ALCOHOL-RELATED DISORDER

A fact sheet adapted from the American Psychology Association

When does drinking become a problem?

For most adults, moderate alcohol use -- no more than two drinks a day for men and one for women and older people -- is relatively harmless.(A "drink" consists of 1.5 ounces of spirits, 5 ounces of wine or 12 ounces of beer, which contain equal amounts of alcohol.)Moderate use, however, lies at one end of a continuum that moves through alcohol abuse to alcohol dependence:

    Alcohol abuse is a drinking pattern that results in adverse consequences that are both significant and recurrent. Alcohol abusers may fail to fulfill major school, work or family obligations. They may have drinking-related legal problems, such as drunk driving arrests.They may have relationship problems related to their drinking.

    People with alcoholism -- technically known as alcohol dependence -- have become compulsive in their alcohol use.Although they can control their drinking at times, they are often unable to stop once they start. As their tolerance increases, they may need more and more alcohol to achieve the same "high". Or they may become physically dependent on alcohol, suffering withdrawal symptoms such as nausea, sweating, restlessness, irritability, tremors, and even hallucinations and convulsions when they stop after a period of heavy drinking. It doesn't matter what kind of alcohol someone drinks or even how much:alcohol dependent people simply lack reliable control over their drinking.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), one in 13 American adults is an alcohol abuser or alcoholic at any given time. A 1997 government survey revealed that drinking problems are also common among younger Americans -- despite the fact that most states outlaw drinking under age 21.Almost five million youths aged 12 to 20 engage in binge drinking, for example, with females downing at least four drinks on a single occasion and males at least five.

What causes alcohol-related disorders?

Problem drinking has multiple causes, with genetic, physiological, psychological and social factors all playing a role.For some alcohol abusers, psychological traits such as impulsiveness, low self-esteem and a need for approval prompt inappropriate drinking.Others drink as a way of coping with emotional pain.Still others use alcohol to "medicate" psychological disorders.Once people begin drinking excessively, the problem can perpetuate itself.Heavy drinking can cause physiological changes that make more drinking the only way to avoid discomfort.

Generic factors render some people especially vulnerable to alcohol dependence.(Contrary to myth, being able to "hold your liquor" means you're probably more at risk -- not less.

How do alcohol-related disorders affect people?

While small amounts of alcohol may have some beneficial physical effects, heavy drinking can cause serious health problems and even death.In fact, 100,00 Americans die from alcohol-related causes each year.Short-term effects include distorted perceptions, memory loss, hangovers and black-outs. Many problems aren't apparent until they become serious, however. Over the long term, heavy drinking can cause impotence, stomach ailments, cardiovascular problems, cancer, central nervous system damage, serious memory loss and liver cirrhosis.It also increases the chances of dying from automobile accidents, homicide and suicide. Although men are much more likely than women to develop alcoholism, women's health suffers more even at lower levels of consumption.

Although moderate drinking may result in relaxation and euphoria, heavy drinking also has a very negative impact on mental health.In fact, alcohol abuse and alcoholism can worsen existing conditions, such as depression or schizophrenia, or induce new problems, such as serious memory loss, depression or anxiety.

People with alcohol-related disorders don't just hurt themselves.Spouses are more likely to face domestic violence. Children are more likely to develop psychological problems, suffer physical and sexual abuse and neglect and -- because of the combination of genetic vulnerability and social learning -- grow up to be alcoholics.Women who drink during pregnancy run a serious risk of damaging their fetuses. It's not just relatives who suffer.Heavy drinkers often kill strangers through accidents or homicide.

When should someone seek help?

Signs of a possible problem include having friends or relatives express concern, being annoyed when people criticize your drinking, feeling guilty about your drinking and thinking that you should cut down but finding yourself unable to do so. Needing a morning drink to steady your nerves or relieve a hangover is another warning sign.

Alcoholics usually can't stop drinking through willpower alone.Most need outside help. They may need medically supervised detoxification to avoid potentially life-threatening withdrawal symptoms such as seizures, for instance.Depending on the problems severity, treatment can take place during office visits, hospital stays or residential treatment programs. Once people are stabilized, they need help resolving psychological issues that may be associated with problem drinking.

How can a psychologist help?

Psychologists serve as integral members of the multidisciplinary team that may be required to provide care. Choose a psychologist who is experienced in working with alcohol-related disorders.

Using individual or group psychotherapy, psychologists can help people address psychological issues involved in their drinking. They can help people boost their motivation, identify situations that trigger drinking and learn new coping methods. They can also provide referrals to self-help groups such as Alcoholic Anonymous, a crucial part of any recovery program.

Psychologists can help families repair relationships and navigate the complex transitions that occur as recovery begins.They can help families understand alcoholism and learn how to support family members in recovery. And they can refer family members to self-help groups such as A1-Anon and Alateen.

Does treatment really work?

Yes. Evidence strongly suggests that many people -- especially those with jobs, families and other forms of social stability -- recover after their first attempt.

While alcoholism is treatable, so far no cure has been found.That means people remain susceptible to relapses even after they've been sober for a long time.Reducing alcohol consumption doesn't work. Most experts agree that the goal should be complete avoidance of alcohol.

GENES AND ALCOHOLISM Research now shows that genes play a major role in alcoholism among men. This has long been suspected. The New York Times reported that having an identical twin with alcohol problems increased a man's risk of becoming an alcoholic almost 10-fold. Having a fraternal brother with alcohol problems raised a man's risk of beaching an alcoholic fivefold. An awareness of your personal risk should be a factor in evaluating your own drinking behavior. Two partners can go out the same amount and drink the same amount and one will be fine, the other will develop a problem. Do not look around you to gauge your potential for a problem based on what your peers are doing.

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