zolpidem and zopiclone
as well as opiates and illegal drugs is common in alcoholics. Alcohol
itself is a sedative-hypnotic and is cross-tolerant with other
sedative-hypnotics such as barbiturates, benzodiazepines and
nonbenzodiazepines. Dependence upon and withdrawal from
sedative-hypnotics can be medically severe and, as with alcohol
withdrawal, there is a risk of psychosis or seizures if not managed
Disability-adjusted life year
Disability-adjusted life year for alcohol use disorders per
100,000 inhabitants in 2004.
Total recorded yearly alcohol per capita consumption (15+), in litres
of pure alcohol
World Health Organization
World Health Organization estimates that as of 2010 there are 208
million people with alcoholism worldwide (4.1% of the population over
15 years of age). Substance use disorders are a major public
health problem facing many countries. "The most common substance of
abuse/dependence in patients presenting for treatment is
alcohol." In the United Kingdom, the number of 'dependent
drinkers' was calculated as over 2.8 million in 2001. About 12%
of American adults have had an alcohol dependence problem at some time
in their life. In the United States and Western Europe, 10 to 20
percent of men and 5 to 10 percent of women at some point in their
lives will meet criteria for alcoholism.
Estonia had the highest
death rate from alcohol in Europe in 2015 at 8.8 per 100,000
Within the medical and scientific communities, there is a broad
consensus regarding alcoholism as a disease state. For example, the
American Medical Association
American Medical Association considers alcohol a drug and states that
"drug addiction is a chronic, relapsing brain disease characterized by
compulsive drug seeking and use despite often devastating
consequences. It results from a complex interplay of biological
vulnerability, environmental exposure, and developmental factors
(e.g., stage of brain maturity)."
Alcoholism has a higher
prevalence among men, though, in recent decades, the proportion of
female alcoholics has increased. Current evidence indicates that
in both men and women, alcoholism is 50–60 percent genetically
determined, leaving 40–50 percent for environmental influences.
Most alcoholics develop alcoholism during adolescence or young
adulthood. 31 percent of college students show signs of alcohol
abuse, while six percent are dependent on alcohol. Under the DSM's new
definition of alcoholics, that means about 37 percent of college
students may meet the criteria.
Alcohol use disorders deaths per million persons in 2012
Alcoholism often reduces a person's life expectancy by around ten
years. The most common cause of death in alcoholics is from
cardiovascular complications. There is a high rate of suicide in
chronic alcoholics, which increases the longer a person drinks.
Approximately 3–15 percent of alcoholics commit suicide, and
research has found that over 50 percent of all suicides are associated
with alcohol or drug dependence. This is believed to be due to alcohol
causing physiological distortion of brain chemistry, as well as social
Suicide is also very common in adolescent alcohol abusers,
with 25 percent of suicides in adolescents being related to alcohol
abuse. Among those with alcohol dependence after one year, some
met the criteria for low-risk drinking, even though only 25.5 percent
of the group received any treatment, with the breakdown as follows: 25
percent were found to be still dependent, 27.3 percent were in partial
remission (some symptoms persist), 11.8 percent asymptomatic drinkers
(consumption increases chances of relapse) and 35.9 percent were fully
recovered—made up of 17.7 percent low-risk drinkers plus 18.2
percent abstainers. In contrast, however, the results of a
long-term (60-year) follow-up of two groups of alcoholic men indicated
that "return to controlled drinking rarely persisted for much more
than a decade without relapse or evolution into abstinence."
There was also "return-to-controlled drinking, as reported in
short-term studies, is often a mirage."
Adriaen Brouwer, Inn with Drunken Peasants, 1620s
1904 advertisement describing alcoholism as a disease.
Historically the name "dipsomania" was coined by German physician C.
W. Hufeland in 1819 before it was superseded by
"alcoholism". That term now has a more specific
meaning. The term "alcoholism" was first used in 1849 by the
Swedish physician Magnus Huss to describe the systematic adverse
effects of alcohol. Alcohol has a long history of use and misuse
throughout recorded history. Biblical, Egyptian and Babylonian sources
record the history of abuse and dependence on alcohol. In some ancient
cultures alcohol was worshiped and in others, its abuse was condemned.
