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"Alcoholism" or "Alcohol Abuse"?
There is a difference!!!

Definitions:

Alcoholism is a chronic disease that makes your body dependent on alcohol.  You may be obsessed with alcohol and unable to control how much you drink, even though your drinking is causing serious problems with your relationships, health, work and finances.

It's possible to have a problem with alcohol, but not display all the characteristics of alcoholism.  This is known as "alcohol abuse", which means you engage in excessive drinking that causes health or social problems, but you aren't dependent on alcohol and haven't fully lost control over the use of alcohol.

Although many people assume otherwise, alcoholism is a treatable disease.  Medications, counseling and self-help groups are among the therapies that can provide ongoing support to help you recover from alcoholism.

Symptoms:

Before treatment or recovery, most people with alcoholism deny that they have a drinking problem.  Other signs of alcoholism and alcohol abuse include:

•  Drinking alone, or in secret
  
  
•  Being unable to limit the amount of alcohol you drink
  
  
•  Not remembering conversations or commitments, sometimes referred to as "blacking out"
  
  
•  Making a ritual of having drinks before, with or after dinner and becoming annoyed when this ritual is disturbed or questioned
  
  
•  Losing interest in activities and hobbies that used to bring pleasure
•  Feeling a need or compulsion to drink
  
  
•  Irritability when your usual drinking time nears, especially if alcohol isn't available
  
  
•  Keeping alcohol in unlikely places at home, at work, or in the car
•  Gulping drinks, ordering doubles, becoming intoxicated intentionally to feel good or drinking to feel "normal"
  
  
•  Having legal problems or problems with relationships, employment or finances
  
  
•  Building a tolerance to alcohol so that you need an increasing number of drinks to feel alcohol's effects
  
  
•  Experiencing physical withdrawal symptoms -- such as nausea, sweating and shaking -- if you don't drink

People who abuse alcohol may experience many of the same signs and symptoms as people who are dependent on alcohol.  However, alcohol abusers don't feel the same compulsion to drink and usually don't experience physical withdrawal symptoms when they don't drink.  A dependence on alcohol also creates a tolerance to alcohol and the inability to control your drinking.

If you've ever wondered if your own alcohol consumption crosses the line of abuse or dependence, ask yourself these questions:

•  Do you need a drink as soon as you get up?
  
  
•  Do you feel guilty about your drinking?
  
  
•  Do you think you need to cut back on your alcohol consumption?
  
  
•  Are you annoyed when other people comment on or criticize your drinking habits?

If you answered yes to two or more questions, it's likely that you have a problem with alcohol.
Even one yes answer may indicate a problem.

Causes

Alcohol addiction -- physical dependence on alcohol -- occurs gradually.  Over time, drinking alcohol alters the balance of some chemicals in your brain, such as gamma-aminobutyric acid (GABA), which inhibits impulsiveness, and glutamate, which excites the nervous system.  Alcohol also raises the levels of dopamine in the brain, which is associated with the pleasurable aspects of drinking alcohol.  Excessive, long-term drinking can deplete or increase the levels of some of these chemicals, causing your body to crave alcohol to restore good feelings or to avoid negative feelings.

Other factors can lead to excessive drinking that contributes to the addiction process. These include:

•  Genetics:  Certain genetic factors may cause a person to be vulnerable to alcoholism or other addictions.
  
  
•  Emotional state.  High levels of stress, anxiety or emotional pain can lead some people to drink alcohol to block out the turmoil.  Certain stress hormones may be associated with alcoholism.
  
  
•  Psychological factors:  Having low self-esteem or depression may make you more likely to abuse alcohol.  Having friends or a close partner who drinks regularly -- but who may not abuse alcohol -- could promote excessive drinking on your part.  It may be difficult for you to distance yourself from these "enablers" or at least from their drinking habits.
  
  
•  Social and cultural factors:  The glamorous way that drinking alcohol is portrayed in advertising and in the media may send the message that it's OK to drink excessively.

Risk Factors

Steady drinking over time can produce a physical dependence on alcohol.  Drinking more than 15 drinks a week for men or 12 drinks a week for women increases the risk of developing dependence on alcohol.  However, drinking by itself is just one of the risk factors that contribute to alcoholism.  Other risk factors include:

•  Age:  People who begin drinking at an early age -- by age 16 or earlier -- are at a higher risk of alcohol dependence or abuse.
•  Genetics:  Your genetic makeup may increase your risk of alcohol dependency.
•  Sex:  Men are more likely to become dependent on or abuse alcohol than are women.
•  Family history:  The risk of alcoholism is higher for people who had a parent or parents who abused alcohol.
•  Emotional disorders: Being severely depressed or having anxiety places you at a greater risk of abusing alcohol.  Adults with attention-deficit/hyperactivity disorder also may be more likely to become dependent on alcohol.

