Getting the Facts
For many people, the facts about alcoholism are not clear.
What is alcoholism, exactly? How does it differ from alcohol abuse? When
should a person seek help for a problem related to his or her drinking?
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has prepared
this document to help individuals and families answer these and other common
questions about alcohol problems. The information below will explain alcoholism
and alcohol abuse, symptoms of each, when and where to seek help, treatment
choices, and additional helpful resources.
A Widespread Problem
For most people, alcohol is a pleasant accompaniment
to social activities. Moderate alcohol use--up to two drinks per day for
men and one drink per day for women and older people (A standard drink
is one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine,
or 1.5 ounces of 80-proof distilled spirits) -- is not harmful for most
adults. Nonetheless, a substantial number of people have serious trouble
with their drinking. Currently, nearly 14 million Americans--1 in every
13 adults--abuse alcohol or are alcoholic. Several million more adults
engage in risky drinking patterns that could lead to alcohol problems.
In addition, approximately 53 percent of men and women in the United States
report that one or more of their close relatives have a drinking problem.
The consequences of alcohol misuse are serious--in many
cases, life-threatening. Heavy drinking can increase the risk for certain
cancers, especially those of the liver, esophagus, throat, and larynx
(voice box). It can also cause liver cirrhosis, immune system problems,
brain damage, and harm to the fetus during pregnancy. In addition, drinking
increases the risk of death from automobile crashes, recreational accidents,
and on-the-job accidents and also increases the likelihood of homicide
and suicide. In purely economic terms, alcohol-use problems cost society
approximately $100 billion per year. In human terms, the costs are incalculable.
What Is Alcoholism?
Alcoholism, which is also known as "alcohol dependence
syndrome," is a disease that is characterized by the following elements:
||Craving: A strong need, or compulsion, to drink. |
||Loss of control: The frequent inability to stop drinking once
a person has begun. |
||Physical dependence: The occurrence of withdrawal symptoms,
such as nausea, sweating, shakiness, and anxiety, when alcohol use is
stopped after a period of heavy drinking. These symptoms are usually
relieved by drinking alcohol or by taking another sedative drug.|
||Tolerance: The need for increasing amounts of alcohol in order
to get "high."|
Alcoholism has little to do with what kind of alcohol
one drinks, how long one has been drinking, or even exactly how much alcohol
one consumes. But it has a great deal to do with a person's uncontrollable
need for alcohol. This description of alcoholism helps us understand why
most alcoholics can't just "use a little willpower" to stop drinking.
He or she is frequently in the grip of a powerful craving for alcohol,
a need that can feel as strong as the need for food or water. While some
people are able to recover without help, the majority of alcoholic individuals
need outside assistance to recover from their disease. With support and
treatment, many individuals are able to stop drinking and rebuild their
lives. Many people wonder: Why can some individuals use alcohol without
problems, while others are utterly unable to control their drinking? Recent
research supported by NIAAA has demonstrated that for many people, a vulnerability
to alcoholism is inherited. Yet it is important to recognize that aspects
of a person's environment, such as peer influences and the availability
of alcohol, also are significant influences. Both inherited and environmental
influences are called "risk factors." But risk is not destiny. Just because
alcoholism tends to run in families doesn't mean that a child of an alcoholic
parent will automatically develop alcoholism.
What Is Alcohol Abuse?
Alcohol abuse differs from alcoholism in that it does
not include an extremely strong craving for alcohol, loss of control,
or physical dependence. In addition, alcohol abuse is less likely than
alcoholism to include tolerance (the need for increasing amounts of alcohol
to get "high"). Alcohol abuse is defined as a pattern of drinking that
is accompanied by one or more of the following situations within a 12-month
||Failure to fulfill major work, school, or home responsibilities;|
||Drinking in situations that are physically dangerous, such as while
driving a car or operating machinery;|
||Recurring alcohol-related legal problems, such as being arrested for
driving under the influence of alcohol or for physically hurting someone
while drunk; |
||Continued drinking despite having ongoing relationship problems that
are caused or worsened by the effects of alcohol.|
While alcohol abuse is basically different from alcoholism,
it is important to note that many effects of alcohol abuse are also experienced
What Are the Signs of a Problem?
