Alcoholism

What 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 drinking. * Tolerance—The need to drink greater amounts of alcohol to get "high." For clinical and research purposes, formal diagnostic criteria for alcoholism also have been developed. Such criteria are included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association, as well as in the International Classification Diseases, published by the World Health Organization. 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. 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. 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. Not drinking is the safest course for most people with alcoholism. Can alcoholism be treated' Yes, alcoholism can be treated. Alcoholism treatment programs use both counseling and medications to help a person stop drinking. Treatment has helped many people stop drinking and rebuild their lives. Alcohol & Stress: At Risk for Alcoholism' | Causes of Fatigue Slideshow | Is Sleepiness Hurting You' | How Pets Improve Your Health Slideshow | | Medical Author: Melissa Conrad Stoppler, MD Medical Editor: William C. Shiel, Jr, MD, FACP, FACR Research and population surveys have shown that persons under stress , particularly chronic stress, tend to exhibit more unhealthy behaviors than less-stressed persons. Stressed people drink more alcohol, smoke more, and eat less nutritious foods than non-stressed individuals. Many people report drinking alcohol in response to various types of stress, and the amount of drinking in response to stress is related to the severity of the life stressors and the individuals' lack of social support networks. While some research studies show that alcohol in low doses may lessen the body's response to stressors, paradoxically, many studies show just the opposite effect, i.e., that alcohol actually increases the stress response by stimulating production of the same hormones the body produces when under stress. These observations are particularly interesting given that most people report that they drink alcohol to reduce stress, and the explanation for this apparent contradiction remains unknown. It may be that the mild arousal effect of the stress hormones released upon alcohol consumption is not entirely unpleasant. Genetic variations in the ways our bodies respond to stress also likely play a role in how alcohol affects our bodies in stress situations. There is little evidence that stress leads to the development of true alcohol dependency or alcoholism. However, stress is strongly associated with alcohol abuse- the misuse of alcohol as self-medication or "therapy." Stress may also be associated with episodes of binge drinking. Alcoholism is a complex medical condition that is believed to be caused by a number of both hereditary and environmental factors. While stress is not considered to be a cause of alcoholism, stressful experiences may lead to relapse of the disease in those who already suffer from alcoholism. If you're concerned about your alcohol consumption, be sure to discuss your concerns with your doctor. For more information, read the "Alcohol Abuse and Alcoholism" article. Last Editorial Review: 10/28/2005Alcohol, Some Sobering Facts If you are like many people, you may drink alcohol occasionally. Or, like others, you may drink moderate amounts of alcohol on a more regular basis. If you are a woman or someone over the age of 65, this means that you have no more than one drink per day; if you are a man, this means that you have no more than two drinks per day. Drinking at these levels usually is not associated with health risks and can help to prevent certain forms of heart disease. But did you know that even moderate drinking, under certain circumstances, is not risk free' And that if you drink at more than moderate levels, you may be putting yourself at risk for serious problems with your health and problems with family, friends, and coworkers' Drinking and Driving It may surprise you to learn that you don't need to drink much alcohol before your ability to drive becomes impaired. For example, certain driving skills--such as steering a car while, at the same time, responding to changes in traffic--can be impaired by blood alcohol concentrations (BACs) as low as 0.02 percent. (The BAC refers to the amount of alcohol in the blood.) A 160-pound man will have a BAC of about 0.04 percent 1 hour after consuming two 12-ounce beers or two other standard drinks on an empty stomach. And the more alcohol you consume, the more impaired your driving skills will be. Although most States set the BAC limit for adults who drive after drinking at 0.08 to 0.10 percent, impairment of driving skills begins at much lower levels. Interactions with Medications Alcohol interacts negatively with more than 150 medications. For example, if you are taking antihistamines for a cold or allergy and drink alcohol, the alcohol will increase the drowsiness that the medication alone can cause, making driving or operating machinery even more hazardous. And if you are taking large doses of the painkiller acetaminophen and drinking alcohol, you are risking serious liver damage. Check with your doctor or pharmacist before drinking any amount of alcohol if you are taking any over-the-counter or prescription medications. For information about your medications, please visit the Medications Center. Interpersonal Problems The more heavily you drink, the greater the potential for problems at home, at work, with friends, and