Alcoholism is widely misunderstood and misrepresented. Often, people equate alcoholism with the low-bottom, skid row alcoholic. This is not true. There are just as many, if not more, high-bottom, functioning alcoholics. What differentiates an alcoholic from the majority of people is the fact that the alcoholic drinks despite adverse consequences. Alcoholism is a type of drug addiction. It is a chronic illness marked by consumption of alcohol to the extent that it interferes with physical or mental health and/or social, family, and occupational responsibilities.
An integral part of the disease of alcoholism is denial. Treatment professionals recognize that individuals have different levels of denial. In fact, people have various levels of awareness of their alcohol use problems. Many individuals with alcoholism persist in denying their problem, and typically, the more severe the addiction, the stronger the denial.
There is both a physical and psychological dependence with the addiction of alcoholism. Physical dependence reveals itself by withdrawal systems when the intake of alcohol is interrupted, tolerance to the effects of alcohol, and evidence of illness due to alcohol consumption. Psychological dependence manifests itself with the use of alcohol for relief of anxiety and depression or for social acceptance and reaction to peer pressures.
Alcohol affects the body in a variety of ways. It affects the central nervous system as a depressant, resulting in a decrease of activity, anxiety, tension, and inhibitions. It slows reactions. Concentration and judgment become impaired. Alcohol also irritates the gastrointestinal tract, eroding the stomach lining causing nausea and vomiting. Vitamins are not properly absorbed which leads to nutritional deficiencies. Liver disease and cirrhosis will also develop with continual consumption of alcohol. Alcohol can also have a negative effect on the cardiovascular system. Sexual dysfunction can also occur causing erectile dysfunction in men and cessation of menstrual cycle in women. Alcohol affects the nervous system and can result in neuropathy and dementia. Chronic alcohol use increases the risk of cancer of the larynx, esophagus, liver, and colon. Alcohol consumption during pregnancy can cause problems in the developing fetus known as fetal alcohol syndrome, which may result in mental retardation of the child or early death.
The social consequences of problem drinking can be as serious as the medical problems. People who abuse alcohol have a higher incidence of unemployment, domestic violence, and difficulty with the law. Statistics show that about half of all traffic fatalities are related to alcohol use.
The development of an alcohol problem usually occurs over a period of time that follows a consistent pattern of progression. At first, a tolerance of alcohol develops. A person is usually able to consume more and more alcohol before its effects are noticed. Memory lapses related to drinking may follow the increase in tolerance. Then a lack of control over drinking occurs and the affected person is no longer able to discontinue drinking whenever desired. The most severe drinking behavior is characterized by prolonged binges of drinking with associated mental or physical complications. Some people are able to maintain some control over their dependence in early stages before a total lack of control occurs.
For instance, many alcoholics will not drink very often. They can go days, weeks, sometimes even months without drinking. Individuals that are binge drinkers, but not daily drinkers can stay in heavy denial for months, even years, because they feel they can "control" their drinking. In fact, these binge drinkers are qualified alcoholics because on whatever occasion, no matter how far apart, they cannot control their drinking once they start. Many alcoholics that are not considered daily drinkers do not stop until some tangible consequence has taken place. For some it may be a DUI, a hospital visit, a concerned friend or a spousal threat. Though they can maintain long periods of sobriety, they are still alcoholics because of the lack of power they have over the consumption of alcohol once they start. It is not necessary to drink every day in order to be an alcoholic. It is not necessary to be physically dependent on alcohol to be an alcoholic. An alcoholic is a person who has problems, either physical, psychologically, socially, or occupationally, because of alcohol.
A person becomes physically dependent on alcohol following continuous and heavy consumption. This is when the classic symptoms of alcohol withdrawal syndrome become evident. These symptoms include elevated temperature, increased blood pressure, rapid heart rate, restlessness, anxiety, psychosis, seizures, and even death. Milder forms of the syndrome include tremulousness, seizures, and hallucinations, typically occurring within 6-48 hours after the last drink. A more serious syndrome, delirium tremens (DTs), involves profound confusion, hallucinations, and severe autonomic nervous system overactivity, typically beginning between 48 and 96 hours after the last drink.
Recent evidence suggests an importance to treat everyone who is suffering from alcohol withdrawal. During withdrawal, a person's central nervous system experiences overactivation. This overactivation can result in damage to the hippocampus, a part of the brain that is thought to be particularly important for memory and control of emotional states. Thus repeated untreated alcohol withdrawals may lead to direct damage to the brain.
National Institute on Alcohol Abuse and Alcoholism No. 5 PH 270 August 1989
