Let us first of all remove any possible misunderstanding that the behaviour of the alcohol and drug dependent person is somehow different. Tom Waller and Daphne Rumball in their book, ‘Treating Drinkers and Drug Users in the Community’ (2004), promote ‘a unified approach to drugs and alcohol’, arguing that it is helpful to view substance use as a single whole. Some might proffer that the only difference between the two is that ‘people with alcoholism tend to be older and more conventional’ than someone who is dependent on street drugs, for example, who tend to be ‘on the whole younger’, and a bit more rebellious by upbringing or instinct’. (Marteau, 2001, p.5-6.) For the purpose of this section on ‘commonly asked questions’, therefore, we will confine our comments to the alcohol dependent person, his family and friends; but those comments apply equally to the drug dependent person, and his family and friends also. Another commonality is that both drug and alcohol dependent people end up trapped in a pattern of compulsive behaviours that are controlled by their physiological dependence and their psychological defences – both, incidentally, executed in ignorance and resulting in stress and pain.
MARTEAU, D., (2001). Addiction. Bath: Mark Allen Publishing
WALLER, T., RUMBALL, D., (2004). Treating Drinkers & Drug Users in the Community. Kundli: Blackwell Publishing
1. What do people mean when they talk about alcoholism (or drug dependence)? Alcoholism, also known as "alcohol dependence," is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law. back to top
2. Is alcoholism (drug addiction) a disease?
Yes. Alcoholism is a chronic, often progressive disease with symptoms that include a strong need to drink despite negative consequences, such as serious job or health problems. Like many other diseases, it has a generally predictable course, has recognized symptoms, and is influenced by both genetic and environmental factors that are being increasingly well defined. back to top
3. Can alcoholism (drug dependence, etc) be inherited?
Alcoholism tends to run in families, and genetic factors partially explain this pattern. Currently, researchers are on the way to finding the genes that influence vulnerability to alcoholism. A person's environment, such as the influence of friends, stress levels, and the ease of obtaining alcohol, also may influence drinking and the development of alcoholism. Still other factors, such as social support, may help to protect even high-risk people from alcohol problems.
Risk, however, is not destiny. A child of an alcoholic parent will not automatically develop alcoholism. A person with no family history of alcoholism can become alcohol dependent. back to top
4. Can alcoholism be cured? Not yet. Alcoholism is a treatable disease, and medication has also become available to help prevent relapse, but a cure has not yet been found. This means that even if an alcoholic has been sober for a long time and has regained health, he or she may relapse and must continue to avoid all alcoholic beverages. back to top
5. Are there any medications for alcoholism? Yes. Two different types of medications are commonly used to treat alcoholism. The first are tranquilizers called benzodiazepines (e.g., Valium, Librium), which are used only during the first few days of treatment to help patients safely withdraw from alcohol.
A second type of medication is used to help people remain sober. A recently approved medicine for this purpose is naltrexone (ReVia). When used together with counselling, this medication lessens the craving for alcohol in many people and helps prevent a return to heavy drinking. Another older medication is disulfiram (Antabuse), which discourages drinking by causing nausea, vomiting, and other unpleasant physical reactions when alcohol is used. back to top
6. Does treatment work?
Alcoholism treatment is effective in many cases. Studies show that a minority of alcoholics remain sober one year after treatment, while others have periods of sobriety alternating with relapses. Still others are unable to stop drinking for any length of time.
Treatment outcomes for alcoholism compare favourably with outcomes for many other chronic medical conditions. The longer one abstains from alcohol, the more likely one is to remain sober. back to top
7. Does a person have to be alcoholic to experience problems from alcohol?
No. Even if you are not alcoholic, abusing alcohol can have negative results, such failure to meet major work, school, or family responsibilities because of drinking; alcohol-related legal trouble; automobile crashes due to drinking; and a variety of alcohol-related medical problems.
Under some circumstances, problems can result from even moderate drinking -- for example, when driving, during pregnancy, or when taking certain medicines. back to top
8. Are certain people more likely to develop alcohol problems than others?
Yes. However, more men than women are alcohol dependent or experience alcohol-related problems. In addition, rates of alcohol problems are highest among young adults ages 18-29 and lowest among adults 65 years and older. Among major U.K. ethnic groups, rates of alcoholism and alcohol-related problems vary. back to top
9. How can you tell whether you or someone close to you has an alcohol problem?
A good first step is to answer the brief questionnaire below, developed by Dr. John Ewing. (To help remember these questions, note that the first letter of a key word in each question spells "CAGE.")
Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt bad or Guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?
One "yes" answer suggests a possible alcohol problem. More than one "yes" answer means it is highly likely that a problem exists. If you think that you or someone you know might have an alcohol problem, it is important to see a doctor or other health provider right away. He or she can determine whether a drinking problem exists and, if so, suggest the best course of action. back to top
10. Can I simply reduce my alcohol use if I have trouble with drinking? That depends. If you are diagnosed as an alcoholic, the answer is "no." Studies show that nearly all alcoholics who try to merely cut down on drinking are unable to do so indefinitely. Instead, cutting out alcohol (that is, abstaining) is nearly always necessary for successful recovery.
