This topic is about alcohol
abuse and dependence in adults. For information about alcohol problems in teens
or children, see the topic
Teen Alcohol and Drug Abuse.
abuse means having unhealthy or dangerous drinking
habits, such as drinking every day or drinking too much at a time. Alcohol
abuse can harm your relationships, cause you to miss work, and lead to legal
problems such as driving while drunk
(intoxicated). When you abuse alcohol, you continue to
drink even though you know your drinking is causing problems.
you continue to abuse alcohol, it can lead to alcohol
dependence. Alcohol dependence is also called
alcoholism. You are physically or mentally
addicted to alcohol. You have a strong need, or
craving, to drink. You feel like you must drink just to get by.
You might be dependent on alcohol if you have three or more of the
following problems in a year:
Alcoholism is a long-term (chronic) disease. It's not a weakness
or a lack of willpower. Like many other diseases, it has a course that can be
predicted, has known symptoms, and is influenced by your genes and your life
Alcohol is part of
many people's lives and may have a place in cultural and family traditions. It
can sometimes be hard to know when you begin to drink too much.
You are at risk of drinking too much and should talk to your doctor if you
Certain behaviors may mean that you're having trouble with alcohol. These
problems may be diagnosed at a routine doctor visit or when you see your doctor
for another problem. If a partner or friend thinks you have an alcohol problem,
he or she may urge you to see your doctor.
Your doctor will ask
questions about your symptoms and past health, and he or she will do a physical
exam and sometimes a mental health assessment. The mental health assessment
checks to see whether you may have a mental health problem, such as
Your doctor also may ask
questions or do tests to look for health problems linked to alcohol, such as
Treatment depends on how
bad your alcohol problem is. Some people are able to cut back to a moderate
level of drinking with help from a counselor. People who are addicted to
alcohol may need medical treatment and may need to stay in a hospital or
Your doctor may decide you need
detoxification, or detox, before you start treatment.
You need detox when you are
physically addicted to alcohol. When you go through detox, you may need
medicine to help with withdrawal symptoms.
After detox, you focus
on staying alcohol-free, or sober. Most people receive some type of therapy,
such as group counseling. You also may need medicine to help you stay
When you are sober, you've taken the first step toward
recovery. To gain full recovery, you need to take
steps to improve other areas of your life, such as learning to deal with work
and family. This makes it easier to stay sober.
You will likely
need support to stay sober and in recovery. This can include counseling and
support groups like Alcoholics Anonymous. Recovery is a long-term process, not
something you can achieve in a few weeks.
Treatment doesn't focus
on alcohol use alone. It addresses other parts of your life, like your
relationships, work, medical problems, and living situation. Treatment and
recovery support you in making positive changes so you can live without
If you feel you have an alcohol problem, get help. Even if you
are successful in other areas of your life, visit a doctor or go to a self-help
group. The earlier you get help, the easier it will be to cut back or quit.
Helping someone with an alcohol problem is hard. If you're
covering for the person, you need to stop. For
example, don't make excuses for the person when he or she misses work.
You may be able to help by talking to the person about what his or her
drinking does to you and others. Talk to the person in private, when the person
is not using drugs or alcohol and when you are both calm. If the person agrees
to get help, call for an appointment right away. Don't wait.
Health Tools help you make wise health decisions or take action to improve your health.
Learning about alcohol abuse and dependence:
It's not clear why some people
abuse alcohol or become
addicted to it and others do not. Alcoholism often
runs in families (genetic), but your drinking habits also
are influenced by your environment and life situations, such as friends or
Other signs include:
Signs of alcohol
problems in children and teens can be different from the ones for adults. For
more information, see the topic
Teen Alcohol and Drug Abuse.
You might not realize that you have a
drinking problem. You might not drink large amounts
when you drink. Or you might go for days or weeks between drinking episodes. But even if you don't drink
very often, it's still possible to be
abusing alcohol and to be at risk for becoming
addicted to it.
dependence can develop very quickly or happen
gradually over years.
