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Understanding Alcohol Use Disorders and Their Treatment,
Psychologists play a vital role
For many people, drinking alcohol is nothing
more than a pleasant way to relax. However, people with alcohol use disorders
drink to excess, endangering both themselves and others. This
question-and-answer fact sheet explains alcohol problems and how psychologists
can help people recover.
When does drinking become a problem?
What causes alcohol-related disorders?
How do alcohol-use disorders affect people?
When should someone seek help?
How can a psychologist help?
When does drinking become a
problem?
For most adults, moderate alcohol use—no more than two drinks a day for men
and one for women and older people—is relatively harmless. (A “drink” means
1.5 ounces of spirits, 5 ounces of wine, or 12 ounces of beer, all of which
contain 0.5 ounces of alcohol.) Moderate use, however, lies at one end of a
range that moves through alcohol abuse to alcohol dependence:
 | Alcohol abuse is a drinking pattern that
results in significant and recurrent adverse consequences. Alcohol abusers
may fail to fulfill major school, work or family obligations. They may
have drinking-related legal problems, such as repeated arrests for driving
while intoxicated. They may have relationship problems related to their
drinking. |
 | People with alcoholism—technically known as
alcohol dependence—have lost reliable control of their alcohol use. It
doesn’t matter what kind of alcohol someone drinks or even how much:
alcohol-dependent people are often unable to stop drinking once they
start. Alcohol dependence is characterized by tolerance (the need to drink
more to achieve the same “high”) and withdrawal symptoms if drinking is
suddenly stopped. Withdrawal symptoms may include nausea, sweating,
restlessness, irritability, tremors, hallucinations, and convulsions.
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Although severe alcohol problems get the most
public attention, even mild to moderate problems cause substantial damage to
individuals, their families, and the community.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA),
1 in 13 American adults is an alcohol abuser or alcoholic at any given time.
A 1997 government survey revealed that drinking problems are also common
among younger Americans. For example, almost 5 million youths aged 12 to 20
engage in binge drinking, which involves females consuming at least four
drinks on a single occasion and males at least five.
What causes alcohol-related disorders?
Problem drinking has multiple causes, with genetic, physiological,
psychological and social factors all playing a role. Not every individual is
equally affected by each cause. For some alcohol abusers, psychological
traits such as impulsiveness, low self-esteem, and a need for approval
prompt inappropriate drinking. Some individuals drink to cope with or
“medicate” emotional problems. Social and environmental factors such as peer
pressure and the easy availability of alcohol can play key roles. Poverty
and physical or sexual abuse increase the odds of developing alcohol
dependence.
Genetic factors make some people especially vulnerable to alcohol
dependence. Contrary to myth, being able to “hold your liquor” means you’re
probably more at risk—not less—for alcohol problems. Yet a family history of
alcohol problems doesn’t mean that children of those with alcohol problems
will automatically grow up to have these problems—nor does the absence of
family drinking problems necessarily protect children from developing these
problems.
Once people begin drinking excessively, the problem can perpetuate itself.
Heavy drinking can cause physiological changes that make more drinking the
only way to avoid discomfort. Individuals with alcohol dependence may drink
partly to reduce or avoid withdrawal symptoms.
How do alcohol-use disorders affect people?
While some research suggests that small amounts of alcohol may have
beneficial cardiovascular effects, there is widespread agreement that
heavier drinking can lead to health problems. In fact, 100,000 Americans die
from alcohol-related causes each year. Short-term effects include memory
loss, hangovers, and blackouts. Long-term problems associated with heavy
drinking include stomach ailments, heart problems, cancer, brain damage,
serious memory loss, and liver cirrhosis. Heavy drinkers also markedly
increase their chances of dying from automobile accidents, homicide, and
suicide. Although men are much more likely than women to develop alcoholism,
women’s health suffers more, even at lower levels of consumption.
Drinking problems also have a very negative impact on mental health. Alcohol
abuse and alcoholism can worsen existing conditions such as depression or
induce new problems such as serious memory loss, depression, or anxiety.
