PROBLEM DRINKING AND ALCOHOLISM

Problem Drinking

At times the line separating problem drinking from alcoholism is difficult to distinguish.  There may be no true line, with the exception that alcoholic is unable to stop drinking.  Problem drinking is a pattern of alcohol use in which a drinker’s behavior creates personal difficulties or difficulties for other people.  What are some of these behaviors? Examples might be drinking to avoid life stressors, going to work intoxicated, drinking and driving, becoming injured or injuring others while drinking, solitary drinking, morning drinking, and occasional blackout, high-risk sexual activity, and being told by others that you drink too much.  For college students, two clear indications of problem drinking are missing classes and lowered academic performance caused by alcohol involvement. 

Problem drinkers are not always heavy drinkers; they might not be daily or even weekly drinkers.  Unlike alcoholics, problem drinkers do not need to drink to maintain “normal” body functions.  However, when they do drink, they (and others around them) experience problems sometimes with tragic consequences.  It’s not surprising that problem drinkers are more likely than other drinkers to eventually develop alcoholism.

Alcoholism

In the early 1990s a revised definition of alcoholism was established by a joint committee of experts on alcohol dependence.  This committee defined alcoholism as follows:

Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.  The disease is often progressive and fatal.  It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.  Each of these symptoms may be continuous or periodic.

This definition incorporates much of the knowledge gained from addiction research during the last two decades.  It is well recognized that alcoholics do not drink for the pleasurable effects of alcohol but to escape being sober.  For alcoholics, being sober is stressful.

Unlike problem drinking, alcoholism involve a physical addiction to alcohol.  For the true alcoholic, when the body is deprived of alcohol, physical and mental withdrawal symptoms become evident.  These withdrawal symptoms can be life threatening.

Uncontrollable shaking can progress to nausea, vomiting, hallucinations, shock, and cardiac and pulmonary arrest.  Uncontrollable shaking combined with irrational hallucinations is called delirium tremens (DT), an occasional manifestation of alcohol withdrawal.

The complex reasons for the physical and emotional dependence of alcoholism have not been fully explained.  Why, when more than 100 million adults use alcohol without becoming dependent on it, are 10 million or more others unable to control its use?

Could alcoholism be an inherited disease? Studies in humans and animals have provided strong evidence that genetics plays a role in some cases of alcoholism.  Two forms of alcoholism are thought to be inherited: type 1 and type 2.  Type 1 is thought to take years to develop and may not surface until midlife.  Type 2 is a more severe form and appears to be passed primarily from fathers to sons.  This form of alcoholism frequently begins earlier in a person’s life and may even start in adolescence.

Genetics may also help protect some Asians from developing alcoholism.  About half or all Far East Asians produce low levels of an important enzyme that helps metabolize alcohol.  These people cannot tolerate even small amounts of alcohol.  Genetic factors pertaining to the absorption rates of alcohol in the intestinal tract have been hypothesized to predispose some Native Americans to alcoholism.  It is likely that more research will be undertaken concerning the role of genetic factors in all of chemical dependence.

The role of personality traits as conditioning factors in the development of alcoholism has received considerable attention.  Factors ranging from unusually low self-esteem to an antisocial personality have been implicated.  Additional factors making people susceptible to alcoholism may include excessive reliance on denial, hypervigilance, compulsiveness, and chronic levels of anxiety.  Always complicating the study of personality traits is the uncertainty of whether the personality profile is a predisposing factor (perhaps from inheritance) or is caused by alcoholism.

Codependence

Within the last decade, a new term has been used to describe the relationship between drug-dependent people and those around them – codependence.  This term implies a kind of dual addiction.  The alcoholic and the person close to the alcoholic are both addicted, one to alcohol and the other to the alcoholic.  People who are codependent often find themselves denying the addiction and enabling the alcohol-dependent person.

Unfortunately, this kind of behavior damages both the alcoholic and the codependent.  The alcoholic’s intervention and treatment may be delayed for a considerable time.  Codependent often pay a heavy price as well.  They often become drug- or alcohol-dependent themselves, or they may suffer a avariety of psychological consequences related  to guilt, loss of self-esteem, depression, and anxiety.  Codependents may at increased risk for physical and sexual abuse.

Researchers continue to explore this dimension of alcoholism.