Excessive alcohol misuse and drunkenness were recognized as causing
social problems even thousands of years ago. However, the defining of
habitual drunkenness as it was then known as and its adverse
consequences were not well established medically until the 18th
century. In 1647 a Greek monk named Agapios was the first to document
that chronic alcohol misuse was associated with toxicity to the
nervous system and body which resulted in a range of medical disorders
such as seizures, paralysis, and internal bleeding. In 1920 the
effects of alcohol abuse and chronic drunkenness led to the failed
prohibition of alcohol in the United States, a nationwide
constitutional ban on the production, importation, transportation, and
sale of alcoholic beverages that remained in place until 1933. In 2005
alcohol dependence and abuse was estimated to cost the US economy
approximately 220 billion dollars per year, more than cancer and
Society and culture
The various health problems associated with long-term alcohol
consumption are generally perceived as detrimental to society, for
example, money due to lost labor-hours, medical costs due to injuries
due to drunkenness and organ damage from long-term use, and secondary
treatment costs, such as the costs of rehabilitation facilities and
detoxification centers. Alcohol use is a major contributing factor for
head injuries, motor vehicle accidents (due to drunk driving),
domestic violence, and assaults. Beyond the financial costs that
alcohol consumption imposes, there are also significant social costs
to both the alcoholic and their family and friends. For instance,
alcohol consumption by a pregnant woman can lead to fetal alcohol
syndrome, an incurable and damaging condition. Estimates of
the economic costs of alcohol abuse, collected by the World Health
Organization, vary from one to six percent of a country's GDP.
One Australian estimate pegged alcohol's social costs at 24% of all
drug abuse costs; a similar Canadian study concluded alcohol's share
was 41%. One study quantified the cost to the UK of all forms of
alcohol misuse in 2001 as £18.5–20 billion. All economic
costs in the United States in 2006 have been estimated at $223.5
Stereotypes of alcoholics are often found in fiction and popular
culture. The "town drunk" is a stock character in Western popular
culture. Stereotypes of drunkenness may be based on racism or
xenophobia, as in the fictional depiction of the Irish as heavy
drinkers. Studies by social psychologists Stivers and Greeley
attempt to document the perceived prevalence of high alcohol
consumption amongst the Irish in America. Alcohol consumption is
relatively similar between many European cultures, the United States,
and Australia. In Asian countries that have a high gross domestic
product, there is heightened drinking compared to other Asian
countries, but it is nowhere near as high as it is in other countries
like the United States. It is also inversely seen, with countries that
have very low gross domestic product showing high alcohol
consumption. In a study done on Korean immigrants in Canada, they
reported alcohol was even an integral part of their meal, and is the
only time solo drinking should occur. They also believe alcohol is
necessary at any social event as it helps conversations start.
Caucasians have a much lower abstinence rate (11.8%) and much higher
tolerance to symptoms (3.4±2.45 drinks) of alcohol than Chinese
(33.4% and 2.2±1.78 drinks respectively). Also, the more
acculturation there is between cultures, the more influenced the
culture is to adopt Caucasians drinking practices. Peyote, a
psychoactive agent, has even shown promise in treating alcoholism.
Alcohol had actually replaced peyote as Native Americans’
psychoactive agent of choice in rituals when peyote was outlawed.
Topiramate, a derivative of the naturally occurring sugar
monosaccharide D-fructose, has been found effective in helping
alcoholics quit or cut back on the amount they drink. Evidence
suggests that topiramate antagonizes excitatory glutamate receptors,
inhibits dopamine release, and enhances inhibitory gamma-aminobutyric
acid function. A 2008 review of the effectiveness of topiramate
concluded that the results of published trials are promising, however,
as of 2008, data was insufficient to support using topiramate in
conjunction with brief weekly compliance counseling as a first-line
agent for alcohol dependence. A 2010 review found that topiramate
may be superior to existing alcohol pharmacotherapeutic options.
Topiramate effectively reduces craving and alcohol withdrawal severity
as well as improving quality-of-life-ratings.
GABAB receptor agonist, is under study for the treatment
of alcoholism. A 2015 systematic review concluded that there is
insufficient evidence for the use of baclofen for withdrawal symptoms
in alcoholism. There is tentative data supporting baclofen in
alcohol dependence however further trials are needed as of 2013.
Ondansetron, a 5HT3 antagonist, appears to have promise as a
Alcohol-related traffic crashes in the United States
Alcohol Use Disorders Identification Test
Alcoholism in family systems
Collaborative Study On The Genetics of Alcoholism
CRAFFT Screening Test
List of countries by alcohol consumption
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Substance use disorder / Substance-related disorders
Physical dependence /
Psychological dependence / Substance dependence
Fetal alcohol spectrum disorder
Fetal alcohol spectrum disorder (FASD)
Fetal alcohol syndrome
Fetal alcohol syndrome (FAS)
Alcoholic liver disease
Alcohol flush reaction
Alcoholism (alcohol use disorder)
Effect of caffeine on memory
Caffeine-induced sleep disorder
Effects of cannabis
Long-term effects of cannabis
Hallucinogen persisting perception disorder
Opioid use disorder
Benzodiazepine use disorder
Inhalant abuse: Toluene toxicity
Poly drug use
Combined drug intoxication
The Big Book
Twelve Steps and Twelve Traditions
The Little Red Book
Day by Day
William Duncan Silkworth
Rowland Hazard III
Bill Wilson House
Disease theory of alcoholism
The Oxford Group
Charles B. Towns
Bill W. and Dr. Bob
My Name Is Bill W.
When Love Is Not Enough: The Lois Wilson Story
Bill W. (2012)
BNF: cb11964742x (data)