alcoholism

(ăl'kə-hô-lĭz'əm, -hŏ-)
n.
A disorder characterized by the excessive consumption of and dependence on alcoholic beverages, leading to physical and psychological harm and impaired social and vocational functioning. Also called alcohol abuse, alcohol dependence.

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The continuous or excessive use of alcohol (ethanol) with associated pathologic results. Alcoholism is characterized by constant or periodic intoxication, although the pattern of consumption varies markedly. Individuals admitted for the first time to an alcoholism treatment center typically have been consuming approximately 3–4 oz (80–100 g) of pure alcohol per day, corresponding to about seven to nine drinks or bottles of beer or glasses of wine. Studies have shown that problem drinking in these populations starts at about 2 oz/day (60 g/day), that is, four to five drinks per day, and that these are consumed in rapid succession, leading to intoxication on three or more days per week. Individuals who consume these levels of alcohol have also a greater than average risk of developing alcoholic liver cirrhosis. However, the levels should not be taken as absolute, since they can vary greatly in different individuals, according to body weight and other factors.

The symptoms and consequences associated with severe alcohol consumption also vary greatly; that is, in some individuals only a few may be present. These may consist of the development of physical dependence manifested as a state of physical discomfort or hyperexcitability (tremors or shakes) that are reduced by continued consumption; the development of tolerance to the effects of alcohol, which leads individuals to increase their consumption; accidents while intoxicated; blackouts, characterized by loss of memory of events while intoxicated; work problems, including dismissal; loss of friends and family association; marital problems, including divorce; financial losses, including bankruptcy or continual unemployment. Medical problems can include gastric ulcers, pancreatitis, liver disease, and brain atrophy. The last is often associated with cognitive deficiencies, as shown by the inability to comprehend relatively simple instructions or to memorize a series of numbers. See also Cognition.

Almost without exception, individuals seeking an early treatment for their alcohol problems have very good probabilities of recovery. The lesser the number of presenting problems described above, the better the chances of favorable outcome, and so an early identification of problem drinking by family, friends, employers, or physicians becomes very important. The types of intervention vary greatly, progressing from self-monitoring techniques to intensive outpatient and inpatient programs to Alcoholics Anonymous groups.

The exact mechanisms of the pharmacological actions of alcohol are not known. Alcohol can act as a stimulant at lower doses and as a depressant at higher doses. Even at very low doses alcohol can impair the sensitivity to odors and taste. Also, low doses are known to alter motor coordination and time and space perception, important aspects of car driving. Some effects are already seen at levels of 0.05%. Pain sensitivity is diminished with moderate doses. In some individuals, alcohol is known to diminish feelings of self-criticism and to inhibit fear and anxiety, effects which are probably related to an alcohol-induced sociability. These effects act, no doubt, as psychological reinforcers for the use of alcoholic beverages.

It is generally accepted that alcohol affects the nerve cell by preventing the production and propagation of electric impulses along a network consisting of axons and synapses. A major finding in the mid-1980s was that some of the neurologic effects of alcohol can be quickly reversed by new experimental drugs. Studies have shown that alcohol enhances the actions of an inhibitory brain neurotransmitter referred to as gamma-aminobutyric acid (GABA). Benzodiazepines, such as diazepam, are anxiety-reducing and sedative drugs which also enhance the effects of GABA. These effects can be reduced by experimental antagonist molecules, which interact in the brain in the same regions where GABA is found. See also Synaptic transmission.

The liver is responsible for about 80% of the metabolism of alcohol. In the liver, alcohol is first oxidized to acetaldehyde and then to acetate, which is metabolized in many tissues, including the brain, heart, and muscles. A 150-lb (68-kg) person metabolizes approximately 0.4 oz (10 g) of pure alcohol per hour (about 1 oz of a distilled beverage per hour) or, if alcohol is continuously present in the bloodstream, about 8–10 oz (190–240 g) of pure alcohol per day, equivalent to 1300–1600 calories per day. Since alcoholic beverages contain negligible levels of essential nutrients, these calories are called “empty calories.” Many alcoholics show malnutrition due to the fact that an important part of their caloric intake is alcohol. Alcohol also impairs the absorption and the metabolism of some essential nutrients. In the presence of alcohol, about 80% of oxygen consumed by the liver is devoted to the metabolism of alcohol; as a consequence, other substances such as fats, normally oxidized by the liver, are not metabolized, leading to fat accumulation in the liver. See also Liver; Malnutrition.

Alcoholic liver disease is characterized by two conditions: failure of the liver to detoxify noxious substances and to produce essential products; and increased resistance to blood flow through the liver. Alcoholic liver disease and liver cirrhosis rank among the 10 leading causes of mortality in the United States and Canada. See also Cirrhosis.

There is abundant evidence that tendency to alcoholism can be of familial origin, due to environmental, cultural, and genetic factors. A Swedish study demonstrated that identical twins are twice as likely to have a common alcoholic problem as fraternal twins. In an American-Danish study, it was shown that children of alcoholic parents are more likely to develop alcoholism (18%) than children of nonalcoholic parents (4%) when both groups of children were adopted by nonrelatives within 6 weeks of birth. See also Behavior genetics; Behavioral toxicology.

Pharmacotherapy for alcohol rehabilitation has been gaining wider acceptance. Specific pharmacotherapies which have received the most research attention utilize naltrexone and disulfiram. Other promising pharmacological interventions are acamprosate and buspirone. Naltrexone is an opiate receptor antagonist which blocks the effects of endogenous opioids in the brain. Research from animal studies suggests that alcohol activates endogenous opioid systems and, thereby, may contribute to the pleasurable effects produced by alcohol consumption. Consequently, naltrexone might reduce the reinforcing effects of alcohol consumed by people and decrease their incentive to drink. Disulfiram is a drug which causes an inhibition of the enzyme aldehyde dehydrogenase, leading to an increase in acetaldehyde blood levels. This rise will produce nausea, vomiting, tachycardia, difficulty in breathing, and changes in blood pressure leading to hypotension. Acamprosate may function to reduce alcohol-induced euphoria related to the effects of excitatory neurotransmitters such as N-methyl-D-aspartate and have some blocking effects on opiate receptors. Buspirone, a nonbenzodiazepine antianxiety agent, may decrease anxiety symptoms associated with a protracted alcohol withdrawal syndrome, thus reducing alcohol relapse potential. Both of these medications require further investigation to determine their effectiveness as a pharmacotherapeutic agent in the treatment of alcoholism.

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Physiological addiction to alcohol, associated with persistent heavy consumption of alcoholic beverages. In addition to the addiction, there may be damage to the liver (cirrhosis), stomach (gastritis), and pancreas (pancreatitis), as well as behavioural changes and peripheral nerve damage.