When to Seek Medical Advice

Because denial is frequently a characteristic of alcoholism, it's unlikely that people who are dependent on or who abuse alcohol will seek medical treatment on their own.  Often it takes family members, friends or co-workers to persuade them to undergo screening for alcoholism or to seek treatment.

If you feel that your drinking is a problem -- you feel guilty about your drinking and just can't control it -- talk with your doctor about treatment options.  Also talk with your doctor if you find that you need a drink first thing in the morning and that you need an increasing amount of alcohol before you start feeling its effects.

Tests and Diagnosis

To be diagnosed with alcoholism, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.

Criteria for alcoholism to be diagnosed include a pattern of alcohol abuse leading to significant impairment or distress, as indicated by three or more of the following at any time during one 12-month period:

•  Tolerance, indicated by an increase in the amount of alcohol you need to feel intoxicated.  As alcoholism progresses, the amount leading to intoxication can also decrease as a result of damage to your liver or central nervous system.
•  Withdrawal symptoms when you cut down or stop using alcohol.  These signs and symptoms include tremors, insomnia, nausea and anxiety.  You may drink more alcohol in order to avoid those symptoms.
•  Drinking more alcohol or drinking over a longer period of time than you intended.
•  Persistently having a desire to cut down on your alcohol intake or making unsuccessful attempts to do so.
•  Spending a great deal of time obtaining, using, or recovering from alcohol use.
•  Giving up important social, occupational or recreational activities.
•  Continuing to use alcohol even though you know it's causing physical and psychological problems.

Problems Often Difficult to Discover

It's often difficult for doctors to decide which people to screen for an alcohol problem.  For example, signs and symptoms such as memory loss or falling might be the result of aging rather than indications of alcohol abuse.  Or people may complain to doctors about digestive problems or pain or weakness, but never reveal their abuse of alcohol.

A doctor who suspects an alcohol problem may ask a number of questions regarding drinking habits in order to get an indication of the amount of drinking.  If answers to those questions indicate possible alcoholism or alcohol abuse, the doctor may do a short screening test using a standardized questionnaire.

Blood alcohol tests aren't useful in diagnosing alcoholism because the tests indicate consumption only at that particular time.  They don't offer clues about long-term alcohol use.  Other blood tests that measure the size of red blood cells, which increases with long-term alcohol use, and a factor known as carbohydrate-deficient transferrin may indicate heavy alcohol consumption.  Sometimes other tests indicate health problems that may be alcohol-related, such as tests showing liver damage or reduced testosterone levels in men.

Denial is a hallmark of alcoholism, and people with alcohol dependence tend to minimize the extent of their drinking.  The doctor may ask for permission to speak with family members or friends.  Concerned family members may also contact the doctor on their own to discuss their concerns.  However, confidentiality rules prevent the doctor from giving out any information without consent.

Complications

Alcohol depresses your central nervous system.  In some people, the initial reaction may be stimulation.  But as you continue to drink, you become sedated.  Alcohol lowers your inhibitions and affects your thoughts, emotions and judgment.  In sufficient amounts, alcohol impairs speech and muscle coordination.  Too much alcohol can severely depress the vital centers of your brain.  A heavy drinking binge may even cause a life-threatening coma.

Over time, excessive alcohol use can cause fatigue and short-term memory loss, as well as weakness and paralysis of your eye muscles.  Other severe health effects may include:

•  Liver disorders:  Drinking heavily can cause alcoholic hepatitis, an inflammation of the liver.  Signs and symptoms may include loss of appetite, nausea, vomiting, abdominal pain and tenderness, fever, yellowing of the skin (jaundice), and sometimes confusion.  After years of drinking, hepatitis may lead to cirrhosis, the irreversible and progressive destruction and scarring of liver tissue.
  
  
•  Gastrointestinal problems:  Alcohol can result in inflammation of the lining of the stomach (gastritis) and interfere with absorption of the B vitamins -- particularly folic acid and thiamin -- and other nutrients.  Heavy drinking can also damage your pancreas, which produces the hormones that regulate your metabolism and the enzymes that help digest fats, proteins and carbohydrates.
  
