Introduction:

Alcoholism is a chronic, progressive, and often fatal disease. It is a primary disorder and not a symptom of other diseases or emotional problems. The chemistry of alcohol allows it to affect nearly every type of cell in the body, including those in the central nervous system. After prolonged exposure to alcohol, the brain becomes dependent on it. The severity of this disease is influenced by factors such as genetics, psychology, culture, and response to physical pain.

Alcoholism is a chronic illness marked by dependence on alcohol consumption. It interferes with physical or mental health, and social, family, or job responsibilities. This addiction can lead to liver, circulatory, and neurological problems. Pregnant women who drink alcohol in any amount may harm the fetus.

Alcoholism, alcohol dependence, and alcohol abuse are associated with the following:

• The only indication of early alcoholism may be the unpleasant physical responses to withdrawal that occur during even brief periods of abstinence.
• Alcoholics have little or no control over the quantity they drink or the duration or frequency of their drinking.
• Alcoholics are preoccupied with drinking, deny their own addiction, and continue to drink even though they are aware of the dangers.
• Over time, some alcoholics become tolerant to the effects of drinking and require more alcohol to become intoxicated, creating the illusion that they can "hold their liquor."
• Alcoholics may have blackouts after drinking and have frequent hangovers that cause them to miss work and other normal activities.
• Alcoholics might drink alone and start their drinking early in the day.
• Alcoholics periodically quit drinking or switch from hard liquor to beer or wine, but these periods rarely last.
• Severe alcoholics often have a history of accidents, marital and work instability, and alcohol-related health problems.
• Episodic violent and abusive incidents involving spouses and children and a history of unexplained or frequent accidents are often signs of drug or alcohol abuse.

Alcoholism can develop insidiously, and often there is no clear line between problem drinking and alcoholism. Eventually alcohol dominates thinking, emotions, and actions and becomes the primary means through which a person can deal with people, work, and life.

Definition of Alcohol Use and Abuse

In addition to alcohol dependence, alcohol use is defined by levels of harm that it may be causing. This information is useful to determine possible interventions at earlier stages. The following categories of alcohol use and abuse use a definition of one drink as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces (a jigger) of 90-proof liquor.

Moderate Drinking. Moderate drinking, particularly red wine, appears to offer health benefits. Moderate drinking is defined as equal to or less than two drinks a day for men and one drink a day for women.

Hazardous (Heavy) Drinking. Hazardous drinking puts people at risk for adverse health events. People who are heavy drinkers consume:

• More than 14 drinks per week, or four to five drinks at one sitting, for men
• More than seven drinks per week, or three drinks at one sitting, for women
• Frequent intoxication

Harmful Drinking. Drinking is considered harmful when alcohol consumption has actually caused physical or psychological harm. This is determined by:

• Clear evidence that alcohol is responsible for such harm.
• The nature of that harm can be identified.
• Alcohol consumption has persisted for at least a month or has occurred repeatedly for the past year.

Certain people are at much higher risk for harmful drinking, such as older individuals with high blood pressure or those taking medications for arthritis or pain.

Alcohol Abuse. People with alcohol abuse have one or more of the following alcohol-related problems over a period of 1 year:

• Failure to fulfill work or personal obligations
• Recurrent use in potentially dangerous situations
• Problems with the law
• Continued use in spite of harm being done to social or personal relationships

Alcohol Dependence. People who are alcohol dependent have three or more of the following alcohol-related problems over a year:

• Increased amounts of alcohol are needed to produce an effect
• Withdrawal symptoms or drinking alcohol is used to avoid these symptoms
• Drinks more over a given period than intended
• Unsuccessful attempts to quit or cut down
• Gives up significant leisure or work activities
• Continues to drink in spite of the knowledge of its physical or psychological harm to oneself or others

Two-thirds of those with alcohol dependence continued to be dependent on alcohol after 5 years.