even with strangers. These problems may include: * Arguments with or estrangement from your spouse and other family members; * Strained relationships with coworkers; * Absence from or lateness to work with increasing frequency; * Loss of employment due to decreased productivity; and * Committing or being the victim of violence. Alcohol Related Birth Defects If you are a pregnant woman or one who is trying to conceive, you can prevent alcohol-related birth defects by not drinking alcohol during your pregnancy. Alcohol can cause a range of birth defects, the most serious being fetal alcohol syndrome (FAS). Children born with alcohol-related birth defects can have lifelong learning and behavior problems. Those born with FAS have physical abnormalities, mental impairment, and behavior problems. Because scientists do not know exactly how much alcohol it takes to cause alcohol-related birth defects, it is best not to drink any alcohol during this time. For more information about FAS, please red our Fetal Alcohol Syndrome article. Long Term Health Problems Some problems, like those mentioned above, can occur after drinking over a relatively short period of time. But other problems--such as liver disease, heart disease, certain forms of cancer, and pancreatitis--often develop more gradually and may become evident only after long-term heavy drinking. Women may develop alcohol-related health problems after consuming less alcohol than men do over a shorter period of time. Because alcohol affects many organs in the body, long-term heavy drinking puts you at risk for developing serious health problems, some of which are described below. Alcohol-related liver disease. More than 2 million Americans suffer from alcohol-related liver disease. Some drinkers develop alcoholic hepatitis, or inflammation of the liver, as a result of long-term heavy drinking. Its symptoms include fever, jaundice (abnormal yellowing of the skin, eyeballs, and urine), and abdominal pain. Alcoholic hepatitis can cause death if drinking continues. If drinking stops, this condition often is reversible. About 10 to 20 percent of heavy drinkers develop alcoholic cirrhosis, or scarring of the liver. Alcoholic cirrhosis can cause death if drinking continues. Although cirrhosis is not reversible, if drinking stops, one's chances of survival improve considerably. Those with cirrhosis often feel better, and the functioning of their liver may improve, if they stop drinking. Although liver transplantation may be needed as a last resort, many people with cirrhosis who abstain from alcohol may never need liver transplantation. In addition, treatment for the complications of cirrhosis is available. Heart disease. Moderate drinking can have beneficial effects on the heart, especially among those at greatest risk for heart attacks, such as men over the age of 45 and women after menopause. But long-term heavy drinking increases the risk for high blood pressure, heart disease, and some kinds of stroke. Cancer. Long-term heavy drinking increases the risk of developing certain forms of cancer, especially cancer of the esophagus, mouth, throat, and voice box. Women are at slightly increased risk of developing breast cancer if they drink two or more drinks per day. Drinking may also increase the risk for developing cancer of the colon and rectum. Pancreatitis. The pancreas helps to regulate the body's blood sugar levels by producing insulin. The pancreas also has a role in digesting the food we eat. Long-term heavy drinking can lead to pancreatitis, or inflammation of the pancreas. This condition is associated with severe abdominal pain and weight loss and can be fatal. For additional information, please read our Alcohol Abuse and Alcoholism article. Portions of the above information was provided with the kind permission of the National Institute on Alcohol Abuse and Alcoholism (http://www.niaaa.nih.gov/publications/harm-al.htm). A Family History of Alcoholism Are You at Risk' | Causes of Fatigue Slideshow | Brain Foods Slideshow | Sleep Disorders Slideshow | | If you are among the millions of people in this country who have a parent, grandparent, or other close relative with alcoholism, you may have wondered what your family's history of alcoholism means for you. Are problems with alcohol a part of your future' Is your risk for becoming an alcoholic greater than for people who do not have a family history of alcoholism' If so, what can you do to lower your risk' What is alcoholism' Alcoholism, or alcohol dependence, is a disease that includes 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 upset stomach, sweating, shakiness, and anxiety after stopping drinking. * Tolerance- The need to drink greater amounts of alcohol to get "high". Many scientific studies, including research conducted among twins and children of alcoholics, have shown that genetic factors influence alcoholism. These findings show that children of alcoholics are about four times more likely than the general population to develop alcohol problems. Children of alcoholics also have a higher risk for many other behavioral and emotional problems. But alcoholism is not determined only by the genes you inherit from your parents. In fact, more than one-half of all children of alcoholics do not become alcoholic. Research shows that many factors influence your risk of developing alcoholism. Some factors raise the risk while others lower it. * Genes are not the only things children inherit from their