Alcoholism can be defined as an ongoing, inappropriate use of alcohol which causes increasingly more serious problems in a person's physical or mental health, work, family, or social life. There is some debate over the term "disease". Alternately, alcoholism can be viewed as a health problem which negatively affects a person's work, social, and family life, and may involve some body organs.
Approximately one out of every 14 or 15 drinkers becomes an alcoholic. That is, he or she loses control of the drinking. There are many definitions of alcoholism. One of the most widely accepted notions of alcoholism is based on the disease model which considers alcoholism as:
. . . a cumulative process in which the individual drinker gradually increases his consumption over the years, from occasional to habitual intoxication, and ultimately to a state of complete physiological and psychological dependence on alcohol. This progression of steps or states to total dependency, or "addiction", is accompanied by a progression of stages of social deterioration, marked by family and marital disruption, anti-social acts, work and money trouble, drinking with social inferiors, etc. (Archer 10).
Initially, labeling alcoholism as a disease helped remove the social disgrace and disapproval of having a problem with alcohol in our society. This change of attitude subsequently resulted in more persons receiving treatment. Since then, the term disease has been interpreted in several different ways. One older interpretation considers alcoholism to be an allergy with which the alcoholic is stricken and cannot control. A more modern interpretation of the disease concept is to imply that the individual who has alcoholism or any other disease must take the responsibility for arresting it, or participating and cooperating in the rehabilitation program.
Another theory states that the disease of alcoholism occurs when one needs more and more alcohol to achieve the same effect, combined with an inability to discontinue drinking despite social, emotional and physical health problems brought on by the heavy drinking. This is currently the most widely accepted view.
An alternative approach considers alcoholism to be a symptom of an excessive behavior pattern rather than a disease in its own right. This concept stresses treatment of the need to use any substance to excess (e.g., coffee, cigarettes, alcohol) instead of treating the alcohol aspect in isolation.
Whether alcoholism is a health problem, a symptom or an actual disease is a complex question. In any event, there is little question that alcoholism is a health problem requiring treatment. Dr. E. M. Jellinek, recognized as a foremost authority in the field, defined alcoholism as "any use of alcoholic beverages that causes any damage to the individual, society or both." Jellinek considered alcoholism an illness in which the various body organs and systems are progressively involved. He developed a typology of the sequential states of the illness. He defined five distinctive types of alcoholics: alpha (uses alcohol to feel good, build self-confidence); beta (not addicted but gets sick, experiences health problems as a result); gamma (psychologically and physically dependent on alcohol); delta (steady concentration of alcohol in the blood); and epsilon (binge drinker).
The next question is, what is the difference between problem drinking and alcoholism? Basically, there is no difference. If the use of alcohol is harming any aspect of a person's health, work, family, or social life, then that person is experiencing a problem with alcohol. Whether the person is referred to as a problem drinker or an alcoholic is a question of word choice.
One opinion holds that the problem drinker is simply experiencing a less advanced problem with alcohol. Or, the term "problem drinking" is used instead of alcoholism because it is thought to be less offensive. Another opinion uses the determining factor of being able to "drink to intent" as a measure of whether or not someone is alcoholic or a problem drinker. In this case, a problem drinker may have experienced some problems associated with alcohol but can still choose on any occasion how much he/she will drink (and may often choose to drink excessively). However, an alcoholic, using this definition, is someone who is consistently unable to choose how much he or she will drink on any occasion. For the most part, the terms are used interchangeably when referring to a person who is having a problem with alcohol.
Alcohol is a central nervous system depressant. In large enough doses, it can serve as an anesthetic and render someone unconscious; in even greater doses, over a short period of time, it can kill.
Its psychological effects may vary according to the dose, situation, mood and personality of the user. A drink or two may result in drowsiness and lethargy, laughter and gaiety, or belligerence and fighting. Generally, after one or two drinks the user will experience feelings of cheerfulness and well-being.
