This document discusses chronic alcohol abuse and alcoholism. It defines alcohol abuse and dependence, and notes that an estimated 8.5% of US adults meet criteria for one or the other. Alcoholism is defined as a physical addiction where drinking continues to cause problems. It is considered a multidimensional condition typically defined by preoccupation with drinking, emotional and vocational problems, and physical health issues. Genetic and environmental factors both contribute to risk. Fetal alcohol syndrome is also discussed as a major health issue caused by maternal drinking.

1. Chapter 9
Chronic Alcohol Abuse and
Alcoholism

2. Alcohol Abuse and
Alcohol Dependence
According to health professionals, alcohol
abuse is defined in terms of
persistent physical, social, or occupational
problems that have become associated with
alcohol use
recurring use of alcohol in physically hazardous
situations

3. Alcohol Abuse and
Alcohol Dependence
Alcohol dependence is defined in terms of
uncontrolled alcohol intake, unsuccessful efforts to
reduce alcohol use, life problems, and alcohol
tolerance and withdrawal.
According to criteria set by the American Psychiatric
Association, an estimated 8.5 percent of U.S. adults
can be classified either as alcohol abusers or as
alcohol dependent.

4. The National Institutes of Health defines alcoholism as
“a physical addiction to alcohol in which people
continue to drink even though the drinking causes
physical, mental and social problems, including
problems with job responsibilities and relationships”
Alcoholism: Stereotypes,
Definitions, and Criteria

5. Alcoholism: Stereotypes,
Definitions, and Criteria
Alcoholism is a multidimensional condition that is
typically defined in terms of four major criteria:
preoccupation with drinking
emotional problems
vocational, social, and family problems
physical problems
Not all criteria have to be met, however, for
alcoholism to be diagnosed.

6. Patterns of Chronic
Alcohol Abuse
Alcoholics can be found in every age, gender, racial,
ethnic, and religious group and in all socioeconomic
and geographic categories.
Men outnumber women in the incidence of alcoholism
by about six to one, although women are more
vulnerable to alcohol-related organ damage.
The elderly tend to be an underreported group with
respect to alcoholism.

7. Patterns of Chronic
Alcohol Abuse
A systems approach to alcoholism examines the
complex interacting relationships among
individuals, family, friends, and community.
The concept of codependency, which originated in
Alcoholics Anonymous, has helped shed light on the
specific effects of alcoholism on spouses and other
family members.
What is “codependency?”
(there is even a “Codependents Anonymous”
organization!)

8. Patterns of Chronic
Alcohol Abuse
Nonetheless, men outnumber women in the incidence
of alcoholism by about six to one, although women are
more vulnerable to alcohol-related organ damage.
The elderly tend to be an underreported group with
respect to alcoholism.

9. Patterns of Chronic
Alcohol Abuse
The children of alcoholics (COAs) carry an increased
risk of becoming alcoholic as a result of a
vulnerability toward alcoholism for both genetic and
environmental reasons
Even so, a male with at least one alcoholic parent
has only a 20-25% chance of becoming and alcoholic
himself

10. The Genetics of Alcoholism
Studies of adoptions and twins have provided
information about the relative influence of genetics
and environment on the development of alcoholism.
Type 1 alcoholic
male or female, late onset
Type 2 alcoholic
male, begins in adolescence
The Type 2 alcoholism appears to have a greater
genetic component in the inheritance pattern.

11. Figure 9.2

12. Table 9.1

13. Type 1 alcoholics can be either male or female, while
Type 2 alcoholics are principally __________.
A. females
B. people over twenty-five only
C. people living in urban environments
D. males
E. bisexual

14. Physiological Effects of Chronic
Alcohol Abuse
Excessive, chronic alcohol use increases the
risk of
liver disease
cardiovascular disease
cancer
pancreatitis
Type II diabetes
neurological disorders
most severely, Korsakoff’s syndrome

15. Physiological Effects of Chronic
Alcohol Abuse
10–15% of pregnant women in the U.S. report having
recently drunk alcohol, and up to 30% drink alcohol at
some point during pregnancy
There is no amount of alcohol that is known to be safe
Total abstinence during pregnancy is ideal, and FAS is
100% preventable.
A particular concern is the development of fetal alcohol
syndrome (FAS) in the offspring of alcoholic mothers.