  
•  Cardiovascular problems:  Excessive drinking can lead to high blood pressure and damage your heart muscle (cardiomyopathy).  These conditions can increase your risk of heart failure or stroke.
  
  
•  Diabetes complications:  Alcohol prevents the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia).  This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level.
  
  
•  Sexual function and menstruation:  Alcohol abuse can cause erectile dysfunction in men.  In women, it can interrupt menstruation.
  
  
•  Birth defects:  Alcohol use during pregnancy may cause fetal alcohol syndrome.  This condition results in birth defects, including a small head, heart defects, a shortening of the eyelids and various other abnormalities.  Developmental disabilities are likely as well.
  
  
•  Bone loss:  Alcohol may interfere with the production of new bone.  This can lead to thinning bones and an increased risk of fractures.
  
  
•  Neurological complications:  Excessive drinking can affect your nervous system, causing numbness of your hands and feet, disordered thinking and dementia.
  
  
•  Increased risk of cancer:  Chronic alcohol abuse has been linked to a higher risk of numerous cancers, including cancer of the mouth, pharynx (throat), esophagus, larynx, liver and colon, rectum, and breast.

The nonmedical complications of alcoholism and alcohol abuse also are grave.  Each year 85,000 Americans die of alcohol-related causes.  Alcohol is a factor in nearly half of all U.S. traffic deaths.  In addition, alcohol abuse is linked to:

•  A greater susceptibility to accidental injuries from other causes.
•  Domestic abuse and divorce.
•  Poor performance at work or school.
•  A higher incidence of suicide and murder.

Treatments and Drugs

Many people with alcoholism or those who abuse alcohol enter treatment reluctantly because they deny that they have a problem.  Health problems or legal difficulties may prompt treatment.  Intervention helps some people recognize and accept the need for treatment.  If you're concerned about a friend or family member, discuss intervention with a professional.

Various treatments are available to help people with alcohol problems.  Depending on the circumstances, treatment may involve an evaluation, a brief intervention, an outpatient program or counseling, or a residential inpatient stay.

Determining Your Level of Dependence

The first step in treatment is to determine whether you're alcohol dependent.  If you haven't lost control over your use of alcohol, treatment may involve reducing your drinking.  If you're dependent on alcohol, simply cutting back is ineffective.  Abstinence must be part of your treatment goal.

If you aren't dependent on alcohol but are experiencing the adverse effects of drinking, the goal of treatment is to reduce alcohol-related problems -- often through counseling or a brief intervention, which usually involves alcohol-abuse specialists who can establish a specific treatment plan.  Interventions may include goal setting, behavior modification techniques, use of self-help manuals, counseling and follow-up care at a treatment center.

Counseling may take many forms.  With cognitive behavioral therapy, you and your therapist identify distorted thoughts and beliefs that trigger psychological stress.  You learn new ways to view and cope with traumatic events.  Emphasis is placed on developing a sense of mastery and control of your thoughts and feelings.

Another option may be aversion therapy, in which drinking alcohol is paired with a strong aversive response -- such as nausea or vomiting induced by a medication.  After repeated pairing, the alcohol itself causes the aversive response, which decreases the likelihood of relapse.

Residential Treatment Programs

Many residential alcoholism treatment programs in the United States include abstinence, individual and group therapy, participation in alcoholism support groups, such as Alcoholics Anonymous (AA), educational lectures, family involvement, work assignments, activity therapy, and the use of counselors and professional staff experienced in treating alcoholism.

Here's what you might expect from a typical residential treatment program:

•  Detoxification and withdrawal:  Treatment for alcoholism may begin with a program of detoxification, usually taking about four to seven days.  You may need to take sedating medications to prevent delirium tremens or other withdrawal seizures.
  
  
•  Medical assessment and treatment:  Common medical problems related to alcoholism are high blood pressure, increased blood sugar, and liver and heart disease.
  
  
•  Psychological support and psychiatric treatment:  Group and individual counseling and therapy support recovery from the psychological aspects of alcoholism.  Many treatment programs also offer couples and family therapy because family support can be an important part of the recovery process.  In fact, involving a spouse in the treatment process may increase the chances of successful recovery.
  
  
•  Emphasis on acceptance and abstinence:  Effective treatment is impossible unless you accept that you're addicted and currently unable to control your drinking.
  
