Alcoholism

What is Alcoholism? Who is an Alcoholic?

Alcoholism, as lay people generally know it, is the fondness, desire, or even need for alcohol in an extreme sense to the point of addiction. Alcohol is the most widely used legal drug worldwide that also predisposes people to dependence or abuse (addiction) in certain parts of the world. Different cultures have varied features of the extent of alcoholism in their societies, especially with different levels of accessibility, rules, and norms of drinking. For instance, some countries have higher levels of alcoholism (e.g., about 10% of the U.S. population), accompanied by higher levels of people's tolerance for alcohol, and then may consider alcoholism as normal and not deviant. Some others, such as many countries in the Middle East and Asia, have laws and religious prescriptions that encourage the prohibition of the import and sale of alcohol, where society's alcoholism levels, and at times distress levels, are extremely low. On the other hand, there are also some other countries, like France and Italy, where drinking alcohol is acceptable and not regulated, and still addiction to alcohol is low. Moreover, different cultures relate to alcoholism differently. Some cultures deny the existence of alcohol addiction and consider talking about any degree of alcoholism or its consequences as taboo. Other countries minimize alcoholism as an issue or concern that warrants any kind of societal or community attention. Still other societies recognize alcoholism as a mental health issue and spend a substantial portion of their resources in abating the problem. In the United States, the direct and indirect costs of alcoholism[Page 71] (i.e., money spent for the prevention, detoxification, and rehabilitation of alcoholism and amount spent because of absenteeism, loss of productivity, and medical claims) amount to an exorbitant $148 billion each year.

Psychologists, especially those who work with alcoholics (i.e., therapists and counselors), use the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR) as a standard reference in defining mental health disorders such as alcoholism. According to the DSM-IV-TR, alcoholism is defined by increased tolerance, increased withdrawal symptoms, persistent and compulsive alcohol intake, and distressing consequences in social, occupational, and familial functioning. Increased tolerance is manifested by ever-increasing consumption of alcohol with lessened psychophysiological effects (not getting drunk easily, inhibitions lessened only slowly, personality change not as dramatic) on the drinker. In short, increased tolerance means a greater capacity for alcohol each time to obtain the desired effects. When the alcoholic experiences a period of time without alcohol, he or she exhibits withdrawal symptoms, including shaking, perspiration, and yearning for alcohol. These symptoms are aversive and make it extremely challenging to go without alcohol. With alcohol abuse or dependence, there are inevitable consequences on the person's functioning that may include being unable to go to work regularly; being unable to concentrate in academic work; having conflicted, chaotic, or distant relationships; or being unable to fulfill one's responsibilities of being a father or mother. DSM-IV-TR classifies alcoholism on two levels, substance abuse and substance dependence, with regard to its severity and frequency. Substance abuse is the pattern of alcohol use that leads to distress for a period of 12 months, whereas substance dependence is the maladaptive pattern of substance use that leads to greater and more extreme impairment for a period of 12 months. Substance dependence is the persistent addiction to alcohol despite greater and more difficult consequences to alcohol intake. Alcohol is the most common drug of abuse and dependence and has a high likelihood of being mixed with other drugs in polysubstance use.

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