Alcoholism is an addictive dependency on alcohol characterized by craving (a strong need to drink); loss of control (being unable to stop); physical dependence and withdrawal symptoms; and tolerance (increasing difficulty of becoming drunk).
"King Alcohol and his Prime Minister" circa 1820
The causes for alcohol abuse and dependence cannot be easily explained. It is often seen as a "disease of affluence," being uncommon among indigenous people until they were colonized. Today, alcohol abuse and alcoholism are a major public health problem in North America, costing that region's inhabitants $170 billion annually. Alcoholism is a life-threatening problem that often ends in death, particularly through liver, pancreatic, or kidney disease, internal bleeding, brain deterioration, alcohol poisoning and suicide. As well, alcoholism is a major contributing factor for head injuries, motor vehicle accidents (MVA), violence and assaults, as well as a leading cause of neurological and other medical problems (e.g., cirrhosis, etc.).
Of the two thirds of the North American population who consume alcohol, 10% are alcoholics, and 6% consume more than half of all alcohol.
Stereotypes of alcoholics are often found in fiction and popular culture: for example the "town drunk," or the stereotype of Russians and the Irish as alcoholics. In modern times, the recovery movement has led to more realistic portraits of alcoholics and their problems, such as in Charles Jackson's The Lost Weekend, Robert Clark Young's One of the Guys, or the film Days of Wine and Roses.
Alcohol dependence can be harder to break and significantly more damaging than dependence on most other addictive substances. The physical symptoms when withdrawing from alcohol are seen to be equal to those experienced during withdrawal from heroin.
Long-term abusers of alcoholic beverages can suffer delirium tremens.
Developed by Dr. John Ewing,  founding Director of the Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, North Carolina.
Several tools may be used to detect the habitual abuse of alcohol. The CAGE questionnaire is one such example that may be used to screen patients quickly in a doctor's office. Two "yes" responses for a male and one "yes" response for a female indicate that the respondent should be investigated further.
The questionnaire asks the following questions:
- Have you ever felt you needed to cut down on your drinking?
- Have people annoyed you by criticising your drinking?
- Have you ever felt guilty about drinking?
- Have you ever felt you needed a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?
Abnormal blood tests are associated with alcoholism.
- Enlarged MCV1
- Elevated GGT2
- Moderate elevation of AST and ALT and an AST:ALT ratio of 2:1.
- High carbohydrate-deficient transferrin 2
The long-term effects of alcohol dependency include:
pancreatitis, or inflammation of the pancreas
heart disease, including coronary artery disease
neuropathy, or damage to the nerves
- bleeding esophageal varices, or enlarged veins in the tube that connects the esophagus to the stomach
- brain degeneration and alcoholic neuropathy
cirrhosis of the liver, a chronic disease that causes destruction of liver cells and loss of liver function
depression, insomnia, anxiety, and suicide
high blood pressure
- increased incidence of many types of cancer, including breast cancer
Wernicke-Korsakoff syndrome, a neuropsychiatric disorder caused by thiamine deficiency that results from poor nutrition in alcoholics
- significant damage to occupational, social, and interpersonal areas, including sexual dysfunction
Treatments for alcoholism include detoxification programs run by medical institutions. These may involve stays for a number of weeks in specialized hospital wards where drugs may be used to avoid withdrawal symptoms, which in severe cases may lead to death.
After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues leading to alcohol dependence. Aversion therapies may be supported by drugs like Disulfiram, which causes a strong and prompt hangover whenever alcohol is consumed. Naltrexone may improve compliance with abstinence planning. The standard pharmocopeia of anti-depressants, anxiolytics and other psychotropic drugs treat underlying mood disorders, neuroses and psychoses associated with alcoholic symptoms.
Another treatment program is based on nutritional therapy. Many alcoholics have insulin resistance syndrome, a metabolic disorder where the body's difficulty in processing sugars causes an unsteady supply to the blood stream. While the disorder can be treated by a hypoglycemic diet, this can affect behaviour and emotions, side-effects often seen among alcoholics in treatment. The metabolic aspects of alcoholism are often overlooked, resulting in poor treatment outcomes. See: 
In the 1900s the self-help group-counselling approach to treatment became increasingly widespread and remains so today. Alcoholics Anonymous is possibly being the best-known example of this movement.
Some programs attempt to help problem drinkers before they become serious alcoholics. These programs focus on harm-reduction and reducing alcohol intake as opposed to cold-turkey approaches. One such program is called Moderation Management.
