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Alcoholism
& Alcohol Abuse
Alcoholism is a topic which receives a fairly steady stream of attention in
the general media, and in everyday conversation. Yet, perhaps for most people,
alcoholism is not understood realistically. Most people tend to think of
alcoholism in terms of its most extreme manifestations, including job loss,
homelessness, financial destitution, etc. While all of these tragic outcomes can
and do occur in the lives of advanced alcoholics, this is not the picture of the
“typical alcoholic.” In fact, the truth is that there is no such thing as a
“typical alcoholic.” Although it is true that alcoholism is known to occur at
different rates of frequency among various ethnic groups, it occurs to some
extent in every group at every socioeconomic level. Therefore, the “typical
alcoholic” is a middle class person who works or goes to school, lives with a
family, attends worship services, etc. If this is true, what then is alcoholism?
Alcoholism perhaps is best described as a maladaptive pattern of regular,
frequent and immoderate use of alcohol. The emphasis to be noted here is that
this is a disorder of behavior; unlike other psychological problems, it is not
defined in terms of how someone feels or thinks, but primarily in terms of the
pattern of behavior of alcohol consumption. It is true that alcoholism is known
to be associated with some psychiatric disorders, but these disorders are not
considered to be the basis of alcoholism, per se, because no one can be
diagnosed with alcoholism or any other problem of substance use, unless they use
or have used the substance in the way described below. In addition to the
obvious behavioral component of alcoholism, there also is an experience of
craving which underlies the drive to drink, which persists even in the face of
very daunting consequences for the problematic drinking. This experience of
craving is the central psychological element of alcoholism and, indeed, all
chronic substance abuse.
In order for someone to be diagnosed officially as alcohol dependent (or
alcoholic), they must have shown the maladaptive pattern of use for a period of
at least 12 months, and they must have at least three of the seven following
symptoms, including:
- tolerance
- withdrawal
- episodes of greater use than the person intended
- unsuccessful efforts or desire to cut back
- large amounts of time spent obtaining the alcohol
- reduction of important life activities
- use of the alcohol in spite of knowledge that a physical or
psychological problem is being made worse by the alcohol
Note that this formal definition of alcoholism does not refer to the amount
of alcohol consumed, but rather to the pattern of use and the effect it has on
the life of the drinker. It should be noted that there is a different pattern of
problematic alcohol use which involves the occurrence or risk of problematic
outcomes, such as driving while intoxicated, alcohol related fighting, inability
to get to work or school, etc. In many cases, these difficulties occur in the
early stages of alcohol dependence, so they may be regarded as the early
symptoms in someone on their way to alcoholism. However, they can persist in
this form without progressing, so that this pattern is regarded as an
alcohol-related problem, but is not usually considered to be alcoholism in the
usual sense. This pattern of problematic alcohol use is referred to as "alcohol
abuse."
Alcoholism is known to be related to still unidentified genetic factors.
About 11 percent of the population of the United States is thought to be
alcoholic at some point in the course of their life, with about 7.5 percent
having some symptoms of alcohol problems within any 12 month period. The normal
course of alcoholism tends to involve periods of abstinence alternating with
periods of relapse. Relapse typically is followed by a return to problems equal
to or worse than the level of difficulty which preceded the period of
abstinence. For those alcoholics who continue drinking, only about 1 to 4
percent of adults are able to establish a pattern of moderate drinking. In other
words, people who are alcoholic almost always need to give up drinking entirely
if they hope to be free of the problem. On the positive side, people who do
decide to give up alcohol are able to live without it with increasing ease over
time. The most difficult time, by far, is the very early stage of abstinence or
“recovery.” Many people succeed in achieving a complete recovery at some time in
the course of their lives.
College student alcohol use is highly unusual in that a very disproportionate
number of students (between 25 and 30 percent) exhibit behaviors which would
qualify them as alcoholic. Fortunately, about 2/3rds of these reduce their
drinking greatly in the years after college, and join the general population of
college educated adults which has a lower level of alcoholism than the general
population. The remaining 1/3rd goes on to a course of relatively chronic
alcoholism. It should be noted that the substantial majority of college students
do not exhibit problematic drinking levels, but that among those who do, the
risk of long-term problems is extremely high: about one in three. Unfortunately,
there is no way, at this point, to identify reliably those students who will
become alcoholic in the long term, although some risk factors are known. The
highest risk factor for alcoholism in general is having a parent or close
relative who is alcoholic, primarily because of the inherited, biological
predisposition for alcoholism. A commonsense risk factor is a pattern of
drinking which is excessive, even compared to the excessive of use of other
heavy-drinking students. A third risk factor is the existence of a psychological
problem which is known to be associated with alcoholism: these include
depression, generalized anxiety, panic disorder, a history of trauma, and
others.
The appropriate treatment of alcoholism varies greatly according to the
severity of the problem, the motivation of the drinker, the presence or absence
of other problems, the history of previous efforts to stop, and many other
considerations. It should be noted that heavy, frequent drinkers might require a
brief period of hospital medical management, because the process of
detoxification can be very difficult physiologically, resulting in acute
physical symptoms. For less advanced cases, treatment can range from voluntary
support groups, such as Alcoholics Anonymous, to individual psychotherapy, to
various inpatient or outpatient rehabilitation services. Medication is useful
for some people in deterring a return to alcohol use either through the threat
of making alcohol very distasteful (Antabuse, or generic form Disulfiram), or by
reducing the discomfort of craving or other symptoms associated with withdrawal.
Clearly, all of these services are directed to increasing or maintaining a
person’s motivation to stop their problematic drinking.
Services for the treatment of alcohol related problems at Villanova
University are offered through the University Counseling Center. The Center
offers the opportunity for any student to consider their own pattern of alcohol
use in an impartial, non-judging, caring and confidential setting. The
Center also helps people begin the process of recovery, and it helps them
approach a longer term plan for their recovery. Referral to medical care can be
arranged, where appropriate, and referral to a host of other important resources
is also available. In addition, treatment for other psychological problems can
be planned and begun. It is important to remember that people can get help with
alcohol problems and that obtaining support for the process of recovery is vital
for most people who are successful in ending this damaging problem. Very few
people are successful in achieving the necessary changes in their lives entirely
on their own. Friends and family of the drinker are often unable to support
efforts to stop drinking, especially in the early stages of the recovery
process. Finally, it should be mentioned that the Center can serve as an important
resource for those who are being affected by the behavior of alcoholics in their
lives, as well as for the alcoholics themselves.
The Counseling Center
The Counseling Center offers caring, confidential help from psychologists
experienced in helping students deal with alcohol related concerns. Call
(610)519-4050 or stop by Room 206, Health Services Building to schedule an
appointment.
Links to further information
All rights reserved. May not be printed on other websites
or reprinted without permission of Villanova Counseling Center.
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