In the beginning, your drinking might not
seem to be any different from the way other people drink. You may drink only
with friends or at parties. It may stay like this, or you may begin to drink
more. Your drinking might become a way for you to feel normal or to cope with
You might think that you can quit drinking at any
time. Many people who have alcohol problems quit for days, weeks, or even
months before they start drinking again. But unless you can consistently keep
your drinking under control and not fall back into unhealthy patterns, you need
heavy drinking harms your liver,
nervous system, heart, and brain. It can cause health
problems or make them worse. These problems include:
Alcohol abuse also can contribute to stomach problems,
medicines and alcohol, and sexual problems. It can
lead to violence, accidents, social isolation, and problems at work, school, or
home. You also may have legal problems, such as traffic tickets or accidents,
as a result of drinking.
Drinking alcohol can cause unique
pregnant women, and people who have other health
conditions. If you are pregnant, you should not drink any alcohol, because it
may harm your baby.
Drinking also makes symptoms of mental health
problems worse. When you
have a drinking problem and a mental health problem, it's called a
dual diagnosis. It's very important to treat all mental health problems, such as depression. You
may drink less when mental health problems are treated.
Many people drink alcohol throughout their lives without any problems. Other people who drink alcohol have problems with it. Why do some people
abuse alcohol and become
dependent on it, while others don't?
Certain things make an alcohol problem more likely. These are called risk
Risk factors include:2
Just because you have risk factors for alcohol problems
doesn't mean you'll have a drinking problem. A person who has many risk factors
won't always develop alcoholism. And a person with no risk factors can become
dependent on alcohol.
or other emergency services if you or someone else:
Call a doctor right away if you or
someone you care about:
Call a doctor if you're concerned that you or someone you care about may have an alcohol problem. To learn what to look for, see Symptoms.
Watchful waiting is a
wait-and-see approach. Watchful waiting is not a good choice for alcohol abuse and dependence.
If you have concerns about
your drinking or the drinking of someone you care about, talk to your
doctor. Early treatment makes recovery more likely.
Health professionals who diagnose and treat alcohol problems include:
professionals who can help with recovery include:
Find a health professional who has chemical dependency
certification (CDC) or is a certified alcoholism counselor (CAC).
Support groups can also help you and your family:
Alcohol use problems
may be diagnosed during a routine doctor visit or when you see
your doctor for another problem. Many people don't go to a doctor for
alcohol problems but for problems that are caused by long-term alcohol
doctor will ask about your
medical history and do a
physical exam. He or she also may ask questions or do
tests to look for health problems linked to alcohol problems, such as
To learn which type of questions your doctor may ask, use this short quiz:
People who drink also may have mental health problems. These may
anxiety disorders, or
post-traumatic stress disorder (PTSD). If you have a
drinking problem and a mental health problem, it's called a
dual diagnosis. A dual diagnosis can make treatment for an alcohol problem
If your doctor thinks you have a mental health problem, he or she may do a
mental health assessment.
Treatment for alcohol
dependence usually includes group therapy, one or more
counseling, and alcohol education. You also may need
12-step program often is part of treatment and
continues after treatment ends.
Treatment doesn't just deal with
alcohol. It will help you manage problems in your daily life so you don't have
to depend on alcohol. You'll learn
good reasons to quit drinking.
Treatment helps you overcome
dependence, but it doesn't happen all at once.
Recovery from alcohol abuse or dependence—staying
sober—is a lifelong process that takes commitment and effort.
If you are abusing
alcohol and are not dependent on it, you may be able to
cut back or quit on your own. But most people need help when they quit
If you want to quit, talk to your doctor. When you get a doctor's help, treatment for
alcohol abuse or dependence is safer, less painful, and quicker. If you can't stop drinking alcohol with just your doctor's help, a
treatment program can help you get through the first cravings for alcohol and
learn how to stay sober.
You might start treatment with
your family doctor, or your doctor may recommend that you enter a treatment
facility. A friend may bring you to a self-help group, such as Alcoholics
Anonymous, or you might go to a clinic that deals with alcohol abuse. You may
just decide that you drink too much and want to cut back or quit on your own.
