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What is alcoholismWhat is Alcoholism?
Alcoholism, also known as alcohol dependence, is a disease that includes the following four symptoms: Craving--A strong need, or urge, to drink.
Loss of control--Not being able to stop drinking once drinking has begun.
Physical dependence--Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping
Tolerance--The need to drink greater amounts of alcohol to get "high."
Is Alcoholism a Disease?
Yes, alcoholism is a disease. The craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems. Like many other diseases, alcoholism is chronic, meaning that it lasts a person's lifetime; it usually follows a predictable course; and it has symptoms. The risk for developing alcoholism is influenced both by a person's genes and by his or her lifestyle. (See also "Publications,"Diagnostic Criteria for Alcohol Abuse and Dependence.) Is alcoholism inherited?
Research shows that the risk for developing alcoholism does indeed run in families. The genes a person inherits partially explain this pattern, but lifestyle is also a factor. Currently, researchers are working to discover the actual genes that put people at risk for alcoholism. Your friends, the amount of stress in your life, and how readily available alcohol is also are factors that may increase your risk for alcoholism. But remember: Risk is not destiny. Just because alcoholism tends to run in families doesn't mean that a child of an alcoholic parent will automatically become an alcoholic too. Some people develop alcoholism even though no one in their family has a drinking problem. By the same token, not all children of alcoholic families get into trouble with alcohol. Knowing you are at risk is important, though, because then you can take steps to protect yourself from developing problems with alcohol. (See also "Publications," The Genetics of Alcoholism.) Can alcoholism be cured?
No, alcoholism cannot be cured at this time. Even if an alcoholic hasn't been drinking for a long time, he or she can still suffer a relapse. To guard against a relapse, an alcoholic must continue to avoid all alcoholic beverages. (See also "Publications/Pamphlets and Brochures,") Can alcoholism be treated?
Yes, alcoholism can be treated. Alcoholism treatment programs use both counseling and medications to help a person stop drinking. Most alcoholics need help to recover from their disease. With support and treatment, many people are able to stop drinking and rebuild their lives. (See also "Publication," New Advances in Alcoholism Treatment.) Which medications treat alcoholism?
A range of medications is used to treat alcoholism. Benzodiazepines (Valium® , Librium®) are sometimes used during the first days after a person stops drinking to help him or her safely withdraw from alcohol. These medications are not used beyond the first few days, however, because they may be highly addictive. Other medications help people remain sober. One medication used for this purpose is naltrexone (ReVia™). When combined with counseling naltrexone can reduce the craving for alcohol and help prevent a person from returning, or relapsing, to heavy drinking. Another medication, disulfiram (Antabuse®), discourages drinking by making the person feel sick if he or she drinks alcohol. Though several medications help treat alcoholism, there is no "magic bullet." In other words, no single medication is available that works in every case and/or in every person. Developing new and more effective medications to treat alcoholism remains a high priority for researchers. (See also "News Releases," Jan. 17, 1995: Naltrexone Approved for Alcoholism Treatment and "Publication," roscience Research and Therapeutic Targets.) From the Alcohol Alert No. 61 ---Neuroscience Research and Therapeutic Targets
Alcoholism, like other addictions, is a brain disorder. Research has shown that genes shape how an individual experiences alcohol—how intoxicating, pleasant, or sedating it is—and how susceptible he or she is to developing alcohol use disorders. Research has also shown that chronic heavy drinking causes long–term—and perhaps permanent—changes in the way the brain responds to alcohol. These parallel insights from neuroscience research are paving the way for new medications that will improve alcoholism treatment and relapse prevention. Addiction science has benefited from rapid progress in cellular and molecular research techniques, from the integration of scientific disciplines in the study of addiction–related behavior, and from the development of more appropriate animal models (1). Research in genetics is paying off in the identification of genes that influence the risk of developing alcoholism (2–7). Many of the genes being identified direct the production of proteins involved in the complex process of signaling between neurons in the brain. For example, genes that encode subunits of receptors for neurotransmitters such as GABA, serotonin, and others have been identified (see below for background on these neurotransmitters). Other genes related to alcoholism risk encode enzymes that metabolize alcohol. Gene discovery offers multiple benefits. Identification of risk–associated genes may provide a means of identifying people at risk. As important, knowing the genes and the proteins they encode is a key to understanding how alcohol interacts with this part of the cel ’s machinery, how variants of the gene raise or lower risk, and how chronic