The immediate physical effects after one or two drinks may include changes in heart rate, a flushing of the skin giving a sensation of warmth, a lowered body temperature, a reduction in muscular coordination, a stimulated appetite, bloodshot eyes, and an increase in saliva flow, gastric juices and urination. A high dose of alcohol results in disorientation, confusion, slurred speech, blurred vision, inadequate muscle control, and, frequently, nausea and vomiting. The presence of other drugs (prescription or nonprescription) in the body can drastically change the effects of alcohol, and vice versa, by either canceling out the effect of one or by intensifying the effect of one or both.
There are essentially three major categories of theories which attempt to explain the etiology of alcoholism: psychological, sociological and physiological. There is no consensus as to which provides the correct explanation for the causes of alcoholism; it is highly likely that a number of factors from several theories are involved. The category of psychological aspects associates alcoholism with certain personality factors. The alcoholic personality has been described by psychiatrists and psychologists as one who has weak ego strength, is emotionally immature, and has basic feelings of inadequacy and inferiority. Such an individual is likely to develop a dependence to alcohol. However, no causal relationship between these character traits and alcoholism has been established. At this point, the relationship between certain personality traits and the use of alcohol is merely correlated and does not exist in all cases. That is, there are many emotionally immature, dependent individuals with poor self-images who do not become alcoholics.
Another psychological theory attempts to explain that alcoholism is the decision theory which refers to the hypothesis that every individual makes a decision in early childhood and adolescence about how he or she is going to lead the rest of his or her life. He or she has decided upon a "script" which he or she lives out. In other words, if an individual sees himself or herself as a failure or as an emotionally ill person, it is likely that he or she will live his or her life in such a fashion as to realize this self-perception.
The third psychological theory which attempts to provide an explanation of problem drinking is the learning theory in which heavy drinking is seen as a learned response. If a person drinks to reduce anxiety or relieve tension, the emotional reward for reduction of such tension provides the individual with positive reinforcement. He or she is likely to continue using alcohol in this fashion since he or she continues to receive positive reinforcement--feeling good, less anxious, and more relaxed. The death of a loved one, serious financial difficulties or physical illness can arouse feelings of grief, fear, or inadequacy. An individual may turn to alcohol for relief or escape. When this happens repeatedly, the person can become a potential alcoholic.
The major sociological theory in this field is the cultural theory which contends that use of alcohol is related largely to cultural factors and the ways in which various cultural groups regard and use alcohol.
There are a variety of physiological theories including the endocrine theory, the metabolic theory and the nutrition theory, which attribute the causes of alcoholism to some deficiency or disturbance in the chemical make-up of the individual. There is little data to strongly support any of these theories.
However, on a more recent note, and highly controversial, "The disease [of alcoholism] is truly physical," says Joan Mathews Larson, the founder of the Health Recovery Center, in Minneapolis. "We've got so much research now - twin studies, adoption studies, genetic information - and there's a kind of chemistry that stands out like a sore thumb in these people that's different from non-alcoholics." Larson further believes that specific biotypes are set up to be victims of alcoholism. Dr. Roger Meyer, a member of the American Psychiatric Association's Council on Addiction Psychiatry which still lists alcoholism as a mental illness, disagrees. "I have never . . . seen anything that links it to alcoholism." Psychologist James Milam, director of Milam Recovery Center in Seattle, concurs with Mathews. He further says that "the physiological nature of alcoholism has been ignored by doctors and academics because many still 'psychologize the disease' and are more interested in moral censure and health-care money facts". (Judge)
Finally, the genetic theory contends that the predisposition to excessive use of alcohol is inherited. It is highly unlikely, however, that cultural and psychological factors play an important role in explaining the fact that there is a high rate of alcohol dependence amongst relatives of alcoholic individuals. (Abernathy)
Physical addiction can result from consuming large amounts of alcohol over an extended period of time. Body tissues build up a tolerance to alcohol and increasingly larger amounts of alcohol are needed to achieve the desired effect. Eventually, physical dependence will occur as the body's tolerance to alcohol increases.
