Addiction FAQs

Q: What do we mean by alcoholism?
A: Alcoholism, also known as "alcohol dependence," is a disease that
includes alcohol craving and continued drinking despite repeated
alcohol-related problems, such as losing a job or getting into trouble with
the law. It includes four symptoms:

• Craving--A strong need, or compulsion, to drink.
• Impaired control--The inability to limit one's drinking on any given
  occasion.
• Physical dependence--Withdrawal symptoms, such as nausea, sweating,
  shakiness, and anxiety, when alcohol use is stopped after a period of heavy
  drinking.
• Tolerance--The need for increasing amounts of alcohol in order to feel its
  effects.

For clinical and research purposes, formal diagnostic criteria for
alcoholism also have been developed. Such criteria are included in the
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
published by the American Psychiatric Association, as well as in the
International Classification Diseases, published by the World Health
Organization.

Q: Is alcoholism a disease?
A: Yes. Alcoholism is a chronic, often progressive disease with symptoms
that include a strong need to drink despite negative consequences, such as
serious job or health problems. Like many other diseases, it has a generally
predictable course, has recognized symptoms, and is influenced by both
genetic and environmental factors that are being increasingly well defined.


Q: Is alcoholism inherited?
A: Alcoholism tends to run in families, and genetic factors partially
explain this pattern. Currently, researchers are on the way to finding the
genes that influence vulnerability to alcoholism. A person's environment,
such as the influence of friends, stress levels, and the ease of obtaining
alcohol, also may influence drinking and the development of alcoholism.
Still other factors, such as social support, may help to protect even
high-risk people from alcohol problems.

Risk, however, is not destiny. A child of an alcoholic parent will not
automatically develop alcoholism. A person with no family history of
alcoholism can become alcohol dependent.

Q: Can alcoholism be cured?
A: Not yet. Alcoholism is a treatable disease, and medication has also
become available to help prevent relapse, but a cure has not yet been found.
This means that even if an alcoholic has been sober for a long time and has
regained health, he or she may relapse and must continue to avoid all
alcoholic beverages.

Q: Are there any medications for alcoholism?
A: Yes. Two different types of medications are commonly used to treat
alcoholism. The first are tranquilizers called benzodiazepines (e.g.,
Valium®, Librium®), which are used only during the first few days of
treatment to help patients safely withdraw from alcohol.

A second type of medication is used to help people remain sober. A recently
approved medicine for this purpose is naltrexone (ReVia TM). When used
together with counseling, this medication lessens the craving for alcohol in
many people and helps prevent a return to heavy drinking. Another older
medication is disulfiram (Antabuse®), which discourages drinking by causing
nausea, vomiting, and other unpleasant physical reactions when alcohol is
used.

Q: Does alcoholism treatment work?
A: Alcoholism treatment is effective in many cases. Studies show that a
minority of alcoholics remain sober 1 year after treatment, while others
have periods of sobriety alternating with relapses. Still others are unable
to stop drinking for any length of time. Treatment outcomes for alcoholism
compare favorably with outcomes for many other chronic medical conditions.
The longer one abstains from alcohol, the more likely one is to remain
sober.
It is important to remember that many people relapse once or several times
before achieving long-term sobriety. Relapses are common and do not mean
that a person has failed or cannot eventually recover from alcoholism. If a
relapse occurs, it is important to try to stop drinking again and to get
whatever help is needed to abstain from alcohol. (See Question 12.) Ongoing
support from family members and others can be important in recovery.

Q: Does a person have to be alcoholic to experience problems from alcohol?
A: No. Even if you are not alcoholic, abusing alcohol can have negative
results, such failure to meet major work, school, or family responsibilities
because of drinking; alcohol-related legal trouble; automobile crashes due
to drinking; and a variety of alcohol-related medical problems. Under some
circumstances, problems can result from even moderate drinking--for example,
when driving, during pregnancy, or when taking certain medicines.

Q: Are certain groups of people more likely to develop alcohol problems
than others?
A: Yes. Nearly 14 million people in the United States--1 in every 13
adults--abuse alcohol or are alcoholic. However, more men than women are
alcohol dependent or experience alcohol-related problems. In addition, rates
of alcohol problems are highest among young adults ages 18-29 and lowest
among adults 65 years and older. Among major U.S. ethnic groups, rates of
alcoholism and alcohol-related problems vary.

