Alcoholism

Signs and Symptoms

Symptoms of alcoholism include:

• Solitary or secretive drinking
• Alcohol cravings
• An inability to control the amount you drink
• Blackouts (not remembering events or conversations)
• Irritability when unable to drink
• Legal problems
• Difficulty sustaining a relationship or a job
• Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety when not drinking
• An increased tolerance to alcohol
• Liver disease
• Stomach pains
• Heart palpitations

Risk Factors

If you have a family history of alcohol abuse, you are more likely to develop the condition than someone without a family history of alcohol abuse. Other factors that may increase your risk include:

• Having 2 or more adverse events during childhood
• Beginning to drink early in life, by age 16 or sooner
• Drinking more than 1 to 2 drinks per day
• Smoking cigarettes (particularly teenagers)
• Being under a lot of stress
• Having a pre-existing psychiatric disorder (such as depression or anxiety)
• Men have higher rates of alcoholism than women
• Broken home

Diagnosis

If you have symptoms associated with alcoholism, you should see your doctor. Your doctor can help make a diagnosis and guide you in selecting an appropriate treatment or combination of therapies. Most alcoholics deny they have a problem, and they are often unlikely to seek treatment by themselves. If you suspect that a friend or a loved one has an alcohol problem, you and other friends and family members may need to convince them to seek help.

Your doctor will take a history and do a physical exam. Questions may include:

• Have you ever thought you needed to cut back on the amount of alcohol you drink?
• Has a spouse, friend, or coworker ever asked you to drink less?
• Do you ever feel guilty about the amount you drink?
• Do you ever drink in the morning or early in the day to soothe a hangover, get the day started, or get rid of the shakes?

Blood tests generally are not helpful because they only show recent alcohol consumption. Your doctor may order liver function tests to see if alcohol has damaged your liver.

Preventive Care

If you drink, do so only in moderation, no more than 2 drinks per day for men, and no more than 1 drink per day for women.

Early intervention is important, especially with teenagers. To prevent teen drinking, consider the following:

• Stay involved and interested in your teenager's life.
• Talk openly to your children, especially pre-teens and teens, about the widespread presence and dangers of alcohol and drugs.
• Have clear, non-negotiable rules about not using alcohol and drugs.
• Act as a role model. Do not drink excessively, use other drugs, or smoke.
• Strongly urge your children to not smoke.
• Encourage your children to become active in sports, music, the arts, or other activities.
• Know where your children and teens are at all times, and make sure they always have adult supervision.
• Monitor your teenager for aggressive behavior, feelings of anger or depression, and poor school performance. If any of these develop, consider whether alcohol may be responsible.
• Never drink and drive or allow your teenager to be driven in the car by someone who has been drinking.
• Expose your children to spiritual practices or religion. Studies show that people who have a religious or spiritual focus in life are less likely to abuse alcohol.

Treatment Approach

The first and most important step in getting treatment for alcoholism is recognizing that you have a problem. Family members and close friends often convince people with alcohol addiction to seek treatment.

Treatment and ongoing recovery must address both physical and psychological addiction, and may include inpatient treatment and/or Alcoholics Anonymous (AA). In an inpatient or residential program, the person generally stays in a hospital or center for 28 days, undergoing first detoxification (usually 4 to 7 days) and then individual and group therapy sessions that emphasize abstinence. Talk to a doctor about what is best for you or your loved one.

Lifestyle

• Attend Alcoholics Anonymous.
• Family members should attend Al-Anon to learn how to help the person with the addiction and to get help and support themselves.
• Exercise regularly to help reduce cravings.

Medications

Your doctor may prescribe the following medications:

For alcohol withdrawal:

Benzodiazepines are tranquilizers used during the first few days of treatment to help you withdraw safely from alcohol. These drugs include:

• Diazepam (Valium)
• Chlordiazepoxid (Librium)
• Lorazepam (Ativan)
• Oxazepam (Serax)

Anticonvulsants may also help with withdrawal symptoms, and do not have the potential for abuse (as benzodiazepines do). They include:

• Carbamazepine (Tegretol)
• Valprioc acid (Depakote)
• Phenytoin (Dilantin)
• Gabapentn (Neurontin)
• Baclofen (Lioresal, Lioresal Intrathecal, Gablofen)

To prevent relapse:

Naltrexone (Revia, Vivitrol): It is used in combination with counseling. It may lessen the craving for alcohol, and help prevent a return to drinking. Taking Revia or Vivitrol blocks receptors in your brain so that you do not get "high" from drinking. It is only used after detoxification, which means it is only used after you are no longer physically addicted to alcohol.

Acamprosate (Campral): May help restore the chemical balance in the brain. It is best used in combination with counseling.

Disulfiram (Antabuse): It is an older medicine that discourages drinking by causing nausea, vomiting, and other unpleasant physical reactions when alcohol is used.

Nutrition and Dietary Supplements

Because chronic use of alcohol decreases your appetite and keeps your body from absorbing vital nutrients, you may be deficient in a number of vitamins and minerals. Your doctor may tell you to take supplements while you are regaining your health. Beneficial supplements may include vitamin B complex, vitamin C, selenium, magnesium, and zinc. A combination of amino acids, such as carnitine, glutamine, and glutathione, may help reduce cravings, blood sugar fluctuations, and stress that is related to alcohol use.