A physically dependent person who stops drinking will usually experience withdrawal symptoms. These symptoms can include any one or a combination of the following: anxiety, sleeplessness, severe agitation, irritability, confusion, tremors, sweating, cramps, vomiting, hallucination, or seizures.
Women become problem drinkers later in life than do men and more often in response to a family-related crisis, such as a divorce or children leaving home. Women are found to more often drink at home, alone, than men, especially those whose occupation is homemaker. Therefore, their alcoholism is more "hidden"; that is, it is not detectable as easily by employment or legal problems and is covered up by family, friends, medical persons, and law enforcement personnel. It is less socially acceptable for a woman to be a heavy drinker; that is, it is not the "lady-like" or nurturing behavior that is often expected of women. Therefore, the social stigma attached to the label of alcoholic may be more traumatic for women than for men, affecting a woman's self-esteem and identity more so than for a man. Mood-altering drugs are more often prescribed for women than for men; therefore, dual addictions must be for women in treatment. More women dependent on alcohol may also have had a concurrent and independent depressive illness, as well as suicidal thoughts and delusions.
Problem drinking has a profound effect upon the family members who must live with this behavior. Those who work with alcoholic people recognize the familiar terms for the psychological and behavioral aspects of alcoholism: denial, confusion, shame, guilt, anxiety, obsession, low self-esteem, blame, social isolation, anger, loss of control, violence, inconsistency, progression, attempts to manipulate, attempts to control the drinking. Less easily recognized is the fact that these words also describe the alcoholic person's family members--spouse, parents, and children as well as others whose interaction with the alcoholic person constitutes close relationship. (Goodman)
Due to a lack of understanding of the nature of the problem, families tend to deny the existence of a problem and feel intense shame. Many attempts probably have been made to control the drinking, such as not trying to upset the drinker, refusing social engagements, and hiding bottles. They may even attempt other various ineffective methods of dealing with the drinking problem by pleading, covering up the behavior, or using violence. These solutions have not yet been found helpful in getting an excessive, problem drinker to stop drinking. Consequently, the alcoholic individual and his family members may experience social isolation because friends are no longer willing or able to tolerate the individual's behavior.
The shame and confusion experienced by families is made more severe by the guilt they feel--that they are in some way responsible for the drinking. They are also plagued by constant anxiety due to loss of respect in the community; possible loss of financial security, health and well-being; and fear of violence.
Finally, they experience anger when all their attempts to "protect" the individual fail and all promises to change the behavior are broken. Communication amongst family members continues to deteriorate and the marital relationship usually suffers to the point that separation and divorce are seen as the only answers. However, such "solutions" often breed other problems such as insecure financial position, finding a new place to live, fear of repercussions or violence. (Alcoholics . . .)
The family members need help in order to recover as much as the alcoholic does, for two reasons: (1) to manage more rationally with the present situation, and (2) if the problem drinker stops drinking, they will be affected by that change and may have to do some changing themselves.
Alcohol abuse and alcoholism can adversely affect productivity in a variety of ways and in many contexts. A worker's alcohol abuse can lead to absenteeism and tardiness, and when the worker is missing or late, he or she obviously is not contributing to production. The worker with alcohol problems also is often less productive on the job. In addiction, the alcohol abuser may well have an adverse impact on his or her follow workers or complementary factors of production. Alcohol abuse often leads to unemployment, and sometimes premature death. (Berry)
While there is no cure for alcoholism, the illness is treatable. However, the individual must totally abstain from alcohol during and after the completion of the active treatment process, otherwise he or she risks losing control and succumbing again to the addiction. The duration of the active treatment process varies widely and is determined by the individual or team professionally treating the person who has an alcohol dependence problem. As in other illnesses, the sooner the alcoholism is recognized and treated, the less likely are the chances that the individual will experience severe physical and mental deterioration.