16. Facial features are a good
diagnostic for underlying brain
damage.
The greater the facial
abnormalities, the greater the
underlying damage.
The exact degree and nature
of deficits depends on timing,
length and severity of
exposure, in addition to
individual differences in fetal
sensitivity to alcohol.
Fetal Alcohol Syndrome
flat face
small head
upturned nose

17. Shorter-than-average height
Low body weight
Poor coordination
Small head size
Hyperactive behavior
Difficulty paying attention
Poor memory
Difficulty in school (especially with math)
Learning disabilities
Speech and language delays
Intellectual disability or low IQ
Poor reasoning and judgment skills
Sleep and sucking problems as a baby
Vision or hearing problems
Problems with the heart, kidney, or bones
Fetal Alcohol Syndrome

18. Fetal Alcohol Syndrome
Anatomical Changes in the Brain
reduction in gross brain size
especially frontal and parietal lobes
agenesis of the corpus callosum
abnormal cerebellar development
reduced size of the caudate nucleus
Functionally
lower cerebral blood flow
reduced glucose utilization
reduced caudate and frontal lobe activation on
spatial memory tasks

19. Fetal alcohol syndrome
A. is not a concern unless the mother is an alcoholic
B. is unavoidable because it results from abnormal
metabolic activity of the fetus
C. can be avoided by drinking only beer and wine
during pregnancy
D. can be a product of changes in sperm of an
alcoholic father
E. can only be avoided with certainty if the mother
abstains from alcohol completely

20. The Concept of Alcoholism as
a Disease
The majority position with respect to alcoholism is
that it should be considered a disease and that
alcoholics should be treated rather than punished.
In 1956, the American Medical Association adopted
the disease model of alcoholism.
Calling alcoholism a disease was a bonanza that
quickly poured many billions of dollars into the
pockets of physicians, hospitals and pharmaceutical
companies and continues to do so.

21. 1992 JAMA article, the Joint Committee of the National
Council on Alcoholism and Drug Dependence, Inc. (NCADD)
and the American Society of Addiction Medicine (ASAM)
published this definition for alcoholism:
“Alcoholism is a primary chronic disease with genetic,
psychosocial and environmental factors influencing its
development and manifestations. The disease is often
progressive and fatal. It is characterized by impaired
control over drinking, preoccupation with the drug alcohol,
use of alcohol despite adverse consequences, and
distortions in thinking, mostly denial. Each of these
symptoms may be continuous or periodic.”
The Concept of Alcoholism as
a Disease

22. The Concept of Alcoholism as
a Disease
Alcoholism does not fit the classic definitions of a
disease in that it is in part defined by attitudes of the
afflicted toward the drinking problem itself, e.g. denial,
or consequences of the drinking problem, an alcoholic
will
“continue to drink even though the drinking causes
physical, mental and social problems, including
problems with job responsibilities and relationships”

23. The Concept of Alcoholism as
a Disease
It is the only disease that is generally diagnosed by the
sufferer rather than by a health professional
Recent surveys of primary care physicians indicate that
the medical profession is frequently ill prepared to
diagnose alcoholism or supervise effective treatment.

24. The Concept of Alcoholism as
a Disease
Naming it as a disease may also give the illusion of
explanation,
“I can’t control my drinking because I am an alcoholic”
(but, alcoholism is defined by that same drinking)
That’s like saying
“I’m hypertensive because I have high blood pressure”.

