Alcoholism is a chronic, often progressive disease. A person with alcoholism typically craves alcohol and drinks despite repeated alcohol-related problems, such as multiple drunk-driving violations, job loss, or relationship problems. Alcoholism involves a physical dependence on alcohol, but other factors include genetic, psychological, and cultural influences.
Alcoholism is characterized by cravings for alcohol and an inability to stop drinking. It is accompanied by a physical dependence (meaning that the person experiences withdrawal symptoms when not drinking) and an increased tolerance for alcohol (meaning the person needs to drink greater amounts to feel "good"). Before entering recovery, most alcoholics deny they have a problem. People who abuse alcohol, but are not dependent on it, may have similar symptoms, but they do not feel the same craving to drink and usually do not experience withdrawal symptoms.
About 17 million people in the United States abuse alcohol, and estimates suggest that more than 70 million Americans have faced alcoholism in their families. Alcohol abuse is one of the 4 most common causes of death in the U.S., and it is involved in almost half of all traffic deaths in the U.S.
Signs and Symptoms
Symptoms of alcoholism include:
- Solitary or secretive drinking
- Alcohol cravings
- An inability to control the amount you drink
- Blackouts (not remembering events or conversations)
- Irritability when unable to drink
- Legal problems
- Difficulty sustaining a relationship or a job
- Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety when not drinking
- An increased tolerance to alcohol
- Liver disease
- Stomach pains
- Heart palpitations
If you have a family history of alcohol abuse, you are more likely to develop the condition than someone without a family history of alcohol abuse. Other factors that may increase your risk include:
- Having 2 or more adverse events during childhood
- Beginning to drink early in life, by age 16 or sooner
- Drinking more than 1 to 2 drinks per day
- Smoking cigarettes (particularly teenagers)
- Being under a lot of stress
- Having a pre-existing psychiatric disorder (such as depression or anxiety)
- Men have higher rates of alcoholism than women
- Broken home
If you have symptoms associated with alcoholism, you should see your doctor. Your doctor can help make a diagnosis and guide you in selecting an appropriate treatment or combination of therapies. Most alcoholics deny they have a problem, and they are often unlikely to seek treatment by themselves. If you suspect that a friend or a loved one has an alcohol problem, you and other friends and family members may need to convince them to seek help.
Your doctor will take a history and do a physical exam. Questions may include:
- Have you ever thought you needed to cut back on the amount of alcohol you drink?
- Has a spouse, friend, or coworker ever asked you to drink less?
- Do you ever feel guilty about the amount you drink?
- Do you ever drink in the morning or early in the day to soothe a hangover, get the day started, or get rid of the shakes?
Blood tests generally are not helpful because they only show recent alcohol consumption. Your doctor may order liver function tests to see if alcohol has damaged your liver.
If you drink, do so only in moderation, no more than 2 drinks per day for men, and no more than 1 drink per day for women.
Early intervention is important, especially with teenagers. To prevent teen drinking, consider the following:
- Stay involved and interested in your teenager's life.
- Talk openly to your children, especially pre-teens and teens, about the widespread presence and dangers of alcohol and drugs.
- Have clear, non-negotiable rules about not using alcohol and drugs.
- Act as a role model. Do not drink excessively, use other drugs, or smoke.
- Strongly urge your children to not smoke.
- Encourage your children to become active in sports, music, the arts, or other activities.
- Know where your children and teens are at all times, and make sure they always have adult supervision.
- Monitor your teenager for aggressive behavior, feelings of anger or depression, and poor school performance. If any of these develop, consider whether alcohol may be responsible.
- Never drink and drive or allow your teenager to be driven in the car by someone who has been drinking.
- Expose your children to spiritual practices or religion. Studies show that people who have a religious or spiritual focus in life are less likely to abuse alcohol.
The first and most important step in getting treatment for alcoholism is recognizing that you have a problem. Family members and close friends often convince people with alcohol addiction to seek treatment.
Treatment and ongoing recovery must address both physical and psychological addiction, and may include inpatient treatment and/or Alcoholics Anonymous (AA). In an inpatient or residential program, the person generally stays in a hospital or center for 28 days, undergoing first detoxification (usually 4 to 7 days) and then individual and group therapy sessions that emphasize abstinence. Talk to a doctor about what is best for you or your loved one.
- Attend Alcoholics Anonymous.
- Family members should attend Al-Anon to learn how to help the person with the addiction and to get help and support themselves.
