Chronic dependence on the use of alcoholic beverages. In 1949 a committee of the World Health Organization defined alcoholics as . those excessive drinkers whose dependence upon alcohol has attained such a degree that it shows a noticeable mental disturbance or an interference with their bodily and mental health, their interpersonal relations, and their smooth social and economic functioning; or who show the prodromal [or first stage] signs of such development.”The alcoholic addict is a compulsive drinker, the victim of an insatiable, uncontrollable drive: “One drink is too many, a thousand are not enough.” Although this drive is the primary characteristic of alcoholic addiction, there are other distinguishing marks. The alcoholic cannot face any trying situation without taking a drink; he secretly takes extra drinks when he is with other people; he drinks excessively when he is alone; and even if his drinking is successfully arrested by treatment, he will almost certainly have a latent tendency to alcoholism for the rest of his life.Of the 70 million users of alcohol in this country, 5 million may be classed as addicts, and the number is increasing at the rate of 200,000 new cases each year. Alcoholism is the fourth most prevalent disease in America and a leading cause of death:12,0 die of chronic alcoholism every year. It accounts for 15 per cent of first admissions to public mental hospitals; a loss to industry of one billion dollars a year due to absenteeism, reduced efficiency, and accidents; an annual cost of 1.25 billion dollars for care, treatment and financial support for alcoholics and their families; a large percentage of arrests (15 per cent of all murders involved drinking); as well as untold suffering and hardship for both the alcoholic and his family.Four out of five alcoholics are men; their average age is forty-five years, and their life span is twelve years shorter than average. Contrary to common opinion only 5 per cent are the“Bowery bum” type; most alcoholics live on a middle or upper economic level. Some groups have been found to be more prone to alcoholism than others, probably for reasons' of tradition: the incidence is high among the Irish and French, and low among Jews, Italians, and Chinese.The amount of alcohol intake necessary to produce intoxication varies with body weight, personality factors, habitual consumption, and physical condition. A 0.1 per cent concentration in the blood is sufficient to produce intoxication, at 0.5 per cent consciousness is lost, and above 0.55 per cent death generally occurs. Recent studies indicate that while alcohol may drug the brain temporarily, it does not in itself cause damage to the brain or other organs—although non-alcoholic components of the beverages sometimes produce toxic effects. A diet that consists almost exclusively of alcohol, however, may result in vitamin and other nutritional deficiencies which lower resistance to disease. In addition, a whole set of psychotic and organic brain disorders is associated with alcoholism: pathological intoxication, delirium tremens, acute alcoholic hallucinosis, Korsakoff’s syndrome, and Wernicke’s syndrome. Alcoholism may also occur as a symptom in general paresis, manic- depressive psychosis, and epilepsy. See these topics.The general reasons for the use of alcohol are reasonably clear. In our culture, consumption of alcohol is an acceptable accompaniment of social intercourse and an accepted technique for achieving a sense of well-being. Alcohol has a depressive effect on the higher brain centers, which enables the drinker to put aside both his troubles and his inhibitions. Even though most of his mental and physical abilities are dulled, he experiences an increased feeling of self-confidence and is enveloped by a warm, expansive, euphoric mood. Some drinkers become drowsy, others ALCOHOLIC ADDICTION55become lively; most drinkers become amiable; a few become pugnacious. These are the usual effects of alcohol taken in limited quantities.The crucial question is why some individuals do not remain controlled, social drinkers but become alcoholic addicts. Although there does not seem to be a clear-cut “alcoholic personality,” many studies indicate that alcoholics tend to be immature, passive-dependent persons who set unrealistic goals for themselves and cannot tolerate tension, failure, or criticism. Insteadofprotecting themselves against anxiety with the usual defense mechanisms such as overcompensation or displacement, they fall into the habit of seeking escape and relief in the bottle. In some instances they are following a pattern set by one or the other parent, and in some cases they may have a physiological make-up which makes alcohol particularly effective—although this has never been proven.At any rate, they usually start by asing alcohol as a means of alleviating oneliness, bolstering confidence, coun- :eracting disappointment, gaining free- lom from inhibitions, or narcotizing :hemselves against feelings of futility. They find that a few drinks are quite fifective in achieving these ends, and it the same time give them a sense }f pleasure and well-being. Though all hese effects quickly wear off, the fu- ure alcoholics soon find that they can je regained at any time by the simple irocess of visiting the nearest bar or iquor store. This encourages them to lse drinking as their standard technique >f dealing with maladjustment and naking themselves feel more comforta- )le. The process by which addiction develops has been