The term ‘alcoholism’ was first used by a Swedish professor of medicine, Magnus Huss (1807-90), to mean poisoning by alcohol. Huss distinguished between two types of alcoholism. Acute alcoholism was a result of the temporary effects of alcohol taken within a short period of time — drunkenness and intoxication; chronic alcoholism was a pathological condition caused by the habitual use of alcoholic beverages in poisonous amounts over a long period of time. Using case studies to illustrate the condition of chronic alcoholism, Huss provided the first systematic description of the physical damage caused by excessive drinking. This first use of the term ‘alcoholism’ in 1852 emerged from a combination of specific historical circumstances within which changes in perceptions of excessive alcohol consumption were taking place.

Prior to the nineteenth century, symptoms and problems related to ‘habitual drunkenness’, or excessive alcohol use, were known and recorded, but habitual drunkards were seen as morally weak or criminal, rather than suffering from an illness or a disease. Public concern revolved around drunkards' moral attitudes and social behaviours, which were regarded as licentious, sinful, or criminal, punishable by a period in the stocks, whipping, or fines — or by the eternal damnation preached in fiery sermons. On the whole, however, the dominant social response

to drunkenness was tolerance and social disapproval; heavy drinking was not, in itself, regarded as a problem. The emergence of a new understanding of habitual drunkenness (or inebriety) as a disease was led by medical and psychiatric practitioners at the beginning of the nineteenth century, most notably by Benjamin Rush (1745-1813) in America and Thomas Trotter (1760-1832) in Scotland. According to some historians, it was Rush who provided the first clearly developed modern conception of alcohol addiction. This included the idea of gradual and progressive addiction; bouts of drunkenness characterized by an inability to refrain from alcohol; the description of the condition as a ‘disease’; and total abstinence as the cure. For the first time, ‘treatment’ became a possible option in responding to the harm associated with habitual drunkenness. Throughout the nineteenth century efforts were made to provide more scientific descriptions of the disease and its cure, leading, in 1901, to the use of the term ‘alcohol addiction’ to describe the inability to give up harmful drinking.

Twentieth century developments

During the first half of the twentieth century interest in alcoholism and the alcoholic waned. Prohibition in America and changing social conditions and consumption patterns in Britain drew attention towards control of the substance and away from the disease and its treatment. But with the repeal of prohibition in America, any attempt to address problems associated with drinking had to be concerned with the behaviour of individuals rather than with the consumption patterns of the nation or the nature of the substance itself. In post-prohibition America and, later, in post war Britain, the freedom of the majority to drink as they pleased was paramount. The nineteenth century temperance approach, which had inveighed against the dangers of alcohol itself, was now rejected as moralistic and unscientific and the focus of attention was, once again, on the disease of alcoholism.

The ‘new’ disease approach to alcoholism started in America and was led by three linked groups, often referred to as the ‘alcoholism movement’: a research group established at the Yale Centre for Alcohol Studies; Alcoholics Anonymous (AA) (a self-help group which was set up in 1935), and the National Committee for Education on Alcoholism (later the National Council on Alcoholism), which became the leading voluntary organization offering alcoholism treatment. The ‘alcoholism movement’ quickly spread to Britain and subsequently throughout the world.

In essence there was little difference between descriptions of the disease in Rush's work and later use of the term. The main objectives in labelling it as the ‘new’ approach to alcoholism were practical and political rather than based on any ‘scientific’ discovery. On the practical side was the desire to gain a better deal for people suffering from alcoholism. Promoting the disease concept was part of a strategy to combat the stigma and prejudice that hindered alcoholics and their families from seeking help and that was a barrier to securing the interest and involvement of the helping professions. On the political side, the concept served as a device to unite diverse interests, including the alcohol industry, because the focus was on a few unfortunate individuals rather than on the drinking habits of the majority.

The strategy was successful. The disease theory was accepted by the American Medical Association in 1956 and by a number of influential doctors and voluntary groups in Britain over the course of the 1950s and 60s. In the early 1950s, the World Health Organization formally declared its support and provided a definition of ‘alcoholism’ which noted that alcoholics were excessive drinkers, dependent on alcohol to the extent that they suffered noticeable mental disturbance or interference with bodily or mental health, interpersonal relations, and economic functioning. They were people who required treatment.

As in the previous century, there was continuing interest in refining the disease concept and in producing classifications or ‘typologies of drinkers’. The most famous typology was derived from the research of E. M. Jellinek, a member of the Yale Centre for Alcohol Studies and a consultant to the WHO during the 1950s. Influenced strongly by AA philosophy, Jellinek distinguished between five different types of alcoholism. Only two types (Gamma and Delta) were diseases because, in his view, they were addictions in the pharmacological sense that physical dependence on alcohol was present and too sudden cessation of alcohol use would result in withdrawal symptoms. The defining characteristics of Gamma and Delta alcoholism were: acquired increased tissue tolerance; adaptive cell metabolism; withdrawal and craving; and loss of control (Gamma alcoholism) or an inability to abstain (Delta alcoholism). Typically, Gamma alcoholics drank mainly in bouts and were often drunk; Delta alcoholics drank regularly to achieve a blood alcohol level at which they felt comfortable, usually without getting drunk. According to Jellinek, ‘alcoholics’ were those who suffered from Gamma or Delta forms of alcoholism. Other forms of alcoholism were considered to be symptomatic, the dependence on alcohol being psychological without the presence of physiological addiction; individuals in those groups were not, therefore, alcoholics.

Alcohol dependence and related disabilities

Jellinek's classification has continued to have a significant influence over beliefs about alcoholism and about appropriate treatment approaches for alcoholics. But the ambiguities in the terms led to repeated efforts to clarify the concepts, resulting eventually in the substitution of ‘alcoholism’ with the term ‘alcohol-dependence syndrome’, approved by the World Health Assembly in 1976 and incorporated, three years later, into the International Classification of Diseases as a new medical diagnosis. One important feature of the syndrome is that it includes both psychological and physiological dependence. It has seven elements: subjective awareness of the compulsion to drink; narrowing of the drinking repertoire (drinking becomes predominantly a response to the need to avoid withdrawal so that daily intake becomes ‘scheduled’) ; primacy of drinking (drinking becomes more important than any other activity) ; altered tolerance to alcohol; repeated withdrawal symptoms; relief or avoidance of withdrawal symptoms by further drinking; reinstatement after abstinence (return to the drinking pattern established before abstinence, which can happen very quickly after starting to drink again).

