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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 in which a person continues to crave alcohol and drink despite repeated alcohol-related problems (like losing a job or getting into trouble with the law). Approximately 18 million people in the United States abuse alcohol. Teen drinking is on the rise with over 4 million adolescents between the ages of 14 and 17 having trouble at school, at home, or even with the law because of alcohol use. This disease contributes to more than 50 percent of car and industrial fatalities, drownings, and child or domestic abuse.

Signs and Symptoms

• Craving for alcohol
• Inability to control drinking habits
• Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when alcohol use is stopped
• Tolerance (the need for increasing amounts of alcohol in order to feel its effects)
• Psychological, social, and occupational dysfunction
• Malnutrition, weight loss, and poor appetite
• Repeated infections—for example, urinary tract infections or pneumonia
• Lung conditions—complicated by smoking
• Central nervous system disorders—unsteady gait or stance; cognitive impairment; psychiatric manifestations (for example, depression, mood swings, anxiety, or psychotic behavior); blackouts; coma
• Impaired concentration and performance at school and work
• Bad judgment – for example, engaging in risky sexual behavior or driving while drunk
• Irritability, hostility, even aggression
• Sleep disruptions
• Diarrhea, vomiting, gastrointestinal bleeding
• Men—increased sexual drive with decreased ability to maintain an erection
• Women—miscarriage, stopping of menstrual periods
• Inflammation of the pancreas
• Liver disease
• Poor wound healing
• Buildup of fluid in the body
• Hypoglycemia (low blood sugar)
• Hypothermia (reduction of body temperature)

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:

• Drinking more than one to two drinks per day
• Smoking cigarettes (particularly teenagers)
• Starting to consume alcohol at an early age
• Being under a lot of stress
• Having a preexisting psychiatric disorder

Diagnosis

If you or someone you care for is experiencing symptoms associated with alcoholism, you should see your health care provider. He or she can help make a diagnosis and guide you in determining which treatment or combination of therapies will work best.

Your provider will take a history and do a physical exam to look for specific organ damage or trauma and to evaluate if your muscles are tender or weak. 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?

Laboratory tests will reveal recent alcohol use if you have a high blood alcohol level. Liver function tests will be done to see if there has been damage to your liver from alcohol. Imaging techniques may be used to look for alcohol-related damage to bones or other organs.

Preventive Care

If you don't drink now, don't start. If you do drink, do so ONLY in moderation. This means no more than two drinks per day if you are a man and no more than one drink per day if you are a woman.

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 that there is always appropriate 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 appropriate treatment for alcoholism is recognizing that you have a problem. Often, family members and close friends initiate treatment for the person with the addiction.

Treatment must address both existing medical issues and rehabilitation, such as motivational techniques for abstaining from drinking, psychotherapy, and Alcoholics Anonymous (or other support groups). For rehabilitation, referred to as "recovery" or staying sober, there are both outpatient and inpatient programs available. Talk to a health care provider about what is best for you or your loved one.

Lifestyle

• Attend Alcoholics Anonymous.
• Family members should attend Al Anon to learn how best to help the person with the addiction and to get help and support themselves.
• Exercise regularly to help reduce cravings.
• Quit smoking.

Medications

Your provider may prescribe the following medications.

• Tranquilizers called benzodiazepines are used during the first few days of treatment to help with safe withdraw from alcohol. Alcohol withdrawal can be life-threatening; therefore, inpatient treatment may be necessary.
• Antipsychotic medications for people who do not respond to benzodiazepines
• Naltrexone, used in combination with counseling, may lessen the craving for alcohol and help prevent a return to drinking. It is only used after detoxification – that is, once you are no longer physically addicted to alcohol.
• Disulfiram, an older medication, which discourages drinking by causing nausea, vomiting, and other unpleasant physical reactions when alcohol is used.
• Medications for specific organ damage or for symptoms associated with alcohol withdrawal.

Nutrition and Dietary Supplements

A well-balanced, nutritionally adequate diet can help stabilize fluctuations in blood sugar due to alcohol and decrease cravings. Follow these tips and work with a nutritionist to evaluate if these steps are helping:

• Eliminate simple sugars.
• Increase complex carbohydrates.
• Consume adequate protein.
• Increase essential fatty acids.
• Decrease saturated fats and fried foods.
• Avoid caffeine.

Because chronic use of alcohol decreases your appetite and interferes with absorption of vital nutrients, taking supplements may be necessary. Potentially beneficial supplements include vitamin B complex, vitamin C, selenium, magnesium, and zinc. A combination of amino acids – namely, carnitine, glutamine, and glutathione – may help reduce cravings, blood sugar fluctuations, and stress related to alcohol use.

