May 25, 2011
Physician Focus: May 2011
By John A. Renner Jr., M.D.
The numbers are startling. Nearly 18 million people in the
United States abuse alcohol or are alcohol dependent; excessive
alcohol use contributes to some 79,000 deaths, 1.6 million
hospitalizations, and four million emergency room visits each
year.
The Centers for Disease Control (CDC) states that alcohol is the
most commonly used and abused drug among youth under 21 in the
country. But the problem is global. According to the World Health
Organization, alcohol causes nearly four percent of deaths
worldwide - some two and half million each year - and is a causal
factor in 60 types of diseases and injuries.
The fact is that alcohol has become a major part of our culture.
Most Americans take it for granted that they will drink, and
research shows just how prevalent drinking is.
More than 90 percent of Americans drink alcohol, and some start
very early. A U.S. Substance Abuse and Mental Health Services
Administration survey earlier this year discovered that nearly 6
percent of 12-14-year-olds - about 700,000 middle-school children -
drank alcohol in the past month. But here's the surprise: 45
percent of them got it free in their own homes, including 16
percent who got it from their parent or guardian.
The 2009 National Survey on Drug Use and Health discovered that
86 percent of American youths by the age of 21 have used alcohol
and that 50 percent are binge drinking (defined as five or more
drinks in a single session for men, four or more for women). Binge
drinking, in fact, has been declared a major public health problem
by the CDC, and the problem has become so serious on college
campuses that Dartmouth College has announced a national initiative
with other universities to curb the behavior. Surveys show more
than 15 percent of adults reporting binge drinking. It is most
common in adult men 18-34.
The ill effects of excessive drinking are clear and well
documented, and we need only to read the stories about drunken
drivers or alcohol-induced violence to know how much of an impact
there can be.
Excessive drinking can also destroy one's health. Alcohol can
affect the liver, heart, and brain. It is associated with dementia
and gastrointestinal cancer, and in many cases, occurs along with
psychiatric disorders such as bipolar disease, depression, or
attention deficit disorder. Besides health concerns, excessive
drinkers also experience more divorce, problems in relationships,
and trouble with work and holding a job. And with drinkers there's
a high rate of smoking, along with a "mixing in" of other drugs
such as painkillers or stimulants.
But the question still arises: Is alcoholism a
disease?
The answer is yes. The old view that it resulted from bad
behavior has given way to abundant evidence that alcoholism is a
biological condition and that it's often inherited and runs in
families. It is indeed a chronic disease, influenced by a person's
family history and lifestyle. That's why it's so important that, in
families where alcoholism is present, parents and adolescents must
be educated that drinking can be dangerous and that a pattern may
be set for young people that could affect them for a lifetime.
Yet alcoholism is only one type of alcohol problem. Alcohol
abuse, such as underage drinking, drinking while driving, and, as
noted above, binge drinking, can be just as harmful. It can lead to
unintentional injuries, violence, risky sexual behavior,
miscarriage and stillbirth among pregnant women, and alcohol
poisoning. Even moderate drinking under certain conditions - such
as pregnancy, or while taking medications - can be dangerous.
What about those reports that drinking is good for you?
Moderate drinking - one or two drinks daily - may have some
benefits, but that applies only to healthy people who have no
medical conditions and who are not on medications.
Alcoholism is the most common addiction in our culture, and it
is difficult for people to hold up a mirror to themselves to
acknowledge the problem. For those with the disease, no cure
exists, but people should know that it can be treated with
counseling and medication. And treatment works. The key is not to
avoid or delay treatment; the sooner one gets into treatment, the
more successful it will be.
To learn more about this topic, visit Alcoholics Anonymous at www.aa.org and the National Institute
on Alcoholism and Alcohol Abuse at www.niaaa.nih.gov. For a
video discussion, visit www.physicianfocus.org.
John A. Renner Jr., M.D. is Associate Chief of Psychiatry at
VA Boston Healthcare System, Associate Professor of Psychiatry at
Boston University School of Medicine, and chair of the American
Psychiatric Association Council on Addiction Psychiatry. Physician
Focus is a public service of the Massachusetts Medical Society.
Readers should use their own judgment when seeking medical care and
consult with their physician for treatment. Send comments
to PhysicianFocus@mms.org