25. Heavy problem drinkers show a single distinctive
pattern of ever greater alcohol use leading to ever
greater bodily, mental, and social deterioration.
The condition, once it appears, persists involuntarily:
the craving is irresistible and the drinking is
uncontrollable once it has begun.
The Concept of Alcoholism as
a Disease
The disease concept makes certain assumptions and
has far-reaching implications for understanding,
treatment and legal treatment of alcoholics.

26. Medical expertise is needed to understand and relieve
the condition (“cure the disease”) or at least ameliorate
its symptoms.
If alcoholism is a disease, then alcoholics are no more
responsible legally or morally for their drinking and its
consequences than epileptics are responsible for the
consequences of their movements during seizures, or
someone with a brain tumor, diagnosed as
schizophrenic, etc.
The Concept of Alcoholism as
a Disease

27. The Concept of Alcoholism as a
Disease
The disease model also diverts attention away from
the social and cultural contributions to the problem

28. 1. Do you lose time from work due to drinking?
2. Is drinking making your home life unhappy?
3. Do you drink because you are shy with other people?
4. Is your drinking affecting your reputation?
5. Have you ever felt remorse after drinking?
6. Have you ever got into financial difficulties as a result of drinking?
7. Do you turn to lower companions and an inferior environment when drinking?
8. Does your drinking make you careless of your family’s welfare?
9. Has your ambition decreased since drinking?
10. Do you crave a drink at a definite time?
11. Do you want a drink the next morning?
12. Does drinking cause you to have difficulty in sleeping?
13. Has your efficiency decreased since drinking?
14. Is drinking jeopardizing your job or business?
15. Do you drink to escape from worries or trouble?
16. Do you drink alone?
17. Have you ever had a complete loss of memory as a result of drinking?
18. Has your physician ever treated you for drinking?
19. Do you drink to build up your self-confidence?
20. Have you ever been to a hospital or institution because of drinking?
Are you an alcoholic?

29. Approaches to Treatment
for Alcoholism
Approaches include behaviorally and psychologically
based treatments (e.g., cognitive behavioral
therapy, contingency management) and spiritually
based treatments (e.g., Alcoholics Anonymous).
It is curious to note that although AA embraces the
disease concept of alcoholism, it embraces a
spiritual rather than a scientific or medical approach
to its treatment.

30. Table 9.2

31. Alcoholics Anonymous is based upon the idea of ______.
A. absolute devotion to its ideals
B. absolute abstinence
C. absolute commitment toward responsible drinking
D. absolute allegiance to one’s country
E. having a place to drink where identities will not be
revealed

32. Approaches to Treatment for
Alcoholism
Other self-help programs, such as Moderation
Management (MM) and SMART Recovery, have been
devised to appeal to those who cannot accept a
spiritual approach or the total abstinence required in
the AA program

33. Approaches to Treatment for
Alcoholism
Moderation Management (MM)
Non-profit, supported by voluntary donations
Alcoholism is a learned behavior, not a disease
For those concerned about drinking habits but not
dependent or are in early-stage dependency
Controlled drinking, not total abstinence
Self-Management and Recovery Training (SMART)
Non-profit organization, recognized by NIDA
A Cognitive/Behavioral Therapy approach
Self-empowering and teaches self-reliance
Total abstinence, controlled drinking up to the individual

34. Chronic Alcohol Abuse and
Alcoholism in the Workplace
Many corporations and other large organizations have
instituted Employee Assistance Programs (EAPs), and
unions have instituted Member Assistance Programs
(MAPs), to help workers with problems of alcohol abuse
or other forms of drug abuse.
e.g. Counseling and Wellness Center for UF
students

35. Physiological Effects of Chronic
Alcohol Abuse
Physical effects of alcoholism include tolerance and
withdrawal, liver disease, cardiovascular disease,
cancer, and neurological disorders such as
Wernicke-Korsakoff syndrome.
A particular concern is the development of fetal
alcohol syndrome (FAS) in the offspring of alcoholic
mothers.