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While those individuals who consume alcohol to the point of abuse or dependence comprise only a small percent of the general public, the impact of their actions is relatively broad, as it can be felt by families, friends, and even communities as a whole. In other words, alcohol abuse and dependence on alcohol have implications not only for the health and welfare of individual drinkers, but also for the lives of persons around them. Alcoholism is therefore an important public health concern, the symptoms and effects of which are crucial to understand.
To identify alcoholism and distinguish it from alcohol abuse, researchers and clinicians in the United States typically rely on diagnostic criteria found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Alcoholism, or more appropriately alcohol dependence, is a chronic disease that endures throughout an affected individual’s lifespan. Typically, dependence is suspected when alcohol use is coupled with the following warning signs or symptoms:
- The strong urge or compulsion to consume alcohol.An individual experiencing such craving spends a great deal of time obtaining and using alcohol, as well as recovering from its effects.
- Loss of control over drinking habits. When thissymptom is present, individuals can no longer limit their consumption or cease drinking once beginning. Alcohol is consumed in greater quantities and over longer periods of time than intended, and there are frequent failed efforts to cut down on or control alcohol use.
- Tolerance to the effects of alcohol. In this phase,markedly increased quantities of alcohol must be consumed in order to experience intoxicating effects (i.e., get “high”); if the amount of alcohol consumed remains constant, a noticeably diminished effect is experienced.
- Physical dependence. This state is characterized bywithdrawal symptoms, such as anxiety after drinking has stopped, nausea, and shakiness; alcohol is consumed in order to alleviate or avoid these physical manifestations.
Individuals who do not meet the diagnostic criteria for alcohol dependence, but drink despite recurrent physical, psychological, interpersonal, legal, or social problems resulting from their drinking behaviors, are categorized as alcohol abusers. It is important to note that someone who abuses alcohol may not necessarily be an alcoholic or ever develop alcohol dependence; however, an alcoholic is an alcohol abuser.
The Effects of Alcoholism on the Drinker
Individuals who are dependent on alcohol expose themselves to numerous conditions that threaten the quality of their lives. For example, because the liver is the human body’s primary organ responsible for metabolizing (i.e., eliminating) alcohol, it is particularly susceptible to alcohol-related damage. Injury to the liver due to heavy alcohol consumption is termed alcoholic liver disease (ALD) by researchers. ALD encompasses three stages or conditions: (1) steatosis (or “fatty liver”); (2) alcohol hepatitis; and (3) the most commonly known, cirrhosis.
While the first stage of ALD, steatosis, can occur after only a few days of heavy drinking, it can be reversed once drinking ceases. The second and more serious stage, alcohol hepatitis, occurs after longer periods of heavy drinking. The National Institute of Alcohol Abuse and Alcoholism equates the following indicators with alcoholic hepatitis: lack of appetite, nausea or vomiting, abdominal pain, fever, and jaundice. This condition can be potentially life threatening. If heavy alcohol consumption continues, inflammation due to alcoholic hepatitis will eventually lead to the final stage of ALD, cirrhosis. Cirrhosis is characterized by fibrosis, also known as scar tissue. As a result of continued abuse of the liver, scar tissue forms and takes the place of healthy liver cells. Consequently, the liver loses its ability to perform essential functions. The presence of alcoholic hepatitis is a telltale sign that cirrhosis could shortly follow.
Cognitive impairment (i.e., brain damage) is another potential consequence of alcohol dependence. Many alcoholics exhibit mild to moderate deficiencies in their intellectual performance, along with alterations to brain-cell activity in various sections of the brain. A very small percentage of long-term, heavy drinkers develop overwhelming, irreversible brain-damage conditions such as Wernicke-Korsakoff syndrome. This amnesic disorder is characterized by the inability to acquire new information or form new memories. Numerous other conditions such as gastrointestinal problems, heart disease and stroke, and carcinoma have also been associated with alcohol dependence.
The Effects of Alcoholism on Society
In addition to documenting the damaging and potentially life-threatening consequences of alcohol dependence for the individual drinker, researchers have also identified numerous impacts of alcoholism that affect those surrounding an alcoholic. Often referred to as social consequences, these include:
- The impact on communities: Intoxication can leadto unintentional accidents—such as automobile crashes and fires—as well as to criminal behavior or disorderly conduct, such as violence toward others and vandalism.
- The impact on families: Alcoholics may neglectfamilial responsibilities, such as caring and providing for children or spouses; if they exhibit violent or aggressive behavior, this may lead to marital conflict, child or spousal abuse, or divorce. If maternal alcohol consumption occurs during pregnancy, serious birth defects such as fetal alcohol syndrome may develop.
- The impact on the workplace: Alcoholism can resultin lost workplace productivity due to time-off for alcohol-related illness or injury, in termination due to decreased job performance or absenteeism, and in increased company costs when termination makes it necessary for new employees to be recruited and trained.
Overcoming Alcohol Dependence
While some of the damage caused by alcohol dependence cannot be reversed, there are numerous treatment options available to alcohol-dependent individuals that may allow them to return to a more balanced and healthy lifestyle. It is important to note, however, that alcoholism cannot be cured. Alcoholics cannot address their affliction and the effects they experience by “cutting back” on the amount they consume. If actual progress is to take place, it is essential that an alcoholic “cut out” any and all drinking. Thus, to guard against relapse, alcoholics must avoid any contact with alcoholic beverages. Permanent sobriety is a long and arduous road; however, there are treatment options available that have shown promise in helping individuals to remain sober.
- National Institute on Alcohol Abuse and Alcoholism. 2000. Research Refines Alcoholism Treatment Options. Alcohol Research and Health 24 (1): 53–61. http://pubs.niaaa.nih.gov/publications/arh24-1/53-61.pdf.
- National Institute on Alcohol Abuse and Alcoholism. 2001. Cognitive Impairment and Recovery from Alcoholism. Alcohol Alert 53 (July). http://pubs.niaaa.nih.gov/publications/aa53.htm.
- National Institute on Alcohol Abuse and Alcoholism. 2005. Alcoholic Liver Disease. Alcohol Alert 64 (January): 1–5. http://pubs.niaaa.nih.gov/publications/aa64/AA64.pdf.
- National Institute on Alcohol Abuse and Alcoholism. Alcoholism: Getting the Facts. http://www.collegedrinkingprevention.gov/ OtherAlcoholInformation/alcoholismFacts.aspx.
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