Thiamine (vitamin B1) is of particular importance if you drink heavy amounts of alcohol on a regular basis. Thiamine deficiency can lead to a brain disorder called Wernicke-Korsakoff syndrome. Replacing thiamine alleviates the symptoms of this syndrome. Wernicke-Korsakoff is actually two disorders in one: (1) Wernicke's disease which involves damage to nerves in the central and peripheral nervous systems and is generally caused by malnutrition associated with habitual alcohol abuse, and (2) Korsakoff syndrome which is characterized by memory impairment along with symptoms of nerve damage. High doses of thiamine can improve confusion and muscle coordination and confusion associated with this disease, but only rarely improves the memory loss.

Gamma-aminobutyric acid (GABA)

Brown rice extracts rich in GABA seem to protect animals from the liver-damaging effects of alcohol. Whether this same benefit would be safe or effective in people requires research.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine.

Evening Primrose ( Oenothera biennis )

Although more conclusive research is needed, there is some evidence to suggest that this herb may lessen cravings for alcohol. Evening primrose is often used as an oil extracted from the seed of this herb. This is commonly called EPO. The main active ingredient of EPO is gamma-linolenic acid (GLA), an omega-6 fatty acid that can also be found in borage and black currant oils.

Ginseng

American and Asian ginseng ( Panax quinquefolium and Panax ginseng respectively) may help treat alcohol intoxication because each of these herbs speed up the metabolism (break down) of alcohol. Faster break down clears alcohol from your body more quickly. In addition, animal research suggests that Asian ginseng may reduce the amount of alcohol that is absorbed from the stomach.

Milk Thistle ( Silybum marianum )

Some studies evaluating milk thistle for the treatment of alcoholic liver disease have found significant improvements in liver function with use of this herb. 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. (Cirrhosis is characterized by scarring and permanent, non-reversible damage to the liver. It is often referred to as end-stage liver disease.)

St. John's Wort ( Hypericum perforatum )

Those with depression and alcoholism share certain similarities in brain chemical activity. In addition, some people (especially men) who are depressed may mask their feelings or try to cope with their low mood by drinking alcohol. For these reasons, researchers have considered whether St. John's Wort, often used to treat depression, may help reduce alcohol consumption. Animal studies suggest that this may prove to be an appropriate use of this herb. St. John's Wort interacts with many different medications. It is particularly important, therefore, that you check with your doctor before using.

Others

Additional herbs that an herbal specialist might consider to support you while undergoing treatment for alcoholism include:

• Dandelion ( Taraxacum officinale ): Traditionally used for liver-related problems and as a nutritional support because it is rich in vitamins and minerals. Tends to work well with milk thistle.
• Skullcap ( Scutellaria lateriflora ): Traditionally used for tension and anxiety, this herb may help ease the withdrawal process.

Homeopathy

There have been few studies examining 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. 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 constipation, nausea, and vomiting
• Lachesis for cravings for alcohol, 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 restructuring your beliefs and thought process about drinking, can help you cope with stress and control your behavior. Talk to your health care provider about finding a qualified cognitive-behavioral therapist.

Acupuncture

Acupuncture has shown potential as an effective treatment for addiction, according to a 1997 Consensus Statement by the National Institutes of Health. While some but not all studies of acupuncture for the treatment of alcohol abuse have shown benefit, many addiction programs that currently offer acupuncture report that people appear to "like acupuncture" and, in many cases, want to continue with their detox program for longer periods of time when acupuncture is provided as a treatment option. This is very important since attendance is essential for the success of treatment.

Acupuncturists treat people with alcoholism based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of alcoholism, a qi deficiency is usually detected in the liver meridian, while the gallbladder meridian tends to contain excess qi. In addition to performing needling treatment, acupuncturists may employ other methods such as moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points). Although not all studies agree, auricular acupuncture may be particularly beneficial.

Traditional Chinese Medicine

Kudzu ( Pueraria lobata )

Although a modern day scientific study suggests that this Chinese herb does not reduce cravings for alcohol or improve one's chances of staying sober, traditional use does include treatment of alcoholism. This one study was quite small; therefore, this traditional use of kudzu requires more thorough research to determine whether it is safe and effective or not.

Other Considerations

Pregnancy

Drinking alcohol while you are pregnant can seriously damage the fetus by causing failure to grow, reduced IQ, or malformed facial features. The only foolproof way to protect your fetus from the devastating effects of alcohol is to completely abstain from drinking alcohol throughout your pregnancy and even when 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, gastointestinal 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

The good news is, however, that even though alcohol abuse is a very 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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• Review Date: 4/1/2004
• Reviewed By: Participants in the review process include: Shiva Barton, ND,Wellspace, Cambridge, MA; Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Boston, Ma., and Senior Medical Editor, A.D.A.M, Inc.; Peter Hinderberger, MD, PhD, Ruscombe Mansion Community Health Center, Baltimore, MD; Marcellus Walker, MD, LAc, (Acupuncture section October 2001) St. Vincent's Catholic Medical Center, New York, NY; Leonard Wisneski, MD, FACP, George Washington University, Rockville, MD; Ira Zunin, MD, MPH, MBA, (Acupuncture section October 2001) President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

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