At the same time as the alcohol dependence syndrome emerged as a new concept, a WHO group were formulating criteria for the identification and classification of alcohol-related disabilities. The report, published in 1977, described the range of mental, physical, and social disabilities related to alcohol use and emphasized that there were degrees of disabilities. It was not only the ‘alcoholic’ or alcohol-dependent person who was adversely affected by alcohol; damage might be incurred even if the individual was neither dependent nor an excessive drinker.

The emphasis on degrees of disability related to alcohol use rather than dependence is significant since it signalled changes in perceptions of the nature of the alcohol problem. The notion that ‘alcoholics’ suffering from a ‘disease’ were different from the remainder of the population was no longer generally accepted (although some groups still base their therapeutic approaches on disease theories). By the 1980s, many people preferred the term ‘problem drinking’, which covered a continuum of drinking harms, from relatively minor harm, such as behaving in socially embarrassing ways when drunk, missing work because of a hangover, or suffering a fall when drinking, to the severe harms associated with excessive and dependent drinking. Problem drinking was not a disease; it was a ‘learned behaviour’, and anyone who drank was at risk of becoming alcohol dependent. Concern now focused on the much greater number of people drinking above recommended levels, or in ways likely to incur harm to themselves, to other people, or to the wider community.

Today, the term ‘alcoholism’ and ‘alcoholic’ are regarded by many people as stigmatizing labels which are unhelpful in developing appropriate responses to alcohol-related harms. But their continuing use by some groups indicates the co-existence of alternative beliefs about the nature of harmful alcohol use and of different approaches to helping those who become ‘problem drinkers’ or ‘alcoholics’.

— Betsy Thom

Bibliography

• Heather, N. and Robertson, I. (1997). Problem drinking: the new approach, (3rd edn). Oxford University Press

See also addiction; disease; drug abuse.

Definition

Alcoholism, or alcohol dependence, is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as "A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress."

That maladaptive pattern is manifested, according to the DSM-IV, by the following behaviors occurring any time within one 12-month period:

• tolerance for alcohol
• withdrawal from alcohol
• alcohol taken in larger amounts and over a longer period of time than was intended
• persistent desire or unsuccessful efforts to cut down or control alcohol use
• much time spent in activities necessary to obtaining alcohol
• various important activities, for example, in socializing or at work, are given up or reduced because of alcohol use
• alcohol use continued regardless of the pattern of physical or psychological problems that it causes or worsens

Alcohol abuse has the same definition but is manifested by one (or more) of the following behaviors occurring within the same 12-month period:

• repeated alcohol use leading to failure to fulfill major role obligations at work, school, or home
• repeated alcohol use in situations in which it is physically hazardous
• repeated alcohol-related legal problems
• persistent alcohol use despite its causing social and interpersonal problems or exacerbating them

This definition and the criteria established by DSMIV apply to both adults and children. The American Academy of Pediatrics (AAP) states that the pattern of use and abuse of alcohol in children and adolescents is not observably different from what is manifested in young people using marijuana or cocaine.

Description

The AAP divides the progression into childhood alcoholism into three stages:

• Stage 1: Experimentation with alcohol. Normally there is no change noted in physical status or behavior, and the drinking usually occurs only on weekends during social occasions with peers, making it the least detectable of the three. Peer pressure to use alcohol "just for fun."
• Stage 2: Actively trying to obtain alcohol. Alcohol use happens during the week to provide relief when stress is felt or to "feel good" when depressed.
• Stage 3: Preoccupation with alcohol. The child or adolescent has nearly lost the capacity for controlling alcohol use. Setting limits results in withdrawal symptoms, including depression, moodiness, or irritability. Severe withdrawal can result in serious medical problems, including delirium tremens.

Demographics

Prevalence and Severity of the Problem

Based on findings mostly coming from the 1990s, the National Council on Alcohol and Drug Dependence (NCAAD) cites the following in its fact sheet Youth, Alcohol and Other Drugs:

• Approximately 10.4 million Americans ages 12 to 20 have at least one drink per month. One fifth of these (2.1 million) are heavy drinkers who have five or more drinks on a minimum of five different occasions. More than half of these (6.8 million) are considered binge drinkers who have five or more drinks on a single occasion.
• Eighty percent of all high school seniors have tried alcohol.
• Eight percent of eighth graders, 24 percent of tenth graders, and 32 percent of high school seniors have been intoxicated from alcohol in the past month.
• Children who begin smoking tobacco before the age of 13 are significantly more at risk for alcohol problems.
• Among high school seniors, alcohol use is more prevalent among Caucasian and Hispanic students than among African American students.
• Junior, middle, and senior high school students consume 35 percent of all wine coolers sold in the United States as well as 1.1 billion cans of beer.
• A Southern Illinois University study showed that students with overall grades of D or F drank on average three times as much alcohol as students with overall grades of A.
• A United States Department of Justice survey showed that nearly one third of children below the age of 18 incarcerated in juvenile institutions are under the influence of alcohol at the time of their arrest.
• More than half (56%) of children and teens in grades five through 12 report that alcohol advertising encourages them to drink.
• Thirty percent of children in grades four through six state that they have received pressure from peers to drink beer.
• Two thirds of teenagers who drink report that they are able to make their own alcohol purchases.
• The total cost of alcohol use by young people, including automobile crashes, violent crime, alcohol poisoning, burns, drowning, suicide attempts, and fetal alcohol syndrome is more than 58 billion dollars each year.
• Eighty percent of teenagers do not know that a 12-ounce can of beer has the same amount of alcohol as a shot of whiskey or a five-ounce glass of wine.

Causes and Symptoms

In their article "Early Identification and Intervention for Adolescent Alcohol Use," Mark Werner and Hoover Adjer Jr., both fellows at the American Academy of Pediatrics (AAP), state that attitudes regarding alcohol use are developed quite early in life, usually by the age of eight. Parental attitudes regarding alcohol and behaviors related to alcohol use have a major impact on how children and young adults view drinking alcohol. Not every child or teen who experiments with alcohol becomes an alcoholic, but NCADD studies have shown that children who drink before the age of 15 are four times more likely to become alcoholic than those who begin drinking after the age of 21. Some evidence supports a genetic component to this disease. Parents who are themselves alcoholic or problem drinkers are more likely to have children who develop alcohol dependence. Statistically, one in five children who have an alcoholic parent becomes an alcoholic, too.

Physical symptoms seen in adult alcoholics, such as gastritis, pancreatitis, hepatitis, or even cirrhosis, usually are absent in childhood alcoholics. Such physical damage normally takes longer to develop and is more typical of long-term adult alcoholics. More often in potential childhood alcoholics, behavioral symptoms provide the most significant clues.

