Globally, alcohol abuse disorders have become a problem for seventy-six million people (Orford, Natera, Copello, Atkinson, 2005). Addiction is a disease, not merely a social disorder. The disease not only affects the inflicted individuals, but can also be detrimental to family members and the greater community. Causes of addiction can be grouped into three categories: psychological traits, the family, and cultural beliefs. In order to remedy this problem, researchers have suggested psychosocial treatment, participation in Alcoholics Anonymous including abstinence from the drug completely, and having drug abuse education to counteract the social culture in which an addict is surrounded.
Keywords: alcoholism, addiction, effects, causes, treatment
Because alcohol is a legal and socially acceptable drug in the United States, its abuse is often unclear and goes un-noticed. Compared with other more intense drugs such as heroin and cocaine, alcohol is not as harshly frowned upon (Read, 2010). However, with seventy-six million people world-wide abusing the substance, alcoholism has become a prevalent disorder in society (Orfold et al., 2005). Alcoholism is an extensive problem, affecting addicts themselves, their families, and communities. Researchers have found the main causes for the disease, and with support of empirical data, have attempted to alleviate these causes with effective treatment strategies. Definition of Problem
In simple terms, alcoholism is defined as a “progressive loss of control,” including a loss of jurisdiction when it comes to forecasting amounts of alcohol that will be consumed in a given sitting (Read, 2010). Despite consequences alcohol has on communal and professional performance, an alcoholic is compelled to obtain the substance no matter the circumstances. A Two-Part Disease
Alcoholism includes two parts: alcohol abuse and alcohol dependence. The four criteria for an alcohol abuse diagnosis include: repetitive drinking resulting in the inability to fulfill a commitment, drinking in dangerous environments, legal problems related to excessive drinking, or continuation of drinking despite relational complications. Alcohol dependence diagnoses depend on the fulfillment of three of seven requirements. These requirements include tolerance, withdrawal, drinking large amounts for extended periods of time, unsuccessful tries at cutting back on alcohol, spending excess time drinking or recovering from drinking, giving up favorable activities for drinking, and lastly, continual drinking, regardless of psychological or physical set back (Kerridge, 2007). Ewing Acronym
The Ewing acronym, CAGE, was formulated in 1984 and is still used today to assess if a patient is considered an alcoholic. The CAGE questionnaire stands for control, anger, guilt, and eye-opener. Control includes the realization of the need to cut back on alcohol consumption. A beginning sign of addiction is when promises to lay off the bottle are broken. Anger is defined as feeling perturbed when confronted about how much alcohol one is consuming. Patients are asked to question how they feel when a spouse, sibling, or other close friend criticizes their habits. If an individual feels guilty about drinking or recognizes a potential improvement in their life without the substance, it is time to realize the extent of the misuse of alcohol. Finally, having the need to wake up and have a drink or deal with a hangover by drinking more is a telling sign of an alcohol abuse issue. If any part of the CAGE questionnaire pertains to an individual, it is probable that he or she is transitioning from an experimental play with alcohol to a serious addiction (Ewing, 1984). Importance of Problem to Society
Colonial Americans did not view alcohol as a harmful substance, with the drug widely accepted in families and communities (Lender & Martin, 1982). With the onset of the Temperance Movement in the 1800’s, alcohol switched roles, now considered the “Demon Rum.” Today, the United States is a temperance country, with high rates of binge drinking and as a result, more social and health problems. Extent of Problem
Alcoholism has become a widespread concern in our society, with one third of Americans becoming dependent on the drug at some point in their lifetime (Read, 2010). According to a 2010 survey of Americans aged twelve or older, over 51.8 percent reported being current drinkers of alcohol, an estimated 131.3 million people (U.S. Department of Health and human Services (HHS), 2010). Nearly one quarter of persons aged twelve or older participated in binge drinking at least once in the thirty days prior to the 2010 survey, translating to nearly 58.6 million people. In 2010, heavy drinking was reported by 6.7 percent of the population aged twelve or older, equaling roughly 16.9 million people. Results from the National Epidemiologic Survey on Alcohol and Related Conditions indicate that four percent of the population at a given time is dependent on alcohol; however, most never seek treatment (Read, 2010) (Hasin, Stinson, Ogburn, & Grant, 2007). In 2009, two million people over the age of twelve received treatment for an alcohol related problem. Of those who reached out for assistance, only twenty-five percent remained abstinent for the first year following treatment completion (Hasin et al., 2007). Effects
Use of alcohol causes a reduction in self-control, the ability to control object permanence, execute behaviors, or regulate emotions (Fillmore, 2003). These effects not only have an impact on alcoholics themselves, but cause disturbances in family systems and communities. Individuals
