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Understanding Alcohol
Use Disorders and Their Treatment
For many people, drinking alcohol is nothing more than a pleasant way to relax.
However, people with alcohol use disorders drink to excess, endangering both
themselves and others. This question-and-answer fact sheet explains alcohol problems
and how psychologists can help people recover.
When does drinking become a problem?
For most adults, moderate alcohol use--no more than two drinks a day for men
and one for women and older people--is relatively harmless. (A "drink" means
1.5 ounces of spirits, 5 ounces of wine, or 12 ounces of beer, all of which contain
0.5 ounces of alcohol.)
Moderate use, however, lies at one end of a range that moves through alcohol
abuse to alcohol dependence:
- Alcohol abuse is a drinking pattern that results in significant
and recurrent adverse consequences. Alcohol abusers may fail
to fulfill major school, work or family obligations. They
may have drinking-related legal problems, such as repeated
arrests for driving while intoxicated. They may have relationship
problems related to their drinking.
- People with alcoholism--technically
known as alcohol dependence--have lost reliable control of
their alcohol use. It doesn't matter what kind of alcohol
someone drinks or even how much: alcohol-dependent people
are often unable to stop drinking once they start. Alcohol
dependence is characterized by tolerance (the need to drink
more to achieve the same "high") and withdrawal
symptoms if drinking is suddenly stopped. Withdrawal symptoms
may include nausea, sweating, restlessness, irritability,
tremors, hallucinations, and convulsions.
- Although severe
alcohol problems get the most public attention, even mild
to moderate problems cause substantial damage to individuals,
their families, and the community.
According to the National Institute on Alcohol
Abuse and Alcoholism (NIAAA),
1 in 13 American adults is an alcohol abuser or alcoholic
at any given time. A 1997 government survey revealed that
drinking problems are also common among younger Americans.
For example, almost 5 million youths aged 12 to 20 engage
in binge drinking, which involves females consuming at
least four drinks on a single occasion and males at least
five.
What causes alcohol-related disorders?
Problem drinking has multiple causes, with genetic, physiological,
psychological and social factors all playing a role. Not
every individual is equally affected by each cause. For some
alcohol abusers, psychological traits such as impulsiveness,
low self-esteem, and a need for approval prompt inappropriate
drinking. Some individuals drink to cope with or "medicate" emotional
problems. Social and environmental factors such as peer pressure
and the easy availability of alcohol can play key roles.
Poverty and physical or sexual abuse increase the odds of
developing alcohol dependence.
Genetic factors make some people especially vulnerable to
alcohol dependence. Contrary to myth, being able to "hold your liquor" means
you're probably more at risk--not less--for alcohol problems.
Yet a family history of alcohol problems doesn't mean that
the children of those with alcohol problems will automatically
grow up to have the same problems--nor does the absence of
family drinking problems necessarily protect children from
developing these problems.
Once people begin drinking excessively, the problem can perpetuate
itself. Heavy drinking can cause physiological changes that
make more drinking the only way to avoid discomfort. Individuals
with alcohol dependence may drink partly to reduce or avoid
withdrawal symptoms.
How do alcohol use disorders affect people?
While some research suggests that small amounts of alcohol
may have beneficial cardiovascular effects, there is widespread
agreement that heavier drinking can lead to health problems.
In fact, 100,000 Americans die from alcohol-related causes
each year. Short-term effects include memory loss, hangovers,
and blackouts. Long-term problems associated with heavy drinking
include stomach ailments, heart problems, cancer, brain damage,
serious memory loss, and liver cirrhosis. Heavy drinkers
also markedly increase their chances of dying from automobile
accidents, homicide, and suicide. Although men are much more
likely than women to develop alcoholism, women's health suffers
more, even at lower levels of consumption.
Drinking problems also have a very negative impact on mental
health. Alcohol abuse and alcoholism can worsen existing
conditions such as depression or induce new problems such
as serious memory loss, depression, or anxiety.
Alcohol problems don't just hurt the drinker. According to
NIAAA, more than half of Americans have at least one close
relative with a drinking problem. Spouses and children of
heavy drinkers are more likely to face family violence; children
are more likely to suffer physical and sexual abuse and neglect
and to develop psychological problems. Women who drink during
pregnancy run a serious risk of damaging their fetuses. Relatives
and friends can be killed or injured in alcohol-related accidents
and assaults.
