Alcoholism, chronic and usually progressive illness involving the excessive
inappropriate ingestion of ethyl alcohol, whether in the form of familiar
alcoholic beverages or as a constituent of other substances. Alcoholism is
thought to arise from a combination of a wide range of physiological,
psychological, social, and genetic factors. It is characterized by an emotional
and often physical dependence on alcohol, and it frequently leads to brain
damage or early death. Some 10 percent of the adult drinkers in the United
States are considered alcoholics or at least they experience drinking problems
to some degree. More males than females are affected, but drinking among the
young and among women is increasing. Consumption of alcohol is apparently on the
rise in the United States, countries of the former Union of Soviet Socialist
Republics, and many European nations. This is paralleled by growing evidence of
increasing numbers of alcohol-related problems in other nations, including the
Third World.


Alcoholism, as opposed to merely excessive or irresponsible drinking, has been
variously thought of as a symptom of psychological or social stress or as a
learned, maladaptive coping behavior. More recently, and probably more
accurately, it has come to be viewed as a complex disease entity in its own
right. Alcoholism usually develops over a period of years. Early and subtle
symptoms include placing excessive importance on the availability of alcohol.
Ensuring this availability strongly influences the person\'s choice of associates
or activities. Alcohol comes to be used more as a mood-changing drug than as a
foodstuff or beverage served as a part of social custom or religious ritual.
Initially, the alcoholic may demonstrate a high tolerance to alcohol, consuming
more and showing less adverse effects than others. Subsequently, however, the
person begins to drink against his or her own best interests, as alcohol comes
to assume more importance than personal relationships, work, reputation, or even
physical health. The person commonly loses control over drinking and is
increasingly unable to predict how much alcohol will be consumed on a given
occasion or, if the person is currently abstaining, when the drinking will
resume again. Physical addiction to the drug may occur, sometimes eventually
leading to drinking around the clock to avoid withdrawal symptoms.


Alcohol has direct toxic as well as sedative effects on the body, and failure to
take care of nutritional and other physical needs during prolonged periods of
excessive drinking may further complicate matters. Advanced cases often require
hospitalization. The effects on major organ systems are cumulative and include a
wide range of digestive-system disorders such as ulcers, inflammation of the
pancreas, and cirrhosis of the liver. The central and peripheral nervous systems
can be permanently damaged. Blackouts, hallucinations, and extreme tremors may
occur. The latter symptoms are involved in the most serious alcohol withdrawal
syndrome, delirium tremens, which can prove fatal despite prompt treatment. This
is in contrast to withdrawal from narcotic drugs such as heroin, which, although
distressful, rarely results in death. Recent evidence has shown that heavy—and
even moderate—drinking during pregnancy can cause serious damage to the unborn
child: physical or mental retardation or both; a rare but severeexpression of
this damage is known as fetal alcohol syndrome.


Treatment of the illness increasingly recognizes alcoholism itself as the
primary problem needing attention, rather than regarding it as always secondary
to another, underlying problem. Specialized residential treatment facilities and
separate units within general or psychiatric hospitals are rapidly increasing in
number. As the public becomes more aware of the nature of alcoholism, the social
stigma attached to it decreases, alcoholics and their families tend to conceal
it less, and diagnosis is not delayed as long. Earlier and better treatment has
led to encouragingly high recovery rates. In addition to managing physical
complications and withdrawal states, treatment involves individual counseling
and group therapy techniques aimed at complete and comfortable abstinence from
alcohol and other mood-changing drugs of addiction. Such abstinence, according
to the best current evidence, is the desired goal, despite some highly
controversial suggestions that a safe return to social drinking is possible.
Addiction to other drugs, particularly to other tranquilizers and sedatives,
poses a major hazard to alcoholics. Antabuse, a drug that produces a violent
intolerance for alcohol as long as the substance remains in the body, is
sometimes used after withdrawal. Alcoholics Anonymous, a support group commonly
used for those undergoing other treatment, in many cases helps alcoholics to
recover without recourse to formal treatment. Despite these encouraging signs,
estimates of the annual number of deaths related to excessive drinking exceed
97,000 in the United States alone. Economic costs related to alcoholism are at
least $100 billion a year. Additional data are needed on various societal costs
of alcoholism as well