Chapte

r9
Chronic Alcohol
Abuse and Alcoholism

Alcohol Abuse
and
According Alcohol
to health professionals,
alcohol
abuse is defined in terms of
Dependence
persistent physical, social, or
occupational problems that have become
associated with alcohol use
recurring use of alcohol in physically
hazardous situations

Alcohol Abuse and

Alcohol
Alcohol Dependence
dependence is defined in terms of

uncontrolled alcohol intake, unsuccessful

efforts to reduce alcohol use, life problems,
and alcohol tolerance and withdrawal.
According to criteria set by the American
Psychiatric Association, an estimated 8.5
percent of U.S. adults can be classified
either as alcohol abusers or as alcohol
dependent.

Alcoholism:
Stereotypes,
Definitions, and Criteria
The National Institutes of Health defines
alcoholism as
a physical addiction to alcohol in which
people continue to drink even though the
drinking causes physical, mental and social
problems, including problems with job
responsibilities and relationships

Alcoholism:
Stereotypes,
Alcoholism is a multidimensional
that is
Definitions,
and condition
Criteria
typically defined in terms of four major criteria:
preoccupation with drinking
emotional problems
vocational, social, and family problems
physical problems
Not all criteria have to be met, however, for
alcoholism to be diagnosed.

Patterns of
Chronic
AlcoholicsAlcohol
can be found in
every age,
Abuse

gender, racial, ethnic, and religious group

and in all socioeconomic and geographic
categories.
Men outnumber women in the incidence of
alcoholism by about six to one, although
women are more vulnerable to alcoholrelated organ damage.

The elderly tend to be an underreported

group with respect to alcoholism.

Patterns of
Chronic
Abuse
A systems Alcohol
approach to alcoholism
examines the complex
interacting relationships among individuals, family, friends, and
community.

The concept of codependency, which originated in Alcoholics

Anonymous, has helped shed light on the specific effects of
alcoholism on spouses and other family members.
What is codependency?
(there is even a Codependents Anonymous organization!)

Patterns of
Chronic
Nonetheless,
men outnumber
women in the
Alcohol
Abuse
incidence of alcoholism by about six to one,
although women are more vulnerable to
alcohol-related organ damage.
The elderly tend to be an underreported
group with respect to alcoholism.

Patterns of
Chronic
Alcohol Abuse

The children of alcoholics (COAs) carry an increased

risk of becoming alcoholic as a result of a
vulnerability toward alcoholism for both genetic and
environmental reasons
Even so, a male with at least one alcoholic parent
has only a 20-25% chance of becoming and
alcoholic himself

The Genetics of
Alcoholism
Studies of adoptions and twins have provided
information about the relative influence of
genetics and environment on the development
of alcoholism.
Type 1 alcoholic
male or female, late onset
Type 2 alcoholic
male, begins in adolescence

The Type 2 alcoholism appears to have a

greater genetic component in the
inheritance pattern.

Figure 9.2

Table
9.1

Type 1 alcoholics can be either male or female, while

Type 2 alcoholics are principally __________.
A. females
B. people over twenty-five only
C. people living in urban environments
D. males
E. bisexual

Physiological Effects of
Chronic Alcohol Abuse
Excessive, chronic alcohol use
increases the risk of
liver disease
cardiovascular disease
cancer
pancreatitis
Type II diabetes
neurological disorders
most severely, Korsakoffs

Physiological Effects of
Chronic Alcohol Abuse
A particular concern is the development of
fetal alcohol syndrome (FAS) in the offspring
of
alcoholic
mothers.
1015% of pregnant women in the U.S. report
having recently drunk alcohol, and up to 30%
drink alcohol at some point during pregnancy
There is no amount of alcohol that is known
to be safe
Total abstinence during pregnancy is ideal,
and FAS is 100% preventable.

Fetal Alcohol
Syndrome
Facial features
are a
good diagnostic for
underlying brain
damage.
The greater the facial
abnormalities, the
greater the underlying
damage.
The exact degree and
nature of deficits
depends on timing,
length and severity of

upturned nose

flat face
small head

Fetal Alcohol
Shorter-than-average
height
Syndrome
Low body weight
Poor coordination
Small head size
Hyperactive behavior
Difficulty paying attention
Poor memory
Difficulty in school (especially with math)
Learning disabilities
Speech and language delays
Intellectual disability or low IQ
Poor reasoning and judgment skills
Sleep and sucking problems as a baby
Vision or hearing problems
Problems with the heart, kidney, or bones

Fetal Alcohol
Anatomical Changes
in the Brain
Syndrome

reduction in gross brain size

especially frontal and parietal lobes
agenesis of the corpus callosum
abnormal cerebellar development
reduced size of the caudate nucleus

Functionally
lower cerebral blood flow
reduced glucose utilization
reduced caudate and frontal lobe activati
spatial memory tasks

Fetal alcohol syndrome

A. is not a concern unless the mother is an alcoholic
B. is unavoidable because it results from abnormal
metabolic activity of the fetus
C. can be avoided by drinking only beer and wine
during pregnancy
D. can be a product of changes in sperm of an
alcoholic father
E. can only be avoided with certainty if the mother
abstains from alcohol completely

The Concept of
Alcoholism as a
Disease

The majority position with respect to alcoholism is that it should be

considered a disease and that alcoholics should be treated rather than
punished.
In 1956, the American Medical Association adopted the disease model of
alcoholism.
Calling alcoholism a disease was a bonanza that quickly poured many
billions of dollars into the pockets of physicians, hospitals
andpharmaceutical companies and continues to do so.