parents. How parents act and how they treat each other and their children has an influence on children growing up in the family. These aspects of family life also affect the risk for alcoholism. Researchers believe a person's risk an alcoholic parent is depressed or has other psychological problems; * both parents abuse alcohol and other drugs; * the parents' alcohol abuse is severe; and * conflicts lead to aggression and violence in the family. The good news is that many children of alcoholics from even the most troubled families do not develop drinking problems. Just as a family history of alcoholism does not guarantee that you will become an alcoholic, neither does growing up in a very troubled household with alcoholic parents. Just because alcoholism tends to run in families does not mean that a child of an alcoholic parent will automatically become an alcoholic too. The risk is higher but it does not have to happen. If you are worried that your family's history of alcohol problems or your troubled family life puts you at risk for becoming alcoholic, here is some common-sense advice to help you: Avoid underage drinking-First, underage drinking is illegal. Second, research shows that the risk for alcoholism is higher among people who begin to drink at an early age, perhaps as a result of both environmental and genetic factors. Drink moderately as an adult-Even if they do not have a family history of alcoholism, adults who choose to drink alcohol should do so in moderation-no more than one drink a day for most women, and no more than two drinks a day for most men, according to guidelines from the U.S. Department of Agriculture and the U.S. Department of Health and Human Services. Some people should not drink at all, including women who are pregnant or who are trying to become pregnant, recovering alcoholics, people who plan to drive or engage in other activities that require attention or skill, people taking certain medications, and people with certain medical conditions. Alcoholism: Does Family History make You at Risk' (cont.)People with a family history of alcoholism, who have a higher risk for becoming dependent on alcohol, should approach moderate drinking carefully. Maintaining moderate drinking habits may be harder for them than for people without a family history of drinking problems. Once a person moves from moderate to heavier drinking, the risks of social problems (for example, drinking and driving, violence, and trauma) and medical problems (for example, liver disease , brain damage, and cancer) increase greatly. Talk to a health care professional-Discuss your concerns with a doctor, nurse, nurse practitioner, or other health care provider. They can recommend groups or organizations that could help you avoid alcohol problems. If you are an adult who already has begun to drink, a health care professional can assess your drinking habits to see if you need to cut back on your drinking and advise you about how to do that.Source: National Institutes of Health (www.nih.gov) | | Drinking and Driving Driving involves multiple tasks, the demands of which can change continually. To drive safely, one must maintain alertness, make decisions based on ever-changing information present in the environment, and execute maneuvers based on these decisions. Drinking alcohol impairs a wide range of skills necessary for carrying out these tasks. This Alcohol Alert examines alcohol impairment of driving skills and describes some factors that increase motor vehicle crash risk. Some Factors That Influence Crash Risk Blood alcohol concentration. The proportion of alcohol to blood in the body is expressed as the blood alcohol concentration (BAC). In the field of traffic safety, BAC is expressed as the percentage of alcohol in deciliters of blood--for example, 0.10 percent (i.e., 0.10 grams per deciliter). A 160-pound man will have a BAC of approximately 0.04 percent 1 hour after consuming two 12-ounce beers or two other standard drinks on an empty stomach. All State laws stipulate driver BAC limits, which now vary by State. According to these laws, operating a vehicle while having a BAC over the given limit is illegal. The BAC limit for drivers age 21 and older in most States is 0.10 percent, although some States have reduced the limit to 0.08 percent. The many skills involved in driving are not all impaired at the same BAC's . For example, a driver's ability to divide attention between two or more sources of visual information can be impaired by BAC's of 0.02 percent or lower. However, it is not until BAC's of 0.05 percent or more are reached that impairment occurs consistently in eye movements, glare resistance, visual perception, reaction time, certain types of steering tasks, information processing, and other aspects of psychomotor performance. Research has documented that the risk of a motor vehicle crash increases as BAC increases and that the more demanding the driving task, the greater the impairment caused by low doses of alcohol. Compared with drivers who have not consumed alcohol, the risk of a single-vehicle fatal crash for drivers with BAC's between 0.02 and 0.04 percent is estimated to be 1.4 times higher; for those with BAC's between 0.05 and 0.09 percent, 11.1 times higher; for drivers with BAC's between 0.10 and 0.14 percent, 48 times higher; and for those with BAC's at or above 0.15 percent, the risk is estimated to be 380 times higher. Youth. Youthful age has been cited as one of the most important variables