Alcoholism is a serious disease in which people have an overwhelming desire for the mental and physical effects of drinking alcoholic beverages. The formal term for alcoholism is alcohol dependence. Alcohol is one of the most widely used drugs in the history of the world. Many adults drink alcoholic beverages on social or ceremonial occasions but have no wish to consume large amounts regularly. People with alcoholism, who are called alcoholics, feel a strong, continuing urge to drink.
Alcoholism has four main symptoms: (1) craving, (2) lack of control, (3) physical tolerance, and (4) physical dependence. Craving is a strong need to drink in spite of serious harmful consequences, such as drinking-related illnesses or job problems. Lack of control is the inability to stop drinking once a drinking episode starts. Physical tolerance is the need to consume increasing amounts of alcohol to feel its effects. Physical dependence occurs when people's bodies become so accustomed to alcohol that they have withdrawal symptoms after they stop drinking. Symptoms of withdrawal include shakiness, rapid heartbeat, nausea, sweating, and anxiety. Physical dependence does not occur in all alcoholics.
People who are not alcoholics may also have serious problems caused by excessive drinking. These problems include difficulties at work or school, neglect of family responsibilities, and strains in personal relationships. Drinking that causes problems but does not meet the formal definition for alcoholism is called alcohol abuse.
Causes of alcoholism.
Scientists do not yet fully understand what causes alcoholism. Although many people use alcohol at times, only a small percentage develop drinking problems. Researchers are beginning to identify ways that the brains of alcoholics differ from the brains of nonalcoholics. For example, tests show that alcoholics and nonalcoholics have different patterns of brain electrical activity. Such differences may provide evidence that alcohol does not affect the brains of alcoholics in the same way it affects nonalcoholics. Because of the way their brains respond, problem drinkers may develop an unusually strong desire for alcohol's effects.
Research shows that heredity plays an important role in alcoholism. For example, the pattern of brain electrical activity associated with alcoholism appears to be inherited. Other studies show that people with an alcoholic parent have a greater risk of developing the disease than do children of nonalcoholics. Scientists are working to identify the particular genes (chemical units of heredity) that increase risk. Most experts think that many genes are involved and that environment also plays a key role in developing the disease. Environmental influences may include income level, family stability, and community acceptance of drinking. Experts think that the relative importance of various genes and environmental factors may differ among individuals.
Other research focuses on understanding how alcohol affects neurotransmitters, chemicals that carry messages among nerve cells. Studies show that alcohol affects many neurotransmitters in the brain, including dopamine and serotonin. Among other messages, these chemicals carry information about pleasure, sadness, and other moods. Prolonged drinking changes levels of neurotransmitter activity, and the levels do not immediately return to normal when drinking stops. As a result, problem drinkers may not "feel right" when they stop drinking because their neurotransmitters have adapted to alcohol.
Effects of alcoholism.
Alcohol affects the entire body. Health problems caused by long-term drinking include damage to the brain, stomach, intestines, and heart. Liver problems, including a disorder called cirrhosis, are especially common in alcoholics. The liver plays a key role in breaking down alcohol, and excess drinking puts abnormal demands on the organ. When alcoholics stop drinking, some experience a severe form of withdrawal called delirium tremens.
Delirium tremens is a state of extreme confusion that is sometimes accompanied by hallucinations (seeing or hearing things that are not really present). Drinking is also a factor in many vehicle crashes, falls, and other accidents.
Treatment aims to help alcoholics stop drinking and remain sober. Behavioural treatments and medications are two important approaches that have succeeded with some alcoholics. Behavioural treatments include participation in Alcoholics Anonymous (A.A.) and various types of counselling. Medications include tranquillisers called benzodiazepines, sold under such trade names as Librium and Valium. Benzodiazepines are used in the first few days after a person stops drinking to help prevent symptoms of withdrawal. Another medication called naltrexone may be prescribed for longer periods in combination with counselling. For many people, naltrexone lessens the craving for alcohol. A medication called disulfiram, sold under the trade name Antabuse, discourages alcohol use by causing nausea, vomiting, and other unpleasant symptoms when people drink.
Additional resources
Monroe, Judy. Alcohol. Enslow, 1994.
Steins, Richard. Alcohol Abuse. 21st Century Bks., 1995. Younger readers.
Vaillant, George E. The Natural History of Alcoholism Revisited. Harvard Univ. Pr., 1995.