Q: How can you tell whether you or someone close to you has an alcohol
problem?
A: A good first step is to answer the brief questionnaire below, developed
by Dr. John Ewing. (To help remember these questions, note that the first
letter of a key word in each question 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" answer suggests a possible alcohol problem. More than one "yes"
answer means it is highly likely that a problem exists. If you think that
you or someone you know might have an alcohol problem, it is important to
see a doctor or other health provider right away. He or she can determine
whether a drinking problem exists and, if so, suggest the best course of
action.

Q: If I have trouble with drinking, can't I simply reduce my alcohol use
without stopping altogether?
A: That depends. If you are diagnosed as an alcoholic, the answer is "no."
Studies show that nearly all alcoholics who try to merely cut down on
drinking are unable to do so indefinitely. Instead, cutting out alcohol
(that is, abstaining) is nearly always necessary for successful recovery.
However, if you are not alcoholic but have had alcohol-related problems, you
may be able to limit the amount you drink. (See Question 13 for recommended
limits.) If you cannot always stay within your limit, you will need to stop
drinking altogether.

Q: How can a person get help for an alcohol problem?
A: You can call the Center for Substance Abuse Treatment at 1-800-662-HELP
for information about treatment programs in your local community and to
speak to someone about an alcohol problem.

Many people also benefit from support groups. For information on local
support meetings run by Alcoholics Anonymous (AA), call your local AA
chapter (check your local phone directory under "Alcoholism") or call
212-870-3400. For meetings of Al-Anon (for spouses and other significant
adults in an alcoholic person's life) and Alateen (for children of
alcoholics), call your local Al-Anon chapter or call the following toll-free
numbers: 1-800-344-2666 (United States) or 1-800-443-4525 (Canada).

Q: If an alcoholic is unwilling to seek help, is there any way to get him or
her into treatment?
A: This can be a challenging situation. An alcoholic cannot be forced to
get help except under certain circumstances, such as when a violent incident
results in police being called or following a medical emergency. This
doesn't mean, however, that you have to wait for a crisis to make an impact.
Based on clinical experience, many alcoholism treatment specialists
recommend the following steps to help an alcoholic accept treatment:

Stop all "rescue missions." Family members often try to protect an alcoholic
from the results of his or her behavior by making excuses to others about
his or her drinking and by getting him or her out of alcohol-related jams.
It is important to stop all such rescue attempts immediately, so that the
alcoholic will fully experience the harmful effects of his or her
drinking--and thereby become more motivated to stop.

Time your intervention. Plan to talk with the drinker shortly after an
alcohol-related problem has occurred--for example, a serious family argument
in which drinking played a part or an alcohol-related accident. Also choose
a time when he or she is sober, when both of you are in a calm frame of
mind, and when you can speak privately.

Be specific. Tell the family member that you are concerned about his or her
drinking and want to be supportive in getting help. Back up your concern
with examples of the ways in which his or her drinking has caused problems
for both of you, including the most recent incident.

State the consequences. Tell the family member that until he or she gets
help, you will carry out consequences--not to punish the drinker, but to
protect yourself from the harmful effects of the drinking. These may range
from refusing to go with the person to any alcohol-related social activities
to moving out of the house. Do not make any threats you are not prepared to
carry out.

Be ready to help. Gather information in advance about local treatment
options. If the person is willing to seek help, call immediately for an
appointment with a treatment program counselor. Offer to go with the family
member on the first visit to a treatment program and/or AA meeting.

Call on a friend. If the family member still refuses to get help, ask a
friend to talk with him or her, using the steps described above. A friend
who is a recovering alcoholic may be particularly persuasive, but any
caring, nonjudgmental friend may be able to make a difference. The
intervention of more than one person, more than one time, is often necessary
to persuade an alcoholic person to seek help.

Find strength in numbers. With the help of a professional therapist, some
families join with other relatives and friends to confront an alcoholic as a
group. While this approach may be effective, it should only be attempted
under the guidance of a therapist who is experienced in this kind of group
intervention.

Get support. Whether or not the alcoholic family member seeks help, you may
benefit from the encouragement and support of other people in your
situation. Support groups offered in most communities include Al-Anon, which
holds regular meetings for spouses and other significant adults in an
alcoholic's life, and Alateen, for children of alcoholics. These groups help
family members understand that they are not responsible for an alcoholic's
drinking and that they need to take steps to take care of themselves,
regardless of whether the alcoholic family member chooses to get help.