However, if you are not alcoholic but have had alcohol-related problems, you may be able to limit the amount you drink. If you cannot always stay within your limit, you will need to stop drinking altogether. back to top
11. How can a person get help for an alcohol problem?
You can call the Al-Anon (020 7403 0888); Alcoholics Anonymous (0845 7697555); Drinkline (0800 917 8282); Health Challenge Wales (02920 825111); Parentline Plus (0808 800 222) or DAN 24/7 the Welsh Drug and Alcohol Helpline (0800 6 33 55 88). Many people also benefit from support groups. back to top
12. If an alcoholic is unwilling to seek help, is there any way to get him or her into treatment?
This can be a challenging situation. An alcoholic cannot be forced to get help except under certain circumstances, such as when a violent incident results in police being called or following a medical emergency.
This doesn't mean, however, that you have to wait for a crisis to make an impact. Based on clinical experience, many alcoholism treatment specialists recommend the following steps to help an alcoholic accept treatment:
Stop all "rescue missions."
Family members often try to protect an alcoholic from the results of his or her behaviour by making excuses to others about his or her drinking and by getting him or her out of alcohol-related jams. It is important to stop all such rescue attempts immediately, so that the alcoholic will fully experience the harmful effects of his or her drinking -- and thereby become more motivated to stop.
Time your intervention.
Plan to talk with the drinker shortly after an alcohol-related problem has occurred--for example, a serious family argument in which drinking played a part or an alcohol-related accident. Also choose a time when he or she is sober, when both of you are in a calm frame of mind, and when you can speak privately.
Tell the family member that you are concerned about his or her drinking and want to be supportive in getting help. Back up your concern with examples of the ways in which his or her drinking has caused problems for both of you, including the most recent incident.
State the consequences.
Tell the family member that until he or she gets help, you will carry out consequences--not to punish the drinker, but to protect yourself from the harmful effects of the drinking. These may range from refusing to go with the person to any alcohol-related social activities to moving out of the house. Do not make any threats you are not prepared to carry out.
Be ready to help. Gather information in advance about local treatment options. If the person is willing to seek help, call immediately for an appointment with a treatment program counsellor. Offer to go with the family member on the first visit to a treatment program and/or AA meeting.
Call on a friend.
If the family member still refuses to get help, ask a friend to talk with him or her, using the steps described above. A friend who is a recovering alcoholic may be particularly persuasive, but any caring, non-judgmental friend may be able to make a difference. The intervention of more than one person, more than one time, is often necessary to persuade an alcoholic person to seek help.
Find strength in numbers.
With the help of a professional therapist, some families join with other relatives and friends to confront an alcoholic as a group. While this approach may be effective, it should only be attempted under the guidance of a therapist who is experienced in this kind of group intervention.
Whether or not the alcoholic family member seeks help, you may benefit from the encouragement and support of other people in your situation. Support groups offered in most communities include Al-Anon, which holds regular meetings for spouses and other significant adults in an alcoholic's life, and Alateen, for children of alcoholics. These groups help family members understand that they are not responsible for an alcoholic's drinking and that they need to take steps to take care of themselves, regardless of whether the alcoholic family member chooses to get help. back to top
13. What is a safe level of drinking?
Adults should not regularly exceed: Men: 3-4 units daily. Women: 2-3 units daily. Don’t drink for 48 hours if you exceed the daily guidelines. There is no known safe level of drinking for under 18s. back to top
14. Is it safe to drink if pregnant? No. Drinking during pregnancy can have a number of harmful effects on the newborn, ranging from mental retardation, organ abnormalities, and hyperactivity to learning and behavioural problems. Moreover, many of these disorders last into adulthood.
While we don't yet know exactly how much alcohol is required to cause these problems, we do know that they are 100-percent preventable if a woman does not drink at all during pregnancy. Therefore, for women who are pregnant or are trying to become pregnant, the safest course is to abstain from alcohol. back to top 15. Does alcohol affect people differently as they get older? Yes. As a person ages, certain mental and physical functions tend to decline, including vision, hearing, and reaction time. Moreover, other physical changes associated with aging can make older people feel "high" after drinking fairly small amounts of alcohol. These combined factors make older people more likely to have alcohol-related falls, automobile crashes, and other kinds of accidents. back to top
16. Does alcohol affect women differently to men? Yes. Women become more intoxicated than men after drinking the same amount of alcohol, even when differences in body weight are taken into account. This is because women's bodies have proportionately less water than men's bodies.
Because alcohol mixes with body water, a given amount of alcohol becomes more highly concentrated in a woman's body than in a man's. That is why the recommended drinking limit for women is lower than for men.
In addition, chronic alcohol abuse takes a heavier physical toll on women than on men. Alcohol dependence and related medical problems, such as brain and liver damage, progress more rapidly in women than in men. back to top 17. I have heard that alcohol is good for your heart. Is this true? Several studies have reported that moderate drinkers -- those who have one or two drinks per day -- are less likely to develop heart disease than people who do not drink any alcohol or who drink larger amounts. Small amounts of alcohol may help protect against coronary heart disease by raising levels of "good" HDL cholesterol and by reducing the risk of blood clots in the coronary arteries.
If you are a non-drinker, you should not start drinking only to benefit your heart. Protection against coronary heart disease may be obtained through regular physical activity and a low-fat diet. And if you are pregnant, planning to become pregnant, have been diagnosed as alcoholic, or have any medical condition that could make alcohol use harmful, you should not drink.
Even for those who can drink safely and choose to do so, moderation is the key. Heavy drinking can actually increase the risk of heart failure, stroke, and high blood pressure, as well as cause many other medical problems, such as liver cirrhosis. back to top
18. If I am taking over-the-counter or prescription medication, do I have to stop drinking? Probably not. More than 100 medications interact with alcohol, leading to increased risk of illness, injury and, in some cases, death. The effects of alcohol are increased by medicines that slow down the central nervous system, such as sleeping pills, antihistamines, antidepressants, antianxiety drugs, and some painkillers.
In addition, medicines for certain disorders, including diabetes and heart disease, can be dangerous if used with alcohol. If you are taking any over-the-counter or prescription medications, ask your doctor or pharmacist whether you can safely drink alcohol. back to top
19. How does drinking alcohol effect children?
We’ll briefly mention some of the roles children play within the alcoholic family system, because they become more compulsive, rigid and embedded as the addiction progresses. The Hero – provides the family with self-worth; he is constantly striving, yet feels inadequate. The Hero can go on to become an enabler in a future adult relationship or continue to strive to be perfect in every way. The Enabler – as a child, he tries to keep the family together by taking responsibility for his parents and siblings, which is inappropriate for a child to do. Angry and fearful – feelings which he represses – he believes the system would collapse without his input. (Mum is very often a provoker and an enabler; the employer or family doctor, etc can also cover up for the alcoholic, or assume responsibility instead of him.) The Rebel/Scapegoat – provides a distraction from the true problem. Often vilified, he is blamed for breaking family rules, but it is the family’s pain that is causing him to act out. The Lost Child – nothing is ever expected of this child; he defends himself by becoming invisible and denying his needs; in return he is ignored. As an adult he believes he is worthless and that it is wrong to have needs and to make them known. The Mascot/Clown – again provides distraction from the main event, and provides light relief. He is never taken seriously and one is reminded of the words of the song “the tears of a clown”. Protected by lies, he can become confused and suffer from severe psychiatric problems - for his only response to stress is to clown.
In Family Therapy, the counsellor will address these family roles by ensuring that all the members have a healthy intent – that is, that their motives are correct. Remaining neutral, he will help them identify and explore distorted beliefs which have been developed to irrationally justify their instincts. They must then be encouraged to believe differently, and to act on those new beliefs. Not to do so will result in them continuing to play their roles outside the family, because that’s their only way of coping. back to top
20. Exactly what is alcoholism?
Alcoholism, which is also known as "alcohol dependence syndrome," is a disease that is characterized by the following elements:
Craving: A strong need, or compulsion, to drink.
Loss of control: The frequent inability to stop drinking once a person has begun.
Physical dependence: The occurrence of withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when alcohol use is stopped after a period of heavy drinking. These symptoms are usually relieved by drinking alcohol or by taking another sedative drug.
Tolerance: The need for increasing amounts of alcohol in order to get "high."
Alcoholism has little to do with what kind of alcohol one drinks, how long one has been drinking, or even exactly how much alcohol one consumes. But it has a great deal to do with a person's uncontrollable need for alcohol.
This description of alcoholism helps us understand why most alcoholics can't just "use a little willpower" to stop drinking. He or she is frequently in the grip of a powerful craving for alcohol, a need that can feel as strong as the need for food or water.
While some people are able to recover without help, the majority of alcoholic individuals need outside assistance to recover from their disease. With support and treatment, many individuals are able to stop drinking and rebuild their lives.
Many people wonder: Why can some individuals use alcohol without problems, while others are utterly unable to control their drinking? Recent research supported by NIAAA has demonstrated that for many people, a vulnerability to alcoholism is inherited.
Yet it is important to recognize that aspects of a person's environment, such as peer influences and the availability of alcohol, also are significant influences. Both inherited and environmental influences are called "risk factors."
But risk is not destiny. Just because alcoholism tends to run in families doesn't mean that a child of an alcoholic parent will automatically develop alcoholism. back to top