These behavioral warning signs, according to the AAP, typically include the following:

• decline in school functioning, decreased attendance, poorer grades, and/or general deterioration in social functioning in school
• increased isolation outside school; rejection of usual long-term friendships in favor of new or different friends
• frequent arguments or less communication with family members; being more secretive
• marked changes in grooming and clothing styles
• noticeable increase in unexplained injuries and fights
• running away from home
• depressive symptoms such as weight loss, sleep problems, lethargy, feelings of hopelessness, mood swings, suicidal feelings, or suicide attempts
• evidence of the presence of risk-taking behaviors such as either driving while under the influence of alcohol or driving with others who are intoxicated, engaging in violent behaviors such as fights, or participating in unsafe sex

When to Call the Doctor

It is worth noting that these behavioral warning flags can appear in non-alcoholic children or teens and also are usually not observed before the second or third stage of childhood alcoholism. Parents observing some or all of these warning signs need professional help to both clarify diagnosis and plan treatment. Individual and family denial is considered a large portion of any alcohol problem. Parents need objectivity and open and honest communication with their children in order to deal effectively with childhood alcoholism and to know when to seek help.

Diagnosis

As noted, behavioral symptoms help to determine the diagnosis, but not usually until the second and third stage of the disease. There are assessments available that can provide both earlier identification and intervention for childhood alcoholism.

Diagnostic assessments for alcoholism, according to the APA, include:

• CAGE, a mnemonic that points to four key questions by highlighting key words: "Cut down," "Annoyed," "Guilty," and "Early" (see below)
• Alcohol Use Disorders Inventory Test (AUDIT)
• Personal Experience Screening Questionnaire (PESQ)
• Problem Oriented Screening Instrument for Teenagers (POSIT)

CAGE is an assessment guide containing the following four questions:

• C: Have you ever felt the need to cut down on your drinking?
• A: Do you get annoyed at criticism by others about your drinking?
• G: Have you ever felt guilty about your drinking or something you have done while drinking?
• E: Have you ever felt the need for a drink early in the morning?

Treatment

Once assessment has led to a diagnosed problem with alcohol, its severity determines the treatment needed. In "Early Identification and Intervention for Adolescent Alcohol Use," Werner and Adjer divide problem teen drinkers into three groups:

• The first category includes those teens who are using alcohol occasionally but still doing well emotionally and developmentally and who are not drinking and driving. The treatment objectives for this group are to encourage abstinence and re-enforce safety by fostering the continuation of not driving while drinking and not driving with others who are drinking.
• The second category includes those teens who are more at-risk because while they are maintaining stability in physical, developmental, and emotional status, they are also drinking and driving. Professionals dealing with members of this group may not be able to maintain confidentiality, and people in this group may benefit from an introduction to organizations such as Students Against Drunk Driving (SADD).
• The third category includes those showing serious signs of impairment, including inability to follow through on obligations at school or on a job, alcohol-related encounters with police or the justice system, and mental health problems such as anxiety, depression, or oppositional-defiant behavior. These children may experience frequent acute intoxication or withdrawal symptoms, medical complications, or an inability to stop or reduce their alcohol intake. Werner and Adjer suggest that professionals dealing with members of this group probably need to set aside confidentiality in order to involve parents in the treatment process. Treatment may include detoxification in an in-patient facility and/or rehabilitation in a youth-centered substance abuse program.

Treatment Options

The following key issues should be considered in determining which treatment option is appropriate:

• severity of the problem and evidence to suggest other mental health problems (e.g. depression, suicide attempts)
• staff credentials of those treating the child or teen, and what forms of therapy (e.g., family, group, medications) are to be used
• nature of family involvement
• how education is to be continued during treatment
• if an in-patient program is necessary, what length it should be
• what aftercare is to be provided following discharge
• what portion of treatment is to be covered by health insurance and what needs to be paid out of pocket

Alcoholics Anonymous

Since its inception in the 1930s, Alcoholics Anonymous (AA) has been an important non-medical means of treating alcoholism with millions of members worldwide, many of whom are teenagers. It is a spiritual but non-religious program that fosters abstinence from alcohol based upon a belief that the person suffering from alcoholism is "powerless" over their addiction. AA suggests that people can stay free of alcohol by using an attitude that focuses on "one day at a time" and that consciously seeks spiritual support from "a power greater than themselves." AA is generally a part of most in-patient treatment and rehabilitation programs.

Prognosis

Prevention provides the best possible prognosis for alcohol abuse and dependence. The National Council on Alcoholism and Drug Dependence estimates that parents who talk with their children regularly about the danger from drugs (including alcohol) have children who are 42 percent less likely to use these substances. Once alcoholism is present, abstinence is the only known completely successful treatment. Children suffering from alcohol dependence continue for the rest of their lives to be at risk for problems with alcohol if they again drink. The prognosis is excellent for young alcoholics who remain alcohol-free and who do not substitute other drugs for alcohol, sometimes called "chewing their booze" in AA.

Prevention

Alcohol use and abuse has been a feature of Western culture for centuries, a facet of American life since Europeans arrived in North America, literally arriving with the pilgrims on the Mayflower. It is typically part of U.S. celebrations and even some American-observed religious rites. Because alcohol overuse and abuse has been so much a part of Western experience, there is clearly a tremendous need–among children and adults—for better education about both alcohol consumption and alcoholism. The statistics indicate that parents, teachers, and healthcare professionals need to begin educating children as early as possible regarding the risks involved in alcohol use. Parents who provide the example of limiting their own alcohol and other drug use can help their children inestimably. It should never be inferred that difficult situations can be better coped with by having a drink or that getting drunk is either helpful or amusing. Moreover, parents and other adults need to set the example by not driving a car or operating machinery while they are drinking or under the influence of alcohol.

The APA suggests the following as the most effective ways that parents can aid their children in resisting drinking:

• Provide children with self-confidence by building self-esteem and not engaging in constant criticism. Good self-esteem is the best defense against peer pressure to drink.
• Listen to children. Parents who listen attentively and provide support during difficult times give their children invaluable aid in coping with pressures.
• Get to know the children's friends.
• Provide supervision and discourage teens from attending parties where alcohol is served or parents are absent, and band together with other parents to arrange alcohol-free social events for children.
• Be available and encourage children and teens to call home for a ride rather than drive with someone who has been drinking; assure children there will be no recrimination, as SADD recommends.
• Teach therapeutic coping mechanisms by modeling how to handle stress, pain, or tension in healthy ways, by exercising, using yoga and meditation, and talking about feelings.
• Understand the tremendous importance of child and adolescent issues, including alcohol and other drug use and acceptance by peers; be ready and able to discuss these subjects with children.
• Encourage and participate in enjoyable, worthwhile activities with children; be reassuring that there is time enough for both work and fun.
• Be willing to learn about alcohol abuse; attend, along with their children, programs offered by schools, churches, and other groups providing information about the prevention of alcohol abuse.
• Maintain healthy lines of communication with children; remember the saying, "You are only as sick as the secrets you keep."