  
•  Drug treatments:  An alcohol-sensitizing drug called disulfiram (Antabuse) may be a deterrent.  Disulfiram won't cure alcoholism, nor can it remove the compulsion to drink.  But if you drink alcohol, the drug produces a severe physical reaction that includes flushing, nausea, vomiting and headaches.  Naltrexone (ReVia), a drug long known to block the narcotic high, also reduces the urge to drink.  Acamprosate (Campral) is an anti-craving medication that may help you combat alcohol cravings and remain abstinent from alcohol.  Unlike disulfiram, naltrexone and acamprosate don't make you feel sick soon after taking a drink.
  
  In June 2006, the Food and Drug Administration (FDA) approved the first injectable drug to treat alcohol dependence.  Vivitrol, a version of the drug naltrexone, is injected in the buttocks once a month by a health care professional.  It may reduce the urge to drink by blocking neurotransmitters in the brain thought to be associated with alcohol dependence.  Vivitrol doesn't affect alcohol withdrawal symptoms.  It's intended for people with alcoholism who are receiving counseling and who haven't had a drink for at least a week.  Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol dependence to use consistently.
  
  
•  Continuing support:  Aftercare programs and support groups help people recovering from alcoholism or alcohol abuse abstain from drinking, manage relapses and cope with necessary lifestyle changes.

Prevention

Knowing and recognizing a family history of alcoholism for you or others is an important step toward seeking treatment before alcohol use or alcohol abuse progresses to alcoholism.

Early intervention is particularly important to prevent alcohol dependence in teenagers.  Alcohol use among teens increases dramatically during the high-school years and leads to serious consequences for many teens.  Each year in the United States, alcohol-related automobile accidents are a major cause of teen deaths.  Alcohol is also often a cause in other teenage deaths, including drownings, suicides and homicides.  Teens who drink are more likely to become sexually active, have sex more frequently and engage in risky, unprotected sex than are teens who don't drink.

For young people, the likelihood of addiction depends on the influence of parents, peers and other role models, susceptibility to advertising, how early in life they begin to use alcohol, the psychological need for alcohol, and genetic factors that may predispose them to addiction.

If you have a teenager, be alert to signs and symptoms that may indicate a problem with alcohol:

•  Less or no interest in activities and hobbies
•  Bloodshot eyes, slurred speech and memory lapses
•  Difficulties or changes in relationships with friends, often characterized by joining a new crowd
•  Declining grades and problems in school
•  Frequent mood changes and defensive behavior

You can help prevent teenage alcohol use.  Start by setting a good example with your own alcohol use.  Talk openly with your child and spend quality time together, but respect your child's need for independence.  Let your child know what behavior you expect -- and what the consequences will be if he or she doesn't follow the rules.  Make sure your child understands the legal and medical consequences of drinking.

Coping and Support

Many people seeking to end their alcohol dependence or abuse, and their family members, find that participating in support groups is an essential part of coping with the disease, preventing or dealing with relapses, and staying sober.

The fellowship of Alcoholics Anonymous (AA) was formed in 1935.  As a self-help group of people recovering from alcoholism, AA offers a sober peer group as an effective model for achieving total abstinence.

The AA program is built around 12 steps, which are straightforward suggestions for people who choose to lead sober lives.  As guides to recovery, the 12 steps help those with alcoholism to accept their powerlessness over alcohol.  They stress the necessity for honesty about the past and present.

Recovery in AA is based on accepting the unique experience of each person.  Through listening and sharing stories, people who abuse or are dependent on alcohol learn they aren't alone.  There are no fees for membership or requirements for following the 12 steps -- only a willingness to try to remain sober.

Eventually family members of people recovering from alcoholism formed a complementary self-help group called Al-Anon.  Al-Anon is designed for people who are affected by someone else's alcoholism.  In sharing their stories, they gain a greater understanding of how the disease affects the entire family.  Al-Anon accepts the 12 steps of AA as the principles by which participants are to conduct their lives.  It also emphasizes the need to learn detachment and forgiveness.  In many communities, Alateen groups also are available for teenage children of those with alcoholism.

Your doctor or counselor can refer you to an AA group or other local support group.  These groups are also commonly listed in the phone book, in the local newspaper and on the Web.

Symptoms of Alcohol Withdrawal --
Withdrawals Can Be Mild, Moderate or Severe

By Buddy T, About.com
Updated July 20, 2009

Alcohol withdrawal refers to a group of symptoms that may occur from suddenly stopping the use of alcohol after chronic or prolonged ingestion.

