• Highlights
• Introduction
• Causes
• Risk Factors
• Complications
• Diagnosis
• Treatment for Alcoholism
• Treatment for Alcohol Withdrawal
• Therapy
• Medications
• Resources
• References

Alcoholism

Description

An in-depth report on the causes, diagnosis, and treatment of alcoholism.

Alternative Names

Alcohol dependence, Alcohol abuse

Risk Factors

About 90% of adults in the U.S. drink alcohol. Every day, more than 700,000 Americans are being treated for alcoholism. In addition, up to half of American men have problems that are caused by alcohol.

Categories of Alcoholic Types

Some researchers have categorized people with alcoholism as Type 1 or Type 2.

• Type 1 individuals are more often women. They typically become alcoholic at a later age, have less severe symptoms or fewer psychiatric problems, and have a better outlook on life than those classified as type 2.
• Type 2 people are more likely to be male. They tend to become alcoholic at an early age and have a high family risk for alcoholism, more severe symptoms, and a negative outlook on life.

Not only do these two groups tend to respond differently to psychotherapeutic approaches, but they may also respond differently to medications.

Age

Drinking in Adolescence. About half of under-age Americans have used alcohol. About 2 million people between the ages of 12 and 20 are considered heavy drinkers, and 4.4 million are binge drinkers. Anyone who begins drinking in adolescence is at risk for developing alcoholism. The earlier a person begins drinking, the greater the risk. A 2006 survey of over 40,000 adults indicated that among those who began drinking before age 14, nearly half had become alcoholic dependent by the age of 21. In contrast, only 9% of people who began drinking after the age of 21 developed alcoholism.

Young people at highest risk for early drinking are those with a history of abuse, family violence, depression, and stressful life events. People with a family history of alcoholism are also more likely to begin drinking before the age of 20 and to become alcoholic. Such adolescent drinkers are also more apt to underestimate the effects of drinking and to make judgment errors, such as going on binges or driving after drinking, than young drinkers without a family history of alcoholism.

Drinking in the Elderly Population. Although alcoholism usually develops in early adulthood, the elderly are not exempt. In fact, doctors may overlook alcoholism when evaluating elderly patients, mistakenly attributing the signs of alcohol abuse to the normal effects of the aging process. A survey of adults over 60 reported that 15% of men and 12% of women were hazardous drinkers, and 9% of men and 3% of women were alcohol dependent. In another study, the prevalence of problem drinking was as high as 49% among nursing home patients.

Alcohol also affects the older body differently. People who maintain the same drinking patterns as they age can easily develop alcohol dependency without realizing it. It takes fewer drinks to become intoxicated, and older organs can be damaged by smaller amounts of alcohol than those of younger people. Also, up to one-half of the 100 most prescribed drugs for older people react adversely with alcohol. Medications used for arthritis or pain pose a particular danger for interaction with alcohol.

Gender

Most alcoholics are men, but the incidence of alcoholism in women has been increasing over the past 30 years. Studies indicate that 9% of men and 2% of women are heavy drinkers, and 23% of men are binge drinkers compared to 9% of women. In general, young women who are problem drinkers follow the drinking patterns of their partners, although they tend to engage in heavier drinking during the premenstrual period.

Women tend to become alcoholic later in life than men, and it is estimated that 1.8 million older women suffer from alcohol addiction. Even though heavy drinking in women usually occurs later in life, the medical problems women develop because of the disorder occur at about the same age as men, suggesting that women are more susceptible to the physical toxicity of alcohol.

Genetics and Family History

Alcoholism often runs in families. The risk for alcoholism in sons of alcoholic fathers is 25%. The family link is weaker for women, but is still a factor in many cases. Genetics certainly play a role in many people with alcoholism, but negative alcoholic behaviors by the parents can also be significant contributors in the risk for alcoholism in the children. They often play off each other in a perpetuating and tragic spiral. A 2002 study, for example, reported that alcoholic parents have a higher risk for being separated from their children, and such children then face a higher risk for alcoholism in adulthood. (A stable family and psychological health, however, cannot fully protect a person with a genetic risk.) Unfortunately, there is no way to predict which members of alcoholic families are most at risk for alcoholism.

