Alcoholism is a chronic illness characterized by the habitual drinking of alcoholic beverages to the extent that health and social functioning are impaired. Alcohol, when consumed in excessive amounts, is habit-forming, and the alcoholic can neither refrain from drinking nor control the amount he consumes. He is both physically and psychologically dependent on alcohol.
It is hard to say just what personality traits are likely to lead to alcoholism. However, it is known that the potential alcoholic usually has feelings of isolation, a low tolerance for frustration, a tendency to act impulsively, a sense of rebellion, and a low capacity to persevere. In most cases the alcoholic develops his addiction gradually. In the early stages he may drink only for social purposes but enjoys the tension-relieving effects of the drinking. In the next stage he begins drinking alone, and soon, to hide his growing addiction, he starts drinking in secret. Finally, he becomes a chronic alcoholic when he finds it necessary to indulge habitually in a morning drink to be able to face the oncoming day.
It is estimated that there are about 5% million alcoholics in the United States, about one fourth of whom suffer serious complications of the disease. The rate of alcoholism varies greatly from country to country and from urban to suburban and rural communities. The country with the highest rate of alcoholism is France. It is followed by the United States, Switzerland, and Sweden. In the United States the highest rate of alcoholism occurs in Nevada; next, in descending order, are California, Rhode Island, Massachusetts, and New York. Urban areas generally have a higher alcoholism rate than rural areas, and the majority of alcoholics are found in homes, factories, and offices-. Only a small percentage of alcoholics are "skid row" or "Bowery" types.
Sociological studies of alcoholism show that more than half the alcoholics in the United States are living with a spouse in an established household. About 70 percent hold jobs involving special responsibilities or skills, and nearly 60 percent are known to have held steady employment at one job for at least 3 years. More than 80 percent are under 50 years of age.
In the United States, drinking as a social custom has become a habit of both leisure and business hours, and drinking patterns are greatly influenced by economic factors. The slum dweller drinks at the local tavern, the businessman drinks at his club, and the suburbanite drinks at the homes of his friends and neighbors. Cultural factors also influence drinking patterns. For example, the highest rates of alcoholism in the United States are found among the Irish and the Poles. The Italians, Greeks, and Jews are at the low end of the scale, despite their high rate of alcohol consumption. Some occupational groups tend to have a relatively high rate of alcoholism; for example, bartenders, liquor salesmen, night-club operators, and seamen. The ratio of men to women alcoholics is about 5.8 to 1. However, recent studies have shown a disturbing rate of increase in alcoholism among women.
Physical and Mental Effects
Alcohol is easily absorbed from the digestive tract into the bloodstream and is quickly distributed throughout the body. It affects nearly all the cells, particularly those of the brain, and contrary to popular belief, it acts as a depressant, not a stimulant. As the concentration of alcohol in the blood increases, more and more centers of the brain are affected. A blood-alcohol level of 0.05 percent, resulting from the drinking of 2 or 3 ounces (60 to 90 ml) of whiskey, depresses only the highest brain centers, those concerned with judgment and inhibition. A blood-alcohol level of 0.1 percent of whiskey (4 to 6 oz, or 102 to 175 ml) affects some of the motor areas of the brain, especially those concerned with speech, balance, and manual dexterity. An alcohol concentration of 0.2 percent (8 to 12 oz, or 235 to 355 ml) depresses all the motor centers and also the midbrain, the area concerned with emotions. When the alcohol concentration reaches about 0.45 percent (18 to 26 oz, or 430 to 770 ml) it depresses the entire area concerned with perception, and the drinker falls into a coma. Finally, at a level of about 0.7 percent (27 to 42 oz, or 800 to 1,240 ml) the centers controlling the heartbeat and breathing are depressed and the person dies.
After a prolonged period of drinking, lasting from a few hours to several days, the alcoholic is usually dehydrated, overactive, and in need of food. He also needs medication to settle his inflamed stomach. As he emerges from the drinking episode he may suffer nausea, headache, heartburn, thirst, tremors, weakness, giddiness, palpitations, and extreme restlessness. These symptoms may be accompanied by insomnia, delirium, hallucinations, convulsions, and a tendency to become easily injured or infected.
Chronic alcoholics usually develop a number of physical traits and disorders. These include puffiness of the face, redness of the eyes, and in some, an enlargement of the tissue of the nose (the so-called whiskey nose). The chronic alcoholic may also suffer from gastritis, with nausea and vomiting. In addition there are several physical complications of alcoholism that are not directly or solely attributable to alcohol but are related to excessive alcohol intake. Although alcohol is rich in calories, it contains no other nutrients, and as a result the alcoholic often is underfed because of his poor eating habits. Sometimes he develops vitamin deficiency diseases or other disorders related to malnutrition. Other physical disorders occurring in alcoholics include skin diseases, neuritis, liver disease, and pancreatitis.