When should someone seek help?
Individuals often hide their drinking or deny they have a
problem. How can you tell if you or someone you know is in
trouble? Signs of a possible problem include having friends
or relatives express concern, being annoyed when people criticize
your drinking, feeling guilty about your drinking and thinking
that you should cut down but finding yourself unable to do
so, and/or needing a morning drink to steady your nerves
or relieve a hangover.
Some people with drinking problems work hard to resolve them,
and often, with the support of family members and/or friends,
these individuals are able to recover on their own. However,
those with alcohol dependence usually can't stop drinking
through willpower alone. Many need outside help. They may
need medically supervised detoxification to avoid potentially
life-threatening withdrawal symptoms such as seizures. Once
people are stabilized, they may need help resolving psychological
issues associated with problem drinking.
There are several approaches available for treating alcohol
problems. No one approach is best for all individuals.
How can a psychologist help?
Psychologists who are trained and experienced in treating
alcohol problems can be helpful in many ways. Before the
drinker seeks assistance, a psychologist can guide the family
or others in helping to increase the drinker's motivation
to change.
A psychologist can begin with the drinker by assessing the
types and degrees of problems the drinker has experienced.
The results of the assessment can offer initial guidance
to the drinker about what treatment to seek and help motivate
the problem drinker to get treatment. Individuals with drinking
problems definitely improve their chances of recovery by
seeking help early.
Using one or more of several types of psychological therapies,
psychologists can help people address psychological issues
involved in their problem drinking. A number of these therapies,
including cognitive-behavioral coping skills treatment and
motivational enhancement therapy, were developed by psychologists.
Additional therapies include 12-Step facilitation approaches
that assist those with drinking problems in using self-help
programs such as Alcoholics Anonymous (AA). All three of
these therapies--cognitive-behavioral coping skills treatment,
motivational enhancement therapy, and 12-Step facilitation
approaches--have demonstrated their effectiveness through
well-designed, large-scale treatment trials. These therapies
can help people boost their motivation to stop drinking,
identify circumstances that trigger drinking, learn new methods
to cope with high-risk drinking situations, and develop social
support systems within their own communities.
Many individuals with alcohol problems suffer from other
mental health conditions, such as severe anxiety and depression,
at the same time. Psychologists can be very helpful for diagnosing
and treating these "co-occurring" psychological
conditions when they begin to create impairment. Further,
a drinker in treatment may receive services from many health
professionals, and a psychologist may play an important role
in coordinating these services.
Psychologists can also provide marital, family, and group
therapies, which often are helpful for repairing interpersonal
relationships and for long-term success in resolving problem
drinking. Family relationships influence drinking behavior,
and these relationships often change during an individual's
recovery. The psychologist can help the drinker and significant
others navigate these complex transitions, help families
understand problem drinking and learn how to support family
members in recovery, and refer family members to self-help
groups such as Al-Anon and Alateen.
Because a person may experience one or more relapses and
return to problem drinking, it can be crucial to have an
appropriate health professional such as a trusted psychologist
with whom that person can discuss and learn from these events.
If the drinker is unable to resolve alcohol problems fully,
a psychologist can help with reducing alcohol use and minimizing
problems.
Psychologists can also provide referrals to self-help groups.
Even after formal treatment ends, many people seek additional
support through continued involvement in such groups.
Alcohol-related disorders severely impair functioning and
health. But the prospects for successful long-term problem
resolution are good for people who seek help from appropriate
sources. Psychologists are applying the substantial knowledge
they have to help people resolve alcohol problems, and they
are working to make treatment services available wherever
needed.
The American Psychological Association Practice Directorate
and the APA Practice Organization College of Professional
Psychology gratefully acknowledge the assistance of Peter
E. Nathan, Ph.D.; John Wallace, Ph.D.; Joan Zweben, Ph.D.;
and A. Thomas Horvath, Ph.D., in developing this fact sheet.
Article reprinted courtesy of the American Psychological Association
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