Some 10 percent of the adult drinkers in the United States are considered alcoholics or at least they experience drinking problems to some degree. More males than females are affected, but drinking among the young and among women is increasing. Consumption of alcohol is apparently on the rise in the United States, countries of the former Union of Soviet Socialist Republics, and many European nations. This is paralleled by growing evidence of increasing numbers of alcohol-related problems in other nations, including the Third World.
Alcoholism, as opposed to merely excessive or irresponsible drinking, has been variously thought of as a symptom of psychological or social stress or as a learned, maladaptive coping behavior. More recently, and probably more accurately, it has come to be viewed as a complex disease entity in its own right. Alcoholism usually develops over a period of years. Early and subtle symptoms include placing excessive importance on the availability of alcohol. Ensuring this availability strongly influences the person's choice of associates or activities. Alcohol comes to be used more as a mood-changing drug than as a foodstuff or beverage served as a part of social custom or religious ritual.
Initially, the alcoholic may demonstrate a high tolerance to alcohol, consuming more and showing less adverse effects than others. Subsequently, however, the person begins to drink against his or her own best interests, as alcohol comes to assume more importance than personal relationships, work, reputation, or even physical health. The person commonly loses control over drinking and is increasingly unable to predict how much alcohol will be consumed on a given occasion or, if the person is currently abstaining, when the drinking will resume again. Physical addiction to the drug may occur, sometimes eventually leading to drinking around the clock to avoid withdrawal symptoms.
Alcohol has direct toxic as well as sedative effects on the body, and failure to take care of nutritional and other physical needs during prolonged periods of excessive drinking may further complicate matters. Advanced cases often require hospitalization. The effects on major organ systems are cumulative and include a wide range of digestive-system disorders such as ulcers, inflammation of the pancreas, and cirrhosis of the liver. The central and peripheral nervous systems can be permanently damaged. Blackouts, hallucinations, and extreme tremors may occur. The latter symptoms are involved in the most serious alcohol withdrawal syndrome, delirium tremens, which can prove fatal despite prompt treatment. This is in contrast to withdrawal from narcotic drugs such as heroin, which, although distressful, rarely results in death. Recent evidence has shown that heavy-and even moderate-drinking during pregnancy can cause serious damage to the unborn child: physical or mental retardation or both; a rare but severe expression of this damage is known as fetal alcohol syndrome.
Treatment of the illness increasingly recognizes alcoholism itself as the primary problem needing attention, rather than regarding it as always secondary to another, underlying problem. Specialized residential treatment facilities and separate units within general or psychiatric hospitals are rapidly increasing in number. As the public becomes more aware of the nature of alcoholism, the social stigma attached to it decreases, alcoholics and their families tend to conceal it less, and diagnosis is not delayed as long. Earlier and better treatment has led to encouragingly high recovery rates.
In addition to managing physical complications and withdrawal states, treatment involves individual counseling and group therapy techniques aimed at complete and comfortable abstinence from alcohol and other mood-changing drugs of addiction. Such abstinence, according to the best current evidence, is the desired goal, despite some highly controversial suggestions that a safe return to social drinking is possible. Addiction to other drugs, particularly to other tranquilizers and sedatives, poses a major hazard to alcoholics. Antabuse, a drug that produces a violent intolerance for alcohol as long as the substance remains in the body, is sometimes used after withdrawal. Alcoholics Anonymous, a support group commonly used for those undergoing other treatment, in many cases helps alcoholics to recover without recourse to formal treatment.
Despite these encouraging signs, estimates of the annual number of deaths related to excessive drinking exceed 97,000 in the United States alone. Economic costs related to alcoholism are at least $100 billion a year. Additional data are needed on various societal costs of alcoholism as well as on the costs of various modes of treatment compared with their actual results.