Nutritional Concerns

Most childhood alcoholics do not reach the serious state of malnutrition that chronic adult alcoholics can reach. However, severe cases of alcohol abuse and dependence may result in a child or teen not eating normally, resulting in weight loss and vitamin deficiencies (B-vitamins particularly). Resumption of normal eating habits and possible addition of vitamin supplements can help in regaining normal nutrition.

Parental Concerns

Parents of alcoholic children often encounter persistent and highly traumatic worries regarding serious physical, emotional, social, and legal problems for the affected child as well as the terrifying possibility of that child's death or serious injury. Clearly, these concerns can take a huge toll in a family. The denial mentioned earlier is often a complicating factor. The notion of "Not my son or daughter!" can actually hinder treatment and recovery for a child. Parents are also often embarrassed by their child's alcohol abuse and may believe that it is somehow their fault. It is not uncommon for parents to feel isolated and to feel as if they are the only ones with this problem. High school programs such as the earlier-described SADD can address some of the fear regarding drunk driving. Parental support groups such as Tough Love programs and twelve-step groups such as Al Anon can help parents to better understand the problem they facing and can help make them aware that they not alone and that they have options.

Al Anon is a twelve-step program (that is, a program based on the twelve steps employed by Alcoholics Anonymous) that provides support and spiritual recovery for the families and loved ones of alcoholics. This program was begun in the early 1940s by the wives of some of AA's earliest members and founders, including Lois Wilson, wife of AA founder Bill Wilson. Twelve-step programs have spun off over the years to meet the needs of specific populations, including adult children of alcoholics and teens who are alcoholics.

Because parents of alcoholic children often believe they are responsible for their child's drinking, the Three C's that Al Anon offers its participants may be particularly helpful. These Three C's state:

• "I didn't cause anyone else's alcoholism."
• "I can't control anyone else's alcoholism."
• "I can't cure anyone else's alcoholism."

Tough Love, a program begun by Phyllis and David York, co-authors of a book by the same title, is designed to help families and especially parents cope with a variety of problems, including alcoholism and drug abuse, that often affect children and ultimately the whole family. Tough Love's approach is different from that of Al Anon. The ten beliefs listed below form the basis for this program and show clearly the difference in philosophy:

• Parents are people too.
• Parents' material and emotional resources are limited.
• Parents and kids are not equal.
• Blaming keeps people helpless.
• Kids' behavior affects parents. Parents' behavior affects kids.
• Taking a stand precipitates a crisis.
• From a controlled crisis comes the possibility of positive change.
• Families need to give and get support in their own community in order to change.
• The essence of family life is cooperation, not togetherness.

Al Anon and Tough Love are offered in a variety of formats to the families of alcoholic children through treatment centers, churches, and other community services. It is clear that there are dramatic differences between these two philosophies. But perhaps the best way for parents to decide which approach makes sense to them is to take the advice Al Anon offers all newcomers: "Take what you like and leave the rest."

Resources

Books

Egendorf, Laura K. Teen Alcoholism. Farmington Hills, MI: Gale, 2001.

Greenleaf, Victoria C. G. Fighting the Good Fight: One Family's Struggle against Adolescent Alcoholism. Fort Bragg, CA: Cypress House, 2002.

Shannon, Joyce Brennflech. Alcohol Information for Teens: Health Tips about Alcohol and Alcoholics. Detroit, MI: Omnigraphics, 2004.

Organizations

Alcoholics Anonymous. (See white pages of local telephone book for area groups.) Web site: www.alcoholicsanonymous.org.

National Council on Alcoholism and Drug Dependence. 20 Exchange Place, Suite 2902, New York, NY 10005. Web site: www.ncadd.org.

National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute of Health, Willco Building, 6000 Executive Blvd., Bethesda, MD 20892–7003. Web site: www.niaaa.nih.gov.

Students Against Drunk Driving (SADD). Marlborough, MA. 01752. Web site: www.saddonline.com.

Web Sites

Al-Anon and Alateen. Available online at www.al-anon.alateen.org (accessed October 16, 2004).

Alcoholics Anonymous. Available online at www.alcoholicsanonymous.org (accessed October 16, 2004).

"Alcohol Use and Abuse: A Pediatric Concern." American Academy of Pediatrics, Committee on Substance Abuse. Available online at (accessed October 16, 2004).

Werner, Mark J., and Hoover Adjer. "Early Identification and Intervention for Adolescent Alcohol Use." American Academy of Pediatrics. Available online at www.aap.org/advocacy/chm98ado.htm (accessed October 16, 2004).

"Youth, Alcohol, and Other Drugs: An Overview." National Council on Alcoholism and Drug Dependence. Available online at www.ncadd.org/facts/youthalc.html (accessed October 16, 2004).

[Article by: Joan Schonbeck, R.N.]

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The term "alcoholism" is a noun and concept suggesting both a destructively and chronically excessive beverage alcohol consumption and a medical-style conception of the source, character, explanation, and social and medical handling of the purported condition. The word's introduction is often attributed to Swedish physician Magnus Huss in 1849. The same two broad ideas have been conveyed in a changing parade of terminology since 1800—including, for example, "dipsomania," "inebriety," "habitual drunkenness," "alcohol addiction," "problem drinker," and others. Ordinary language has many words for the excessive drinker, too—including "drunkard," "boozehound," "sot," "lush," "wino," etc.—although these do not necessarily connote medico-scientific causation. Slang words or phrases for drunkenness are most numerous of all—for example, "blitzed," "bombed," "blasted," "three sheets to the wind," "wiped out," and a great many more—one scholar counted hundreds. Beginning in the late 1970s, "alcohol dependence," or the "alcohol dependence syndrome," became the preferred medico-psychiatric terms for the condition. However, the word "alcoholism" has persisted in popular thought and common usage.

An American preoccupation with alcohol-related excess dates back to the beginnings of the republic and beyond. Dr. Benjamin Rush—a physician, signer of the Declaration of Independence, and often regarded as father to both American psychiatry and the American temperance movement—authored a treatise in 1784 titled An Inquiry into the Effects of Ardent Spirits, in which the disease character of chronic drunkenness was asserted. Establishment of an inebriate's asylum was proposed as early as 1830 in Connecticut, and such an institution given form in a widely read paper by Dr. Samuel Woodward in 1838. The Washingtonian Movement, a lay self-and mutual-help movement, gained wide fame in the 1840s and occasioned the rise of special homes for inebriates. This short-lived movement in turn gave way to the development of larger asylums in the 1850s and 1860s—the first such state-run institution opened in Binghamton, New York in 1864. Dr. Leslie Keeley opened the first of his private treatment sanatoriums in 1880, and by 1901 was reported to have thirty-nine facilities nationwide. National Prohibition (1919–1933) did little, however, to advance alcoholism treatment in the nation.