Thiamine (vitamin B1): Your doctor may prescribe a thiamine supplement during withdrawal. Heavy use of alcohol causes thiamine deficiency, which can lead to a serious brain disorder called Wernicke-Korsakoff syndrome.

People who abuse alcohol are often deficient in vitamin A. Take supplements beyond the recommended daily allowance only under a doctor's supervision. High doses of vitamin A can damage the liver, and may cause alcoholic liver disease to develop more quickly in people who drink heavily.

Some members of the alcohol recovery community recommend a heavier, nutritionally-oriented approach. This includes intravenous (IV) nutritional therapies, along with targeted amino acid supplementation, to modulate brain function. The mainstream alcoholism treatment community considers some of these approaches controversial, so make sure you work with a reputable doctor and update every member of your recovery team on the type of therapies you are using.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider. However, you should not use herbs alone to treat alcoholism. Counseling and peer groups such as AA are also needed.

• Milk thistle (Silybum marianum): Milk thistle is often used to treat liver problems. Some studies looking at milk thistle to treat alcoholic liver disease have found significant improvements in liver function. People with the mildest form of alcohol-related liver damage seem to improve the most. Milk thistle is less effective for those with severe liver disease, such as cirrhosis, which is characterized by scarring and permanent, irreversible damage to the liver. However, there are no studies looking at whether milk thistle is useful for alcohol withdrawal. People who are allergic to ragweed may have an allergic reaction to milk thistle. Milk thistle may interact with several medications. Speak with your physician. Some compounds in milk thistle may resemble estrogen in their composition, so people with hormone-sensitive conditions should speak to their doctor.
• Kudzu (Pueraria lobata): Animal studies suggest that kudzu, used in traditional Chinese medicine to treat alcohol abuse, might help reduce cravings. Human studies are mixed. One study in humans failed to show any benefit, while another found that heavy drinkers who had taken kudzu supplements for 7 days drank significantly less beer when given the opportunity than heavy drinkers who had taken a placebo. Kudzu can interact with many medicines, including blood thinners, methotrexate, diabetes medicines, estrogens, and estrogen-modifying medicines, including birth control medicines and breast cancer medicines, such as Tamoxifen. There is some concern that Kudzu could worsen liver disorders and/or slow blood clotting. Speak to your physician.
• Dandelion (Taraxacum officinale): Dandelion is used traditionally for liver-related problems, although there is evidence that it helps alcohol withdrawal symptoms. It is often combined with milk thistle. Dandelion can interact with many medicines, including lithium. People who aer allergic to ragweed could have an adverse reaction to dandelion. Speak with your physician.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend a treatment for alcoholism based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Homeopathy alone should not be used to treat alcoholism, but can be a supportive therapy along with counseling and groups such as AA. The following are a few examples of remedies that an experienced homeopath might consider for symptoms related to alcohol abuse or withdrawal:

• Arsenicum album: For anxiety and compulsiveness, with nausea, vomiting, and diarrhea.
• Nux vomica: For irritability and compulsiveness with nausea, vomiting, and constipation.
• Lachesis: For alcohol cravings, headaches, and difficulty swallowing.
• Staphysagria: For angry individuals who tend to suppress their emotions and may have been abused physically, sexually, or psychologically in the past.

Mind-Body Medicine

Cognitive behavioral therapy (CBT) with a psychologist or psychiatrist is a very effective treatment approach for alcohol addiction. This type of therapy, which is geared toward changing your beliefs and thought process about drinking, can help you cope with stress and control your behavior. Talk to your doctor about finding a qualified cognitive behavioral therapist.

Yoga, too, has shown promis in preliminary studies reducing drug and alcohol use among people who have post-traumatic stress disorder (PTSD).

Acupuncture

In some cases, acupuncture may be a useful supportive therapy for addiction. Some, but not all studies of acupuncture for the treatment of alcohol abuse have shown that it can reduce cravings and symptoms of withdrawal. However, acupuncture alone should not be used to treat alcohol addiction, but it may be used in combination with counseling and groups such as AA.

Other Considerations

Pregnancy

Drinking alcohol while pregnant can seriously damage the baby, causing a condition known as fetal alcohol syndrome. Fetal alcohol syndrome causes irreversible physical and mental disabilities. The only safe way to protect against damage to the baby is not to drink during pregnancy, or even if you are trying to become pregnant.

Prognosis and Complications

Possible complications associated with heavy alcohol use include:

• Mental confusion or delirium
• Severe amnesia
• An unsteady gait
• Loss of sperm cells
• Repeated vomiting, ulcers, gastrointestinal bleeding
• Pancreatitis

In addition, long-term use of alcohol decreases life expectancy by about 15 years and puts you at significant risk for:

• Liver damage, even liver failure (called cirrhosis)
• High blood pressure, heart disease, and heart failure
• Brain and nerve damage
• Certain types of cancer, including mouth, throat, laryngeal (voice box), esophageal, and breast
• Osteoporosis
• Nutritional deficiencies
• Infections, including pneumonia and tuberculosis
• Low bone mineral density and osteoporosis

Relapse in alcoholism is common. Risk factors for relapse can include environment cues, any mood-altering substance, and stress. Even though alcohol abuse is a serious condition with potentially dire consequences, it is treatable. If you or someone you love has a problem, seek the help and advice of a health care professional as early as possible.

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