What Is Alcoholism? Who Is An Alcoholic?
Alcoholism, as lay people generally know it, is the fondness, desire, or even need for alcohol in an extreme sense to the point of addiction. Alcohol is the most widely used legal drug worldwide that also predisposes people to dependence or abuse (addiction) in certain parts of the world. Different cultures have varied features of the extent of alcoholism in their societies, especially with different levels of accessibility, rules, and norms of drinking. For instance, some countries have higher levels of alcoholism (e.g., about 10% of the U.S. population), accompanied by higher levels of people’s tolerance for alcohol, and then may consider alcoholism as normal and not deviant. Some others, such as many countries in the Middle East and Asia, have laws and religious prescriptions that encourage the prohibition of the import and sale of alcohol, where society’s alcoholism levels, and at times distress levels, are extremely low. On the other hand, there are also some other countries, like France and Italy, where drinking alcohol is acceptable and not regulated, and still addiction to alcohol is low. Moreover, different cultures relate to alcoholism differently. Some cultures deny the existence of alcohol addiction and consider talking about any degree of alcoholism or its consequences as taboo. Other countries minimize alcoholism as an issue or concern that warrants any kind of societal or community attention. Still other societies recognize alcoholism as a mental health issue and spend a substantial portion of their resources in abating the problem. In the United States, the direct and indirect costs of alcoholism (i.e., money spent for the prevention, detoxification, and rehabilitation of alcoholism and amount spent because of absenteeism, loss of productivity, and medical claims) amount to an exorbitant $148 billion each year.
Psychologists, especially those who work with alcoholics (i.e., therapists and counselors), use the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR) as a standard reference in defining mental health disorders such as alcoholism. According to the DSM-IV-TR, alcoholism is defined by increased tolerance, increased withdrawal symptoms, persistent and compulsive alcohol intake, and distressing consequences in social, occupational, and familial functioning. Increased tolerance is manifested by ever-increasing consumption of alcohol with lessened psychophysiological effects (not getting drunk easily, inhibitions lessened only slowly, personality change not as dramatic) on the drinker. In short, increased tolerance means a greater capacity for alcohol each time to obtain the desired effects. When the alcoholic experiences a period of time without alcohol, he or she exhibits withdrawal symptoms, including shaking, perspiration, and yearning for alcohol. These symptoms are aversive and make it extremely challenging to go without alcohol. With alcohol abuse or dependence, there are inevitable consequences on the person’s functioning that may include being unable to go to work regularly; being unable to concentrate in academic work; having conflicted, chaotic, or distant relationships; or being unable to fulfill one’s responsibilities of being a father or mother. DSM-IV-TR classifies alcoholism on two levels, substance abuse and substance dependence, with regard to its severity and frequency. Substance abuse is the pattern of alcohol use that leads to distress for a period of 12 months, whereas substance dependence is the maladaptive pattern of substance use that leads to greater and more extreme impairment for a period of 12 months. Substance dependence is the persistent addiction to alcohol despite greater and more difficult consequences to alcohol intake. Alcohol is the most common drug of abuse and dependence and has a high likelihood of being mixed with other drugs in polysubstance use.
What Are The Treatments Of Alcoholism As A Mental Health Disorder?
As a mental health concern, there have been many attempts, some more effective and efficacious than others, to treat alcohol abuse or dependence. Among them are medical treatment, psychotherapy, lifestyle change, and community interventions. Individual psychotherapy, usually consisting of cognitive-behavioral orientation and techniques, is one of the treatments used when there is availability of psychotherapy and financial resources. The cognitive orientation in therapy taps into modifying the alcoholic’s irrational or self-defeating beliefs that fuel the addiction. Psychotherapy using the behavioral orientation aims at providing reward or reinforcement for acceptable behavior and establishing healthy alternative associations that retard the drinking behavior. Group therapy is another form of treatment, whereby a group of six to eight people struggling with alcohol abuse or dependence meets regularly with one or two therapists. Group therapy has proved effective because of the valuable resource each group member is to the other. Moreover, the group lends itself to the value of universality; enables identifying with each other; allows for sharing and encouraging change, information, ideas, and ways of coping; and extends hope and courage among each other. Over the years, community treatments have proved not only cost-efficient but also effective, even to the substance-dependent person. It is for this reason that halfway houses, outpatient groups, and Alcoholics Anonymous have been successful. Alcoholics Anonymous, because its vision is rooted in the quest for spiritual meaning and its essence relies heavily on modeling and companionship, has proved very popular and effective for substance abusers and substance-dependent people. In these forms of treatment, a necessary feature is relapse prevention. Because alcohol abuse and dependence are very challenging to treat, preventing relapse, preparing for relapse, having alternative behaviors, coaching on how to deal with relapse, and planning for this have been essential in treatment. In any form of treatment, a great deal of weight and credibility is accorded to the therapist working with substance use disorders; the therapist is especially effective and trusted when he or she has recovered from alcoholism.
What Are The Costs And Consequences Of Alcoholism?