A "modern alcoholism movement," ostensibly aimed at rescuing the alcoholic from the ignorance and maltreatment of the past, had its beginnings very soon after the repeal of Prohibition on 5 December 1933. The Fellowship of Alcoholics Anonymous (AA) often dates its origins to a chance meeting between its two founders, "Bill W." (William G. Wilson) and "Dr. Bob" (Robert H. Smith) in May 1935. Soon afterward, the American scientific community began a push to unravel the mystery of alcoholism and other alcohol-related problems. Although the two post-Prohibition enterprises—AA and modern science—were remarkably different from each other in character and approach, a loose coalition of the two was fashioned in the mid-1940s by Marty Mann and E. M. Jellinek.

Marty Mann was the daughter of a well-to-do socialite family that fell on hard times in the Great Depression, and was herself brought low by heavy drinking in the mid-1930s. Mann was hired by E. M. Jellinek of the Yale Center on Alcohol Studies, the chief center for new alcohol science at the time, to persuade the American public that alcoholism was a disease, that the alcoholic required and deserved treatment, and that such care was a public responsibility. Mann's organization—originally named the National Committee for Education on Alcoholism (NCEA); later (and in its heyday), the National Council on Alcoholism (NCA); and eventually, the National Council on Alcoholism and Drug Dependence (NCADD)—was launched in October 1944. Behind the scenes, Jellinek and the leadership of Yale's alcohol science enterprise were hoping that Mann's new campaign would provide grassroots support for the expansion of alcoholism treatment and the promotion of scientific research—in much the same way that the American Cancer Society had served that function for cancer researchers. Jellinek doubtless looked forward to the expansion of AA as an ever growing source of members interested in scientific inquiry into alcoholism.

Perhaps the crowning achievement of the modern alcoholism movement was the creation of the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA), signed into law by President Richard M. Nixon on New Year's Eve, 1970. Along with the success of the modern alcoholism movement, however, came more than a few challenges and changes. New research, sponsored by NIAAA, undermined some of the tenets of the movement's traditional beliefs about alcoholism—seeming to show, for example, that some alcoholics could safely return to controlled drinking. The availability of new and significantly increased government funding for alcoholism research and treatment tended both to professionalize the field and to bring in competing conceptual models and institutions. Moreover, popular attention began to shift its focus to other alcohol-related problems: a new emphasis on fetal alcohol syndrome in the mid-1970s; the rise around 1980 of the Mothers Against Drunk Driving (MADD) campaigns; and a growing concern with college and underage drinking in the 1990s. These issues tended to dilute societal attention paid to the alcoholic, though a thriving alcoholism research enterprise continued apace at NIAAA.

Alcoholism, once the province of a determined post-Prohibition and post-World War II (1939–1945) movement, has become parent to a wider preoccupation with addictions. Through it all, however, AA has continued to sustain its central place in the alcoholism topic arena—despite the growth of a diffuse and vocal chorus of critics and providers of would-be alternatives. Illicit drugs—and the so-called "War on Drugs"—and tobacco have eclipsed alcohol in popular attention, and also to an extent reshaped and recontextualized alcohol as "a drug," or one among several "substance abuse" or "chemical dependency" problems.

Bibliography

Baumohl, Jim, and Robin Room. "Inebriety, Doctors, and the State: Alcoholism Treatment Institutions Before 1940." In Recent Developments in Alcoholism. Edited by Marc Galanter. Vol. 5. New York: Plenum Publishing, 1987. Essential reading on pre-1940 alcoholism treatment and conceptualization.

Blocker, Jack S., Jr. American Temperance Movements: Cycles of Re-form. Boston: Twayne Publishers, 1989. This author sees the alcoholism movement period as the most recent chapter in an ongoing historical story of temperance cycles.

Brown, Sally, and David R. Brown. A Biography of Mrs. Marty Mann: The First Lady of Alcoholics Anonymous. Center City, Minn.: Hazelden Information and Educational Services, 2001. A praiseful account but nevertheless rich in biographical information.

Katcher, Brian S. "Benjamin Rush's educational campaign against hard drinking." American Journal of Public Health 83, no. 2 (1993): 273–281.

Kurtz, Ernest. Not-God: A History of Alcoholics Anonymous. Center City, Minn.: Hazelden Information & Educational Services, 1979. The classic history of AA's origins and earlier years.

Levine, Harry Gene. "The vocabulary of drunkenness." Journal of Studies on Alcohol. 42, no. 3 (1981): 1038–1051. More words for drunkenness than you ever imagined.

White, William L. Slaying the Dragon: The History of Addiction Treatment and Recovery in America. Bloomington, Ill.: Chestnut Health Systems/Lighthouse Institute, 1998. A valuable historical compendium.

Wiener, Carolyn L. The Politics of Alcoholism: Building an Arena Around a Social Problem. New Brunswick, N.J.: Transaction Books, 1981. How the U.S. National Institute on Alcohol Abuse and Alcoholism affected this country's alcohol problems social arena.

—Ron Roizen

Swedish researcher Magnus Huss first used the term "alcoholism" in 1849 to describe a variety of physical symptoms associated with drunkenness. By the 1860s, Russian medical experts built on Huss's theories, relying on models of alcoholism developed in French and German universities to conduct laboratory studies on the effects of alcohol on the body and mind. They adopted the term "alcoholism" (alkogolizm) as opposed to "drunkenness" (pyanstvo) to connote the phenomenon of disease, and determined that it mainly afflicted the lower classes.

In 1896, at the urging of the Swiss-born physician and temperance advocate E. F. Erisman, the Twelfth International Congress of Physicians in Moscow established a special division on alcoholism as a medical problem. Within a year the Kazan Temperance Society established the first hospital for alcoholics in Kazan. In 1897, physician and temperance advocate A. M. Korovin founded a private hospital for alcoholics in Moscow, and in 1898 the Trusteeships of Popular Temperance opened an outpatient clinic.

That same year, growing public concern over alcoholism led to the creation of the Special Commission on Alcoholism and the Means for Combating It. Headed by psychiatrist N. M. Nizhegorodtsev, the ninety-five members of the commission included physicians, psychiatrists, temperance advocates, academics, civil servants, a few clergy, and two government representatives. Classifying alcoholism as a mental illness, members of the commission blamed widespread alcoholism on the tsarist government, which relied heavily on liquor revenues and refused to improve the socioeconomic conditions of the lower classes.

