Symptoms

Alcoholism symptoms include:

• Being unable to limit the amount of alcohol you drink
• Feeling a strong need or compulsion to drink
• Developing tolerance to alcohol so that you need an increasing amounts to feel its effects
• Having legal problems or problems with relationships, employment or finances due to drinking
• Drinking alone or in secret
• Experiencing physical withdrawal symptoms — such as nausea, sweating and shaking — when you don't drink
• Not remembering conversations or commitments, sometimes referred to as "blacking out"
• Making a ritual of having drinks at certain times and becoming annoyed when this ritual is disturbed or questioned
• Losing interest in activities and hobbies that used to bring you pleasure
• Irritability when your usual drinking time nears, especially if alcohol isn't available
• Keeping alcohol in unlikely places at home, at work or in your car
• Gulping drinks, ordering doubles, becoming intoxicated intentionally to feel good or drinking to feel "normal"

People who abuse alcohol may have many of the same signs and symptoms as people who have full-blown alcoholism. However, if you abuse alcohol but aren't completely addicted to it, you may not feel as much of a compulsion to drink. You may not have physical withdrawal symptoms when you don't drink. But alcohol abuse can still cause serious problems. As with alcoholism, you may not be able to quit drinking without help.

If you've ever wondered whether your drinking crosses the line into alcohol abuse or dependence, ask yourself these questions:

• If you're a man, do you ever have five or more drinks in a day? One standard drink is equivalent to 12 ounces (354.9 milliliters) of beer, 5 ounces (147.9 milliliters) of wine or 1.5 ounces (44.4 milliliters) of 80-proof spirits.
• If you're a woman, do you ever have four or more drinks in a day?
• Do you need a drink as soon as you get up?
• Do you feel guilty about your drinking?
• Do you think you need to cut back on how much you drink?
• Are you annoyed when other people comment on or criticize your drinking habits?

If you answered yes to even one of these questions, you may have a problem with alcohol.

When to see a doctor If you feel that you don't have control over your drinking, talk with your doctor. See your doctor even if you don't think you have alcoholism, but you're concerned that you might be drinking too much or that alcohol may be causing problems in your life. Other ways to get help include talking with a mental health provider or seeking help from a support group such as Alcoholics Anonymous.

Because denial is a frequent characteristic of alcohol abuse and alcoholism, you may not feel like you need treatment. You might not recognize how much you drink or how many problems in your life are related to alcohol use. Listen to family members, friends or co-workers when they ask you to examine your drinking habits or to seek help.

Causes

Alcohol addiction — physical dependence on alcohol — occurs gradually. Over time, drinking too much changes the balance of chemicals in your brain associated with the pleasurable aspects of drinking alcohol. Excessive, long-term drinking can affect the balance of these chemicals, causing your body to crave alcohol to restore good feelings or to avoid negative feelings.

Risk factors

Risk factors for alcoholism include:

• Steady drinking over time. Drinking too much on a regular basis for an extended period can produce a physical dependence on alcohol.
• Age. People who begin drinking at an early age are at a higher risk of alcohol dependence or abuse.
• Sex. Men are more likely to become dependent on alcohol than are women. However, women are at greater risk of developing some medical complications linked to drinking, such as liver disease.
• Family history. The risk of alcoholism is higher for people who have a parent who abused alcohol.
• Depression and other mental health problems. It's common for people with a mental health disorder such as anxiety or depression to abuse alcohol or other substances.
• Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcoholism. The glamorous way that drinking is sometimes portrayed in the media may also send the message that it's OK to drink excessively.

Complications

Alcohol depresses your central nervous system. In some people, the initial reaction may be stimulation. But as you continue to drink, you become sedated. Alcohol lowers your inhibitions and affects your thoughts, emotions and judgment. Too much alcohol affects your speech and muscle coordination and affects vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma.

Excessive drinking can cause a number of problems. Some of these include:

• Reduced judgment and lowered inhibitions, leading to poor choices and dangerous situations or behaviors
• Motor vehicle accidents and other types of accidents
• Domestic problems
• Poor performance at work or school
• A higher likelihood of committing violent crimes

Health problems caused by excessive drinking can include:

• Liver disorders. Drinking heavily can cause alcoholic hepatitis, an inflammation of the liver. After years of drinking, hepatitis may lead to the irreversible and progressive destruction and scarring of liver tissue (cirrhosis).
• Digestive problems. Alcohol can result in inflammation of the lining of the stomach (gastritis) and can interfere with absorption of B vitamins and other nutrients. Heavy drinking can also damage your pancreas, which produces the hormones that regulate your metabolism and the enzymes that help digest fats, proteins and carbohydrates.
• Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of heart failure or stroke.
• Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level.
• Sexual function and menstruation. Alcohol abuse can cause erectile dysfunction in men. In women, it can interrupt menstruation.
• Eye problems. Over time, excessive alcohol use can cause weakness and paralysis of your eye muscles.
• Birth defects. Alcohol use during pregnancy may cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems.
• Bone loss. Alcohol may interfere with the production of new bone. This can lead to thinning bones (osteoporosis) and an increased risk of fractures.
• Neurological complications. Excessive drinking can affect your nervous system, causing numbness of your hands and feet, disordered thinking, dementia, and short-term memory loss.
• Increased risk of cancer. Chronic alcohol abuse has been linked to a higher risk of numerous cancers, including mouth, throat, liver, colon and breast cancer.