related to crash risk. Young drivers are inexperienced not only in driving but in drinking and in combining the two activities. In 1994, almost 7,800 persons ages 16 through 20 were drivers in fatal motor vehicle crashes. Twenty-three percent of these drivers, for whom drinking any quantity of alcohol is illegal, had BAC's of 0.01 percent or higher, compared with 26 percent of drivers age 21 and older. According to Hingson and colleagues, each 0.02-percent increase in BAC above 0.00 percent places 16- to 20-year-old drivers at greater risk for a crash than older drivers. Roadside surveys indicate that young people are less likely than adults to drive after drinking; however, especially at low and moderate BAC's, their crash rates are substantially higher than those of other groups. Driving inexperience and immaturity are considered to be the main causes of motor vehicle crashes among drivers ages 16 to 20, even when alcohol is not involved. In one study, Hingson and colleagues concluded that drivers in this age group have a greater risk than older drivers of being involved in a fatal crash even with a BAC of 0.00 percent. Young people's lack of driving experience renders them less likely than more experienced drivers to cope successfully with hazardous situations. This, combined with a penchant for risk-taking driving behavior such as speeding--along with a tendency both to underestimate the dangerous consequences of such behaviors and to overestimate their driving skill--contributes to the high crash rate among young drivers. Excessive habitual consumption of alcoholic beverages despite physical, mental, social, or economic harm (e.g., cirrhosis, drunk driving and accidents, family strife, frequently missing work). Persons who drink large amounts of alcohol over time become tolerant to its effects. Alcoholism is usually considered an addiction and a disease. The causes are unclear, but there may be a genetic predisposition. It is more common in men, but women are more likely to hide it. Treatment may be physiological (with drugs that cause vomiting and a feeling of panic when alcohol is consumed; not an effective long-term treatment), psychological (with therapy and rehabilitation), or social (with group therapies). Group therapies such as Alcoholics Anonymous are the most effective treatments. Suddenly stopping heavy drinking can lead to withdrawal symptoms, including delirium tremens. For more information on alcoholism, visit Britannica.com. The continuous or excessive use of alcohol (ethanol) with associated pathologic results. Alcoholism is characterized by constant or periodic intoxication, although the pattern of consumption varies markedly. Individuals admitted for the first time to an alcoholism treatment center typically have been consuming approximately 3–4 oz (80–100 g) of pure alcohol per day, corresponding to about seven to nine drinks or bottles of beer or glasses of wine. Studies have shown that problem drinking in these populations starts at about 2 oz/day (60 g/day), that is, four to five drinks per day, and that these are consumed in rapid succession, leading to intoxication on three or more days per week. Individuals who consume these levels of alcohol have also a greater than average risk of developing alcoholic liver cirrhosis. However, the levels should not be taken as absolute, since they can vary greatly in different individuals, according to body weight and other factors. The symptoms and consequences associated with severe alcohol consumption also vary greatly; that is, in some individuals only a few may be present. These may consist of the development of physical dependence manifested as a state of physical discomfort or hyperexcitability (tremors or shakes) that are reduced by continued consumption; the development of tolerance to the effects of alcohol, which leads individuals to increase their consumption; accidents while intoxicated; blackouts, characterized by loss of memory of events while intoxicated; work problems, including dismissal; loss of friends and family association; marital problems, including divorce; financial losses, including bankruptcy or continual unemployment. Medical problems can include gastric ulcers, pancreatitis, liver disease, and brain atrophy. The last is often associated with cognitive deficiencies, as shown by the inability to comprehend relatively simple instructions or to memorize a series of numbers. See also Cognition. Almost without exception, individuals seeking an early treatment for their alcohol problems have very good probabilities of recovery. The lesser the number of presenting problems described above, the better the chances of favorable outcome, and so an early identification of problem drinking by family, friends, employers, or physicians becomes very important. The types of intervention vary greatly, progressing from self-monitoring techniques to intensive outpatient and inpatient programs to Alcoholics Anonymous groups. The exact mechanisms of the pharmacological actions of alcohol are not known. Alcohol can act as a stimulant at lower doses and as a depressant at higher doses. Even at very low doses alcohol can impair the sensitivity to odors and taste. Also, low doses are known to alter motor coordination and time and space perception, important aspects of car driving. Some effects are already seen at levels of 0.05%. Pain sensitivity is diminished with moderate doses. In some individuals, alcohol is known to diminish feelings of