Excessive alcohol intake is harmful to the body, causing memory loss, blackouts, loss of consciousness, and damage to organs, the brain and liver in particular. Neural changes caused by habitual use of alcohol are characterized by impulsive and extravagant behavior (Fillmore, 2003). Dependency on alcohol often causes relapse, a rapid return to previous drinking behaviors (Rehm, Room, Monteiro, Gmel, Graham, & Rehn, 2003). Worldwide, 3.7 percent of all deaths are attributed to alcohol overdoses. Additionally, due to the effects of extreme alcohol consumption on the body, a person’s life expectancy can be cut short by 4.4 percent. In many cases, alcohol use leads to other illicit drug use; of the 16.9 million people considered to be heavy drinkers in 2010, 31.8 percent were also illicit drug users (HHS, 2010). Most commonly, alcohol use was tied to tobacco use. The National Department of Health and Human Services (2010) reported, “Among heavy alcohol users aged twelve or older, 54.5 percent smoked cigarettes in the past month, while only 17.9 percent of non-binge current drinkers and 16.1 percent of persons who did not drink alcohol in the past month were current smokers.” Alcoholism puts individuals at risk for driving under the influence. In 2010, 11.4 percent of those aged twelve or older were suspected of driving under the influence at least once during the year (HHS, 2010). Families
With nearly eight percent of the population sharing a household with an alcoholic family member, it has been concluded that the effects of alcoholism do not stop at the individual, but also impact the families of alcoholics. A Norwegian study found that family members of alcoholics must deal with being kept up at night, being harassed, feeling fearful of drunkards, or being physically injured (Rossow & Hauge, 2004). Another study found that alcoholism contributes to interpersonal conflict, domestic violence, separation or divorce, financial difficulties, and parental inadequacy within the family (Pickens, Preston, Miles, Gupman, Johnson, & Newlin, 2001). In particular, children of alcoholics are more prone to experience physical or sexual abuse (Obot, Wagner, & Anthony, 2001). In fact, the researchers of a Latin-American study following Daniel, an alcoholic father, found that after six months of treatment, he was less angry and more affectionate, leading him to develop a closer relationship with his children (Reinaldo & Pillon, 2008). When treating an alcoholic, family members are often a voluntary, unrecognized resource, offering health and social care.
Economic costs can take two forms: actual monetary contributions and time. Health care costs must be taken care of and additional time and effort is needed to make appointments, do housework, and provide childcare. Families with an alcoholic have higher health care costs than families with an asthma or diabetes patient (Ray, Mertens, & Weisner, 2009 ). Families must also deal with a psychological cost, often referred to as the “unhappiness quotient.” In research by Copello, Templeton, and Powell (2009), six costs were summarized. First, the day-to-day cost includes financial support from family members. Incidental cost is money unintentionally given to relatives for alcohol. Cost of crime is the likelihood of having money or personal property stolen by alcohol abusers. There is the lost opportunity for employment, or a second income. Healthcare costs are a burden placed on the family. Finally, the effects of dependent drug use cause unhappiness for family members living in that environment (Copello, Templeton, & Powell, 2009).
With roughly seventy-six million people suffering from alcoholism in the world, it has been concluded that the disease indirectly affects another seventy-six million people in society. A 2011 study found that twenty-nine percent of the population had at least one heavy drinker in their life (Casswell, You, & Huckle, 2011). Nineteen percent reported having one heavy drinker, seven percent reported two heavy drinkers, while three percent reported three or more heavy drinkers in their life. A quarter of the twenty nine percent having at least one heavy drinker in their life was living in the same household as the alcoholic. A direct correlation was found between being involved with an alcoholic and lower personal wellbeing and health. Exposure to excessive drinking has been associated with a decrease in usual activities, coupled with increased levels of anxiety and depression.
Prevalence of alcohol in violent crimes is more common than the use of cocaine, crack, heroin, or any other illegal drug. According to probation officer Edward Read (2010), forty percent of violent crimes committed in the United States list alcohol abuse as a significant factor. Particularly in household disputes, seventy-five percent of violent incidences against spouses have involved alcohol. As of 2010, seventy percent of the offender population held in jails were considered to be problem drinkers. Causes of the Problem
Research shows that the development of alcoholism can stem from certain psychological traits, the family system, and cultural differences. However, alcoholism is often caused by a combination of these factors. While it is possible to develop an addiction solely because of poor coping mechanisms, it is more likely to have low anxiety control coupled with a family history of alcoholism and a culture that values social drinking. Psychological Traits
Tension relief, anxiety control, personality disorders, and impulsivity, among other aspects of an individual’s psychological qualities have a significant effect on the development of an alcohol disorder (Cohen, 1983). Relaxation is sought to relieve the stress and tension from certain situational pressures. In fact, research states, “Expectancies about the effects of alcohol relaxation or social facilitation predict up to fifty percent of the variance in alcohol use” (Goldman, Del Boca, & Darkes, 1999). In operant conditioning, feelings of guilt, shame, low self-esteem, depression, or loneliness brought on by tension-filled situations are temporarily forgotten while drinking. When a heavy drinker has self-medicated these problems successfully in the past, striving to relieve tension in future situations can lead to increased drinking. Immature, dependent people who do not cope well with anxiety are the type of people who look to alcohol to solve problems.
