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Defining alcoholism


According to the U.S. Center for Disease Control, there are approximately 88,000 deaths attributable to excessive alcohol use each year in the United States. This makes alcohol use the third leading lifestyle-related cause of death in the nation.

Alcoholism in the clinical sense is much more than, “having too much to drink”. It is not defined by the quantity that one drinks or the drinker’s regularity, although those factors certainly are relevant.

Alcoholism is a chronic progressive disease recognized as such by the American Medical Association, the American Psychiatric Association, and Alcoholics Anonymous. The disease model of alcoholism is now widely accepted over the behavioral model.

The ASAM, American Society of Addiction Medicine, defines Alcoholism as:

“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 continuous or periodic use: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.

The international organization known as A.A., Alcoholics Anonymous, which boasts nearly two million members worldwide, endorses the disease model as well. While A.A. does not offer an official definition for Alcoholism, they do state in their literature:

“Most of us agree that, for us, it could be described as a physical compulsion, coupled with a mental obsession. We mean that we had a distinct physical desire to consume alcohol beyond our capacity to control it, and in defiance of all rules of common sense.”

In 1994, the American Psychiatric Association differentiated alcohol use and abuse from dependence and offered the following definition and seven criteria for determining alcoholic dependence or Alcoholism:

A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

  1. Tolerance, as defined by either a need for increased amounts to achieve intoxication or desired effect, or markedly diminished effect with continued use of the same amount
  2. Withdrawal, as manifested by nausea, sweating, or shakiness after stopping drinking
  3. Alcohol is often used in larger amounts or over a longer period than was intended
  4. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use
  5. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects
  6. Important social, occupational, or recreational activities are given up or reduced because of alcohol use
  7. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol (e.g. continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Those who have studied alcohol dependence as well as other substance dependence agree that the following four features are the distinguishing features of the disease of Alcoholism:

  1. Craving - a strong need to drink
  2. Loss of control - not being able to stop drinking once you've begun
  3. Physical dependence – withdrawal symptoms, such as nausea, sweating or shakiness after stopping drinking
  4. Tolerance - the need to drink greater amounts of alcohol in order to get “high”

Not all children of alcoholic families become alcoholics. In addition, some people develop alcoholism even though no one in their family has a drinking problem.

Alcoholism cannot be cured at this time. Even if an alcoholic has not been drinking for a long time, he or she can still suffer a relapse. Not drinking is the safest course for most people with alcoholism.

Alcoholism can be treated however; treatment programs use both counseling and medications to help a person stop drinking. Treatment has helped many people to stop drinking and live in long-term recovery.

For more information on recovery from alcohol please visit, Alcoholics Anonymous.

Source material: ASAM, APA 2000, Alcoholics Anonymous, United States C.D.C., DSM-IV

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