The Concept of
Alcoholism as a
1992 JAMA article,
the Joint Committee of the
Disease
National Council on Alcoholism and Drug
Dependence, Inc. (NCADD) and the American
Society of Addiction Medicine (ASAM) published
this definition for alcoholism:
Alcoholism is a primary chronic disease with
genetic, psychosocial and environmental
factors influencing its development and
manifestations. The disease is often progressive
and fatal. It is characterized by impaired control
over drinking, preoccupation with the drug
alcohol, use of alcohol despite adverse

The Concept of
Alcoholism as a
Disease

Alcoholism does not fit the classic definitions

of a disease in that it is in part defined by
attitudes of the afflicted toward the drinking
problem itself, e.g. denial, or consequences
of the drinking problem, an alcoholic will
continue to drink even though the drinking
causes physical, mental and social
problems, including problems with job
responsibilities and relationships

The Concept of
Alcoholism as a
Disease

It is the only disease that is generally

diagnosed by the sufferer rather than by a
health professional
Recent surveys of primary care physicians
indicate that the medical profession is
frequently ill prepared to diagnose alcoholism
or supervise effective treatment.

The Concept of
Alcoholism as a
Disease

Naming it as a disease may also give the

illusion of explanation,
I cant control my drinking because I am an
alcoholic (but, alcoholism is defined by that
same drinking)
Thats like saying
Im hypertensive because I have high blood
pressure.

The Concept of
Alcoholism as a
Disease

The disease concept makes certain

assumptions and has far-reaching
implications for understanding, treatment
and
legal
treatment
of alcoholics.
Heavy
problem
drinkers
show a single
distinctive pattern of ever greater alcohol
use leading to ever greater bodily, mental,
and social deterioration.
The condition, once it appears, persists
involuntarily: the craving is irresistible and
the drinking is uncontrollable once it has

The Concept of
Alcoholism as a
Disease
Medical expertise
is needed to understand
and relieve the condition (cure the
disease) or at least ameliorate its
symptoms.
If alcoholism is a disease, then alcoholics are
no more responsible legally or morally for
their drinking and its consequences than
epileptics are responsible for the
consequences of their movements during
seizures, or someone with a brain tumor,
diagnosed as schizophrenic, etc.

The Concept of
Alcoholism as a Disease
The disease model also diverts attention
away from the social and cultural
contributions to the problem

Are you an alcoholic?

1. Do you lose time from work due to drinking?
2. Is drinking making your home life unhappy?
3. Do you drink because you are shy with other people?
4. Is your drinking affecting your reputation?
5. Have you ever felt remorse after drinking?
6. Have you ever got into financial difficulties as a result of drinking?
7. Do you turn to lower companions and an inferior environment when
drinking?
8. Does your drinking make you careless of your familys welfare?
9. Has your ambition decreased since drinking?
10. Do you crave a drink at a definite time?
11. Do you want a drink the next morning?
12. Does drinking cause you to have difficulty in sleeping?
13. Has your efficiency decreased since drinking?
14. Is drinking jeopardizing your job or business?
15. Do you drink to escape from worries or trouble?
16. Do you drink alone?
17. Have you ever had a complete loss of memory as a result of
drinking?
18. Has your physician ever treated you for drinking?
19. Do you drink to build up your self-confidence?
20. Have you ever been to a hospital or institution because of drinking?

Approaches to
Treatment for
Alcoholism

Approaches include behaviorally and psychologically based treatments

(e.g., cognitive behavioral therapy, contingency management) and
spiritually based treatments (e.g., Alcoholics Anonymous).
It is curious to note that although AA embraces the disease concept of
alcoholism, it embraces a spiritual rather than a scientific or medical
approach to its treatment.

Table 9.2

Alcoholics Anonymous is based upon the idea of ______.

A. absolute devotion to its ideals
B. absolute abstinence
C. absolute commitment toward responsible drinking
D. absolute allegiance to ones country
E. having a place to drink where identities will not be
revealed

Approaches to
Treatment for
Other self-help
programs, such as Moderation
Alcoholism

Management (MM) and SMART Recovery, have

been devised to appeal to those who cannot
accept a spiritual approach or the total abstinence
required in the AA program

Approaches to
Treatment for
Moderation Management (MM)
Alcoholism
Non-profit, supported
by voluntary donations
Alcoholism is a learned behavior, not a disease
For those concerned about drinking habits but
not dependent or are in early-stage dependency
Controlled drinking, not total abstinence

Self-Management and Recovery Training

(SMART)
Non-profit organization, recognized by
Self-empowering and teaches self-reliance
NIDA
Total
abstinence, controlled
drinking
up to the
A Cognitive/Behavioral
Therapy
approach
individual

Chronic Alcohol
Abuse and
Alcoholism
in
the
Many corporations and other large organizations have
instituted Employee
Assistance Programs (EAPs), and
Workplace
unions have instituted Member Assistance Programs
(MAPs), to help workers with problems of alcohol abuse or
other forms of drug abuse.
e.g. Counseling and Wellness Center for UF students

Physiological Effects of
Chronic Alcohol Abuse
Physical effects of alcoholism include
tolerance and withdrawal, liver disease,
cardiovascular disease, cancer, and
neurological disorders such as WernickeKorsakoff syndrome.
A particular concern is the development
of fetal alcohol syndrome (FAS) in the
offspring of alcoholic mothers.