The chronic alcoholic often suffers from various mental disorders. Generally, he is mentally clouded, egocentric, and obnoxious to others. He may also suffer hallucinations, delirium tremens, impairment of memory, and other mental disorders.
Occasionally, an unstable person, particularly one who has had a brain injury or who is hysterical, epileptic, or psychopathic, will go into a transitory psychotic episode on drinking even a small amount of alcohol. In this condition he is confused and disoriented and may have hallucinations. He may suddenly become very anxious, depressed, aggressive, or suicidal. This state may last for a few moments or a day or two and usually terminates in a deep sleep. When he awakens, the person cannot remember the episode.
Alcoholism is one of the most expensive diseases in terms both of money and of happiness. Excessive drinking costs the United States more than $1 billion a year, a cost carried by governmental, social, philanthropic, and religious agencies, as well as by industry. As a public health problem, alcoholism is outranked only by heart disease, cancer, and mental illness. Socially, alcoholics involve not only themselves but also their friends and relatives. Their disruptive influence often results in broken homes, separation, divorce, burdensome welfare and relief payments, fatal traffic accidents, and sometimes even homicide or suicide. Industry bears a grave burden with the alcoholic, who not only loses time from his own job but who is also a serious accident hazard to the other people working around him.
Drinking and Youth
Drinking patterns vary widely from community to community, and the patterns among young people seem distinctly affected by prevailing social customs and cultural influences. More girls than boys abstain from drinking. Religious influence or affiliation is often a significant factor in abstention.
At the college level, drinking is commonly a group activity to satisfy social needs or pressures for conformity. Here, occasional intoxication is much more common than alcoholism, but it often produces automobile accidents, sexual misconduct, and aggressive behavior that may lead to lasting physical damage.
When heavy drinking persists beyond college age, it usually occurs in people who have some or all of the following characteristics: their parents were heavy drinkers; they have a desire to drink as a means of reducing anxiety; they feel great hostility toward their parents, or a sense of rebellion in general; and they prefer to spend their leisure time drinking rather than participating in normal social activities.
Drinking and Driving
Alcohol impairs a driver's judgment and performance, and as a result the alcoholic driver is a significant cause of traffic accidents, particularly those causing serious injury and death. In some areas more than half the fatal accidents involve drivers who have been drinking heavily. On modern superspeed highways the light-to-moderate drinker also contributes greatly to traffic accidents.
To help law-enforcement agencies determine whether a driver has been drinking, many chemical tests have been devised to determine the presence of alcohol in the body. Alcohol concentrations can be measured in the exhaled breath, the saliva, the blood, the spinal fluid, and the urine. Since it is generally best to make on-the-spot determinations of blood-alcohol levels, most law enforcement agencies use the Drunko-meter test, or a modification of it. In this test the subject blows into a balloon containing a solution of potassium permanganate. If the alcohol content of the exhaled air is above a certain level, the solution will change color. Although direct blood tests are more accurate, they are seldom used because the subject's blood cannot be drawn without his consent and a physician is needed to puncture the vein and obtain the blood sample. While many law-enforcement agencies would like to see chemical testing of the blood-alcohol level more widely used in prosecuting traffic violations and accident cases, so far only about 35 states in the United States allow the introduction of alcohol tests as evidence in court. In granting drivers licenses, only 9 or 10 states require the individual to consent to take such tests if they are warranted.
The most effective treatment of alcoholism includes both medical and psychiatric measures. For most serious alcoholics, psychiatric hospitalization for a long period of time is the best procedure. This form of treatment provides opportunities for medical care, psychotherapy, and social rehabilitation. Many states provide for voluntary admission of alcoholics to psychiatric hospitals, and some states and industrial organizations maintain special clinics for the treatment of alcoholics. However, very little can be done to help the alcoholic unless he recognizes his need for help and is sufficiently motivated to overcome his addiction. One of the greatest problems of treating alcoholism is that few alcoholics have a real motivation for long-term treatment or cure. Most deny they are addicts, and, more important, are unwilling to recognize their inability to deal with the stresses of everyday living.
Complete abstinence from alcohol is an essential part of the treatment, and the alcoholic, like the drug addict, experiences a number of unpleasant withdrawal symptoms. Very often he needs sedatives during this period. He may also require abstinence-producing drugs, such as Disulfiram, and various drugs to correct any vitamin deficiencies or problems of metabolism.
A cure, in the sense of regaining the ability to drink socially, is rare. For most chronic alcoholics, total abstinence is the only way to keep the disease from recurring. In most treatment clinics it has been found that certain types of people have a better chance of recovery than others. Generally, a person who is married and has some economic resources, an occupational skill, a record of few, if any, arrests, a strong motivation for cure, and a superior intellect does better than other individuals.