A great number of consequences to alcoholism have been identified. It is especially obvious to someone living with an alcoholic or loving someone with substance dependence that the costs are huge, the expenses endless, and the consequences in relationships exorbitant. Alcohol abuse and dependence affect one’s ability to be productive at work—attendance at work usually drops with increasing occasions of hangover. The alcoholic’s concentration, initiative, and motivation for work are usually jeopardized with addiction to alcohol. There is disruption or loss of a sense of vocation and urgency for a career, and there is indifference about not having a regular source of income. In terms of relationships, alcoholism not only creates distance from strangers (e.g., because of behavior when intoxicated) but also creates estrangement, fear, and threat to relationships that are supposedly important and endearing to the alcoholic. It is unfortunate that the most vulnerable to the relationships fostered with alcoholics are their children, spouses, parents, siblings, friends, and co-workers. These relationships may be characterized by distance, indifference, conflict, anger, chaos, and unpredictability. Because of the alcoholism and changes in the alcoholic’s personality and functioning, these relationships are likened to being on an emotional rollercoaster. Psychophysiological changes in alcoholism differ among alcoholics—some people become more extroverted, others more introverted, and still others more expressive of anger or affection; some become impulsive or bolder and exhibit risky behavior. Whatever the changes, however, they all affect the alcoholic’s relationships and perceptions of other people, as well as other people’s attitude towards the alcoholic. Because inhibitions are depressed by alcoholism, these relationship changes may reinforce the psychophysiological changes. Finally, the most obvious and easily apparent consequence is economic or financial. Although alcohol as a substance may be relatively inexpensive, its abuse or dependence has economic impact in the context of an already impoverished household or when the vocational, social, medical, and intrapersonal consequences have financial repercussions. For instance, an alcoholic father who is laid off from work because of irregular attendance and the lack of productivity is then unable to provide for food, shelter, and health care for his family. Or, for instance, a mother’s substance dependence can no longer be tolerated by her husband, who divorces or abandons her without many resources or even takes the children away from her. Continuous and persistent intake of alcohol also presents risks for diseases such as cirrhosis, high blood pressure, stroke, hepatitis, and cancer, which can almost always be very costly, financially and psychoemotionally.
How Does Alcoholism Develop?
It is acknowledged that enumerating the causes of alcoholism may put this discussion at the risk for degrading or blaming the victim. It is thereby the hope that this list of causes conveys the respect for the struggle and predicament of people with alcoholism. Developmentally, drinking alcohol is often first experienced in adolescence. Certain familial, genetic, behavioral, and cultural norms (availability, encouragement of family, prices, accessibility, media and advertisement) and the individual’s predisposition all interact to determine whether the adolescent continues to drink in early adulthood and whether the individual pursues abusive drinking into adulthood.
The genetic cause of alcoholism has been confirmed by research; people with parents who are abusers or dependents usually have higher tolerance for alcohol and a higher predisposing risk for addiction. Behaviorally, alcoholism may have been established as a person’s way of coping with problems, hardship, or emotional emptiness and depression. Drinking alcohol can also be due to a strong pressure from one’s peers and one’s community. Relying on alcohol for relaxation and relief from life’s challenges can also be learned and may then be passed on to the next generation. Moreover, the psychophysiological effects of drinking may be reinforcing; that is, because the personality and bodily changes to the drinker are perceived as favorable, these effects may be rewarding, and the drinking is reinforced as well, which eventually may lead to abuse and then dependence. Relationally and usually more common in collectivistic cultures, behavioral and emotional patterns are learned in response to the alcoholic. In families with an alcoholic, these patterns may eventually allow the alcoholic to continue with the dependence. For instance, qualitative studies focusing on the spouses and children of alcoholics report that the way of coping with the alcoholic member, which is to survive and cope emotionally and financially by themselves, eventually “allows” the alcoholic to continue with the dependence. A vicious cycle then develops in which the worse the alcoholism becomes, the more the family tries to cope without the help and presence of the alcoholic, and then the more the alcoholic continues with the dependence, with seemingly no detrimental consequences.
Alcoholism is defined by people as their experiences and lives witness the addiction in their own or in their loved ones’ lives. Psychologists generally use the DSM-IV-TR as the standard definition for substance abuse and substance dependence. This definition is used to more effectively treat alcoholism as a mental health disorder. Because alcoholism has been a long-standing concern in most cultures, many forms of treatments have been used. The consequences of alcoholism are costly, not just to the individual (career, intrapersonal, social, personality, economic), but also to the individual’s loved ones (relationships, commitments, and responsibilities). As with any addiction, societies have been spending a lot of financial, personnel, and psychological resources in the treatment of alcoholism, especially acknowledging the many causes of alcoholism. It is the soul of changing an addiction in that the desire and intentionality of the alcoholic person are most imperative. In essence, ceasing alcoholism is highly probable only when the alcoholic has set his or her heart on changing.
- American Council on Alcoholism (ACA), http://www.aca-usa.org/
- Black, C. (2001). It will never happen to me: Growing up with addiction as youngsters, adolescents, adults. Minneapolis, MN:
- Elliott, (2003). Containing the uncontainable: Alcohol misuse and the Personal Choice Community Programme. London: Whurr.
- Galanter, M. (Ed.). (2002). Alcohol and violence: Epidemiology, neurobiology, psychology, family issues. New York: Kluwer
- Heather, , & Stockwell, T. (Eds.). (2004). The essential handbook of treatment and prevention of alcohol problems. Chichester, West Sussex, UK, & Hoboken, NJ: Wiley.
- Mail, P. D. (Ed.). (2002). Alcohol use among American Indians and Alaska Natives: Multiple perspectives on a complex problem. Bethesda, MD: S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism.
- National Institute on Alcohol Abuse and (2001). Alcoholism: Getting the facts. Retrieved from http://www.niaaa.nih.gov/publications/booklet.htm
- National Institute on Drug Ab (1995). Infofacts. Costs to society. Retrieved from http://www.nida.nih.gov/Infofax/ costs.html
- Tuason, T. (1992). Five urban poor families with alcoholic fathers: A clinically descriptive and exploratory study. Unpublished master’s thesis, Ateneo de Manila University, Quezon City, Philippines.
- University of Pittsburgh Medical Center. (2005). Alcoholism. Retrieved from http://alcoholism.upmc.com
- Wilmes, D. (1998). Parenting for prevention: How to raise a child to say no to alcohol/drug. For parents, teachers, and other concerned Minneapolis, MN: Hazelden.