Related Terms

• AA, abstinence, alcohol, alcohol abuse, Alcoholics Anonymous, alcohol intoxication, alcohol tolerance, alcohol withdrawal, alcohol withdrawal syndrome, alcoholic, alcoholic hepatitis, alcoholism, bone loss, cancer, cirrhosis, delirium tremens, diabetes, fetal alcohol syndrome, gastritis, heart failure, high blood pressure, jaundice, National Council on Alcoholism and Drug Dependence, National Institute on Alcohol Abuse and Alcoholism, NCADD, NIAAA, pathologic intoxication, sedative, seizure, stroke, Wernick-Korsakoff encephalopathy.

Background

• Alcohol abuse occurs when a person engages in excessive drinking that results in health or social problems. Alcohol may continue to be abused despite serious adverse health, personal, work-related and financial consequences. Alcohol abusers, however, may not fully lose control over the use of alcohol and progress to alcoholism. A person afflicted with alcohol dependence may experience alcohol withdrawal with symptoms such as anxiety attacks, confusion, insomnia, sweating, increased pulse rate and temperature, tremors or severe depression.

• Most experts believe that it is possible to have a problem with alcohol, but not display all the characteristics of alcoholism. For instance, alcohol abuse does not necessarily involve alcohol dependence, which is the need for repeated doses of alcohol to maintain a certain feeling of well-being.

• Most experts believe that steady drinking over time may produce a physical dependence on alcohol. Drinking over 15 drinks a week for men or 12 drinks a week for women increases the risk of developing dependence on alcohol. However, drinking by itself is just one of the risk factors that contribute to alcoholism.

• Alcoholism is a chronic, often progressive disease that is a result of uncontrollable alcohol dependence. It is thought to develop as a result of a combination of individual genetic, psychological and social factors. Other risk factors may include:

• Age: People who begin drinking at an early age (by age 16 or earlier) are at a higher risk of becoming an alcoholic.

• Genetics: Genetic makeup may cause imbalances in one or more of several brain chemicals and increase risk of alcohol dependency.

• Gender: Men are more likely to become alcoholics or abuse alcohol.

• Family history: The risk of alcoholism is higher for people who had a parent or parents who abused alcohol.

• Emotional disorders: Those with severe depression or anxiety may have a greater risk of abusing alcohol. Adults with attention-deficit hyperactivity disorder may also be more likely to become dependent on alcohol.

• According to the National Council on Alcoholism and Drug Dependence (NCADD), almost 18 million Americans abuse alcohol. Each year more than 100,000 Americans die of alcohol-related causes. Alcohol is a factor in nearly half of all United States traffic deaths. Alcoholism and alcohol abuse have also been linked to major social, economic and public health problems. A wide range of treatments is available. Self-help groups are one popular treatment option, and may provide ongoing support for people recovering from alcohol abuse and alcoholism.

Treatment

• A healthcare professional typically first evaluates the person who is having alcohol-related problems. Common medical problems related to alcoholism may include high blood pressure, increased blood sugar, and liver and heart disease. Treatment, which is often tailored to the individual, may involve an evaluation, a brief intervention, an outpatient program, counseling or a residential inpatient stay. Most treatments emphasize acceptance and abstinence, instead of moderation.

• Many residential alcoholism treatment programs in the United States include promotion of abstinence from alcohol, individual and group therapy, participation in Alcoholics Anonymous (AA), educational lectures, family involvement, work assignments, activity therapy and the use of counselors, many of whom are recovering/ed alcoholics and professional staff. In addition to residential treatment, other approaches to alcoholism may include acupuncture, cognitive behavior therapy, couples therapy, and aversion therapy.