For meeting locations, call your local Al-Anon chapter (check your local
phone book under "Alcoholism") or call the following toll-free numbers:
1-800-344-2666 (United States) or 1-800-443-4525 (Canada).

Q: What is a safe level of drinking?
A: Most adults can drink moderate amounts of alcohol--up to two drinks per
day for men and one drink per day for women and older people--and avoid
alcohol-related problems. (One drink equals one 12-ounce bottle of beer or
wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled
spirits.)

However, certain people should not drink at all. They include women who are
pregnant or trying to become pregnant; people who plan to drive or engage in
other activities requiring alertness and skill; people taking certain
medications, including certain over-the-counter medicines; people with
medical conditions that can be worsened by drinking; recovering alcoholics;
and people under the age of 21.

Q: Is it safe to drink during pregnancy?
A: No. Drinking during pregnancy can have a number of harmful effects on
the newborn, ranging from mental retardation, organ abnormalities, and
hyperactivity to learning and behavioral problems. Moreover, many of these
disorders last into adulthood. While we don't yet know exactly how much
alcohol is required to cause these problems, we do know that they are
100-percent preventable if a woman does not drink at all during pregnancy.
Therefore, for women who are pregnant or are trying to become pregnant, the
safest course is to abstain from alcohol.

Q: As people get older, does alcohol affect their bodies differently?
A: Yes. As a person ages, certain mental and physical functions tend to
decline, including vision, hearing, and reaction time. Moreover, other
physical changes associated with aging can make older people feel "high"
after drinking fairly small amounts of alcohol. These combined factors make
older people more likely to have alcohol-related falls, automobile crashes,
and other kinds of accidents.

In addition, older people tend to take more medicines than younger persons,
and mixing alcohol with many over-the-counter and prescription drugs can be
dangerous, even fatal. (See Question 18.) Further, many medical conditions
common to older people, including high blood pressure and ulcers, can be
worsened by drinking. Even if there is no medical reason to avoid alcohol,
older men and women should limit their intake to one drink per day.

Q: Does alcohol affect a woman's body differently from a man's body?
A: Yes. Women become more intoxicated than men after drinking the same
amount of alcohol, even when differences in body weight are taken into
account. This is because women's bodies have proportionately less water than
men's bodies. Because alcohol mixes with body water, a given amount of
alcohol becomes more highly concentrated in a woman's body than in a man's.
That is why the recommended drinking limit for women is lower than for men.
(See Question 13 for recommended limits.)

In addition, chronic alcohol abuse takes a heavier physical toll on women
than on men. Alcohol dependence and related medical problems, such as brain
and liver damage, progress more rapidly in women than in men.

Q: I have heard that alcohol is good for your heart. Is this true?
A: Several studies have reported that moderate drinkers--those who have one
or two drinks per day--are less likely to develop heart disease than people
who do not drink any alcohol or who drink larger amounts. Small amounts of
alcohol may help protect against coronary heart disease by raising levels of
"good" HDL cholesterol and by reducing the risk of blood clots in the
coronary arteries.

If you are a nondrinker, you should not start drinking only to benefit your
heart. Protection against coronary heart disease may be obtained through
regular physical activity and a low-fat diet. And if you are pregnant,
planning to become pregnant, have been diagnosed as alcoholic, or have any
medical condition that could make alcohol use harmful, you should not drink.

Even for those who can drink safely and choose to do so, moderation is the
key. Heavy drinking can actually increase the risk of heart failure, stroke,
and high blood pressure, as well as cause many other medical problems, such
as liver cirrhosis.

Q: If I am taking over-the-counter or prescription medication, do I have to
stop drinking?
A: Possibly. More than 100 medications interact with alcohol, leading to
increased risk of illness, injury and, in some cases, death. The effects of
alcohol are increased by medicines that slow down the central nervous
system, such as sleeping pills, antihistamines, antidepressants, antianxiety
drugs, and some painkillers. In addition, medicines for certain disorders,
including diabetes and heart disease, can be dangerous if used with alcohol.
If you are taking any over-the-counter or prescription medications, ask your
doctor or pharmacist whether you can safely drink alcohol.