Alcoholism statistics show that depressed people, schizophrenics, and sociopathic persons are a high percentage of those with the disease (Cohen, 1983). Being impulsive includes having “cannot stop” and “cannot wait” inhibitions. In other words, impulsive persons have difficulty holding a predetermined response, such as the number of drinks an individual will have in one sitting, and an inability to adapt behavior when a reward is delayed (Robinson, Eagle, Mar, Bari, Banerjee, & Jiang, 2008). An individual has a loss of willpower when an impulsive register is coupled with an inadequate reflective register necessary to moderate a response. The imbalance between the two systems is caused by an overactive reactive system and a limited reflective system, resulting in weakened control (Lubman, Yucel, & Pantelis, 2004). A combination of some or all of these traits is a pre-cursor for alcoholism. Family
While alcoholism is not necessarily inherited, the clearest forecaster of alcoholism lies in the family history of the disease. With a family member diagnosed as an alcoholic, there are two ways the disease could be passed along to the next generation. Alcoholism can be obtained through genetic heterogeneity or go through a mixed form of transmission, including a dominant gene coupled with other psychological or social traits (Jellinek & Jollifer, 1940). A Greek adoption study answers the nature versus nurture question regarding alcoholism. When compared to a control group of adopted children without alcoholic parents, adopted children with an alcoholic biological parent develop alcohol addiction more often (Lykoyras, Moussas, & Botsis, 2004). The ratio of alcoholism development in boys with alcoholic parents to boys with non-alcoholic parents is four times as many, disregarding adoption of biological up bringing (McGue, 1994). One way that alcoholism is acquired is through modeling, most often of a same sex parent (Cohen, 1983). When a role model relies heavily upon alcohol to get through every day, adolescents are more likely to adopt similar habits by identification. Adolescence is a time when coping patterns are being explored and identified.
Teenagers review parents’ behaviors and responses, and imitate those actions in order to form a similar result, establishing most patterns of behavior. If drinking is acceptable within the household, drinking habits are likely to be formed. Additionally, parenting styles have influence on the development of alcoholism. If parents either neglect or overprotect their children, negative effects arise. Neglect removes a reliable role model in a child’s life. Thus, children have the ability to model anyone or any other group, rather than a dedicated family unit. Overprotection causes dependence, low self-esteem, and poor problem solving or decision-making abilities. Researchers in a 2009 study found that both men and women with father authoritarian figures had higher levels of depressive symptoms and more alcohol related problems (Morgan-Lopez & Patock-Peckham, 2009). When faced with challenging situations or feelings of frustration or confusion, an individual’s ability to effectively handle these situations is never fully developed, thus aiding in the expansion of alcohol consuming behavior. Research suggests that a combination of genetic factors and the nature of the family unit is the most telling cause of alcoholism. Culture and Media
Cultural traditions and stereotypes portrayed by the media aid in the development of alcoholism. There are particular cultures such as the French, Irish, and Americans who have high numbers of diagnosed alcoholics (Cohen, 1983). Alcoholism in the Italian and Chinese cultures is much less common. The value of alcohol in a society, child rearing practices, or the acceptance of intoxication in public are given reasons for the varying differences within different societies. Individuals in a society with significant pressure to drink and higher rates of excessive drinking are at greater risk for obtaining the addiction. The United States and other English speaking nations are characterized by binge drinking, leading to social and health problems. In the United States, alcohol is considered a psychotropic agent, associated with misbehavior (Allamani, 2002). Other cultures drink alcohol for the taste and smell, closely related to specific foods and not to drugs and their effects. Certain attitudes toward the interpretation of drinking can cause some to slip into alcoholic tendencies. Especially for certain groups within a culture, heavy drinking is a cultural norm. For young, urban males, drinking shows manliness (Cohen, 1983). It allows for individuals to identify with a group.