Alcohol use leads to serious consequences for many teens. Alcohol-related motor vehicle accidents are a major cause of teen deaths. Alcohol is also often a cause in other teenage deaths, including drowning, suicides and homicides. Teens who drink are more likely to become sexually active, have sex more frequently and engage in risky, unprotected sex than are teens who don't drink.

Appointment

You're likely to start by seeing your primary care doctor or a general practitioner.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect from your doctor:

• Consider your drinking habits. Take an honest look at how often and how much you drink. Be prepared to discuss any problems that alcohol may be causing.
• Write down any symptoms you've had, including any that may seem unrelated to your drinking.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For alcohol abuse or alcoholism, some basic questions to ask your doctor include:

• Do you think I drink too much or show signs of alcohol abuse or dependence?
• Do you think alcohol could be causing or worsening my other health problems?
• Do you think I need to cut back or quit drinking?
• What is the best course of action?
• Do I need any medical tests for underlying physical problems?
• What are the alternatives to the primary approach that you're suggesting?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Some questions your doctor may ask include:

• How often do you drink?
• How much do you drink?
• Do you have any family members with alcohol problems?
• Do you ever feel you're not in control of your drinking?
• Have family members, friends or co-workers ever suggested you need to cut back or quit drinking?
• Do you feel like you need to drink more than you used to to get the same effects?
• Have you tried to stop drinking? If so, was it difficult and did you have any withdrawal symptoms?
• Have you had legal problems or problems at school, at work or in your relationships that may be related to alcohol use?
• Have there been times that you have behaved in a dangerous, harmful or violent way when you've been drinking?
• Do you have any physical health problems such as liver problems or diabetes?
• Do you have any mental health problems, such as depression or anxiety?
• Do you use illegal drugs?

Tests and diagnosis

A doctor who suspects you might have an alcohol problem will ask you a number of questions regarding drinking habits and may have you fill out a questionnaire. The doctor may ask for permission to speak with family members or friends. Family members may also contact the doctor on their own to discuss their concerns. However, confidentiality rules prevent your doctor from giving out any information about you without your consent.

There are no specific tests to diagnose alcoholism, but you may need other tests for health problems that may be linked to your alcohol use.

To be diagnosed with alcoholism, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DMS), published by the American Psychiatric Association.

The criteria required for a diagnosis of alcoholism include a pattern of alcohol abuse leading to significant problems, as indicated by three or more of the following at any time during one 12-month period:

• Tolerance, indicated by an increase in the amount of alcohol you need to feel intoxicated. As alcoholism progresses, the amount leading to intoxication can also decrease as a result of damage to your liver or central nervous system.
• Withdrawal symptoms when you cut down or stop using alcohol. These can include tremors, insomnia, nausea and anxiety. You may drink more alcohol in order to avoid those symptoms.
• Drinking more alcohol than you intended or drinking over a longer period of time than you intended.
• Having an ongoing desire to cut down on how much you drink or making unsuccessful attempts to do so.
• Spending a good deal of time drinking, obtaining alcohol or recovering from alcohol use.
• Giving up important activities, including social, occupational or recreational activities.
• Continuing to use alcohol even though you know it's causing you physical and psychological problems.

Treatments and drugs

Many people with alcoholism enter treatment reluctantly because they don't recognize that they have a problem. An intervention from loved ones is needed to help some people recognize and accept that they need to get help. If you're concerned about a friend or family member, talk to a professional for advice about how to approach that person about his or her drinking.

Various treatments are available to help people with alcohol problems. Depending on the circumstances, treatment may involve a brief intervention, an outpatient program or counseling, or a residential inpatient stay.

The first step in treatment is to determine whether you're alcohol dependent. If you haven't lost control over your use of alcohol, treatment may involve reducing your drinking. If you're dependent on alcohol, simply cutting back is ineffective. Giving up alcohol entirely must be part of your treatment goal.