Denial and Enabling

Problem drinkers and alcoholics frequently use the psychological defense mechanism of denial to maintain their drinking behavior.  By convincing themselves that their lives are  not affected by their drinking, problem drinkers and alcoholics are able to maintain their drinking patterns.  A person’s denial is an unconscious process that is apparent only to rational observers.

Formerly, it was up to alcoholics to admit that their denial was no longer effective before they could be admitted to a treatment program.  This is not the case today.  Currently, family members, friends, or coworkers of alcohol-dependent people are encouraged to intervene and force an alcohol-dependent person into treatment.

During treatment, it is important to chemically dependent people to break through the security of denial and admit that alcohol controls their lives.  This process is demanding and often time-consuming, but it is necessary for recovery.

For family and friends of chemically dependent people, denial is part of a process known as enabling.  In this process, people close to problem drinker or alcoholic inadvertently support drinking behavior by denying that a problem really exists.  Enablers unconsciously make excuses for the drinker, try to keep the drinker’s work and family life intact, and in effect make the continued abuse of alcohol possible.  For example, college students enable problem drinkers when they clean up a drinker’s messy room, lie to professors about student’s class absences, and provide class notes or other assistance to a drinker who can’t keep up academically.

Alcohol counselors contend that enablers are an alcoholic’s worst enemy because they can significantly delay the onset of effective therapy.  Do you know of a situation in which you or others have enabled a person with an alcohol problem?

Alcoholism and the Family

Considerable disruption occurs in the families of alcoholics, not only from the consequences of the drinking behavior (such as violence, illness, and unemployment), but also because of the uncertainty of the family’s role in causing and prolonging the situation.  Family members often begin to adopt a variety of new roles that will allow them to cope with the presence of the alcoholic in the family.  Among the more commonly seen roles are the family hero, the lost child, the family mascot, and the scapegoat.  Unless family members receive appropriate counseling, these roles may remain intact for a lifetime.

Once an alcoholic’s therapy has begun, family members are encouraged to participate in many aspects of the recovery.  This participation will also help them understand how they are affected by alcoholism.  If therapy and aftercare include participation in Alcoholics Anonymous (AA), family mambers will be encouraged to become affiliated with related support groups.

Helping the Alcoholics: Rehabilitation and Recovery

Once an alcoholic realizes that alcoholism is not a form of moral weakness but rather a clearly defined illness, the chances for recovery is remarkably good.  It is estimated that as many as two-third of alcoholics can recover.  Recovery is especially enhanced when the addicted person has a good emotional support system, including concerned family members, friends, and employer.  When this support system is not well established, the alcoholic’s chances for recovery are considerably lower.

AA is a voluntary support group of recovering alcoholics who meet regularly to help each other get and stay sober.  Over 100,00 groups exist in 150 countries worldwide.  AA encourages alcoholics to admit their lack of power over alcohol and to turn their lives over to a higher power (although the organization is nonsectarian).  Members of AA are encouraged not to be judgmental about the behavior of other members.  They support everyone with a problem caused by a alcohol.

Al-Anon and Alateen are parallel organizations that give support to people who live with alcoholics.  Al-Anon is geared toward spouses and other relatives, and Alateen focuses on children of alcoholics.  There are 28,000 Al-Anon groups and 3000 Alateen gropus worldwide.  Both organizations help members realize that they are not alone and that successful adjustments can be made to nearly every alcoholic-related situation.  AA, Al-Anon, and Alateen chapter organizations are usually listed in the telephone book or in the classified sections of local newspapers.  You can locate Al-Anon and Alateen on the Web at www.al-anon.alateen.org.

For people who feel uncomfortable with the concept that their lives are controlled by a higher power, secular recovery programs are becoming popular.  These programs maintain that sobriety comes from within the alcoholic.  Secular programs strongly emphasize self-reliance, self-determination, and rational thinking about one’s drinking.  Secular Organizations for Sobriety (SOS) and Rational Recovery are examples of secular recovery programs.

Drugs to Treat Alcoholism

Could there be a medical cure for alcoholism? For nearly 50 years, the only prescription drug physicians could use to help drinkers stop drinking was disulfiram (Antabuse).  Antabuse would cause drinkers to become extremely nauseated whenever they used alcohol.

In 1995 the Food and Drug Administration approved the drug naltrexone (ReVia) that works by reducing the craving for alcohol and the pleasurable sensations felt when drinking.  Combining naltrexone with conventional behavior modification has shown promising results.  Additionally, the use of antidepressants by some alcoholics has been especially helpful during treatment.