The same symbolism that portrays drinking as “macho” is used in media advertising, reinforcing drinking behaviors. A study analyzing alcohol commercials and magazine alcohol advertisements recognized that male actors appeared more often than females (Finn & Strickland, 1982). For example, men outnumbered women five to one in television beer ads. Working men, athletes, and other “masculine” roles were cast for these same commercials. Over half of television beer ads portrayed a message of macho men taking a break from a culturally masculine activity to have a beer. In movies, strong emotional scenes involving pressure or intense decision-making have actors gulping drinks (Cohen, 1983). There is the “one gulp” scene when pressures are low and the more dramatic, “five gulp” scene when stakes are high. Media’s propaganda depicts drinking as the norm and an effective coping mechanism, contributing to eventual alcoholism for some. Effective Strategies
To counteract the causes of alcoholism, effective strategies must be put into place to aid in the recovery of alcoholics. To offset the negative psychological traits of an alcoholic, psychosocial treatment is successful in altering social behaviors. Alcoholics Anonymous programs seek to find a community that emphasizes abstinence for alcoholics. In a culture that values drinking, educational programs are put into place to inform potential drinkers about the effects and dangers of excessive drug use. Psychosocial Treatment
Psychosocial treatments with the highest effectiveness focus on behavioral interventions, concentrating on developing effective coping mechanisms and improving the combination of patients’ abilities and environmental demands (Nathan & Gorman, 2002). Assertiveness and communication are developed in social skills training. It teaches patients how to initiate social conversations, express their thoughts and feelings, and respond appropriately to criticism. The community reinforcement method includes interventions to aid with familial, work, or legal situations. It often involves a club where patients can go to enjoy leisure activities without the presence of alcohol.
This method is used in a group setting so patients can interact, engage with each other, and provide criticism. The buddy system and group counseling aid in identifying problems and preventing relapse. This helps alcoholics deal with stressful situations in a positive way, not simply turning to alcohol for relief. However, group counseling gives patients an opportunity to discuss their alcoholic tendencies, often elevating the situation instead of minimizing it. Through these methods, alcoholics must learn to reevaluate their drinking, indicating a moderation of problematic drinking. Alcoholics Anonymous and Abstinence
Of the two million people over the age of twelve who received alcohol treatment, the majority of patients participated in Alcoholics Anonymous with long term after care, including attendance at meetings and having a sponsor (Slaymaker & Sheehan, 2008). A study found that among 302 respondents from treatment centers in California, both forms of Alcoholics Anonymous participation were closely associated with abstinence (Witbrodt, & Kaskutas, 2005). The main purpose of the group is to help patients achieve sobriety and then stay sober. It is a twelve step process to quit drinking alcohol and remain sober (Branscum & Sharma, 2010). The program is readily available, with facilities in every state and abroad. Additionally, financial limitations are not a problem because the service is free to its members.
The sponsor that is assigned to an individual patient is most likely a recovering alcoholic, permitting for personal stories of sobriety to be exchanged as well as personal assistance through the recovery process. Where as patients likely modeled alcoholic tendencies of family members when developing the addiction, they are now able to model sobriety techniques of dry sponsors in pursuit of abstinence. In a review of the effectiveness of Alcoholics Anonymous, three studies concluded that, “no experimental studies unequivocally demonstrated the effectiveness of Alcoholics Anonymous or twelve step facilitation approaches for reducing alcohol dependence or problem” (Ferri, Amato, & Davoli, 2006). Alcoholics Anonymous does have a high drop out rate however. It is unclear if this is because they have achieved abstinence or they have relapsed Education and Prevention Programs
To counteract the social acceptance of alcohol in the United States, culturally focused intervention emphasizes the development of personal and social skills, placing emphasis on the ability to cope with pressures to drink alcohol (Epstein, Diaz, & Botvin, 1995). This type of prevention program emphasizes the need to resist peer pressure and form positive personal relationships. Also, education programs are put in place with a five-session curriculum to inform students at a young age about drug use and major consequences. A research study evaluating adolescent’s intentions of alcohol use following educational and culturally focused intervention program suggest that both skills training and culturally focused methods decreased adolescents’ intentions to drink beer or wine. Two years later a follow up study found that both prevention approaches produced significant reductions in how often adolescents drank and how often they were drunk. Prevention programs do not seek to change the culture in which individuals live, but instead seek to educate adolescents on the negative effects of alcohol and drug abuse in efforts to eliminate the possibility of developing alcoholism in the future.
With alcohol addiction directly or indirectly affecting upwards of two hundred million people, alcoholism is seen everywhere in our society. Psychological traits, the family unit, and the overall culture and media have significant influence on the development of alcoholism. Psychosocial treatments have been put into effect to better develop coping mechanisms. Alcoholics Anonymous and other twelve step programs provide alcoholics with a support group when striving for sobriety. Finally, education and prevention programs seek to inform society about the dangers of alcohol abuse, in order to counteract a culture that encourages social drinking. With an implementation of these strategies, research has proven that alcoholism rates should decrease, with positive social and health effects on the individual, families, and communities.
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