Although they accepted the definition of alcoholism as a disease, professionals could not agree on exactly what it was, what caused it, or how to cure it. These were topics of heated debate, and they could not be seriously discussed without critical analysis of the government's social and economic policies. Hence, the range of opinions expressed in professional discourse over alcoholism reflected the fragmentation of middle-class ideologies near the end of the imperial period: the abstract civic values of liberalism and modernization as borrowed from the West; a powerful and persistent model of custodial statehood; and a pervasive culture of collectivism.

With the Bolshevik Revolution of 1917, definitions of alcoholism changed. Seeking Marxist interpretations for most social ills, Soviet health practitioners defined alcoholism as a petit bourgeois phenomenon, a holdover from the tsarist past. Working from the premise that illness could only be understood in its social context, they determined that alcoholism was a social disease influenced by factors such as illiteracy, poverty, and poor living conditions. In 1926 the director of the State Institute for Social Hygiene, A. V. Molkov, opened a department, headed by E. I. Deichman, for the sole purpose of studying alcoholism as a social disease. Within four years, however, the department was closed and the institute disbanded. By placing blame for alcoholism on social causes, Molkov, Deichman, and others were, in effect, criticizing the state's social policies - a dangerous position in the Stalinist 1930s.

In 1933 Josef Stalin announced that success was being achieved in the construction of socialism in the USSR; therefore, it was no longer plagued by petit bourgeois problems such as alcoholism. For the next fifty-two years, alcoholism did not officially exist in the Soviet Union. Consequently, all public discussion of alcoholism ended until 1985, when Mikhail S. Gorbachev launched a nationwide but ill-fated temperance campaign.

Bibliography

Herlihy, Patricia. (2002). The Alcoholic Empire: Vodka and Politics in Late Imperial Russia. Oxford: Oxford University Press.

Segal, Boris. (1987). Russian Drinking: Use and Abuse of Alcohol in Prerevolutionary Russia. New Brunswick, NJ: Publications Division, Rutgers Center of Alcohol Studies.

Segal, Boris. (1990). The Drunken Society: Alcohol Abuse and Alcoholism in the Soviet Union, a Comparative Study. New York: Hippocrene Books.

White, Stephan. (1996). Russia Goes Dry: Alcohol, State, and Society. Cambridge, UK: Cambridge University Press.

—KATE TRANSCHEL

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Alcoholism is not a psychoanalytic concept. The most rigorous definition, following from the basic notion of dependence, is the one provided by Pierre Fouquet: "An alcoholic is any man or woman who has lost the ability to do without alcohol." The word "alcoholism" was introduced by the Swedish physician Magnus Huss (1849) and mentioned in France by M. Gabriel (1866) in his medical dissertation. It appears in Freud's writings prior to 1900 in association with hysteria and hypnosis, as a form of "subjection," a "morbid habit," falling somewhere "between the organic affections and the disorders of the imagination." Principal occurrences of the word appear in letters to Wilhelm Fliess (especially that of December 22, 1897), in the attached manuscript (Draft H., 1895), and especially in the key text "Sexuality in the Aetiology of the Neuroses" (1898a). "Habit," Freud writes, "is a mere form of words, without any explanatory value" and "success will only be an apparent one, so long as the physician contents himself with withdrawing the narcotic substance from his patients, without troubling about the source from which their imperative need for it springs" (p. 276).

It was initially believed (Sigmund Freud, Karl Abraham, Sándor Ferenczi) that alcohol does not create symptoms but only promotes them, removing inhibitions, and destroying sublimation. The theory of alcohol addiction (1905d) is summarized in terms of its predominance among men beginning with the onset of puberty; its relationship to sexuality, and latent homosexuality, already identified as narcissistic and specular by Viktor Tausk (1913) and Lou Andreas-Salomé (1912); oral fixation, and autoerotic behavior. Emphasis later focused on the nature of the defensive process, an immediately effective means, but one that is too accessible, which is why it is so dangerous (1930a [1929]). The economic approach to affects was emphasized next—concepts of alexithymia (McDougall, 1978), instinctual discharge by the body ("resomatization of affects"), and acting out ("dispersion," "destruction of affects," "acts-symptoms"), depending on the author—all at the expense of psychic elaboration.

Alcohol plays the role of a unique substitute object and a trap, creating a pseudo-reality; the hallucinations associated with delirium tremens cease with the administration of alcohol. The narcissistic problematic (withdrawal) in fact harbors an autoerotic component and gives rise to defenses, barriers, or narcissistic prostheses, such as an overinvestment in work, children, "friends," etc., and alcohol. The mechanism of splitting into non-alcoholic (common, neurotic) and alcoholic sectors of the ego has denial as its corollary, but it is a denial that does not involve the perception of an external reality (difference of the sexes, castration) but rather the internal perception of the body itself. There exist silent zones, "matrices of painful, deadly territories that threaten the unity of the ego" (Mijolla and Shentoub, 1973). These are the parts of the body that lie outside symbolization and outside language, as described by Jean Clavreul (1959). For Paul Schilder and Walter Bromberg (1933), alcoholism is accompanied by a regression from castration that leads to bodily fragmentation. The alcoholic short circuit leaves no room for the establishment of loss, the source of desire, but rather establishes an ensemble of needs and repetitive acts that are without meaning. An analogy can be made with pathological games. Shame or opprobrium are distinguished from guilt. The superego of an alcoholic is demanding but "soluble in alcohol" (Simmel, 1930). There is no strong image with which the subject identifies, but identification can occur with someone hated, which can lead to "self-hatred." The indulgent and demanding mother who creates insecurity is the object of reverse fantasies (idealization).

The symbolism of alcohol is that of vital fluids (blood, "the blood of the vine," sperm, milk) or destructive humors (urine, feces), of the breast and the penis, good and/or bad. This symbolism is present in all the myths associated with alcohol, from Dionysus to the Eucharist.

The situation in terms of a psychoanalytic classification is still the subject of controversy. It is a narcissistic disorder, closer to manic-depression and paranoia than to neurosis, psychosis, or perversion. Its issues fall within the framework of addiction.

Intolerance to alcohol can be interpreted as a reaction formation to the excitations that alcohol promotes, or to the frequently negative attitudes toward alcoholics, sometimes as extreme as hatred (Winnicott, D. W., 1947), or even to the most primitive issues of the alcoholic that are awakened in the therapist. From the standpoint of treatment, it is a matter of detoxification or social prohibition (1927c)—"Not all men abandon this toxic supplement with the same facility" (1905c), "the only effective remedy is the resolution that draws its strength from a powerful current of the libido"—as opposed to involvement of the superego (1966b [1932]). The effectiveness of temperance movements appear to be associated with libidinal investments "torn from alcohol" and given expression in exhibitionism, or homosexual and narcissistic masochism.