Treatment for alcoholism can include:

• Detoxification and withdrawal. Treatment for alcoholism may begin with a program of detoxification, which generally takes four to seven days. You may need to take sedating medications to prevent shaking, confusion or hallucination (delirium tremens) or other withdrawal symptoms. Detoxification is usually done at an inpatient treatment center or at a hospital.
• Learning skills and establishing a treatment plan. This usually involves alcohol-abuse specialists. It may include goal setting, behavior modification techniques, use of self-help manuals, counseling and follow-up care at a treatment center.
• Psychological counseling. Counseling and therapy for groups and individuals support recovery from the psychological aspects of alcoholism. You may benefit from couples or family therapy — family support can be an important part of the recovery process.
• Oral medications. An alcohol-sensitizing drug called disulfiram (Antabuse) may help prevent you from drinking. Disulfiram won't cure alcoholism, nor can it remove the compulsion to drink. But if you drink alcohol, the drug produces a physical reaction that includes flushing, nausea, vomiting and headaches. Naltrexone (ReVia), a drug long known to block the good feelings alcohol causes, reduces the urge to drink. Acamprosate (Campral) may help you combat alcohol cravings. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick soon after taking a drink.
• Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol dependence to use consistently.
• Continuing support. Aftercare programs and support groups help people recovering from alcoholism or alcohol abuse to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group such as Alcoholics Anonymous.
• Treatment for psychological problems. Alcoholism commonly occurs along with other mental health disorders. You may need psychological counseling (psychotherapy), medications, or other treatment for depression, anxiety or another mental health condition.
• Medical treatment for other conditions. Common medical problems related to alcoholism are high blood pressure, increased blood sugar, liver disease and heart disease.

Residential treatment programs For a serious alcohol problem, you may need a stay at a residential treatment facility. Many residential treatment programs include individual and group therapy, participation in alcoholism support groups such as Alcoholics Anonymous, educational lectures, family involvement, activity therapy, and working with counselors and professional staff experienced in treating alcoholism.

Home remedies

Coping with alcohol abuse or dependence usually requires that you change your habits and make different lifestyle choices.

• Consider your social situation. Make it clear to your friends and family that you are not drinking. You may need to distance yourself from friends and social situations that impair your recovery.
• Develop healthy habits. For example, good sleep, regular exercise and eating well all can make it easier for you to recover from alcoholism.
• Do things that don't involve alcohol. You may find that many of your activities involve drinking. Replace them with hobbies or pastimes that are not centered around alcohol.

Alternative medicine

There are a number of alternative medicine techniques that may be helpful when recovering from alcoholism. These include:

• Yoga. Yoga's series of postures and controlled breathing exercises may help you relax and manage stress.
• Meditation. During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress.
• Acupuncture. With acupuncture, hair-thin needles are inserted under the skin. It may relieve cravings for alcohol and ease withdrawal symptoms. Acupuncture may also reduce anxiety and depression.
• Spiritual practice. People who are involved with some kind of regular spiritual practice may find it easier to maintain recovery from alcoholism or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery.

Coping and support

Many people who have alcoholism and their family members find that participating in support groups is an essential part of coping with the disease, preventing or dealing with relapses, and staying sober.

Alcoholics Anonymous Alcoholics Anonymous (AA) is a self-help group of people recovering from alcoholism. AA offers a sober peer group as an effective model for achieving total abstinence. The AA program is built around 12 steps, which are straightforward suggestions for people who choose to lead sober lives. As guides to recovery, the 12 steps help those with alcoholism to accept their powerlessness over alcohol. They stress the necessity for honesty about the past and present.

Recovery in AA is based on accepting the unique experience of each person. Through listening and sharing stories, people who abuse or are dependent on alcohol learn they aren't alone. There are no fees for membership or requirements for following the 12 steps — only a willingness to try to remain sober.

Al-Anon and Alateen Al-Anon is designed for people who are affected by someone else's alcoholism. In sharing their stories, they gain a greater understanding of how the disease affects the entire family. Al-Anon accepts the 12 steps of AA as the principles by which participants are to conduct their lives. It also emphasizes the need to learn detachment and forgiveness. In many communities, Alateen groups also are available for teenage children of those with alcoholism.

Your doctor or counselor can refer you to an AA group or other local support group. These groups are also commonly listed in the phone book, in the local newspaper and on the Web.

Prevention

Early intervention is important to prevent alcoholism in teens. For young people, the likelihood of addiction depends on the influence of parents, peers and other role models; susceptibility to advertising; how early in life they begin to use alcohol; the psychological need for alcohol; and genetic factors that may increase their risk of addiction.

If you have a teenager, be alert to signs and symptoms that may indicate a problem with alcohol:

• Loss of  interest in activities and hobbies
• Bloodshot eyes, slurred speech and memory lapses
• Difficulties or changes in relationships with friends, often characterized by joining a new crowd
• Declining grades and problems in school
• Frequent mood changes and defensive behavior

You can help prevent teenage alcohol use. Start by setting a good example with your own alcohol use. Talk openly with your child and spend quality time together, but respect your child's need for independence. Let your child know what behavior you expect — and what the consequences will be if he or she doesn't follow the rules.