exposure to alcohol can change gene expression (the translation of genes into proteins) and set the stage for addiction. Some of the genes being identified raise the risk of both alcoholism and so–called comorbid disorders, like depression, that often occur along with alcohol problems. Knowledge of these genes should provide insight into the brain mechanisms that underlie these disorders. Finally, identifying genes provides potential targets for medication development. A recent Alcohol Alert on the genetics of alcoholism describes some of the approaches being used to identify genes related to alcoholism risk (8). This Alcohol Alert provides a brief overview of what research is revealing about how alcohol affects the brain and how the resulting changes contribute to alcohol dependence. Also addressed is what research is showing about the effect of stressful life experiences on the brain and how they may contribute to risk of alcohol dependence and relapse to drinking. Beyond understanding how alcohol affects the brain, the hoped–for outcome of this work is the identification of neurologic targets for potential medications. Some of the medications in clinical use or testing that have come out of this work are reviewed below. Alcohol Interferes with Brain Cell Communication
Large and often widespread networks of brain cells perform the brain’s essential functions: storing information, regulating basic body functions, and directing behavior. The basis of these brain networks is communication from cell to cell by chemical messengers called neurotransmitters. Released into narrow gaps, or synapses, between cells, neurotransmitters cross the synapse and activate proteins called receptors. Receptor activation, in turn, leads to a series of molecular interactions within the receiving cell. Some of the molecular interactions are short–term and remain localized to the area of the cell containing the receptors. Others result in lasting changes, at multiple locations throughout the cell, in protein expression, structure, and composition. Intoxication and other short–term (acute) effects of alcohol are caused largely by temporary, reversible changes in specific receptors and associated molecules. With repeated (chronic) alcohol exposure, long–lasting changes occur in receptors and in the series of chemical interactions they signal. However, neuroscientists have found that receptor changes are only one example of many permanent changes in the brain, collectively referred to as ―neuroadaptation,‖ caused by the presence of alcohol. Strong evidence exists that neuroadaptation involves changes at many different levels, from the genetically directed production of critical proteins (9–12) to physical changes in the structure of the cells on both sides of the synapse—that is, both the signaling and the receiving cell. Unraveling these different aspects of neuroadaptation may be the key to understanding how addiction develops. Recent studies have linked neuroadaptation with tolerance (the need to drink more alcohol to achieve the same level of intoxication) (13,1) and with the symptoms of withdrawal (14). Neuroadaptation also appears to underlie the persistent sense of discomfort, often described as ―craving,‖ that can lead to relapse even after long periods of abstinence (14–17). Medications from Neuroscience
Based on neuroscience research, scientists are developing medications that potentially could target both the acute responses to alcohol and the neuroadaptations that can accompany chronic drinking. Potential medications may target specific receptor types, the series of chemical reactions set off by receptor activation, or the production of critical protein enzymes involved in these processes within cells. To use these strategies effectively and safely, however, researchers must first understand in detail where and how alcohol exerts its effects. Naltrexone and acamprosate are two medications that act on receptor systems in the brain on which alcohol is known to have an impact and that have shown some success for treating alcoholism. Naltrexone binds with receptors for endogenous opioids, naturally occurring opiate–like substances that stimulate pleasurable feelings and suppress pain. Animal studies suggest that opiate antagonists like naltrexone block some of alcohol’s rewarding effects. Clinical studies have reported that alcohol–dependent patients given naltrexone drink less frequently, and in smaller quantities, than patients given a placebo (18). Naltrexone has been approved by the U.S. Food and Drug Administration (FDA) for alcoholism treatment. Acamprosate’s precise mechanism of action is not yet known, but it is thought to affect activity of the neurotransmitter glutamate (18,19). In clinical studies in Europe, patients on acamprosate experienced higher abstinence rates, and for those who did relapse, longer periods of abstinence (18). Clinical studies using acamprosate are ongoing in the United States, but it has not yet been FDA approved. Despite promising results for some patients using naltrexone or acamprosate, not everyone responds. It is likely that different subtypes of alcoholics have different genetically determined traits shaping their response to alcohol and underlying their vulnerability to alcohol problems. For these reasons, the need remains for new medications, with a variety of drugs eventually providing a way to target treatment according to a person’s individual biology. Does alcoholism treatment work?
