Substance Abuse Alcoholism

Alcoholism and alcohol abuse are serious, chronic conditions that adversely affect health, relationships and careers. Current surveys estimate that 14 million Americans are either alcoholic or engage in alcohol abuse: roughly one in thirteen people in the country. Over fifty percent of US adults report at least one family member whom they feel exhibits alcoholism symptoms or abuses alcohol on a regular basis.

Alcoholism Symptoms or Alcohol Abuse?

The difference between alcoholism and alcohol abuse is a matter of degree. While many signs of alcohol abuse are present in alcoholism, occasional abusers aren’t necessarily alcoholics. Alcohol abuse is a pattern of behavior; alcoholism is a disease. Both conditions require treatment.

CAGE and Alcohol Abuse

Neither alcoholism nor alcohol abuse are necessarily apparent to someone with a drinking problem. The CAGE test is a set of four quick questions designed to detect alcohol abuse or alcoholism. Answering yes to a single CAGE question indicates a possible alcohol problem. Answering yes to two or more questions indicates a high risk of alcohol abuse or alcoholism.

The CAGE Questions

Can you answer “yes” to any of these questions?

  • Have you ever felt the need to Cut down on alcohol consumption?
  • Are you Annoyed when people question your drinking habits?
  • Do you feel Guilty about your alcohol use?
  • Have you ever used alcohol as an Eye Opener to recover from a hangover?

Note that the CAGE questions are guidelines, not clear diagnostic criteria. Some people answer no to all four problems, but are still diagnosed with alcoholism or alcohol abuse. If alcohol adversely affects any area of your life, either socially, at work or at home, consult a health professional about your drinking habits.

Alcoholism Symptoms

Popular thought condemns the alcoholic as a morally unfit individual too “weak-willed” or “unwilling” to stop drinking. This simply isn’t true. Alcohol is an addictive drug, and alcoholism is a disease, not a personality flaw. Like any disease, alcoholism has specific symptoms.

Alcoholism Symptom #1: Craving Craving alcohol is perhaps the most misunderstood alcoholism symptom. Alcohol consumption is an over-riding compulsion for the alcoholic. “Willpower” or “strength of character” is rarely sufficient to overcome alcoholic cravings. The compulsion to drink can be as powerful an urge as eating and drinking for an alcoholic.

Alcoholism Symptom #2: Loss of Control Once an alcoholic begins to drink, he or she cannot control the urge to continue drinking. This is another alcoholism symptom that contributes to the misconception that the alcoholic is weak willed. However, the compulsion to keep drinking is beyond the alcoholic’s control.

Alcoholism Symptom #3: Physical Dependence An alcoholic gradually develops a physical dependency on alcohol, as the body and brain become accustomed to alcohol’s effects. If the alcoholic abstains from alcohol, withdrawal symptoms result. These symptoms include nausea, anxiety, physical shaking and irritability when deprived of alcohol. In severe cases, withdrawal symptoms can include delirium tremens, which produces severe tremors and seizures.

Alcoholism Symptom #4: Tolerance Over time an alcoholic develops a physical tolerance to the effects of alcohol due to chemical changes in the brain. Tolerance results in the alcoholic requiring progressively greater amounts of alcohol to feel the drug’s pleasurable effects. High tolerance levels for alcohol exacerbate other alcohol symptoms and health complications.

Alcohol Abuse Symptoms

Alcohol abusers have negative and debilitating drinking patterns that are not accompanied by the symptoms of alcoholism. While alcohol abusers don’t experience craving, uncontrollable drinking, physical dependence and tolerance, alcoholics may experience many of the signs of alcohol abuse.

Alcohol abuse results in one or more of the following conditions over a twelve-month period:

  • failure to meet responsibilities at work, home or school
  • risky, dangerous drinking, such as drinking while driving
  • regular law enforcement conflicts related to drinking, such as driving under the influence or assault while drunk
  • continued drinking in spite of the negative effects of alcohol on career, health or relationships.

Warning Signs of Alcoholism or Alcohol Abuse

These are common signs of alcohol abuse:

  • drinking alcohol to get to sleep
  • drinking for socialization
  • drinking to relax or relieve stress
  • hiding alcoholic drinks or empty bottles
  • lying about alcohol consumption
  • no memory of events while drinking
  • inability to stop drinking
  • worrying that alcohol may run out over a holiday or weekend.

Why Does Alcoholism Affect Only Certain People?

Millions of people engage in alcohol abuse or risky drinking habits that could develop into alcoholism. Not all of these people move from alcohol abuse into full-blown alcoholism. What makes one person an alcoholic and not another?

