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Alcoholism


Signs and Symptoms
Risk Factors
Diagnosis
Preventive Care
 
Treatment Approach
Other Considerations
Supporting Research

Alcoholism is a chronic, often progressive disease. A person with alcoholism typically craves alcohol and drinks despite repeated alcohol related problems, such as  multiple drunk-driving violations, job loss, or relationship problems. Alcoholism involves a physical dependence on alcohol, but other factors include genetic, psychological, and cultural influences.

Alcoholism is characterized by cravings for alcohol and an inability to stop drinking. It is accompanied by a physical dependence (meaning that the person experiences withdrawal symptoms when not drinking) and an increased 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.

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 of all traffic deaths in the U.S.

Signs and Symptoms

Symptoms of alcoholism include:

  • Solitary or secretive drinking
  • Alcohol cravings
  • An inability to control the amount you drink
  • Blackouts (not remembering events or conversations)
  • Irritability when you can’t get a drink at your regular time
  • Legal problems
  • Difficulty sustaining a relationship or a job
  • Withdrawal symptoms when you stop drinking, such as nausea, sweating, shakiness, and anxiety
  • An increased alcohol
  • 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 have symptoms associated with alcoholism, you should see your doctor. Your doctor can help make a diagnosis and guide you in determining which treatment or combination of therapies will work best. If you suspect that a friend or loved one has alcoholism, you should know that most alcoholics deny they have a problem, and they are often unlikely to seek treatment by themselves. You and other friends and family members may need 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. 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 important, 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 doctor 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)
  • Baclofen (Lioresal, Lioresal Intrathecal, Gablofen)

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. Take supplements beyond the recommended daily allowance only under a 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.

Some members of the alcohol recovery community recommend a heavier, nutritionally oriented approach. This includes intravenous (IV) nutritional therapies along with targeted amino acid supplementation to modulate brain function. Some of these approaches are considered controversial by the mainstream alcoholism treatment community, so make sure you work with a reputable doctor and have every member of your recovery team up to date on the type of therapies you are using.

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 provider. However, you should not use herbs alone 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. Some compounds in milk thistle may resemble estrogen in their composition, so people with hormone sensitive conditions should be careful. Talk with your doctor before taking milk thistle supplements.
  • Kudzu (Pueraria lobata) -- Animal studies suggest that kudzu, used in traditional Chinese medicine to treat alcohol abuse, might help reduce cravings. Human studies are mixed. One study in humans failed to show any benefit, while another found that heavy drinkers who had taken kudzu supplements for 7 days drank significantly less beer when given the opportunity than heavy drinkers who had taken a placebo. Kudzu can interact with many medications, including blood-thinners, methotrexate, diabetes medications, and estrogens.
  • 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. Dandelion can interact with many medications, including lithium.

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 nausea, vomiting, and constipation

Lachesis -- for cravings for alcohol cravings, 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.

Supporting Research

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Assanangkornchai S, Srisurapanont M. The treatment of alcohol dependence.Curr Opin Psychiatry.2007 May;20(3):222-7. Review.

Carai MAM, Agabio R, Bombardelli E, et al. Potential use of medicinal plants in the treatment of alcoholism.Fitoterapia. 2000;71:538-542.

Cooney JL, Cooney NL, Pilkey DT, Kranzler HR, Oncken CA. Effects of nicotine deprivation on urges to drink and smoke in alcoholic smokers.Addiction. 2003;98(7):913-921.

Correale M, Laonigro I, Altomare E, Di Biase M. Alcohol-induced cardiac disease.G Ital Cardiol (Rome).2009;10(1):18-27.

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Ferri M, Amato L, Davoli M. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database Syst Rev. 2006 Jul 19;3:CD005032. Review.

Garland EL, Gaylord SA, Boettiger CA, Howard MO. Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: results of a randomized controlled pilot trial.J Psychoactive Drugs. 2010;42(2):177-92.

Heilig M, Goldman D, Berrettini W, O'Brien CP. Pharmacogenetic approaches to the treatment of alcohol addiction.Nat Rev Neurosci.2011 Oct 20;12(11):670-84.

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Liu Q, Lawrence AJ, Liang JH. Traditional Chinese medicine for treatment of alcoholism: from ancient to modern.Am J Chin Med.2011;39(1):1-13.

Lukas SE, Penetar D, Berko J, Vicens L, Palmer C, Mallya G, Macklin EA, Lee DY. An extract of the Chinese herbal root kudzu reduces alcohol drinking by heavy drinkers in a naturalistic setting.Alcohol Clin Exp Res.2005 May;29(5):756-62.

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Malik P, Gasser RW, Kemmler G, Moncayo R, Finkenstedt G, Kurz M, Fleischhacker WW. Low bone mineral density and impaired bone metabolism in young alcoholic patients without liver cirrhosis: a cross-sectional study.Alcohol Clin Exp Res.2009;33(2):375-81.

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Review Date: 12/15/2011
Reviewed By: 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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