- Exercise regularly to help reduce cravings.
Your doctor may prescribe the following medications:
For alcohol withdrawal:
Benzodiazepines are tranquilizers used during the first few days of treatment to help you withdraw safely from alcohol. These drugs include:
- Diazepam (Valium)
- Chlordiazepoxid (Librium)
- Lorazepam (Ativan)
- Oxazepam (Serax)
Anticonvulsants may also help with withdrawal symptoms, and do not have the potential for abuse (as benzodiazepines do). They include:
- Carbamazepine (Tegretol)
- Valprioc acid (Depakote)
- Phenytoin (Dilantin)
- Gabapentn (Neurontin)
- Baclofen (Lioresal, Lioresal Intrathecal, Gablofen)
To prevent relapse:
Naltrexone (Revia, Vivitrol): It is used in combination with counseling. It may lessen the craving for alcohol, and help prevent a return to drinking. Taking Revia or Vivitrol blocks receptors in your brain so that you do not get "high" from drinking. It is only used after detoxification, which means it is only used after you are no longer physically addicted to alcohol.
Acamprosate (Campral): May help restore the chemical balance in the brain. It is best used in combination with counseling.
Disulfiram (Antabuse): It is an older medicine that discourages drinking by causing nausea, vomiting, and other unpleasant physical reactions when alcohol is used.
Nutrition and Dietary Supplements
Because chronic use of alcohol decreases your appetite and keeps your body from absorbing vital nutrients, you may be deficient in a number of vitamins and minerals. Your doctor may tell you to take supplements while you are regaining your health. Beneficial supplements may include vitamin B complex, vitamin C, selenium, magnesium, and zinc. A combination of amino acids, such as carnitine, glutamine, and glutathione, may help reduce cravings, blood sugar fluctuations, and stress that is related to alcohol use.
Thiamine (vitamin B1): Your doctor may prescribe a thiamine supplement during withdrawal. Heavy use of alcohol causes thiamine deficiency, which can lead to a serious brain disorder called Wernicke-Korsakoff syndrome.
People who abuse alcohol are often deficient in vitamin A. Take supplements beyond the recommended daily allowance only under a doctor's supervision. High doses of vitamin A can damage the liver, and may cause alcoholic liver disease to develop more quickly in people who drink heavily.
Some members of the alcohol recovery community recommend a heavier, nutritionally-oriented approach. This includes intravenous (IV) nutritional therapies, along with targeted amino acid supplementation, to modulate brain function. The mainstream alcoholism treatment community considers some of these approaches controversial, so make sure you work with a reputable doctor and update every member of your recovery team on the type of therapies you are using.
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider. However, you should not use herbs alone to treat alcoholism. Counseling and peer groups such as AA are also needed.
- Milk thistle (Silybum marianum): Milk thistle is often used to treat liver problems. Some studies looking at milk thistle to treat alcoholic liver disease have found significant improvements in liver function. People with the mildest form of alcohol-related liver damage seem to improve the most. Milk thistle is less effective for those with severe liver disease, such as cirrhosis, which is characterized by scarring and permanent, irreversible damage to the liver. However, there are no studies looking at whether milk thistle is useful for alcohol withdrawal. People who are allergic to ragweed may have an allergic reaction to milk thistle. Milk thistle may interact with several medications. Speak with your physician. Some compounds in milk thistle may resemble estrogen in their composition, so people with hormone-sensitive conditions should speak to their doctor.
- Kudzu (Pueraria lobata): Animal studies suggest that kudzu, used in traditional Chinese medicine to treat alcohol abuse, might help reduce cravings. Human studies are mixed. One study in humans failed to show any benefit, while another found that heavy drinkers who had taken kudzu supplements for 7 days drank significantly less beer when given the opportunity than heavy drinkers who had taken a placebo. Kudzu can interact with many medicines, including blood thinners, methotrexate, diabetes medicines, estrogens, and estrogen-modifying medicines, including birth control medicines and breast cancer medicines, such as Tamoxifen. There is some concern that Kudzu could worsen liver disorders and/or slow blood clotting. Speak to your physician.
- Dandelion (Taraxacum officinale): Dandelion is used traditionally for liver-related problems, although there is evidence that it helps alcohol withdrawal symptoms. It is often combined with milk thistle. Dandelion can interact with many medicines, including lithium. People who aer allergic to ragweed could have an adverse reaction to dandelion. Speak with your physician.
Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend a treatment for alcoholism based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Homeopathy alone should not be used to treat alcoholism, but can be a supportive therapy along with counseling and groups such as AA. The following are a few examples of remedies that an experienced homeopath might consider for symptoms related to alcohol abuse or withdrawal:
- Arsenicum album: For anxiety and compulsiveness, with nausea, vomiting, and diarrhea.
- Nux vomica: For irritability and compulsiveness with nausea, vomiting, and constipation.
- Lachesis: For alcohol cravings, headaches, and difficulty swallowing.
- Staphysagria: For angry individuals who tend to suppress their emotions and may have been abused physically, sexually, or psychologically in the past.
Cognitive behavioral therapy (CBT) with a psychologist or psychiatrist is a very effective treatment approach for alcohol addiction. This type of therapy, which is geared toward changing your beliefs and thought process about drinking, can help you cope with stress and control your behavior. Talk to your doctor about finding a qualified cognitive behavioral therapist.
Yoga, too, has shown promis in preliminary studies reducing drug and alcohol use among people who have post-traumatic stress disorder (PTSD).
In some cases, acupuncture may be a useful supportive therapy for addiction. Some, but not all studies of acupuncture for the treatment of alcohol abuse have shown that it can reduce cravings and symptoms of withdrawal. However, acupuncture alone should not be used to treat alcohol addiction, but it may be used in combination with counseling and groups such as AA.
Drinking alcohol while pregnant can seriously damage the baby, causing a condition known as fetal alcohol syndrome. Fetal alcohol syndrome causes irreversible physical and mental disabilities. The only safe way to protect against damage to the baby is not to drink during pregnancy, or even if you are trying to become pregnant.
Prognosis and Complications
Possible complications associated with heavy alcohol use include:
- Mental confusion or delirium
- Severe amnesia
- An unsteady gait
- Loss of sperm cells
- Repeated vomiting, ulcers, gastrointestinal bleeding
In addition, long-term use of alcohol decreases life expectancy by about 15 years and puts you at significant risk for:
- Liver damage, even liver failure (called cirrhosis)
- High blood pressure, heart disease, and heart failure
- Brain and nerve damage
- Certain types of cancer, including mouth, throat, laryngeal (voice box), esophageal, and breast
- Nutritional deficiencies
- Infections, including pneumonia and tuberculosis
- Low bone mineral density and osteoporosis
Relapse in alcoholism is common. Risk factors for relapse can include environment cues, any mood-altering substance, and stress. Even though alcohol abuse is a serious condition with potentially dire consequences, it is treatable. If you or someone you love has a problem, seek the help and advice of a health care professional as early as possible.
Addolorato G, Leggio L, Hopf FW, Diana M, Bonci A. Novel therapeutic strategies for alcohol and drug addiction: focus on GABA, ion channels and transcranial magnetic stimulation. Neuropsychopharmacology. 2011 Oct 26. [Epub ahead of print]
Ambrose, ML, Bowden SC, Whelan G. Thiamin treatment and working memory function of alcohol-dependent people: preliminary findings. Alcohol Clin Exp Res. 2001;25(1):112-6.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.
Assanangkornchai S, Srisurapanont M. The treatment of alcohol dependence. Curr Opin Psychiatry. 2007;20(3):222-227. Review.
Carai MAM, Agabio R, Bombardelli E, et al. Potential use of medicinal plants in the treatment of alcoholism. Fitoterapia. 2000;71:538-42.
Carr G. Alcoholism: A modern Look at an ancient illness. Primary Care: Clinics in Office Practice. 2011;38(1).
Cooney JL, Cooney NL, Pilkey DT, Kranzler HR, Oncken CA. Effects of nicotine deprivation on urges to drink and smoke in alcoholic smokers. Addiction. 2003;98(7):913-21.
Correale M, Laonigro I, Altomare E, Di Biase M. Alcohol-induced cardiac disease. G Ital Cardiol (Rome). 2009;10(1):18-27.
Dager AD, Anderson BM, Stevens MC, et al. Influence of alcohol use and family history of alcoholism on neural response to alcohol cues in college drinkers. Alcohol Clin Exp Res. 2013;37 Suppl 1:E161-71.
Das UN. Essential Fatty acids - a review. Curr Pharm Biotechnol. 2006;7(6):467-482.
Ferri F. Ferri's Clinical Advisor 2016. 1st ed. Philadelphia, PA: Elsevier Mosby; 2016.
Ferri M, Amato L, Davoli M. Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database Syst Rev. 2006;3:CD005032. Review.