Research suggests genetics and family history play a role in the likelihood that alcoholism develops. Having an alcoholic family member greatly increases an individual’s chance of also developing alcoholic symptoms.

Researchers are quick to point out, however, that while genetic factors increase the risk of alcoholism, other factors influence whether an individual becomes an alcoholic. They include:

  • cultural views on alcohol and alcoholism
  • friends’ and families’ attitudes towards alcohol
  • peer pressure
  • personal lifestyle and personality
  • availability and affordability of alcohol
  • where a person lives.

Treatment of Alcoholism

No cure exists for alcoholism. Treatment helps the alcoholic control alcoholic symptoms, but once alcoholic, a person is always at risk of relapsing into alcoholic behavior, even after years of sobriety. Alcoholism is a chronic, progressive disease, so alcoholism treatment must be ongoing.

Initial alcoholism treatment usually involves detoxification: a four to seven day process designed to safely remove alcohol from the alcoholic’s system. Withdrawal symptoms are common during detoxification, and medication may be required to alleviate symptoms.

Combinations of psychological therapy and medication appear to produce better results than either treatment method alone. Alcoholic counseling may take place in individual or group sessions, and includes a number of strategies:

  • motivation enhancement therapy to strengthen the alcoholic’s commitment to treatment and abstinence
  • cognitive-behavioral therapy to identify triggers and develop non-alcohol based coping strategies
  • twelve-step facilitation programs such as Alcoholics Anonymous.

Medication and Alcoholism Treatment

Medications are available to reduce the severity of alcoholism symptoms and discourage drinking. Antabuse® (disulfiram) has been used to treat alcoholism since 1949. Antabuse does not alleviate alcoholism cravings; instead it reacts with alcohol, making the alcoholic experience severe nausea when alcohol is consumed.

A more recent medication, ReVia® (naltrexone), targets alcoholism symptoms directly. Naltrexone dulls symptoms of craving and compulsion by affecting the brain’s reward system. As a result, the alcoholic is less likely to experience severe cravings.

Alcoholics Anonymous and Alcoholism Recovery

Alcoholics Anonymous (AA) is the original 12-step facilitation program, an international association providing recovering alcoholics an opportunity help and support one another’s quest for sobriety.

AA has helped thousands of recovering alcoholics, but is not an alcoholism treatment in and of itself. Most members also receive counseling and/or medication as part of their ongoing alcoholism treatment. Nor do all alcoholics identify with AA’s methods of support. Such individuals should ask their health care providers for alternative support groups.

Relapse and Alcoholism

Alcoholism symptoms can be controlled, but a recovering alcoholic is never cured of alcoholism. Once in treatment, an alcoholic should avoid all types of alcoholic beverages. Cutting back on alcohol does not work. Complete abstinence is necessary.

Under these circumstances, relapses are common. When they occur, the alcoholic must stop drinking as soon as possible and resume treatment. Alcoholics and their families should not let an alcoholic relapse diminish the importance of the sobriety between relapses: Every sober day is a victory.

Alcohol Abuse Treatment

Alcohol abuse is treated somewhat differently from alcoholism. Cutting down on alcohol is an option for alcohol abusers, although often abstinence is the best course. The goal of alcohol abuse treatment is to alter behavior patterns so alcohol no longer adversely effects life and relationships.

Detoxification and medications are not commonly used to treat alcohol abuse. The focus is on counseling, changing established behavior and developing healthy alternatives to alcohol abuse. Alcohol abuse treatment sometimes benefits from Alcoholics Anonymous meetings.

Health Consequences of Alcoholism and Alcohol Abuse

Over 100,000 Americans die from alcohol-related health complications annually. Fifty percent of all traffic deaths in the US are linked to alcohol use.

Alcohol is a sedative that depresses the body’s nervous system. Drunk in large quantities, alcohol is a potentially lethal toxin. Excessive alcohol consumption can impair brain functioning to the point of coma and death. Increased tolerance to alcohol increases the risk of alcohol poisoning, as does the binge drinking often associated with alcohol abuse.

Alcoholism and alcohol abuse cause or worsen a long list of health complications:

In addition, both alcoholism and alcohol abuse increase the risk of serious or fatal accidents. Performance at work or school is adversely affected by excessive alcohol consumption. Alcoholics and people who abuse alcohol have a greater than normal risk of being involved in assaults, domestic violence, murder and suicide.


American Psychological Association. (nd). Understanding alcohol use disorders and their treatment.

Enoch, M-A.