• Drug treatments for alcohol craving: Several prescription drugs are available in the United States that may treat alcoholism, or deter patients from drinking. An alcohol-sensitizing drug called disulfiram (Antabuse) may be a strong deterrent. This medication works by interfering with the metabolism of acetaldehyde. If a person drinks alcohol, the drug produces a severe physical reaction that includes flushing, nausea, vomiting and headaches. Naltrexone (ReVia) is an opioid antagonist, a drug long known to block the narcotic high; it may reduce a recovering alcoholic's urge to drink. Acamprosate (Campral) is an anti-craving medication that may help a person combat alcohol cravings and remain abstinent from alcohol. Unlike disulfiram, naltrexone and acamprosate do not make a person feel sick soon after taking a drink. It works by maintaining alcohol abstinence by mimicking a GABA analogue. These drugs do not cure alcoholism nor can they remove the compulsion to drink.

• Drugtreatments for alcohol withdrawal side effects: Sedative drugs may be used to prevent delirium tremens or other withdrawal seizures.

• Herbs and supplements: There are very few proven treatments for alcohol-related conditions. Globe artichoke (Cynara scolymus L.) has unclear or conflicting evidence supporting its use as a treatment for alcohol induced hangovers. Some traditional or theoretical treatments of alcoholism, which lack sufficient evidence, may include 5-HTP, betel nut, choline, ginkgo, music therapy, niacin, nux vomica, reflexology, riboflavin and selenium.

• Nutritional therapy: Following abstinence from alcohol, it may be necessary to correct nutritional imbalances. A patient that is being withdrawn from chronic excessive alcohol consumption is typically given large amounts of thiamine (Vitamin B1) to correct any associated thiamine deficiency that could lead to Wernicke-Korsakoff encephalopathy.

• Psychological support and psychiatric treatment: Group and individual counseling and therapy support recovery from the psychological aspects of alcoholism. Sometimes, emotional symptoms of the disease may mimic psychiatric disorders. Many treatment programs also offer couples and family therapy because family support can be an important part of the recovery process.

• One well-known support group is Alcoholics Anonymous (AA), which is an international, spiritually oriented community of alcoholics who meet in groups. AA began in the 1930s to help alcoholics with their addiction; members' main goals are to stay sober and help other alcoholics do the same. AA formed the original 12-step program to recovery of addiction and asserts that a recovering alcoholic's only option is to completely abstain from alcohol. This organization is almost exclusively run by alcoholics. Other groups that provide similar treatment without AA's spiritual focus include LifeRing Secular Recovery and SMART Recovery.

Theory/Evidence

• Alcohol affects virtually every organ system in the body and, in high doses, may cause coma and death. It affects several neurotransmitter systems in the brain, including opiates, GABA, glutamate, serotonin, and dopamine. Increased opiate levels are thought to account for the euphoric effect of alcohol; alterations in GABA are believed to cause anxiolytic (anxiety relieving) and sedative effects. Alcohol also inhibits the receptor for glutamate, meaning that long-term ingestion of alcohol may increase the number of glutamate receptors. Many drugs target these receptors in alcoholics to reduce cravings and aid in abstinence.

• When alcohol is withdrawn, the central nervous system experiences increased excitability. Persons who abuse alcohol over the long term are more prone to alcohol withdrawal syndrome than persons who have been drinking for only short periods. Withdrawal symptoms, such as delirium tremens, usually being 48 to 72 hours after alcohol withdrawal. Other symptoms may include anxiety attacks, confusion, insomnia, sweating, increased pulse rate and temperature, tremors and severe depression. Brain excitability caused by long-term alcohol ingestion can lead to cell death and cerebellar degeneration, Wernicke-Korsakoff syndrome, tremors, alcoholic hallucinations, delirium tremens, and seizures. Based on research, alcohol abuse may lead to an increased number of opiate receptors in the brains of recently abstinent alcoholic patients, and the number of receptors has been found to correlate with cravings for alcohol.