Garland EL, Gaylord SA, Boettiger CA, Howard MO. Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: results of a randomized controlled pilot trial. J Psychoactive Drugs. 2010;42(2):177-192.
Gonzalez-Reimers E, Santolaria-Fernandez F, Martin-Gonzalez MC, Fernandez-Rodriguez CM, Quintero-Platt G. Alcoholism: a systemic proinflammatory condition. World J Gastroenterol. 2014;20(40):14660-140671.
Hall M. Alcoholism & depression. Home Healthc Nurse. 2012;30(9):543-550.
Heilig M, Goldman D, Berrettini W, O'Brien CP. Pharmacogenetic approaches to the treatment of alcohol addiction. Nat Rev Neurosci. 2011;12(11):670-684.
Hillemacher T, Kahl KG, Heberlein A, Muschler MA, Eberlein C, Frieling H, Bleich S. Appetite- and volume-regulating neuropeptides: Role in treating alcohol dependence. [Review]. Curr Opin Investig Drugs. 2010;11(10):1097-1106.
Kunz S, Schulz M, Lewitzky M, Driessen M, Rau H. Ear acupuncture for alcohol withdrawal in comparison with aromatherapy: a randomized-controlled trial. Alcohol Clin Exp Res. 2007;31(3):436-442.
Le Berre AP, Pitel AL, Chanraud S, et al. Chronic alcohol consumption and its effect on nodes of frontocerebellar and limbic circuitry: comparison of effects in France and the United States. Hum Brain Mapp. 2014;35(9):4635-4653.
Leone MA, Vigna-Taglianti F, Avanzi G, Brambilla R, Faggiano F. Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses. Cochrane Database Syst Rev. 2010;(2):CD006266.
Liu Q, Lawrence AJ, Liang JH. Traditional Chinese medicine for treatment of alcoholism: from ancient to modern. Am J Chin Med. 2011;39(1):1-13.
Lukas SE, Penetar D, Berko J, Vicens L, Palmer C, Mallya G, Macklin EA, Lee DY. An extract of the Chinese herbal root kudzu reduces alcohol drinking by heavy drinkers in a naturalistic setting. Alcohol Clin Exp Res. 2005;29(5):756-762.
Lyndall GJ, Bass NJ, McQuillin A, et al. Confirmation of prior evidence of genetic susceptibility to alcoholism in a genome-wide association study of comorbid alcoholism and bipolar disorder. Psychiatr Genet. 2011;21(6):294-306.
Lyon JE, Khan RA, Gessert CE, Larson PM, Renier CM. Treating alcohol withdrawal with oral baclofen: A randomized, double-blind, placebo-controlled trial. J Hosp Med. 2011;6(8):474-479.
Malik P, Gasser RW, Kemmler G, Moncayo R, Finkenstedt G, Kurz M, Fleischhacker WW. Low bone mineral density and impaired bone metabolism in young alcoholic patients without liver cirrhosis: a cross-sectional study. Alcohol Clin Exp Res.. 2009;33(2):375-381.
Mantere O, Suominen K, Valtonen HM, et al. Concomitants of family histories of mood disorders and alcoholism in a clinical cohort of patients with bipolar I and II disorder. J Nerv Ment Dis. 2012;200(5):388-394.
Martinotti G, Andreoli S, Reina D, Di Nicola M, Ortolani I, Tedeschi D, Fanella F, Pozzi G, Iannoni E, D'Iddio S, Prof LJ. Acetyl-l-Carnitine in the treatment of anhedonia, melancholic and negative symptoms in alcohol dependent subjects. Prog Neuropsychopharmacol Biol Psychiatry. 2011;35(4):953-958.
Narendran R, Mason NS, Paris J, HImes ML, Douaihy AB, Frankie WG. Decreased prefrontal cortical dopamine transmission in alcoholism. Am J Psychiatry. 2014;171(8):881-888.
Oh SH, Soh JR, Cha YS. Germinated brown rice extract shows a nutraceutical effect in the recovery of chronic alcohol-related symptoms. J Med Food. 2003;6(2):115-121.
Otto KC. Acupuncture and substance abuse: a synopsis, with indications for further research. Am J Addict. 2003;12(1):43-51.
Overstreet DH, Keung WM, Rezvani AH, Massi M, Lee DY. Herbal remedies for alcoholism: promises and possible pitfalls. Alcohol Clin Exp Res. 2003;27(2):177-185.