History of Abuse

Individuals who were abused as children have a higher risk for substance abuse later on. In a 2003 study, for example, 72% of women and 27% of men with substance abuse disorders reported physical or sexual abuse or both. They also had worse response to treatment than those without such a history.

Ethnicity

Overall, there is no difference in alcoholic prevalence among African-Americans, Caucasians, and Latin Americans. Some population groups, however, such as Irish and Native Americans, have an increased incidence of alcoholism while others, such as Jewish and Asian Americans, have a lower risk. Although the biological or cultural causes of such different risks are not known, certain people in these population groups may have a genetic susceptibility or invulnerability to alcoholism because of the way they metabolize alcohol.

Psychiatric and Behavioral Disorders

Psychiatric Disorders. Severely depressed or anxious people are at high risk for alcoholism, smoking, and other forms of addiction. In a major study of alcohol-dependent people, 78% of men and 86% of women also suffered from an accompanying psychiatric or substance abuse disorder. Either anxiety or depression may increase the risk for self-medication with alcohol.

Depression is the most common psychiatric problem in people with alcoholism or substance abuse. Estimates of depression in people with alcoholism are as high as 67%. Studies have reported depression accompanies about one-third of all cases of alcoholism. According to a 2000 study, for instance, the risk for heavy drinking in women who are depressed was 2.6 times greater than the risk in women who are not depressed.

Specific anxiety disorders, such as panic disorders and social phobia, may pose particular risks for alcohol and substance abuse. Social phobia causes an intense fear of being publicly scrutinized and humiliated. Panic disorders cause intense anxiety and panic attacks. People with these disorders may use alcohol as a way to become less inhibited in public situations or to calm feelings of panic. While anxiety disorders are found in about 15% of all adults, over 50% of people with alcohol abuse problems suffer from these conditions. A 2005 study suggested that people who have anxiety disorders are more likely to resume drinking after treatment for alcohol dependence. [For more information, see In-Depth Report #28: Anxiety.]

Long-term alcoholism itself may cause chemical changes that produce anxiety and depression. In fact, a study on elderly people with depression reported that when even moderate drinkers reduced consumption, their mood improved. It is not always clear, then, whether people with emotional disorders are self-medicating with alcohol, or whether alcohol itself is producing mood swings.

Behavioral Disorders and Lack of Impulse Control. Studies are also finding that alcoholism is strongly related to impulsive, excitable, and novelty-seeking behavior, and such patterns are established early on. Children who later become alcoholics or who abuse drugs are more likely to have less fear of new situations than others, even if there is a greater risk for harm than in nonalcoholics. Specifically, children with attention deficit hyperactivity disorder (ADHD), a condition that shares these behaviors, have a higher risk for alcoholism in adulthood. The risk is especially high in children with ADHD and conduct disorder.

Socioeconomic Factors

Alcoholism is not restricted to any social or economic levels. For example, a thorough 1996 study reported no higher prevalence of alcoholism among adult welfare recipients than in the general population (about 7%). There was also no difference in prevalence between African-Americans and Caucasians in low-income groups. On the other hand, people in low-income groups who drank did display some tendencies that differed from the general population of drinkers. For instance, in one study as many women as men were heavy drinkers in lower income groups. Excessive drinking may also be more dangerous in lower income groups. One study found that alcohol was a major factor in the higher death rate of people, particularly men, in lower socioeconomic groups compared with those in higher groups.

Geographic Factors

Although 54% of urban adults use alcohol at least once a month compared to 42% in nonurban areas, living in the city or the country does not affect the risks for bingeing or heavy alcohol use. One study reported that people in the north central U.S. are at highest risk for heavy drinking (6.4% heavy use and 19% binge drinking), and those in the Northeast have the lowest risk (4.5% heavy use and 13% binge drinking).

• Review Date: 12/3/2006
• Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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