• In the National Comorbidity Survey, alcoholism was 2.5 times more prevalent in men than in women. The lifetime prevalence was found to be 20% in men and 8% in women. The rates of alcohol abuse or dependence in the past year were 10% for men and 4% for women. Women do not appear to metabolize alcohol as efficiently as men. Women were also found to more commonly combine alcohol with prescription drugs of abuse than males. Women living with substance-abusing men are at high risk for alcoholism. A recent report from the Substance Abuse and Mental Health Services Administration (SAMHSA) revealed that men accounted for four out of every five alcohol-specific substance abuse treatment admissions. Based on this study, alcohol problems are less likely to be recognized in women, and women with alcohol problems are less likely to be treated. This may be because women are less likely than men to have job, financial, or legal troubles as a result of drinking.

• Other research has indicated that the commonness of alcoholism declines with increasing age, although evidence in this area is conflicting. The prevalence in elderly populations is unclear, but is estimated to be approximately 3%. However, one study of the United States Medicare population found that alcohol-related hospitalizations were as common as hospitalizations for heart attack (myocardial infarction). Another study noted that among older patients with alcoholism, from one third to one half develop alcoholism after the age of 60 years.

• Alcoholism may be slightly more common in lower income and less educated groups according to a 1996 study that examined the natural history of alcoholism and the differences between college-educated and inner-city alcoholic persons. The increased financial, emotional, and societal stressors of occupying a lower socio-economic group may cause individuals to resort to the consumption of alcohol as a coping mechanism.

• Currently, there are no available high-quality trials evaluating the safety or efficacy of herbs and supplements used for alcohol abuse or alcohol withdrawal. Globe artichoke (Cynara scolymus L.) has unclear or conflicting evidence supporting its use as a treatment for alcohol induced hangovers. Some traditional or theoretical treatments of alcoholism, which lack sufficient evidence, include 5-HTP, betel nut, choline, ginkgo, music therapy, niacin, Nux vomica, riboflavin, selenium, and reflexology.

Safety

• Interactions between alcohol and herbs, supplements, drugs or food are quite common and a qualified healthcare provider should be consulted before making decisions about therapies and/or health conditions.

• Those with genetic psychiatric disorders, such as schizophrenia and bipolar disorder, who abuse alcohol, should consult with a qualified psychiatrist.

• Experts believe that steady drinking over time can produce a physical dependence on alcohol. Drinking over 15 drinks a week for men or 12 drinks a week for women increases the risk of developing dependence on alcohol. Caution is advised in those with environmental and genetic predispositions to developing alcoholism or alcohol abuse.

• Alcohol, in any amount, may affect many body systems. Alcohol depresses the central nervous system by acting as a sedative (calming agent). In some people, the initial reaction may be stimulation (active agent), but as drinking continues, sedating or calming effects may occur. Initially, alcohol affects thought, emotion and judgment. In sufficient amounts, alcohol impairs speech and muscle coordination and produces sleep. Taken in large enough quantities, alcohol is a lethal poison that may cause a life-threatening coma by severely depressing the vital centers of the brain.

• Excessive use of alcohol can produce several harmful effects on the brain and nervous system and cause fatigue, short-term memory loss, as well as weakness and paralysis of eye muscles.

• Alcohol withdrawal: Sudden alcohol abstinence may also cause life-threatening symptoms, including grand mal seizures.

• Birth defects: Alcohol use during pregnancy may cause fetal alcohol syndrome. This condition results in birth defects, including a small head, heart defects, a shortening of the eyelids and various other abnormalities. As these children grow older, they may have various developmental disabilities.

• Bone loss: Alcohol may interfere with the production of new bone. This can lead to thinning bones and an increased risk of fractures.

• Cardiovascular problems: Excessive drinking may lead to high blood pressure and damage the heart muscle (cardiomyopathy). These conditions can put a person at increased risk of heart failure or stroke. Alcoholic cardiomyopathy (weakness of the heart) generally develops ten years after chronic, excessive alcohol use. This damage is done from the direct tissue damage caused by the alcohol.