Alcoholism treatment works for many people. But just like any chronic disease, there are varying levels of success when it comes to treatment. Some people stop drinking and remain sober. Others have long periods of sobriety with bouts of relapse. And still others cannot stop drinking for any length of time. With treatment, one thing is clear, however: the longer a person abstains from alcohol, the more likely he or she will be able to stay sober. Do you have to be an alcoholic to experience problems?
No. Alcoholism is only one type of an alcohol problem. Alcohol abuse can be just as harmful. A person can abuse alcohol without actually being an alcoholic--that is, he or she may drink too much and too often but still not be dependent on alcohol. Some of the problems linked to alcohol abuse include not being able to meet work, school, or family responsibilities; drunk-driving arrests and car crashes; and drinking-related medical conditions. Under some circumstances, even social or moderate drinking is dangerous--for example, when driving, during pregnancy, or when taking certain medications. (See also "Publications/Pamphlets and Brochures,") Are specific groups of people more likely to have problems?
Alcohol abuse and alcoholism cut across gender, race, and nationality. Nearly 14 million people in the United States--1 in every 13 adults--abuse alcohol or are alcoholic. In general, though, more men than women are alcohol dependent or have alcohol problems. And alcohol problems are highest among young adults ages 18-29 and lowest among adults ages 65 and older. We also know that people who start drinking at an early age--for example, at age 14 or younger--greatly increase the chance that they will develop alcohol problems at some point in their lives. (See also "News Releases," March 17, 199Alcohol and Minorities: An Update.) How can you tell if someone has a problem?
Answering the following four questions can help you find out if you or a loved one has a drinking problem: Have you ever felt you should cut down on your drinking? Have people annoyed you by criticizing your drinking? Have you ever felt bad or guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover? One "yes" answer suggests a possible alcohol problem. More than one "yes" answer means it is highly likely that a problem exists. If you think that you or someone you know might have an alcohol problem, it is important to see a doctor or other health care provider right away. They can help you determine if a drinking problem exists and plan the best course of action. Can a problem drinker simply cut down?
It depends. If that person has been diagnosed as an alcoholic, the answer is "no." Alcoholics who try to cut down on drinking rarely succeed. Cutting out alcohol--that is, abstaining--is usually the best course for recovery. People who are not alcohol dependent but who have experienced alcohol-related problems may be able to limit the amount they drink. If they can't stay within those limits, they need to stop drinking altogether. (See Question 13 which addresses the issue, "What is a safe level of drinking?") (See also "Publications/Pamphlets and Brochures," If an alcoholic is unwilling to get help, what can you do about it?
This can be a challenge. An alcoholic can't be forced to get help except under certain circumstances, such as a violent incident that results in court-ordered treatment or medical emergency. But you don't have to wait for someone to "hit rock bottom" to act. Many alcoholism treatment specialists suggest the following steps to help an alcoholic get treatment: Stop all "cover ups." Family members often make excuses to others or try to protect the alcoholic from the results of his or
her drinking. It is important to stop covering for the alcoholic so that he or she experiences the full consequences of drinking.
Time your intervention. The best time to talk to the drinker is shortly after an alcohol-related problem has occurred--like a
serious family argument or an accident. Choose a time when he or she is sober, both of you are fairly calm, and you have a
chance to talk in private.
Be specific. Tell the family member that you are worried about his or her drinking. Use examples of the ways in which the
drinking has caused problems, including the most recent incident.