Pilowsky DJ, Keyes KM, Hasin DS. Adverse childhood events and lifetime alcohol dependence. Am J Public Health . 2009;99(2):258-263.
Procopio DO, Saba LM, Walter H, et al. Genetic markers of comorbid depression and alcoholism in women. Alcohol Clin Exp Res. 2013;37(6):896-904.
Purohit V, Abdelmalek MF, Barve S, Benevenga NJ, Halsted CH, Kaplowitz N, et al. Role of S-adenosylmethionine, folate, and betaine in the treatment of alcoholic liver disease: summary of a symposium. Am J Clin Nutr. 2007;86(1):14-24.
Rakel D. Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.
Rakel RE, Rakel D. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2011.
Reddy S, Dick AM, Gerber MR, Mitchell K. The effect of a yoga intervention on alcohol and drug abuse risk in veteran and civilian woemn with posttraumatic stress disorder. J Altern Complement Med. 2014;20(10):750-756.
Rezvani AH, Overstreet DH, Perfumi M, Massi M. Plant derivatives in the treatment of alcohol dependency. Pharmacol Biochem Behav. 2003;75(3):593-606.
Roerecke M, Rehm J. Ischemic heart disease mortality and morbidity rates in former drinkers: a meta-analysis. Am J Epidemiol. 2011;173(3):245-258.
Ryan M, Merrick EL, Hodgkin D, et al. Drinking patterns of older adults with chronic medical condtions. J Gen Intern Med. 2013;8(10):1326-1332.
Shebek J, Rindone JP. A pilot study exploring the effect of kudzu root on the drinking habits of patients with chronic alcoholism. J Alt Compl Med. 2000;6:45-48.
Singh AK, Jiang Y, Benlhabib E, Gupta S. Herbal mixtures consisting of puerarin and either polyenylphosphatidylcholine or curcumin provide comprehensive protection against alcohol-related disorders in P rats receiving free choice water and 15% ethanol in pure water. J Med Food. 2007;10(3):526-542.
Sinha R, Fox HC, Hong KI, Hansen J, Tuit K, Kreek MJ. Effects of adrenal sensitivity, stress- and cue-induced craving, and anxiety on subsequent alcohol relapse and treatment outcomes. Arch Gen Psychiatry. 2011;68(9):942-952. PMID: 21536969 www.ncbi.nlm.nih.gov/pubmed/21536969.
Sukul NC, Ghosh S, Sinhababu SP, Sukul A. Strychnos nux-vomica extract and its ultra-high dilution reduce voluntary ethanol intake in rats. J Altern Complement Med. 2003;7(2):187-193.
Trumpler F, Oez S, Stahli P, Brenner HD, Juni P. Acupuncture for alcohol withdrawal: a randomized controlled trial. Alcohol. 2003;38(4):369-375.
Ventegodt S, Clausen B, Langhorn M, Kromann M, Andersen NJ, Merrick J. Quality of life as medicine III. A qualitative analysis of the effect of a five-day intervention with existential holistic group therapy or a quality of life course as a modern rite of passage. Scientific World J. 2004;4:124-133.
Vieten C, Astin JA, Buscemi R, Galloway GP. Development of an acceptance-based coping intervention for alcohol dependence relapse prevention. Subst Abus. 2010;31(2):108-116.
Waldron M, Bucholz KK, Lynskey MT, Madden PA, Heath AC. Alcoholism and timing of separation in parents: findings in a midwestern birth cohort. J Stud Alcohol Drugs. 2013;74(2):337-348.
Waldron M, Vaughan EL, Bucholz KK, et al. Risks for early substance involvement associated with parental alcoholism and parental separation in an adolescent female cohort. Drug Alcohol Depend. 2014;138:130-136.
Wedekind D, Herchenhein T, Kirchhainer J, Bandelow B, Falkai P, Engel K, Malchow B, Havemann-Reinecke U. Serotonergic function, substance craving, and psychopathology in detoxified alcohol-addicted males undergoing tryptophan depletion. J Psychiatr Res. 2010;44(16):1163-1169.
Wilson SR, Knowles SB, Huang Q, Fink A. The prevalence of harmful and hazardous alcohol consumption in older U.S. adults: data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES). J Gen Intern Med. 2014;29(2):312-319.
Xu BJ, Zheng YN, Sung CK. Natural medicines for alcoholism treatment: a review. Drug Alcohol Rev. 2005;24(6):525-536.
Review Date: 12/19/2015
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.