Alcohol problems don’t just hurt the drinker. According to NIAAA, more than
half of Americans have at least one close relative with a drinking problem.
Spouses and children of heavy drinkers are more likely to face family
violence; children are more likely to suffer physical and sexual abuse and
neglect and to develop psychological problems. Women who drink during
pregnancy run a serious risk of damaging their fetuses. Relatives and
friends can be killed or injured in alcohol-related accidents and assaults.
When should someone seek help?
Individuals often hide their drinking or deny they have a problem. How can
you tell if you or someone you know is in trouble? Signs of a possible
problem include having friends or relatives express concern, being annoyed
when people criticize your drinking, feeling guilty about your drinking and
thinking that you should cut down but finding yourself unable to do so,
and/or needing a morning drink to steady your nerves or relieve a hangover.
Some people with drinking problems work hard to resolve them, and often,
with the support of family members and/or friends, these individuals are
able to recover on their own. However, those with alcohol dependence usually
can’t stop drinking through willpower alone. Many need outside help. They
may need medically supervised detoxification to avoid potentially
life-threatening withdrawal symptoms such as seizures. Once people are
stabilized, they may need help resolving psychological issues associated
with problem drinking.
There are several approaches available for treating alcohol problems. No one
approach is best for all individuals.
How can a Mental Health
Professional help?
Mental Health Professionals who are trained and experienced in
treating alcohol problems can be helpful in many ways. Before the drinker
seeks assistance, a psychologist can guide the family or others in helping
to increase the drinker’s motivation to change.
A Mental Health Professional can begin with the drinker by assessing
the types and degrees of problems the drinker has experienced. The results
of the assessment can offer initial guidance to the drinker about what
treatment to seek and help motivate the problem drinker to get treatment.
Individuals with drinking problems definitely improve their chances of
recovery by seeking help early.
Using one or more of several types of psychological therapies,
a Mental Health Professional
can help people address psychological issues involved in their problem
drinking. A number of these therapies, including cognitive-behavioral coping
skills treatment and motivational enhancement therapy, were developed by
psychologists. Additional therapies include 12-Step facilitation approaches
that assist those with drinking problems in using self-help programs such as
Alcoholics Anonymous (AA). All three of these therapies—cognitive-behavioral
coping skills treatment, motivational enhancement therapy, and 12-Step
facilitation approaches—have demonstrated their effectiveness through
well-designed, large-scale treatment trials. These therapies can help people
boost their motivation to stop drinking, identify circumstances that trigger
drinking, learn new methods to cope with high-risk drinking situations, and
develop social support systems within their own communities.
Many individuals with alcohol problems suffer from other mental health
conditions, such as severe anxiety and depression, at the same time.
Psychologists can be very helpful for diagnosing and treating these
“co-occurring” psychological conditions when they begin to create
impairment. Further, a drinker in treatment may receive services from many
health professionals, and a psychologist may play an important role in
coordinating these services.
Mental Health
professionals can also provide marital, family, and group therapies,
which often are helpful for repairing interpersonal relationships and for
long-term success in resolving problem drinking. Family relationships
influence drinking behavior, and these relationships often change during an
individual’s recovery. The Mental Health professional can help the
drinker and significant others navigate these complex transitions, help
families understand problem drinking and learn how to support family members
in recovery, and refer family members to self-help groups such as Al-Anon
and Alateen.
Because a person may experience one or more relapses and return to problem
drinking, it can be crucial to have an appropriate health professional such
as a trusted psychologist with whom that person can discuss and learn from
these events. If the drinker is unable to resolve alcohol problems fully, a
psychologist can help with reducing alcohol use and minimizing problems.
Mental Health professionals can also provide referrals to self-help
groups. Even after formal treatment ends, many people seek additional
support through continued involvement in such groups.
Alcohol-related disorders severely impair functioning and health. But the
prospects for successful long-term problem resolution are good for people
who seek help from appropriate sources. Psychologists are applying the
substantial knowledge they have to help people resolve alcohol problems, and
they are working to make treatment services available wherever needed.
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