The Facts

It is estimated that about three-quarters of the population drink alcohol. Of this number, about 4 to 5 million Canadians will find that their alcohol consumption leads to serious problems involving their health, work, finances, and relationships with family and friends. When a person uses alcohol despite apparent harm to their health and well-being, it is called alcohol use disorder or alcoholism.

In general, men are more likely than women to develop alcoholism. However, the incidence of alcoholism among women has increased in the past 30 years.

Causes

Alcoholism, or alcohol use disorder, is a medical condition. While the exact cause of alcoholism is unknown, research has shown increasing evidence that susceptibility to it may be inherited and the risk of developing this medical condition rises significantly in families with relatives (in particular, parents and siblings) who are dependent on alcohol.

Additional risk factors include having a psychiatric condition such as schizophrenia, depression, or an anxiety disorder. Poverty, social isolation, troubled upbringing, and shyness may also be risk factors.

In addition, how one's body processes alcohol can affect the risk of developing a dependence on alcohol. Research has shown that people who need comparatively more alcohol to achieve an effect are more likely to become alcohol dependent.

All drugs affect a "reward mechanism" in the brain. If a person feels good each time they use a drug, it tends to make them want to use the drug again. This common feature could explain why people abuse drugs, including alcohol. As with most drugs, though, if you use them regularly, your body tends to require increasing amounts of the substance to achieve the same effect. This is called tolerance, and it may be the final factor that contributes to the development of drug or alcohol dependence.

Symptoms and Complications

Alcohol is poisonous to many types of human cells. In small quantities it can suppress their activity. In large doses, it can kill them. While most drugs that act on the brain stimulate production of brain hormones like serotonin and dopamine, alcohol actually reduces levels of these chemicals while increasing levels of some others. It's a depressant in that it has the opposite chemical effect to a prescribed antidepressant. Nevertheless, since it also depresses activity in the part of the brain that restrains and inhibits our behaviour, most people find the effect pleasant while quantities are taken in moderation.

At higher doses, it quickly becomes apparent that alcohol is in fact toxic. The main symptoms are vomiting, stupor, behavioural changes, and major impairment of the central nervous system followed by dehydration and headache. At high doses, alcohol can be fatal by shutting down breathing or stopping the heart.

Even non-lethal doses can kill. Aspiration pneumonia is a condition that occurs when people, sleeping off a very heavy night's drinking, suffocate when their own vomit is inhaled into their lungs. There is a gag reflex that should automatically prevent this, but it can malfunction when the nervous system is depressed.

Anyone who drinks alcohol after going a long time without food can have an attack of hypoglycemia, a sudden shortage of blood sugar, causing nervous symptoms like stupor or abnormal behaviour and, in severe cases, coma or convulsions. If your stomach is empty enough, you could end up in hospital with hypoglycemia despite being under the legal driving limit. This is especially dangerous if you have diabetes and are already taking insulin to lower your blood sugar.

Long-term heavy drinking can cause a range of chronic problems. These include:

• arrhythmias – abnormal heart rhythms that can instantly kill even young people if they are abusing alcohol
• beriberi (vitamin B1 deficiency) – lack of vitamin B1 (thiamine), is common in those dependent on alcohol and can accelerate heart damage and mental degeneration
• brain damage – alcohol kills brain cells
• diabetes
• heart damage (cardiomyopathy) involving changes in the heart's size and structure
• hypertension (high blood pressure)
• liver disease such as cirrhosis
• loss of feeling in hands, feet, and elsewhere due to effects on nervous system
• stomach ulcers and gastritis (inflamed lining of the stomach)

These are just a few conditions closely linked to alcoholism. In fact, heavy alcohol use increases the risk for almost all diseases, including a number of cancers.

Drinking during pregnancy has been shown to have a negative effect on babies. Research shows that even small amounts of alcohol consumed during pregnancy can lead to neurological changes in the developing fetus. Moderate amounts of alcohol consumed during pregnancy can lead to the birth of a child with fetal alcohol spectrum disorder (FASD) – a lifelong disorder which includes permanent physical, behavioural and learning problems.

Being intoxicated frequently may be obvious and destructive. Relationships and job performance may suffer due to alcohol use.

Making the Diagnosis

Most people will know deep down whether they are controlling their drinking or their drinking is controlling them. If you sometimes feel guilty about the amount you drink, there's a good chance you may have a problem.

Other warning signs of alcohol use disorder include:

• getting annoyed when others suggest you drink less
• drinking even when you know it could have bad consequences (e.g., at work)
• having a drink in the morning to prepare you for your day
• regularly drinking more than you planned at social occasions
• hiding alcohol at home or at work
• drinking alone or in secret
• losing interest in activities and hobbies you used to enjoy
• often attempting to decrease alcohol use
• craving alcohol
• using alcohol in hazardous situations

If you think you or someone you love may be at risk for alcohol use disorder, seek help. A variety of resources are available to you.

Treatment and Prevention

A few people suffer serious physical problems when they try to quit alcohol. Hallucinations and delirium tremens, which most people regard as symptoms of intoxication, are in fact caused by sudden sobriety. Fear, confusion, fever, and high heart rate are just some of the symptoms seen in those addicted to alcohol who have a severe physical reaction when the drug is no longer present in their system. Hospital care and antianxiety medication can help ease the physical effects during this stage of withdrawal.

For most people who quit, the greatest danger is a return to alcohol consumption (relapse).

Getting a loved one to seek help for alcohol dependence can be difficult, since denial of the problem is common and is related to the cognitive changes associated with the illness. You may need to raise the subject more than once, and you may need to involve friends and family members in the discussion to show the extent of your concerns. It's best to approach the subject in a calm way, without accusations and with a focus on care and support for the person involved. Rather than speaking in a generalized way, point to specific behaviours and events that have caused the concern.

Be aware that a variety of effective interventions exist to treat alcoholism. Some people will be able to change their rate of alcohol consumption, or quit altogether, simply by having had the devastating effects of their behaviour pointed out to them by someone they trust. Unfortunately, interventions by family and friends are sufficient in only a minority of cases.

Alcoholics Anonymous (AA) can provide a beneficial option. Known for its 12-step program, this international organization can provide significant value for many people through self-help and peer support. For more information, look for AA in your local phone book.

Alternatively, many communities have access to various publicly supported alcohol dependence programs, and many private programs exist as well. Talk to your health care professional to find out what types of services are available.

Several medications may also help when used in combination with other forms of treatment. These medications work in different ways. Some suppress the urge to drink (e.g., naltrexone*), some cause uncomfortable physical reactions if alcohol is consumed (e.g., disulfiram), and some ease the physical symptoms of the withdrawal process (e.g., diazepam, clonidine).