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National Institute on Alcohol Abuse and Alcoholism

Understanding Alcohol-Related Disorders and Their Treatment, Psychologists play a vital role

For many people, drinking alcohol is nothing more than a pleasant way to relax. People with alcohol-related disorders drink to excess, endangering both themselves and those around them. This question-and-answer fact sheet explains these potentially life-threatening disorders and how psychological therapies can help people recover.

When does drinking become a problem?
For most adults, moderate alcohol use -- no more than two drinks a day for men and one for women and older people -- is relatively harmless. (A "drink" consists of 1.5 ounces of spirits, 5 ounces of wine or 12 ounces of beer, which contain equal amounts of alcohol.) Moderate use, however, lies at one end of a continuum that moves through alcohol abuse to alcohol dependence:
•Alcohol abuse is a drinking pattern that results in adverse consequences that are both significant and recurrent. Alcohol abusers may fail to fulfill major school, work or family obligations. They may have drinking-related legal problems, such as drunk driving arrests. They may have relationship problems related to their drinking.
•People with alcoholism-technically known as alcohol dependence-have become compulsive in their alcohol use. Although they can control their drinking at times, they are often unable to stop once they start. As their tolerance increases, they may need more and more alcohol to achieve the same "high." Or they may become physically dependent on alcohol, suffering withdrawal symptoms such as nausea, sweating, restlessness, irritability, tremors and even hallucinations and convulsions when they stop after a period of heavy drinking. It doesn't matter what kind of alcohol someone drinks or even how much: alcohol dependent people simply lack reliable control over their drinking.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), one in 13 American adults is an alcohol abuser or alcoholic at any given time. A 1997 government survey revealed that drinking problems are also common among younger Americans -- despite the fact that most states outlaw drinking under age 21. Almost five million youths aged 12 to 20 engage in binge drinking, for example, with females downing at least four drinks on a single occasion and males at least five.

What causes alcohol-related disorders?
Problem drinking has multiple causes, with genetic, physiological, psychological and social factors all playing a role. For some alcohol abusers, psychological traits such as impulsiveness, low self-esteem and a need for approval prompt inappropriate drinking. Others drink as a way of coping with emotional pain. Still others use alcohol to "medicate" psychological disorders. Once people begin drinking excessively, the problem can perpetuate itself. Heavy drinking can cause physiological changes that make more drinking the only way to avoid discomfort.
Genetic factors render some people especially vulnerable to alcohol dependence. (Contrary to myth, being able to "hold your liquor" means you're probably more at risk -- not less.) Yet a family history of alcoholism doesn't mean that children of alcoholics will automatically grow up to become alcoholics themselves. Environmental factors such as peer pressure and the easy availability of alcohol can also play key roles. Although alcohol-related disorders can strike anyone, poverty and physical or sexual abuse also increase the odds.

How do alcohol-related disorders affect people?
While some research suggests that small amounts of alcohol may have beneficial cardiovascular effects, there is widespread agreement that heavier drinking can lead to health problems. In fact, 100,000 Americans die from alcohol-related causes each year. Short-term effects include distorted perceptions, memory loss, hangovers and black-outs. Many problems aren't apparent until they become serious, however. Over the long term, heavy drinking can cause impotence, stomach ailments, cardiovascular problems, cancer, central nervous system damage, serious memory loss and liver cirrhosis. It also increases the chances of dying from automobile accidents, homicide and suicide. Although men are much more likely than women to develop alcoholism, women's health suffers more even at lower levels of consumption.
Although moderate drinking may result in relaxation and euphoria, heavy drinking also has a very negative impact on mental health. In fact, alcohol abuse and alcoholism can worsen existing conditions, such as depression or schizophrenia, or induce new problems, such as serious memory loss, depression or anxiety.
People with alcohol-related disorders don't just hurt themselves, however. According to NIAAA, more than half of Americans have at least one close relative with a drinking problem. The results can be devastating. Spouses are more likely to face domestic violence. Children are more likely to develop psychological problems, suffer physical and sexual abuse and neglect and -- because of the combination of genetic vulnerability and social learning -- grow up to be alcoholics. Women who drink during pregnancy run a serious risk of damaging their fetuses. It's not just relatives who suffer. Heavy drinkers often kill strangers through accidents or homicide.

When should someone seek help?
Because some in our society view alcohol-related disorders as a sign of moral weakness, individuals often hide their drinking or deny they have a problem. How can you tell if you or someone you know is in trouble? Signs of a possible problem include having friends or relatives express concern, being annoyed when people criticize your drinking, feeling guilty about your drinking and thinking that you should cut down but finding yourself unable to do so. Needing a morning drink to steady your nerves or relieve a hangover is another warning sign.
Alcoholics usually can't stop drinking through willpower alone. Most need outside help. They may need medically supervised detoxification to avoid potentially life-threatening withdrawal symptoms such as seizures, for instance. Depending on the problem's severity, treatment can take place during office visits, hospital stays or residential treatment programs. Once people are stabilized, they need help resolving psychological issues that may be associated with problem drinking.

How can a psychologist help?
Psychologists play a vital role in the successful treatment of alcohol-related disorders, serving as integral members of the multidisciplinary team that may be required to provide care. Be sure to choose a psychologist who is experienced in working with alcohol-related disorders. To improve the chances of recovery, seek help early.
Using several types of psychological therapies, psychologists can help people address psychological issues involved in their problem drinking. These therapies include cognitive-behavioral coping skills treatment, motivational enhancement therapy and 12-step facilitation approaches. All have received support from well-designed, large-scale treatment trials. These therapies can help people boost their motivation to stop drinking, identify circumstances that trigger drinking, learn new methods to cope with high-risk drinking situations and develop social support systems within their own communities. In addition to psychological therapies, psychologists can provide referrals to self-help groups such as Alcoholics Anonymous.
The treatment process doesn't end once drinking does, however. To help prevent relapses, psychologists typically keep working with people as they begin new lives. Even after formal treatment ends, many people seek additional support through continued involvement in self-help groups.
Because families influence both drinking and recovery, marital and family therapy may prove helpful. Psychologists can help families repair relationships and navigate the complex transitions that occur as recovery begins. They can help families understand alcoholism and learn how to support family members in recovery. And they can refer family members to self-help groups such as Al-Anon and Alateen.
Does treatment really work? Yes. Evidence strongly suggests that many people -- especially those with jobs, families and other forms of social support -- can resolve their alcohol-related problems after their first attempt. Not everyone is so fortunate, however. Some require a number of attempts to solve their drinking-related problems.
Alcohol-related disorders severely impair functioning and health. But the prospects for successful, long-term problem resolution are good for people who seek help from appropriate sources. Qualified psychologists with experience in this area can help those who suffer from alcohol-related disorders address their problems and resolve them in an appropriate manner.
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The American Psychological Association Practice Directorate and the APA College of Professional Psychology gratefully acknowledge the assistance of Peter E. Nathan, PhD, John Wallace, PhD, and Joan Zweben, PhD, in developing this fact sheet.
January 2000