Alcoholism: What Is It?
There is a wide range of problems associated with alcohol use – from problem drinking on an occasional basis to misuse of alcohol, and ultimately to alcoholism. Alcohol dependence, which is also called alcoholism, is often progressive and fatal. It is a primary, chronic disease that is influenced by genetic, environmental, and psychosocial factors.
Risky drinking is defined by the National Institute on Alcohol Abuse and Alcoholism (or NIAAA). Consuming four or more drinks each day or fourteen or more drinks a week is listed as risky for men. For women, it is considered risky to consume three or more alcoholic beverages each day or seven or more each week. The NIAAA’s definition of “standard drinks” equals roughly 1.5 ounces of hard liquor, 5 ounces of wine, or 12 ounces of typical American beer. These figures are based on mass-market beer and wine. Beers contain varying amounts of alcohol with certain ones containing nearly twice the amount as typical mass-market beer. When it comes to wine, there is more consistency with alcohol content. However, wine coolers usually contain lower amounts of alcohol, while certain wines, like port and zinfandels, can contain about twice the alcohol.
By definition, it is necessary to consume alcohol to develop alcoholism. However, it is not using alcohol itself that predicts alcoholism development. Developing alcoholism doesn’t follow a formula – people are different, and so are the quantities, frequencies, and regularities of alcohol consumption required to develop alcoholism. Additionally, how a person responds to alcohol will vary based on their general health, age, size, and any medications they may be taking. For some people, a fewer amount of drinks can adversely affect their health.
Pregnant women, and those planning to be, are advised by the Surgeon General to abstain from consuming alcohol altogether since there is no known safe level for expecting mothers.
Signs and Symptoms of Alcoholism
The NIAAA lists the following signs and symptoms associated with alcoholism:
- Tolerance: a need to drink more than usual to obtain the same experience alcohol provided initially
- Physical dependence: withdrawal symptoms, for example, shakiness, anxiety, sweating, and nausea once drinking has stopped
- Craving: a feeling that is a strong urge to drink
- Loss of control: the sense that one is not able to stop drinking after they have started drinking
The United States Centers for Disease Control and Prevention (or CDC) classifies alcohol misuse as a pattern of drinking which causes certain problematic situations, including the inability to complete significant work, home, or school responsibilities, or recurring legal problems involving alcohol (like DUI or public intoxication arrests).
The National Survey on Drug Use and Health states that there are nearly 15 million adults in America that are dependent on alcohol or misuse it. Additionally, almost 20 percent of U.S. patients share with their primary healthcare providers that their drinking behaviors are hazardous or risky. The NIAAA reports that less than ten percent of those with an alcohol use disorder get the treatment they need.
Alcoholism and Long-Term Health Risks
The CDC shares the following social and medical problems that can be developed with long-term excessive alcohol use:
- Psychiatric conditions, a wide range of issues, such as anxiety, depression, and suicide
- Neurological conditions that may include neuropathy or stroke, dementia, or diseased peripheral nerves
- Cardiovascular problems, including irregular heartbeat, high blood pressure, and weakened and enlarged heart
- Cancers, including breast, colon, liver, throat, mouth, and esophagus
- Gastrointestinal diseases, such as gastritis and pancreatitis
- Liver diseases, such as cirrhosis (scarring) and alcoholic hepatitis (inflammation)
For those with hepatitis C virus (HCV) and excess alcohol use, the liver function is reduced, and alcohol can interfere with HCV medications; also HCV, along with other liver diseases, plus alcohol equals increased likelihood of developing cirrhosis and causing death.
Typically, women are more sensitive to alcohol’s effects and, even though they may consume less alcohol than men, may be more likely to develop alcohol-related health problems sooner than men. Alcohol use during pregnancy can lead to low birth weight, premature birth, stillbirth, miscarriage, and other issues for the baby, including malformation of the brain, heart, and other organs, abnormal facial features, hearing and vision problems, and growth deficits. Additionally, the March of Dimes discloses that a child’s brain damage from their mother’s alcohol use during pregnancy can result in learning disabilities, speech and language delays, and behavioral problems.
Tests for Alcoholism
Clinical screening surveys are the primary tests used to diagnose alcohol dependence or misuse. There are several hundred surveys out there that can be used. The ones that are most common and have scientifically-validated questions include the Alcohol Use Disorders Identification Test (AUDIT), the Michigan Alcohol Screening Test (MAST), a Brief MAST which is a shorter version of the MAST, and a short, quick survey called the CAGE questionnaire. The surveys ask different questions regarding the ability to stop drinking, frequency of drinking, and what problems result from drinking.
There are currently no laboratory testing options to identify alcoholism. However, there are tests that can help detect issues that can arise from drinking, including organ damage. The Substance Abuse and Mental Health Administration share the following testing options that may be used:
Gamma-glutamyl transferase (GGT) is a liver enzyme that is increased by different conditions that affect the liver, including heavy alcohol use.
Mean corpuscular volume (MCV) is a test that measures red blood cell size and is usually done in conjunction with a complete blood count (CBC) test. For heavy drinkers, MCV can increase over time; however, many other conditions can affect it.
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are enzymes that can signal liver damage that is often related to heavy alcohol use.
Carbohydrate-deficient transferrin (CDT) is a test that can indicate a heavy drinking relapse after abstinence. However, the tests can be less sensitive for younger people and women.
Ethyl glucuronide (EtG) and Ethyl sulfate (EtS) are biomarkers and direct analytes of alcohol breakdown – commonly a urine test.
Phosphatidyl ethanol (PEth) is a marker that is typically measured in blood. Normally, it is used to indicate moderate to heavy drinking.
Other tests include:
Comprehensive metabolic panel (CMP) or liver panel is a group of tests that evaluate liver and organ function.
Magnesium is commonly low in those who use alcohol because of inadequate diet and magnesium loss by the kidneys.
A blood alcohol level (ethanol test) is a test that can determine if a person had recent alcohol use. However, it does not diagnose alcoholism.
Treatment for Alcoholism
Alcoholism, like many other chronic diseases, cannot be cured. There are, however, effective treatments to help alcoholics stay sober, but they must acknowledge that they have an alcohol problem and the drive to quit drinking. These treatments most often include group therapy, counseling, and alcohol education.
If a person decides to stop drinking alcohol, they can enter a treatment facility for a short period to rehabilitate. These treatment centers are designed to counsel patients, give support, and help them get through their initial symptoms and safely withdraw from alcohol.
Sometimes, benzodiazepines (Valium or similar drugs) may be employed to help ease some of the symptoms of alcoholism.
The FDA has approved three oral medications to help people refrain from drinking alcohol – disulfiram, acamprosate, and naltrexone. Typically, these are prescribed to patients who wish to stop drinking but need some help. Naltrexone limits a person’s craving for alcohol but can cause severe withdrawal symptoms in people who are opiate dependent; naltrexone is also available in a long-acting, injectable form. Disulfiram causes nausea, vomiting, and flushing when a person drinks any alcohol. Acamprosate also works to reduce alcohol cravings. All three are designed to be used in conjunction with counseling.
Just as there is no single test for screening or diagnosing alcohol dependence, there is no one therapy or medication that definitively treats alcoholism in all those who suffer from it. Just like a lot of chronic diseases, alcoholism is not easy to resolve, and many alcoholics will relapse several times before achieving lasting sobriety.
While some alcohol-related liver and other organ damage may be resolvable, some damage may be permanent. Patients should work long-term with their doctors to maintain sobriety and address any resultant complications.