self-criticism and to inhibit fear and anxiety, effects which are probably related to an alcohol-induced sociability. These effects act, no doubt, as psychological reinforcers for the use of alcoholic beverages. It is generally accepted that alcohol affects the nerve cell by preventing the production and propagation of electric impulses along a network consisting of axons and synapses. A major finding in the mid-1980s was that some of the neurologic effects of alcohol can be quickly reversed by new experimental drugs. Studies have shown that alcohol enhances the actions of an inhibitory brain neurotransmitter referred to as gamma-aminobutyric acid (GABA). Benzodiazepines, such as diazepam, are anxiety-reducing and sedative drugs which also enhance the effects of GABA. These effects can be reduced by experimental antagonist molecules, which interact in the brain in the same regions where GABA is found. See also Synaptic transmission. The liver is responsible for about 80% of the metabolism of alcohol. In the liver, alcohol is first oxidized to acetaldehyde and then to acetate, which is metabolized in many tissues, including the brain, heart, and muscles. A 150-lb (68-kg) person metabolizes approximately 0.4 oz (10 g) of pure alcohol per hour (about 1 oz of a distilled beverage per hour) or, if alcohol is continuously present in the bloodstream, about 8–10 oz (190–240 g) of pure alcohol per day, equivalent to 1300–1600 calories per day. Since alcoholic beverages contain negligible levels of essential nutrients, these calories are called “empty calories.” Many alcoholics show malnutrition due to the fact that an important part of their caloric intake is alcohol. Alcohol also impairs the absorption and the metabolism of some essential nutrients. In the presence of alcohol, about 80% of oxygen consumed by the liver is devoted to the metabolism of alcohol; as a consequence, other substances such as fats, normally oxidized by the liver, are not metabolized, leading to fat accumulation in the liver. See also Liver; Malnutrition. Alcoholic liver disease is characterized by two conditions: failure of the liver to detoxify noxious substances and to produce essential products; and increased resistance to blood flow through the liver. Alcoholic liver disease and liver cirrhosis rank among the 10 leading causes of mortality in the United States and Canada. See also Cirrhosis. There is abundant evidence that tendency to alcoholism can be of familial origin, due to environmental, cultural, and genetic factors. A Swedish study demonstrated that identical twins are twice as likely to have a common alcoholic problem as fraternal twins. In an American-Danish study, it was shown that children of alcoholic parents are more likely to develop alcoholism (18%) than children of nonalcoholic parents (4%) when both groups of children were adopted by nonrelatives within 6 weeks of birth. See also Behavior genetics; Behavioral toxicology. Pharmacotherapy for alcohol rehabilitation has been gaining wider acceptance. Specific pharmacotherapies which have received the most research attention utilize naltrexone and disulfiram. Other promising pharmacological interventions are acamprosate and buspirone. Naltrexone is an opiate receptor antagonist which blocks the effects of endogenous opioids in the brain. Research from animal studies suggests that alcohol activates endogenous opioid systems and, thereby, may contribute to the pleasurable effects produced by alcohol consumption. Consequently, naltrexone might reduce the reinforcing effects of alcohol consumed by people and decrease their incentive to drink. Disulfiram is a drug which causes an inhibition of the enzyme aldehyde dehydrogenase, leading to an increase in acetaldehyde blood levels. This rise will produce nausea, vomiting, tachycardia, difficulty in breathing, and changes in blood pressure leading to hypotension. Acamprosate may function to reduce alcohol-induced euphoria related to the effects of excitatory neurotransmitters such as N-methyl-D-aspartate and have some blocking effects on opiate receptors. Buspirone, a nonbenzodiazepine antianxiety agent, may decrease anxiety symptoms associated with a protracted alcohol withdrawal syndrome, thus reducing alcohol relapse potential. Both of these medications require further investigation to determine their effectiveness as a pharmacotherapeutic agent in the treatment of alcoholism. The term ‘alcoholism’ was first used by a Swedish professor of medicine, Magnus Huss (1807-90), to mean poisoning by alcohol. Huss distinguished between two types of alcoholism. Acute alcoholism was a result of the temporary effects of alcohol taken within a short period of time — drunkenness and intoxication; chronic alcoholism was a pathological condition caused by the habitual use of alcoholic beverages in poisonous amounts over a long period of time. Using case studies to illustrate the condition of chronic alcoholism, Huss provided the first systematic description of the physical damage caused by excessive drinking. This first use of the term ‘alcoholism’ in 1852 emerged from a combination of specific historical circumstances within which changes in perceptions of excessive alcohol consumption were taking place. Prior to the nineteenth century, symptoms and problems related to ‘habitual drunkenness’, or excessive alcohol use, were known and recorded, but habitual drunkards were seen as morally weak or criminal, rather than suffering from an illness or a