There is a double risk of using the term "alcoholism": the risk of turning it into a closed and homogenized entity, or of breaking apart the clinical concept, reductively assimilating it to various diagnostic classifications (neurosis, psychosis, perversion—fetishism, for example—paranoia, manic-depression, psychopathy, etc.). To compound the problem, concepts such as homosexuality, orality, "disappointment," and "libidinal viscosity," risk serving as facile or even completely inappropriate explanations.

Freud himself often superimposed the phenomenology of drunkenness and the psychopathology of alcohol addiction, and even considered the relation of the alcoholic to his poison as nonconflictual, "the purest harmony," and "an example of a happy marriage" (1912d, p. 188). Blind spots with respect to his own relationship to toxic substances (cocaine, tobacco) led him outside the field of psychoanalysis when he postulated a "toxological theory" in psycho-pathology, which he did not abandon until the Outline of Psychoanalysis (Descombey, 1994).

There are a number of concepts related to alcoholism: addiction, alcoholic intoxication, alcoholic delirium and jealousy, delirium tremens (Viktor Tausk's delirium of action or occupation), alcohol-associated epilepsy. And it can be asked, as Freud asked about psychosis, if the terms "denial" and "repression" have the same meaning with respect to alcoholism as they do for the psychopathology of the neuroses. The same question could also be asked about the familiar use of the concepts of desire and pleasure when it comes to a clinical practice that is situated "beyond the pleasure principle" or within the register of need.

Post-Freudian authors who have done substantive work on alcoholism include James Glover (1938) and the Kleinians Herbert Rosenfeld (1964) (paranoidschizoid and depressive positions), Sándor Radó (1933) (pharamacothymia, initial anxiety depression, pharmacogenic orgasm, addiction crisis), and Michael Balint (1977) (basic fault). There has also been renewed interest in the subject in the work of the French psychoanalysts Jean Clavreul (1959), Alain de Mijolla and Salem A. Shentoub (1973); the Lacanians François Perrier (1975), Charles Melman (1976), A. Rigaud (1976), M. Lasselin (1979), and F. Gondolo-Calais (1980); as well as Jacques Ascher (1978), Joyce McDougall (1989), M. Monjauze (1991), and Jean-Paul Descombey (1985-1994).

Bibliography

Bromberg, William, and Schilder, Paul. (1933). Alcoholic hallucinations—castration and dismembering motives. International Journal of Psychoanalysis, 14, 206-224.

Clavreul, Jean. (1959). La parole de l'alcoolique. Psychanalyse, 5, 257-280.

Descombey, Jean-Paul. (1985). Alcoolique, mon frère, toi: l'alcoolisme entre médecine, psychiatrie et psychanalyse. Toulouse: Privat.

——. (1994). Précis d'alcoologie clinique. Paris: Dunod.

Freud, Sigmund. (1898a). Sexuality in the aetiology of the neuroses. SE, 3: 259-285.

——. (1905d). Three essays on the theory of sexuality. SE, 7: 123-243.

——. (1912d). On the universal tendency to debasement in the sphere of love. SE, 11; 177-190.

Huss, Magnus. (1849). Alcoholismus chronicus eller kronisk alkoholsjukdom. Stockholm: n.p.

McDougall, Joyce. (1989). Theaters of the body: a psychoanalytic approach to psychosomatic illness. New York: Norton.

Mijolla, Alain de, and Shentoub, Salem A. (1973). Pour une psychanalyse de l'alcoolisme. Paris: Payot.

Further Reading

Director, L. (2002). Relational psychoanalysis in the treatment of chronic drug & alcohol abuse. Psychoanalytic Dialogues, 12, 551-580.

—JEAN-PAUL DESCOMBEY

A chronic disease associated with the excessive and habitual use of alcohol; the disease, if left unattended, worsens and can kill the sufferer. Alcoholism is marked by physical dependency and can cause disorders in many organs of the body, including the liver (see cirrhosis), stomach, intestines, and brain. It is also associated with abnormal heart rhythms, with certain cancers, and, because of loss of appetite, with poor nutrition. The cause of alcoholism is very complicated and most often involves a mixture of physical, psychological, and possibly genetic factors.

a common disease caused by prolonged abuse of alcoholic (i.e. ethanol-containing) beverages. A genetic predisposition can be demonstrated in some individuals. Fatty liver develops rapidly after an episode of acute abuse, and chronic abuse leads to hepatic cirrhosis, cardiomegaly, premature atherosclerosis, and brain atrophy. Ethanol is metabolized by alcohol dehydrogenase (ADH) to acetaldehyde, which is then oxidized to acetate by aldehyde dehydrogenase (ALDH). An inactive form of an isozyme of ADH (ADH20) is transmitted as an autosomal dominant trait in a high percentage of Orientals and is caused by an inactivating polymorphism. The mitochondrial isozyme of ALDH (ALDH20) is also common in Orientals. Both defects increase the vulnerability to alcoholism of those who carry them.

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n

The continued extreme dependence on excessive amounts of alcohol, accompanied by a cumulative pattern of deviant behaviors. The most frequent medical consequences of alcoholism are chronic gastritis, central nervous system depression, and cirrhosis of the liver, each of which can compromise the delivery of dental care.

For a list of words related to alcoholism, see:

• Afflictions and Conditions - alcoholism: addiction to alcoholic liquor
• Drunkenness, Drunkards, and Alcoholism - alcoholism: condition of uncontrollable continual or sporadic heavy drinking of alcohol

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Dansk (Danish)
n. - alkoholisme, alkoholmisbrug

Nederlands (Dutch)
alcoholisme

Français (French)
n. - alcoolisme

Deutsch (German)
n. - Alkoholismus

Ελληνική (Greek)
n. - (παθολ.) αλκοολισμός

Italiano (Italian)
alcolismo

Português (Portuguese)
n. - alcoolismo (m)

Русский (Russian)
алкоголизм

Español (Spanish)
n. - alcoholismo

Svenska (Swedish)
n. - alkoholism

中文（简体）(Chinese (Simplified))
酒精中毒, 酗酒

中文（繁體）(Chinese (Traditional))
n. - 酒精中毒, 酗酒

한국어 (Korean)
n. - 알코올 중독

日本語 (Japanese)
n. - 習慣性の飲酒, アルコール中毒

العربيه (Arabic)
‏(الاسم) ألكحوليه, إدمان ألمسكرات, ألتسمم بالكحول‏

עברית (Hebrew)
n. - ‮התמכרות לשתיית אלכוהול, אלכוהוליזם, כהלת‬

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