You may have a treatment team to help you. This team may include a
psychiatrist, counselors, doctors,
social workers, nurses, and a case manager. A case
manager helps plan and manage your treatment.
When you first seek
treatment, you may be asked questions about your drinking, health problems,
work, and living situation. Be open and honest to get the best treatment
possible. Your treatment team may write a treatment plan, which includes your
treatment goals and ways to reach those goals. This helps you stay on track.
Your doctor may decide you need
detoxification, or detox, before you start treatment.
You need detox when you are
physically addicted to alcohol. This means that when you stop
drinking, you have physical
withdrawal symptoms, such as feeling sick to your
stomach or intense anxiety.
Detox helps get you ready for
treatment. It doesn't help you with the mental, social, and behavior changes
you have to make to get and stay sober.
Whether you need detox
and whether you can go through it at home or need to go to a clinic or other
facility depends on how severe your withdrawal symptoms are. Most people don't
need to stay at a clinic but do need to check in with a doctor or other health
professional. Whether you need to spend time in a clinic (called inpatient
care) also depends on other problems you may have, such as a mental health
Your doctor may give you medicines to help reduce
Your doctor can help you decide which type of program is best
If you are thinking about going into a treatment program,
here are some
questions to ask.
programs usually include
counseling, such as:
A treatment program may include medicines that can help
keep you sober during recovery. You may take medicine that can help reduce your craving for alcohol or that makes you sick to your stomach when you drink.
Most programs provide education about alcohol abuse and
dependence. Understanding alcohol problems can help you and your family know
how to overcome them. Some programs also offer job or career training.
Treatment programs often include going to a support group, such as
Alcoholics Anonymous (AA). Your family members also
might want to attend a support group such as
Al-Anon or Alateen.
Medicines can be used to help treat
dependence. Some medicines reduce
withdrawal symptoms during
detoxification. Other medicines help you stay sober
during the long process of
Medicines most often used to
treat withdrawal symptoms during detoxification include:
Medicines used to help you stay sober during recovery include:
Alcohol abuse can cause your
body to become low in certain vitamins and minerals, especially thiamine
(vitamin B1). You might need to take thiamine supplements to improve your
nutrition during recovery. Thiamine helps prevent
Wernicke-Korsakoff syndrome, which causes brain
You also might need supplements
to help replace fluids and
dependence means finding a way to stay sober while
changing your attitudes and behaviors. You will work to restore relationships
with your family and friends and people at your job or school. You will need to
find meaning and happiness in a healthy lifestyle that doesn't include alcohol.
Recovery is not a cure. It is a lifelong process. It begins in
treatment, but it doesn't end when your treatment ends. There are
10 principles of recovery(What is a PDF document?) that can help you reach your goals and learn new things to
help yourself. They help you gain self-confidence and respect for yourself.
They make clear that you're in charge of your recovery. How far you go is up to
stay sober after treatment, focus on your goals. Find things to do, such as
sports or volunteer work. Learn how to say
no to alcohol and drugs.
An important part of recovery is being
sure you have support. You can:
Stopping alcohol use is very hard. It's not unusual to have
setbacks, even years later. Very few people succeed the first time they try.
Many people who are trying to recover from alcohol addiction will have lapses
or relapses along the way.
It's smart to
plan for a lapse or relapse before it happens. Your doctor, family, and friends can
help you do this.
Some people find that
relieving stress helps them during recovery. Although
there is little research to show that managing stress helps you stay sober, you
may find that it helps you feel better overall.
You can find ways to deal with stress, such as sharing your feelings with others or writing to express your journey through recovery. Do something you enjoy, like a hobby or volunteer work. Learn how to relax your mind and body with breathing exercises or meditation.
You can do many things to reduce stress. To learn more, see the topic
When you abuse or are dependent on alcohol, you often get away
from some of the basics of good health. Part of recovery is finding your way
back to a healthy lifestyle.
dependence can harm your relationships with family and
friends. You and your family may feel you have turned against each other. You
may be angry at your family and friends, and they may be angry at you.