A Soviet poster reading "Daddy, don't drink", referring to the massive alcoholism problem in Russia
The social problems arising from alcoholism can include loss of employment, financial problems, marital conflict and divorce, convictions for crimes such as drunk driving or public disorder, loss of accommodation, and loss of respect from others who may see the problem as self-inflicted and easily avoided. Exhaustive studies, including those by author Wayne Kritsberg , show that alcoholism affects not only the addicted but can profoundly impact the family members around them. Children of alcoholics can be affected even after they are grown. This condition is usually referred to as "The Adult Children of Alcoholics Syndrome." Al-Anon
, a group modelled after Alcoholics Anonymous, offers aid to friends and family members of alcoholics.
Many people incorrectly assume that once an alcoholic stops drinking, all is well. However, many people who have stopped drinking still refer to themselves as "alcoholics" or "recovering alcoholics."
Social dependence versus physical dependence
Symptoms of a person's dependence on alcohol may include, but are not limited to, a feeling of necessity in regards to consumption of alcohol, or an inability to resist alcohol if offered. Though these symptoms often arise from a physical dependence on the substance, it is not uncommon for individuals, especially teenagers and adolescents between the ages of fifteen and twenty, to rely on alcohol as a means of social interaction. If a person cannot refuse alcohol in the presence of others, insists on drinking alcohol excessively for fear of alienation and neglect, or feels they cannot socially interact with others unless under the influence then this person is considered socially dependent on the substance.
These traits can be noticed in individuals who relocate (such as students attending a new university) whereby an individual with no past history of alcohol consumption begins to consume alcohol in order to associate and relate to others. Social dependence, though not physically threatening in early stages, can lead to physical dependence if the person cannot control their urges and moreso their reasons for drinking.
Alcohol politics and public health
Because alcohol problems affect society as a whole, it is a part of the political responsibility of governments and parliaments to build up an alcohol policy in order to reduce the harm by alcohol consumption. Alcohol politics are a rather unbeloved theme because very often consumer behavior, personal economic interest, and simply social reality are hinderances for an objective approach and way of acting. Scientific research has found that taxation and a ban on advertising are the most effective ways to reduce alcohol consumption. Educational prevention has shown to be only effective by raising the knowledge and perhaps the readiness to accept higher prices. It doesn't change drinking behavior. (T. Babor, et.al.: No Ordinary Commodity: Alcohol and Public Policy, Oxford Press, 2003) The World Health Organization, the European Union and other regional bodies are working on alcohol action plans and programs, which should encourage individual states to introduce similar programs. Unfortunately, the alcohol industry is well organized and lobbying all over the world to undermine such efforts. They concentrate their expansion and promotion now to the Third World, as sales in the industrialized countries have more or less stopped growing. The tragedy is that those countries in Africa and Asia are not prepared to fight against alcohol problems and there is no social network to help alcoholics or their families.
Organisations working with alcoholics include:
There are several distinct but not mutually exclusive clinical alcohol withdrawal syndromes caused by alcohol withdrawal:
- Tremulousness - "the shakes"
- Activation syndrome - characterized by tremulousness, agitation, rapid heart beat and high blood pressure.
Seizures - acute grand mal seizures can occur in alcohol withdrawal in patients who have no history of seizure or any structural brain disease.
Hallucinations - usually visual or tactile in alcoholics
- Delirium tremens - can be severe and often fatal.
Unlike withdrawal from opioids such as heroin, which can be very unpleasant but is rarely fatal, alcohol withdrawal can kill (by uncontrolled convulsions) if it is not properly managed by a doctor. The pharmacological management of alcohol withdrawal is based on the fact that alcohol, barbiturates and benzodiazepines have remarkably similar effects on the brain and can be substituted for each other. Since benzodiazepines are the safest of the three classes of drugs, alcohol consumption is terminated and a long-acting benzodiazepine, e.g., Valium® is substituted to block the alcohol withdrawal syndrome. The benzodiazepine dosage is then tapered slowly over a period of days or weeks.
1. Tonnesen H, Hejberg L, Frobenius S, Andersen JR. Erythrocyte mean cell volume--correlation to drinking pattern in heavy alcoholics. Acta Med Scand. 1986;219(5):515-8. (Medline abstract)
2. Schwan R, Albuisson E, Malet L, Loiseaux MN, Reynaud M, Schellenberg F, Brousse G, Llorca PM. The use of biological laboratory markers in the diagnosis of alcohol misuse: an evidence-based approach. Drug Alcohol Depend. 2004 Jun 11;74(3):273-9. (Medline abstract)
3. Ewing, John A. “Detecting Alcoholism: The CAGE Questionaire” JAMA 252: 1905-1907, 1984