Emergency treatment during acute alcohol intoxication and many withdrawal symptoms requires immediate medical attention. There are also both short-term and long-term types of in-patient treatment. Some persons require a short stay in the hospital to "dry" the alcohol out of their bodies and to begin to repair the damage which their bodies have suffered. Long-term in-patient treatment programs are generally of one month duration, although the length of such programs can vary widely. In general, in-patient programs are recommended for the chronic alcoholic who would benefit from temporary removal from normal living circumstances into an alcohol-free environment. The purpose of such treatment programs is to help the individual withdraw on a long-term basis from dependence on alcohol by physically and psychologically breaking the dependency and orienting the individual toward new problem-solving behaviors and an alternative lifestyle. These therapies are used in different combinations depending upon the needs of the individual. The treatment, however, does not end once an individual has been discharged from an in-patient facility. The alcoholic needs constant support from family, friends, and others who have been down the same long, difficult road. A referral for follow-up treatment is usually made to an out-patient facility, a day program, or to Alcoholics Anonymous.
An alcoholic can also be referred for out-patient treatment from an in-patient facility for ongoing support or can be referred directly to any out-patient facility for primary treatment. Intensive treatments such as medications or therapies similar to in-patient therapies are also essential components of out-patient treatment. The major difference is that the individual does not live in the institution for the duration of the program. In addition, in-patient treatment tends to be more stringent than an out-patient program. Finally, support and assistance from family members can be incorporated into the active treatment process.
Alcoholics Anonymous is a fellowship of recovering alcoholics who provide assistance to others attempting to break their alcohol dependence and strive toward sobriety. The program is based on twelve "steps and traditions", and this spiritual element plays an important role in the therapeutic process. Alcoholics Anonymous has proved to be an extremely effective self-help group in assisting recovering alcoholics to maintain sobriety and in providing them with ongoing support. ("Handbook for . . .")
"People in AA have a great blessing--the blessing of alcoholism. It is a blessing because it is a disease that visibly breaks people . . . . It puts people into visible crisis, and as a result they get into community - an AA group." (Peck)
While the individual is not to be blamed for being an alcoholic, he or she will not be able to do anything to arrest the progress of the illness unless the appropriate help is obtained. Support plays an important role in linking abstention from alcohol with positive consequences and experiences. The condition is treatable and, the earlier the treatment is provided, the more likely are the chances of recovery.
Bibliography
Abernathy, Mari W. "Alcohol-Related Problems: A Perspective", The Community Health Nurse and Alcohol-Related Problems: A Book of Readings. Rockville, Maryland: National Institute on Alcohol Abuse and Alcoholism. Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, New York: Alcoholics Anonymous, Rev. ed. 1991. Judge, Mark Gauvreau, "Alcoholism's Deadly Sweet Tooth", Common Boundary, Mt. Morris, Il: Common Boundary, Nov./Dec. 1993. Archer, Janet,"Occupational Alcoholism: A Review of its Issues and a Guide to the Literature" in Alcoholism and Its Treatment in Industry, edited by Carl J. Schramm, Baltimore: The John Hopkins University Press. Berry, Ralph E. Jr., and James P. Boland, "The Work-Related Costs of Alcohol Abuse," in Alcoholism and Its Treatment in Industry, edited by Carl J. Schramm, Baltimore: The John Hopkins University Press. Goodman, Louise M., "Support for the Family of the Person with Alcohol Related Problems", The Community Health Nurse and Alcohol-Related Problems: A Book of Readings, Rockville, Maryland. "Handbook for the Alcoholism Counselor", 2nd ed., U.S. Department of Health, Education and Welfare, Baltimore. Jellinek, E. M.,The Disease Concept of Alcoholism, New Haven: Hillhouse Press. Peck, M. Scott, "Spiritual Thirst", New Age Journal, Dec. 1993.
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