How can you tell whether you, or someone close to you,
may have a drinking problem? Answering the following four questions can
help you find out. (To help remember these questions, note that the first
letter of a key word in each of the four questions spells "CAGE.")
||Have you ever felt you should cut down on your drinking?|
||Have people annoyed you by criticizing your drinking? |
||Have you ever felt bad or guilty about your drinking? |
||Have you ever had a drink first thing in the morning to steady your
nerves or to get rid of a hangover (eye opener)? |
One "yes" response suggests a possible alcohol problem.
If you responded "yes" to more than one question, it is highly likely
that a problem exists. In either case, it is important that you see your
doctor or other health care provider right away to discuss your responses
to these questions. He or she can help you determine whether you have
a drinking problem and, if so, recommend the best course of action for
Even if you answered "no" to all of the above questions,
if you are encountering drinking-related problems with your job, relationships,
health, or with the law, you should still seek professional help. The
effects of alcohol abuse can be extremely serious--even fatal--both to
you and to others.
The Decision To Get Help
Acknowledging that help is needed for an alcohol problem
may not be easy. But keep in mind that the sooner a person gets help,
the better are his or her chances for a successful recovery.
Any reluctance you may feel about discussing your drinking
with your health care professional may stem from common misconceptions
about alcoholism and alcoholic people. In our society, the myth prevails
that an alcohol problem is somehow a sign of moral weakness. As a result,
you may feel that to seek help is to admit some type of shameful defect
in yourself. In fact, however, alcoholism is a disease that is no more
a sign of weakness than is asthma or diabetes. Moreover, taking steps
to identify a possible drinking problem has an enormous payoff--a chance
for a healthier, more rewarding life.
When you visit your health care provider, he or she will
ask you a number of questions about your alcohol use to determine whether
you are experiencing problems related to your drinking. Try to answer
these questions as fully and honestly as you can. You also will be given
a physical examination. If your health care professional concludes that
you may be dependent on alcohol, he or she may recommend that you see
a specalist in diagnosing and treating alcoholism. You should be involved
in making referral decisions and have all treatment choices explained
The nature of treatment depends on the severity of an
individual's alcoholism and the resources that are available in his or
her community. Treatment may include detoxification (the process of safely
getting alcohol out of one's system); taking doctor-prescribed medications,
such as disulfiram (Antabuse®) or naltrexone (ReViaTM),
to help prevent a return to drinking once drinking has stopped; and individual
and/or group counseling. There are promising types of counseling that
teach recovering alcoholics to identify situations and feelings that trigger
the urge to drink and to find new ways to cope that do not include alcohol
use. Any of these treatments may be provided in a hospital or residential
treatment setting or on an outpatient basis.
Because the involvement of family members is important
to the recovery process, many programs also offer brief marital counseling
and family therapy as part of the treatment process. Some programs also
link up individuals with vital community resources, such as legal assistance,
job training, child care, and parenting classes.
Virtually all alcoholism treatment programs also include
meetings of Alcoholics Anonymous (AA), which describes itself as a "worldwide
fellowship of men and women who help each other to stay sober." While
AA is generally recognized as an effective mutual help program for recovering
alcoholics, not everyone responds to AA's style and message, and other
recovery approaches are available. Even those who are helped by AA usually
find that AA works best in combination with other elements of treatment,
including counseling and medical care.
Can Alcoholism Be Cured?
While alcoholism is a treatable disease, a cure is not
yet available. That means that even if an alcoholic has been sober for
a long while and has regained health, he or she remains susceptible to
relapse and must continue to avoid all alcoholic beverages. "Cutting down"
on drinking doesn't work; cutting out alcohol is necessary for a successful
However, even individuals who are determined to stay
sober may suffer one or several "slips," or relapses, before achieving
long-term sobriety. Relapses are very common and do not mean that a person
has failed or cannot eventually recover from alcoholism. Keep in mind,
too, that every day that a recovering alcoholic has stayed sober prior
to a relapse is extremely valuable time, both to the individual and to
his or her family. If a relapse occurs, it is very important to try to
stop drinking once again and to get whatever additional support is needed
to abstain from drinking.
Help for Alcohol Abuse
If your health care provider determines that you are
not alcohol dependent but are nonetheless involved in a pattern of alcohol
abuse, he or she can help you: