Alcohol is the most abused drug in the United States.

Coastal rainbow with blue sky For most people who drink, it is a pleasant accompaniment to social activities. Over half of Americans aged 12 and older report being current drinkers (National Survey on Drug Use and Health, 2014). According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA, 2016), women and people over age 59 are at low risk for developing an alcohol use disorder, when they drink no more than 3 drinks on any single day and no more than 7 drinks per week; and, men under age 60 who drink no more than 4 drinks on any single day and no more than 14 drinks per week. (A standard drink is one 12-ounce bottle or can of either beer or a wine cooler, one 5-ounce class of wine, or 1.5 ounces of 80-proof distilled liquor.)

Nonetheless, a large number of people get into serious trouble because of their drinking. Nearly 17 million Americans abuse alcohol or are alcoholic (NIAAA, 2015). Several million more adults engage in risky drinking that could lead to alcohol problems. These patterns include binge drinking and heavy drinking on a regular basis. NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men --- in about 2 hours. The Substance Abuse and Mental Health Administration defines heavy drinking as drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days (SAMHSA, 2016). In addition, 53 percent of men and women in the United States report that one or more of their close relatives have a drinking problem (NIAAA, 2015).

The consequences of alcohol misuse are serious in many cases, often life threatening. Heavy drinking can increase the risk of certain cancers, especially those of the liver, esophagus, throat, and larynx. Heavy drinking can also cause liver cirrhosis, immune system problems, brain damage, and harm to the fetus during pregnancy.
In addition, drinking increases the risk of death from automobile crashes as well as recreational and on-the-job injuries. Furthermore, both homicide and suicides are more likely to be committed by persons who have been drinking. In purely economic terms, alcohol-related problems cost society approximately $249 billion per year (NIAAA, 2014). In human terms, the costs cannot be calculated. Alcoholism, also known as alcohol dependence, is a disease that includes four symptoms:

Craving: A strong need, or compulsion, to drink.
Loss of control: The inability to limit one's drinking on any given occasion.
Physical dependence: Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, occur when alcohol use is stopped after a period of heavy drinking.
Tolerance: The need to drink greater amounts of alcohol in order to get high.

Although some people are able to recover from alcoholism without help, the majority of alcoholics need assistance. With treatment and support, many individuals are able to stop drinking and rebuild their lives.

Many people wonder why some individuals can use alcohol without problems, but others cannot. One important reason has to do with genetics. Scientists have found that having an alcoholic family member makes it more likely that, if you choose to drink, you too may develop alcoholism. Genes, however, are not the whole story. In fact, scientists now believe that certain factors in a person's environment influence whether a person with genetic risk for alcoholism ever develops the disease. A person's risk of developing alcoholism can increase based on the person's environment, including where and how he or she lives; family, friends, and culture; peer pressure; and, even how easy it is to get alcohol.

Alcohol abuse differs from alcoholism in that it does not include a strong craving for alcohol, loss of control over drinking, or physical dependence. Alcohol abuse is defined as a pattern of drinking that results in one or more of the following situations within a 12-month period:

Failure to fulfill major work, school, or home responsibilities.
Drinking in situations that are physically dangerous, such as while driving a car or operating machinery.
Having recurring alcohol-related legal problems, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk.
Continued drinking despite having ongoing relationship problems that are caused or worsened by the drinking.

Although alcohol abuse is distinct from alcoholism, many effects of alcohol abuse are also experienced by alcoholics. Even though alcoholism can be treated, a cure is not yet available. In other words, even if an alcoholic has been sober for a long time and has regained health, he or she remains susceptible to relapse and must continue to avoid all alcoholic beverages. Cutting down on drinking doesn't work; cutting out alcohol is necessary for a successful recovery.

However, even individuals who are determined to stay sober may suffer one or more slips, or relapses, before achieving long-term sobriety. Relapses are very common and do not mean that a person has failed or cannot recover from alcoholism.

Keep in mind, too, that every day that a recovering alcoholic has stayed sober prior to a relapse is valuable, both to the individual and to his or her family. If a relapse occurs, it is very important to stop drinking once again and to get the support you need to abstain from drinking.

Lets begin with a brief quiz that helps people identify whether they have a drinking problem.

The CAGE Questionnaire

The acronym CAGE stands for: Cut down Annoyed Guilty Eye-opener

The CAGE questionnaire was developed by Dr. John Ewing, founding director of the Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill. These four questions, using the CAGE acronym, provide a quick and easy way to see if you or your loved-one might have a drinking problem.

Exercise #1
Select yes or no for each of the following questions:

Have you or your loved-one ever felt you/they should cut down on your/their drinking?

In other words, have you ever felt that you were drinking too much and needed to slow down or even stop? Notice that the question doesn’t ask if you actually tried to quit or cut down. The question simply asks if you ever felt the need to cut down your drinking.
Have people annoyed you or your loved-one by criticizing or complaining about your/their drinking?

In other words, are people telling you that they believe your drinking is a problem? Have people complained to others about your drinking? Has your drinking been the subject of arguments or conflicts?
Have you or your loved-one ever felt guilty about your/their drinking?

Some people feel guilty for things that they did while drinking and regret saying or doing certain things. Other people feel guilty about their drinking because of the harm that it does to themselves or to others.
Have you or your loved-one ever had a drink in the morning (an eye-opener) to steady your/their nerves or to get rid of a hangover?

A drink in the morning is sometimes called an eye-opener. People who drink in moderation generally don’t have bad hangovers. Many people who drink in the morning to get rid of a hangover are really trying to deal with a craving for alcohol.

Even though this CAGE test is simple, it is very useful for helping people figure out whether they or a loved-one may have a drinking problem. If you answered yes to two or more of these questions, there is a good chance that you or your loved-one has a problem with drinking. The questions that follow can help you focus more on how drinking has negatively affected you or your loved-one's life.

Exercise #2
Please answer the following questions:

Describe examples of times you or your loved-one felt that you/they should cut down or reduce your/their drinking or drug use.
Describe a few specific examples of times people complained about your or your loved-one's drinking or drug use.
Have you or your loved-one ever felt guilty for drinking or using drugs? Explain.
If you or your loved-one has ever had a drink or used a drug in the morning as an eye-opener, what were you/they feeling that made you/them need to do so?

Alcohol is called a sedative-hypnotic drug, since it acts as both a sedative and a hypnotic. Sedatives calm people down and reduce anxiety. Hypnotics cause people to become sleepy. Thus, alcohol is a drug that can calm people, reduce anxiety, and make people sleep.

In moderate amounts, alcohol helps many people relax and socialize more easily. It also makes many people feel more confident in themselves. However, the confidence alcohol gives is often misplaced. For instance, although many people think they drive well while drinking, they actually have slower reactions, poor concentration, and bad judgment. They are also more likely to say or do things that they later regret.

Exercise #3
Please answer the following questions:

In what ways have you or your loved-one experienced the sedative and hypnotic (sleep-inducing) properties of alcohol?
Have you or your loved-one ever used alcohol to reduce anxiety? Yes or No (If yes, what happened?)
When drinking, have you or your loved-one ever felt confident about some activity, such as driving, but been told by others that you/they were doing it poorly? Yes or No (If yes, what happened?)
Can you or your loved-one describe things that you/they have said or done while drinking that you/they wish you had not?

Addiction involves compulsion, loss of control, and continued use despite bad consequences. Addiction is a process (meaning it is not a single event). As a result, the compulsion, loss of control, and bad consequences develop over time. Addiction is also progressive, meaning that it gets worse with time if not treated.

The rate at which addiction develops varies depending on the drug used and the route of ingestion. For example, addiction to heroin or cocaine can develop in a matter of weeks or months of regular use. Addiction to smoked or injected heroin or cocaine can develop much quicker. For many people, addiction to alcohol progresses at a slower rate than cocaine or heroin addiction. For some people, it can take years rather than months for it to develop. Since it is a more gradual process, many people don’t notice the development of alcoholism until it is out of control.

There are four main stages in the development of alcoholism. These stages often overlap, and it may take anywhere from a couple of years to twenty for someone to progress from stage 1 to stage 4.

Stage 1:	Regular and heavy drinking begins to cause tolerance. This means that the same amount of alcohol produces less of an effect for the person over time. To get the same desired effect, the person needs to drink more.
Stage 2:	The drinker will begin to have memory lapses about things that happened while drinking. These may be “blackouts,” in which the person loses all memory for a period of time, or “brownouts,” when he or she has a poor or incomplete memory of events.
Stage 3:	A person loses the ability to control his or her drinking. During this stage, many people use more than one drug at the same time, and they may switch from one drug to another.
Stage 4:	This stage includes prolonged binges of intoxication. These binges cause the drinker mental or physical problems. This stage is often called late-stage alcoholism.

Exercise #4
Please answer the following questions:

Have you or your loved-one ever noticed that you/they had to drink more alcohol to get the same effect? Yes or No (If yes, give an example.)
Have you or your loved-one ever had a blackout? Yes or No How did you/they feel when you/they realized what had happened? What did you/they do?
Have you or your loved-one ever gone on a drinking binge? Yes or No How long did it last?

Alcohol is not a “safe” or weak drug. It is a powerful substance that can cause serious damage to many parts of the body. The following are possible health consequences of alcohol abuse:

Cancer: Using alcohol frequently and in large amounts increases the risk of various types of cancers. Alcoholics have a higher risk for cancers of the mouth, tongue, back of the throat (pharynx), voice box (larynx), and esophagus. Also, the risk of liver cancer is higher among alcoholics.

Liver problems: Drinking high volumes of alcohol can cause many liver problems such as fatty liver, alcoholic hepatitis, and cirrhosis of the liver. Higher doses and longer bouts of drinking increase the risk for developing these problems.

Nervous system problems: Alcohol can cause serious harm to the nervous system. Many alcoholics don’t get enough vitamin B1. This can disrupt nerve cells’ activity. It may lead to a type of brain damage that can cause confusion and difficulties in walking and talking (Wernicke’s encephalopathy). It may also cause someone to go into a coma. Some people develop a form of memory loss, confusion, and disorientation (Korsakoff’s psychosis). Alcohol can cause such nervous system problems as cramps, numbness, and pain in the legs and hands. Vitamin B1 injections and a balanced diet often reverse these symptoms.

Heart problems: Using large amounts of alcohol can lead to a number of different heart problems. Alcoholics have a greater risk of heart failure. They also risk coronary heart disease, high blood pressure, and strokes.

Digestive problems: Drinking can cause a number of digestive problems. Drinking large amounts can cause gastritis, an inflammation of the lining of the stomach, and peptic ulcer, in which an area of the digestive system loses the mucus membrane that protects it.

Exercise #5
Please answer the following questions:

Have you or your loved-one ever thought of alcohol as a substance that could damage your/their body? Yes or No (If yes, give examples.)
Are you or your loved-one aware of anyone in your/their family who has suffered from serious medical problems because of alcohol? Yes or No (If yes, give examples.)

In addition to the direct problems caused by alcohol, alcohol can harm the body indirectly in several ways. It can harm the body by creating toxic (or poisonous) chemicals, causing poor nutrition, and altering body chemistry.

Alcohol is toxic or poisonous to the body. After you drink alcohol, your body breaks it down into simpler chemicals called metabolites, which can poison or irritate human tissue.

Alcohol replaces nutritious food with empty calories. Alcohol supplies calories needed for energy but provides no vitamins, minerals, or protein. Since alcohol reduces appetite by irritating the stomach, alcoholics often eat little or no nutritious food, leading to nutritional problems such as a lack of vitamin B1. Regular use of alcohol can disrupt a person’s body chemistry in many ways. For instance, it can cause a very low level of sugar in the blood (hypoglycemia). This problem may lead to weakness, headache, hunger, problems seeing, anxiety, personality changes, delirium, coma, and even death if untreated. Similarly, alcohol can cause a serious increase of fat in the blood (hyperlipidemia), which can seriously damage the liver, heart, and blood vessels.

Exercise #6
Please check the answer that seems most true:

	Alcohol can damage your heart, liver, nervous system, and digestive system.
	Alcohol can damage the chemical balance in your body.
	Alcohol can replace nutritional food with empty calories.
	All of the above
	None of the above

Alcohol (and other drugs) can be especially dangerous for a pregnant woman by increasing the risk of miscarriage. In addition, alcohol used by a pregnant woman can cause physical and mental defects in her unborn child. Alcohol can cause a combination of birth defects known as fetal alcohol syndrome (FAS). While FAS can be caused by regularly drinking as little as two glasses of wine or beer a day, occasional binge drinking may cause it as well. A baby with FAS is abnormally short and has small eyes and a small jaw. This baby may have a smaller brain than normal, various heart defects, a cleft lip, a cleft palate, and joint problems such as a dislocated hip. The FAS baby nurses poorly, is irritable, and sleeps poorly. About one-fifth of FAS babies die during the first few weeks after birth. Many who do survive are mentally and physically disabled in some way. The first eight weeks of pregnancy are the most important period of the embryo’s development; the baby is particularly susceptible to drugs at this time. Unfortunately, during that period, many women may not yet realize that they are pregnant.

Exercise #7
Please check the answer that seems most true:

Which of the following are possible results of drinking by a pregnant mother?

	Miscarriage
	An underweight baby
	An irritable baby
	A baby that will die soon after birth
	A baby with birth defects
	All of the above

Exercise #8
Please check the answer that seems most true:

A baby with fetal alcohol syndrome may

	Be abnormally short at birth
	Have a smaller brain than normal
	Experience various heart defects
	Have facial deformities
	Have trouble nursing
	All of the above

Many people who would not consider themselves alcoholics still have used alcohol regularly along with or in place of their drug of choice. They may have drunk to come down from a drug or to heighten the effects of another drug. Because their attention was focused on their drug of choice, they may not have seen that their tolerance to alcohol was also increasing. Because alcohol is legal and easy to acquire, most users of other drugs also drink alcohol at least occasionally.

It is important that you commit to abstinence from all mood-altering drugs, including alcohol. Even if you did not drink regularly before, drinking may endanger your sobriety. Alcohol can be a trigger for thoughts about other drugs, drug cravings, and drug use. In addition, alcohol impairs a drinker’s perception, thinking, and judgment. At the same time, alcohol decreases inhibitions while increasing confidence. With fewer inhibitions and poor judgment, you would more likely use a drug other than alcohol as well.

Exercise #9
Please answer the following questions:

If you or your loved-one use both alcohol and other drugs, what are some of the ways in which alcohol and other drugs became associated for you/them?
Do you or your loved-one think drinking might affect your/their decision to use other drugs? If so, how?

Caring for a person who has problems with alcohol can be very stressful. It is important that, as you try to help your loved-one, you find a way to take care of yourself as well. It may help to seek support from others, including friends, family, community, and support groups. If you are developing your own symptoms of depression or anxiety, think about seeking professional help for yourself.

Remember that your loved-one is ultimately responsible for managing his or her illness. However, your participation can make a big difference. Based on clinical experience, many health providers believe that support from friends and family members is important in overcoming problems with alcohol. But friends and family may feel unsure about how best to provide support. The groups for family and friends listed on this website under menu item Addiction->Resources->Family may be a good starting point.

Remember that changing deeply set habits is hard, takes time, and requires repeated efforts. We usually experience failures along the way, learn from them, and then keep going. Alcohol use disorders are no different. Try to be patient with your loved-one. Overcoming this disorder is not easy or quick.

Pay attention to your loved-one when he or she is doing better or simply making an effort. Too often we are so angry or discouraged that we take it for granted when things are going better. A word of appreciation or acknowledgement of a success can go a long way.

When you have had enough, ACIS counselors are available to help you and your loved-one get started on the path to recovery.

What is excessive alcohol use?

Excessive alcohol use includes binge drinking, heavy drinking, any alcohol use by people under the age 21 minimum legal drinking age, and any alcohol use by pregnant women.

What is binge drinking?

According to the National Institute on Alcohol Abuse and Alcoholism binge drinking is defined as a pattern of alcohol consumption that brings the blood alcohol concentration (BAC) level to 0.08% or more. This pattern of drinking usually corresponds to 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours.

What do you mean by heavy drinking?

For men, heavy drinking is typically defined as consuming 15 drinks or more per week. For women, heavy drinking is typically defined as consuming 8 drinks or more per week.

What is the difference between alcoholism and alcohol abuse?

Alcohol abuse is a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work. Manifestations of alcohol abuse include the following:

Failure to fulfill major responsibilities at work, school, or home.
Drinking in dangerous situations, such as drinking while driving or operating machinery.
Legal problems related to alcohol, such as being arrested for drinking while driving or for physically hurting someone while drunk.
Continued drinking despite ongoing relationship problems that are caused or worsened by drinking.
Long-term alcohol abuse can turn into alcohol dependence.

Dependency on alcohol, also known as alcohol addiction and alcoholism, is a chronic disease.

The signs and symptoms of alcohol dependence include:

A strong craving for alcohol.
Continued use despite repeated physical, psychological, or interpersonal problems.
The inability to limit drinking.

What does it mean to get drunk?

“Getting drunk” or intoxicated is the result of consuming excessive amounts of alcohol. Binge drinking typically results in acute intoxication.

Alcohol intoxication can be harmful for a variety of reasons, including:

Impaired brain function resulting in poor judgment, reduced reaction time, loss of balance and motor skills, or slurred speech.
Dilation of blood vessels causing a feeling of warmth, but resulting in rapid loss of body heat.
Increased risk of certain cancers, stroke, and liver diseases (e.g., cirrhosis), particularly when excessive amounts of alcohol are consumed over extended periods of time.
Damage to a developing fetus if consumed by pregnant women.
Increased risk of motor-vehicle traffic crashes, violence, and other injuries.

Coma and death can occur if alcohol is consumed rapidly and in large amounts.

I’m young. Is drinking bad for my health?

Yes. Studies have shown that alcohol use by youth and young adults increases the risk of both fatal and nonfatal injuries. Research has also shown that youth who use alcohol before age 15 are five times more likely to become alcohol dependent than adults who begin drinking at age 21. Other consequences of youth alcohol use include increased risky sexual behaviors, poor school performance, and increased risk of suicide and homicide.

Is it okay to drink when pregnant?

No. There is no safe level of alcohol use during pregnancy. Women who are pregnant or plan on becoming pregnant should refrain from drinking alcohol. Several conditions, including Fetal Alcohol Spectrum Disorders have been linked to alcohol use during pregnancy. Women of child bearing age should also avoid Binge drinking to reduce the risk of unintended pregnancy and potential exposure of a developing fetus to alcohol.