A Widespread Problem For most people who drink, alcohol is a pleasant accompaniment to social activities.

Moderate alcohol useup to two drinks per day for men and one drink per day for women and older peopleis not harmful for most adults. (A standard drink is one 12-ounce bottle or can of either beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.) Nonetheless, a large number of people get into serious trouble because of their drinking. Currently, nearly 14 million Americans1 in every 13 adultsabuse alcohol or are alcoholic. several million more adults engage in risky drinking that could lead to alcohol problems. These patterns include binge drinking and heavy drinking on a regular basis. In addition, 53 percent of men and women in the United States report that one or more of their close relatives have a drinking problem. The consequences of alcohol misuse are serious in many cases, life threatening. Heavy drinking can increase the risk for certain cancers, especially those of the liver, oesophagus, throat, and larynx (voice box). Heavy drinking can also cause liver cirrhosis, immune system problems, brain damage, and harm to the fetus during pregnancy. In addition, drinking increases the risk of death from automobile crashes as well as recreational and on-the-job injuries. Furthermore, both homicides and suicides are more likely to be committed by persons who have been drinking. In purely economic terms, alcohol-related problems cost society approximately $185 billion per year. In human terms, the costs cannot be calculated.

What Is Alcoholism?
Alcoholism, also known as alcohol dependence, is a disease that includes four symptoms: Craving: A strong need, or compulsion, to drink. Loss of control: The inability to limit ones drinking on any given occasion.

 Physical dependence: Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, occur when alcohol use is stopped after a period of heavy drinking. Tolerance: The need to drink greater amounts of alcohol in order to get high. People who are not alcoholic sometimes do not understand why an alcoholic cant just use a little willpower to st op drinking. However, alcoholism has little to do with willpower. Alcoholics are in the grip of a powerful craving, or uncontrollable need, for alcohol that overrides their ability to stop drinking. This need can be as strong as the need for food or water. Although some people are able to recover from alcoholism without help, the majority of alcoholics need assistance. With treatment and support, many individuals are able to stop drinking and rebuild their lives. Many people wonder why some individuals can use alcohol without problems but others cannot. One important reason has to do with genetics. Scientists have found that having an alcoholic family member makes it more likely that if you choose to drink you too may develop alcoholism. Genes, however, are not the whole story. In fact, scientists now believe that certain factors in a persons environment influence whether a person with a genetic risk for alcoholism ever develops the disease. A persons risk for developing alcoholism can increase based on the persons environment, including where and how he or she lives; family, friends, and culture; peer pressure; and even how easy it is to get alcohol.

What Is Alcohol Abuse?

Alcohol abuse differs from alcoholism in that it does not include an extremely strong craving for alcohol, loss of control over drinking, or physical dependence. Alcohol abuse is defined as a pattern of drinking that result in one or more of the following situations within a 12-month period: Failure to fulfil major work, school, or home responsibilities;

 Drinking in situations that are physically dangerous, such as while driving a car or operating machinery; Having recurring alcoholrelated legal problems, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk; and Continued drinking despite having ongoing relationship problems that are caused or worsened by the drinking. Although alcohol abuse is basically different from alcoholism, many effects of alcohol abuse are also experienced by alcoholics.

Getting Well
The type of treatment you receive depends on the severity of your alcoholism and the resources that are available in your community. Treatment may include detoxification (the process of safely getting alcohol out of your system); taking doctor-prescribed medications, such as disulfiram (Antabuse) or naltrexone (ReVia), to help prevent a return (or relapse) to drinking once drinking has stopped; and individual and/or group counseling. There are promising types of counseling that teach alcoholics to identify situations and feelings that trigger the urge to drink and to find new ways to cope that do not include alcohol use. These treatments are often provided on an outpatient basis. Because the support of family members is important to the recovery process, many programs also offer brief marital counseling and family therapy as part of the treatment process. Programs may also link individuals with vital community resources, such as legal assistance, job training, childcare, and parenting classes.

Alcoholics Anonymous
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Can Alcoholism Be Cured?

r ur i no y il l n o r or ni Al oug l o oli m n n l o oli n o r or long im n r g in l or r m in u i l or l n mu on inu o oi ll l o oli rg u ing o n on rin ing o n or ; u ing ou l o ol i n ry or u ul r o ry o r n in i i u l li or r l or o no m n r on il or nno r o r rom l o oli m K in min oo ry y r o ring l o oli y o r rior o rl i r m ly lu l im o o in i i u l n o i or r mily o r rmin o y o r m y u r on or r l i ing long rm o ri y l r ry ommon n

If a r lapse o urs, i is very impor an to try to stop drin ing on e again and to get whatever additional support you need to abstain from drin ing

Help for Alcohol Abuse

If your health care provider determines that you are not alcohol dependent but are nonetheless involved in a pattern of alcohol abuse, he or she can help you to E amine the benefits of stopping an unhealthy drin ing pattern Set a drin ing goal for yourself. Some people choose to abstain from alcohol. Others prefer to limit the amount they drin . E amine the situations that trigger your unhealthy drin ing patterns, and develop new ways of handling those situations so that you can maintain your drin ing goal. Some individuals who have stopped drin ing after experiencing alcohol related problems choose to attend AA meetings for information and support, even though they have not been diagnosed as alcoholic.

New Directions
With NIAAAs support, scientists at medical centers and universities throughout the country are studying alcoholism. The goal of this research is to develop better ways of treating and preventing alcohol problems. Today, NIAAA funds approximately 90 percent of all alcoholism research in the United States. Some of the more exciting investigations focus on the causes, consequences, treatment, and prevention of alcoholism
Genetics: Alcoholism is a complex disease. Therefore, there are li ely to be many

genes involved in increasing a persons risk for alcoholism. Scientists are searching for these genes, and have found areas on chromosomes where they are probably located. Powerful new techniques may permit researchers to identify and measure the specific contribution of each gene to the complex behaviors associated with heavy drinking.
Treatment: NIAAA supported researchers have made considerable progress in

evaluating commonly used therapies and in developing new types of therapies to treat alcohol related problems. One large-scale study sponsored by NIAAA found that each of three commonly used behavioral treatments for alcohol abuse and alcoholism

motivation enhancement therapy, cognitive-behavioral therapy, and 12-step facilitation therapysignificantly reduced drinking in the year following treatment.

alcoholism a high priority. We believe that a range of new medications will be developed based on the results of genetic and neuroscience research. In fact, neuroscience research has already led to studies of one medicationnaltrexone (ReVia)as an anticraving medication. NIAAA-supported researchers found that this drug, in combination with behavioral therapy, was effective in treating alcoholism. Naltrexone, which targets the brains reward circuits, is the first medication approved to help maintain sobriety after detoxification from alcohol since the approval of disulfiram (Antabuse) in 1949. The use of acamprosate, an anticraving medication that is widely used in Europe, is based on neuroscience research. Researchers believe that acamprosate works on different brain circuits to ease the physical discomfort that occurs when an alcoholic stops drinking. Acamprosate should be approved for use in the United States in the near future, and other medications are being studied as well.

researchers have found that available medications work best with behavioral therapy. Thus, NIAAA has initiated a large-scale clinical trial to determine which of the currently available medications and which behavioral therapies work best together. Naltrexone and acamprosate will each be tested separately with different behavioral therapies. These medications will also be used together to determine if there is some interaction between the two that makes the combination more effective than the use of either one alone.

Co bined

edic tions/behavioural therapies: NIAAA-supported

Medic io

develop ent: NIAAA has made developing medications to treat