disease. Public concern revolved around drunkards' moral attitudes and social behaviours, which were regarded as licentious, sinful, or criminal, punishable by a period in the stocks, whipping, or fines — or by the eternal damnation preached in fiery sermons. On the whole, however, the dominant social response to drunkenness was tolerance and social disapproval; heavy drinking was not, in itself, regarded as a problem. The emergence of a new understanding of habitual drunkenness (or inebriety) as a disease was led by medical and psychiatric practitioners at the beginning of the nineteenth century, most notably by Benjamin Rush (1745-1813) in America and Thomas Trotter (1760-1832) in Scotland. According to some historians, it was Rush who provided the first clearly developed modern conception of alcohol addiction. This included the idea of gradual and progressive addiction; bouts of drunkenness characterized by an inability to refrain from alcohol; the description of the condition as a ‘disease’; and total abstinence as the cure. For the first time, ‘treatment’ became a possible option in responding to the harm associated with habitual drunkenness. Throughout the nineteenth century efforts were made to provide more scientific descriptions of the disease and its cure, leading, in 1901, to the use of the term ‘alcohol addiction’ to describe the inability to give up harmful drinking. Alcoholism Causes The cause of alcoholism is not well established. There is growing evidence for genetic and biologic predispositions for this disease, but this research is controversial. Studies examining adopted children have shown that children of alcoholic biological parents have an increased risk of becoming alcoholics. Relatively recent research has implicated a gene (D2 dopamine receptor gene) that, when inherited in a specific form, might increase a person's chance of developing alcoholism. Twice as many men are alcoholics. And 10-23% of alcohol-consuming individuals are considered alcoholics. Usually, a variety of factors contribute to the development of a problem with alcohol. Social factors such as the influence of family, peers, and society, and the availability of alcohol, and psychological factors such as elevated levels of stress, inadequate coping mechanisms, and reinforcement of alcohol use from other drinkers can contribute to alcoholism. Also, the factors contributing to initial alcohol use may vary from those maintaining it, once the disease develops. Alcoholism Symptoms Alcoholism is a disease. It is often diagnosed more through behaviors and adverse effects on functioning than by specific medical symptoms. Only 2 of the diagnostic criteria are physiological (those are tolerance changes and withdrawal symptoms).   * Alcohol abuse and alcoholism are associated with a broad range of medical, psychiatric, social, legal, occupational, economic, and family problems. For example, parental alcoholism underlies many family problems such as divorce, spouse abuse, child abuse and neglect, welfare dependence, and criminal behaviors, according to government sources. * The great majority of alcoholics go unrecognized by physicians and health care professionals. This is largely because of the alcoholic's ability to conceal the amount and frequency of drinking, denial of problems caused by or made worse by drinking, the gradual onset of the disease, and the body's ability to adapt to increasing alcohol amounts. *  Family members often deny or minimize alcohol problems and unwittingly contribute to the continuation of alcoholism by well-meaning behaviors such as shielding the alcoholic from adverse consequences of drinking or taking over family or economic responsibilities. Often the drinking behavior is concealed from loved ones and health care providers. *  Alcoholics, when confronted, will often deny excess consumption of alcohol. Alcoholism is a diverse disease and is often influenced by the alcoholic's personality as well as by other factors. Therefore, signs and symptoms often vary from person to person. There are, however, certain behaviors and signs that indicate someone may have a problem with alcohol. These behaviors and signs include insomnia, frequent falls, bruises of different ages, blackouts, chronic depression, anxiety, irritability, tardiness or absence at work or school, loss of employment, divorce or separation, financial difficulties, frequent intoxicated appearance or behavior, weight loss, or frequent automobile collisions. *  Late signs and symptoms include medical conditions such as pancreatitis, gastritis, cirrhosis, neuropathy, anemia, cerebellar atrophy, alcoholic cardiomyopathy (heart disease), Wernicke's encephalopathy (abnormal brain functioning), Korsakoff's dementia, central pontine myelinolysis (brain degeneration), seizures, confusion, malnutrition, hallucinations, peptic ulcers, and gastrointestinal bleeding. * Compared with children in families without alcoholism, children of alcoholics are at increased risk for alcohol abuse, drug abuse, conduct problems, anxiety disorders, and mood disorders. Alcoholic individuals have a higher risk of psychiatric disorders and suicide. They often experience guilt, shame, and depression, especially when their alcohol use leads to significant losses (for example, job, relationships, status, economic security, or physical health). Many medical problems are caused by or made worse by alcoholism as well as by the alcoholic's poor adherence to medical treatment. *