State the results. Explain to the drinker what you will do if he or she doesn't go for help--not to punish the drinker, but to
protect yourself from his or her problems. What you say may range from refusing to go with the person to any social activity
where alcohol will be served, to moving out of the house. Do not make any threats you are not prepared to carry out.
Get help. Gather information in advance about treatment options in your community. If the person is willing to get help, call
immediately for an appointment with a treatment counselor. Offer to go with the family member on the first visit to a treatment
program and/or an Alcoholics Anonymous meeting.
Call on a friend. If the family member still refuses to get help, ask a friend to talk with him or her using the steps just
described. A friend who is a recovering alcoholic may be particularly persuasive, but any person who is caring and
nonjudgmental may help. The intervention of more than one person, more than one time, is often necessary to coax an
alcoholic to seek help.
Find strength in numbers. With the help of a health care professional, some families join with other relatives and friends to
confront an alcoholic as a group. This approach should only be tried under the guidance of a health care professional who is
experienced in this kind of group intervention.
Get support. It is important to remember that you are not alone. Support groups offered in most communities include Al-Anon,
which holds regular meetings for spouses and other significant adults in an alcoholic's life, and Alateen, which is geared to
children of alcoholics. These groups help family members understand that they are not responsible for an alcoholic's drinking
and that they need to take steps to take care of themselves, regardless of whether the alcoholic family member chooses to get
help. (See Question 19 for referral to support groups.)
You can call the National Drug and Alcohol Treatment Referral Routing Servic at 1-800-662-HELP (4357) for information about treatment programs in your local community and to speak to someone about an alcohol problem. What is a safe level of drinking?
For most adults, moderate alcohol use--up to two drinks per day for men and one drink per day for women and older people--causes few if any problems. (One drink equals one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.) Certain people should not drink at all, however: Women who are pregnant or trying to become pregnant People who plan to drive or engage in other activities that require alertness and skill (such as using high-speed People taking certain over-the-counter or prescription medications People with medical conditions that can be made worse by drinking (See also "Publications"Moderate DrinkingAlcohol-Medication InteractionsFetal Alcohol Exposure and the Brain; andAlcohol and Transportation Safety) Does alcohol affect older people differently?
Alcohol's effects do vary with age. Slower reaction times, problems with hearing and seeing, and a lower tolerance to alcohol's effects put older people at higher risk for falls, car crashes, and other types of injuries that may result from drinking. Older people also tend to take more medicines than younger people. Mixing alcohol with over-the-counter or prescription medications can be very dangerous, even fatal. More than 150 medications interact harmfully with alcohol. (See Question 18 for more information.) In addition, alcohol can make many of the medical conditions common in older people, including high blood pressure and ulcers, more serious. Physical changes associated with aging can make older people feel "high" even after drinking only small amounts of alcohol. So even if there is no medical reason to avoid alcohol, older men and women should limit themselves to one drink per day. (See also "Publications/Pamphlets and Brochures"lcohol and Aging.) Alateen's Purpose
Alateen is part of Al-Anon, which helps families and friends of alcoholics recover from the effects of living with the problem drinking of a relative or friend. Alateen is our recovery program for young people. Alateen groups are sponsored by Al-Anon members. Our program of recovery is adapted from Alcoholics Anonymous and is based upon the Twelve Steps, Twelve Traditions, and the Twelve Concepts of Service. The only requirement of membership is that there be a problem of alcoholism in a relative or friend. Al-Anon/Alateen is not affiliated with any other organization or outside entity.
Oncogene (2007), 1–5& 2007 Nature Publishing Group All rights reserved 0950-9232/07 $30.00p21Waf1/Cip1/Sdi1 mediates retinoblastoma protein degradationEV Broude1, ME Swift2, C Vivo1, B-D Chang1, BM Davis1, S Kalurupalle1, MV Blagosklonny1and IB Roninson11Cancer Center, Ordway Research Institute, Albany, NY, USA and 2Department of Molecular Genetics, University of Illinois atChicago, Chi