If you can, talk with your family and friends about your drinking
recovery. Your family and friends need to know that
they did not cause your alcohol problem but that they can help you during recovery.
If someone close to you has had a drinking problem, you know how
hard it can be. You know how living or dealing with someone who abuses or is
dependent on alcohol can change and even destroy your life. You're an important part of your loved one's treatment and recovery. Your emotions and life may change too, and taking care of yourself is also important.
be very hard to live with a family member who has a drinking problem. It's best
not to try to control, excuse, or cover up the person's drinking. Instead,
encourage your family member to seek treatment. Find a good time to talk to the person.
the choice for treatment has been made, you play an important part. You can
help your loved one stop drinking and help repair the damage done to your
family or relationship. Here are some things you can do:
Taking care of yourself while you help your loved one is
important. You probably will feel relief and happiness when the person decides
to get help. But treatment and recovery mean changes in your life too. Your
emotions may become more complicated. You may:
These feelings are normal. You've been through a bad
period of your life, and what happened is not easy to forget. Nor is it easy to
forgive your loved one. Keep in mind that recovery is the road to a better life and
that you can help your loved one get there.
You may find that talking to people who also have loved ones with alcohol problems helps your own recovery. Al-Anon and similar programs are for people with
family members or friends with alcohol problems. Other support groups are
specially designed for certain age groups, such as Alateen for teens and Alatot for
These programs help you recover from the
effects of being around someone who abused or was dependent on alcohol. You
also may try
NCADD provides facts and scientific information about alcohol and
drugs and related health issues, with specific resources for parents and youth.
The organization also has a national intervention network and provides
information about treatment programs and prevention.
NIAAA provides pamphlets, brochures, and referral
information about alcohol use problems. Information can be obtained by writing
or calling or by printing it from the Web site.
Al-Anon is a support group and self-help program for family members
and friends of people with alcohol and drug use problems. The program is based
on the same principles as AA. Phone numbers for local offices are listed in
area telephone books.
Alcoholics Anonymous (AA) is a support group and self-help program
for recovery from alcohol use problems as well as other substance abuse
problems. Meetings are available in most communities at various times. Meetings
can be "open" (for the person and his or her family) or "closed" (for the
person only). Special groups for women, teens, and gay/lesbian people may be
available in some areas. AA provides written information on the program of
recovery. Phone numbers for local offices are listed in local area phone
This Web site provides information about excessive alcohol use, including underage and binge drinking. The Web site offers resources and educational materials on alcohol abuse.
SAMHSA provides information on substance abuse prevention and
treatment. Its website is the gateway to the Center for Substance Abuse
Prevention (www.samhsa.gov/prevention) and the Center for Substance Abuse
National Institute on Alcohol Abuse and Alcoholism
(2005). Helping Patients Who Drink Too Much: A Clinician's Guide (NIH Publication No. 07-3769). Washington, DC:
National Institutes of Health. Also available online:
Schuckit MA (2009). Alcohol-related disorders section
of Substance-related disorders. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 10th
ed., vol. 1, pp. 1268–1288. Philadelphia: Lippincott Williams and
Buchner DM (2012). Physical activity. In L Goldman, A Shafer, eds., Cecil Medicine, 24th ed., pp. 56–58. Philadelphia: Saunders.
Other Works Consulted
Department of Veterans Affairs, Department of Defense (2009). Clinical Practice Guideline: Management of Substance Use Disorders (SUD). Available online: http://www.healthquality.va.gov/Substance_Use_Disorder_SUD.asp.
Sadock BJ, Sadock VA (2007). Alcohol-related disorders
section of Substance-related disorders. In Kaplan and Sadock's Synopsis of Psychiatry, 10th ed., pp. 390–407. Philadelphia: Lippincott
Williams and Wilkins.
Sherin K, Seikel S (2011). Alcohol use disorders. In RE Rakel, DP Rakel, eds., Textbook of Family Medicine, 8th ed., pp. 1091–1104. Philadelphia: Saunders.
January 17, 2012
E. Gregory Thompson, MD - Internal Medicine
& Peter Monti, PhD - Alcohol and Addiction
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