traced in great detail )y Jellinek (1952). His study of over wo thousand chronic alcoholics revealed four distinct stages in the procss (Fig. 2). In the prealcoholic symp- omatic phase, the prospective alcoholic Fig. 2. Phases of alcoholic addiction and recovery.Finds special relief in the usual drinking situations, either because his tensions are greater than average or his ability to handle his problems is less than average. In a few months he progresses from occasional relief-drinking to constant relief-drinking. In the prodromal phase, he experiences occasional blackouts— that is, he carries on conversations and other activities while under the influence of alcohol but cannot remember a thing the next day. This tendency to amnesic episodes without loss of consciousness is a particularly clear danger signal. During this period, the future alcoholic starts his drinking with a few quick gulps to get ahead of the game, drinks surreptitiously, begins to feel guilty about his drinking, and tries to avoid reference to alcohol in his conversation.The crucial phase is characterized by uncontrolled drinking leading to frequent intoxication. This is accompanied by “alcoholic alibis” devised to justify his drinking and answer the criticisms and warnings of others. He often feels remorseful about his drinking, but to alleviate this distressing feeling usually resorts to more drinking. He also has frequent hangovers, but the medicine he takes to ease the pain is a few drinks. He now begins to use many dodges to control his drinking, such as changing his beverage, or drinking only at certain hours. These devices are ineffective and he soon finds himself drinking in the afternoon as well as in the evening. As a result he loses one job after another, and one friend after another—although he sometimes tries to save face by quitting them before they quit him.At this point the alcoholic’s wife and children withdraw from social activities to avoid embarrassment, and his life becomes even more restricted. Improper nutrition begins to have an effect on his sexual drive, but as potency decreases, “alcoholic jealousy” increases, and he is likely to accuse his wife of infidelity. To all these mounting tensions there is but one answer for the alcoholic: more drinking. He now begins to hide liquor in unlikely places, and cannot face the day without a drink.The chronic phase is ushered in with daily intoxication and frequent, prolonged “benders.” The alcoholic will now drink anything any time and with anyone. His tolerance for alcohol starts to decrease, and half his usual intake will produce tremors, vague feelings of apprehension, and mental confusion— but again the only way he seeks relief is through more drinking. In about 10 per cent of these chronic cases, an out-and-out psychosis develops. Others drift into Skid Row until pneumonia or some other disease puts an end to their lives. The rest at least some of them finally admit defeat and accept treatment.In acute intoxication cases, treatment must take place in a hospital where medical care, including the use of tran- quilizing drugs, is given to alleviate nausea, encourage sleep, and prevent withdrawal symptoms. To reinforce the patient against future drinking, Antabuse or conditioned-response therapy may be used. These deterrent techniques prepare the way for psychotherapy and sociotherapy, which help the patient attain emotional insight and achieve more constructive patterns of adjustment.Residential treatment is usually required for alcoholics, and the most successful results have been achieved by a combination of comfortable living, good food and congenial environment, with daily group psychotherapy and opportunities to do odd jobs and develop occupational skills. Social workers are usually called upon to reduce home stresses and prepare the way for the patient’s return. A new trend is to use halfway houses as a transition back to community life. When the alcoholic is ready to attempt regular life again and even before that—he is frequently encouraged to become a member of an Alcoholics Anonymous group, so that he can benefit from the emotional and social support of others in his battle against addiction.When full, intensive treatment is applied, between 60 and 80 per cent of alcoholics succeed in maintaining sobriety. However, they must recognize that they will be susceptible to alcohol for the rest of their lives and cannot become ordinary social drinkers.If the alcoholic toll is to be reduced, a continuous educational program must be conducted on all economic levels and directed to older children as well as adults. AJcoholism should be presented as a psychiatric and social problem, and the alcoholic should be pictured as a sick person in desperate need of help rather than a moral degenerate. Above all, it is necessary to acquaint the entire public with the warning signals which can lead to early detection and preventive treatment. Among the most indicative are these four: (1) increasing consumption, even though it may be gradual; (2) morning drinking, to alleviate a hangover or face the day; (3) uncontrolled behavior: senseless, embarrassing, or violent actions while under the influence of alcohol; (4) pulling blanks: drinking enough to cause blackouts or amnesic episodes. Any one of these indicators is an ominous warning; and if all four apply, the individual is well on the way to chronic alcoholism.

Cite this page: N., Pam M.S., "ALCOHOLIC ADDICTION," in, November 28, 2018, (accessed May 8, 2021).