• Diabetes complications: Alcohol prevents the release of glucose from the liver and can increase the risk of blood sugar falling too low (hypoglycemia). This is dangerous for a person with diabetes who takes insulin to lower blood sugar level.

• Gastrointestinal problems: Alcohol may result in inflammation of the lining of the stomach (gastritis), which can lead to tears in the upper part of the stomach and lower part of the esophagus. Alcohol can also interfere with the absorption of the B vitamins, particularly folic acid and thiamin and other nutrients. The pancreas has two functions: it produces the hormones insulin and glucagon, which help regulate metabolism, and it produces pancreatic juices and enzymes that help digest fats, proteins and carbohydrates. Heavy drinking may also damage the pancreas, causing pancreatitis.

• Increased risk of cancer: Chronic alcohol abuse has been linked to a higher risk of cancer of the esophagus, larynx, liver and colon.

• Liver disorders: Drinking heavily may cause a person to develop alcoholic hepatitis, an inflammation of the liver. Signs and symptoms may include loss of appetite, nausea, vomiting, abdominal pain and tenderness, fever, yellowing of the skin (jaundice) and sometimes mental confusion. After years of drinking, hepatitis may lead to cirrhosis, the irreversible and progressive destruction of liver tissue. A healthy liver processes nutrients into substances the body can use, manufactures bile to help digest fats and regulates the amounts of sugar, protein and fat that enter the bloodstream.

• Neurological complications: Excessive drinking may affect the nervous system, causing numbness of hands and feet, disordered thinking and dementia. One severe result of alcoholism is Wernicke's Korsakoff syndrome. The syndrome is characterized by cerebellar degeneration (wear and tear) and encephalopathy (disease of the brain). It is characterized by ataxia (loss of coordination) and evolves over weeks or months but can disappear at any point.

• Marchiafava-Bignami disease: This is a rare demyelination of the corpus callosum in the brain that occurs in chronic alcoholics, predominantly men. Patients may become agitated and confused, with progressive dementia. Some patients recover over several months; in others, seizures and coma develop and may precede death.

• Pathologic intoxication: This is a rare syndrome. It is characterized by repetitive, automatic movements and extreme excitement with aggressive, uncontrolled irrational behavior after ingesting a relatively small amount of alcohol. The episode may last for minutes or hours and is followed by prolonged sleep with amnesia of the event on awakening.

• Psychiatric: Studies have indicated that both homicides and suicides may be more likely to be committed by persons who have been drinking.

• Sexual function and menstruation: Alcohol abuse may cause erectile dysfunction in men. In women, it may interrupt menstruation.

• Other: Other complications of alcoholism and alcohol abuse may include: domestic abuse and divorce, poor performance at work or school, increased likelihood of motor vehicle fatalities and arrest for drunken driving, and greater susceptibility to accidental injuries from other causes.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Alcoholism. 1 June 2006. www.merck.com

2. Alcohol is cause of almost half of all treatment admissions for older adults. 2 June 2006. www.samhsa.gov

3. Baer JS, Sampson PD, Barr HM, et al. A 21-year longitudinal analysis of the effects of prenatal alcohol exposure on young adult drinking. Arch Gen Psychiatry 2003 Apr; 60(4): 377-85.

4. de Roux A, Cavalcanti M, Marcos MA, et al. Impact of alcohol abuse in the etiology and severity of community-acquired pneumonia. Chest. 2006 May;129(5):1219-25. View Abstract

5. Mulligan MK, Ponomarev I, Hitzemann RJ, et al. Toward understanding the genetics of alcohol drinking through transcriptome meta-analysis. Proc Natl Acad Sci U S A. 2006 Apr 18;103(16):6368-73. View Abstract

6. Sood B, Delaney-Black V, Covington C, et al. Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect. Pediatrics. 2001 Aug;108(2):E34. View Abstract

7. Vaillant GE: A long-term follow-up of male alcohol abuse. Arch Gen Psychiatry 1996 Mar; 53(3): 243-9.