Not everyone who stops drinking experiences withdrawal symptoms, but most people who have been drinking for a long period of time, or drinking frequently, or drink heavily when they do drink, will experience some form of withdrawal symptoms if they stop drinking suddenly.

There is no way to predict how any individual will respond to quitting.  If you plan to stop drinking and you have been drinking for years, or if you drink heavily when you do drink, or even if you drink moderately but frequently, you should consult a medical professional before going "cold turkey."

Withdrawal Symptoms:

Mild to moderate psychological symptoms:

•  Feeling of jumpiness or nervousness
•  Feeling of shakiness
•  Anxiety
•  Irritability or easily excited
•  Emotional volatility, rapid emotional changes
•  Depression
•  Fatigue
•  Difficulty with thinking clearly
•  Bad dreams

Mild to moderate physical symptoms:

•  Headache - general, pulsating
•  Sweating, especially the palms of the hands or the face
•  Nausea
•  Vomiting
•  Loss of appetite
•  Insomnia, sleeping difficulty
•  Paleness
•  Rapid heart rate (palpitations)
•  Eyes, pupils different size (enlarged, dilated pupils)
•  Skin, clammy
•  Abnormal movements
•  Tremor of the hands
•  Involuntary, abnormal movements of the eyelids

Severe symptoms:

•  Agitation
•  Fever
•  Convulsions
•  A state of confusion and hallucinations (visual) (known as delirium tremens)
•  "Black outs" (when the person forgets what happened during the drinking episode)

Getting Treatment for Alcohol Withdrawal Symptoms

By Buddy T, About.com
Updated August 05, 2009

With the proper medical care, alcohol withdrawal symptoms can be greatly reduced or even eliminated.  There are specific treatments available for anyone who wants to stop drinking, even after long-term, chronic alcohol abuse.

Approximately 95 percent of people who quit drinking alcohol experience mild to moderate withdrawal symptoms and can usually be treated by healthcare providers on an out-patient basis, but five percent experience severe withdrawal symptoms and must be treated in a hospital or a facility that specializes in detoxification.

If you are experiencing alcohol withdrawal symptoms, seek medical attention immediately.  You can contact your family physician or healthcare provider, the local emergency room or urgent care center so that they can do an assessment of the severity of your withdrawal symptoms.

According to the MedlinePlus Medical Encyclopedia, the goals for healthcare providers are to treat the immediate withdrawal symptoms, prevent complications, and begin long-term preventative therapy.

Observation The person being treated for withdrawal usually will have to stay at the hospital for observation at least initially, so that heart rate, breathing, body temperature, and blood pressure can be monitored, as well as fluids and electrolytes (chemicals in the body such as sodium and potassium).

Sedation:  The severely alcohol dependent patient's symptoms can progress rapidly and may quickly become life-threatening.  Drugs that depress the central nervous system (such as sedatives) may be required to reduce symptoms, often in moderately large doses.

Tranquilizers:  Treatment may require maintenance of a moderately sedated state for a week or more until withdrawal is complete.  A class of medications known as the Benzodiazepines (tranquilizers such as Valium) are often useful in reducing a range of symptoms.

Drying Out:  A "drying out" period may be appropriate. No alcohol is allowed during this time.  The healthcare provider will watch closely for signs of delirium tremens.

Hallucinations Treated:  Hallucinations that occur without other symptoms or complications are uncommon.  They are treated with hospitalization and antipsychotic medications as needed.

Medical Conditions Tested:  Testing and treatment for other medical problems associated with use of alcohol is necessary.  This may include disorders such as alcoholic liver disease, blood clotting disorders, alcoholic neuropathy, heart disorders (such as alcoholic cardiomyopathy), chronic brain syndromes (such as Wernicke-Korsakoff syndrome), and malnutrition.

Rehab:  Rehabilitation for alcoholism is often recommended.  This may include social support groups, medications, and behavior therapy.

Health Risks of Alcohol Abuse
By Buddy T, About.com Guide to Alcoholism

Excessive alcohol consumption and the abuse of drugs are just plain dangerous.  Alcohol and drug abuse can affect your health and your ability function and think, and women are negatively affected even more than men.  Heavy drinkers and drug abusers are not only a danger to themselves, but to others -- on the highways, at home and in the workplace.

Health Effects of Alcohol

Almost every system in the body can be negatively affected by excessive or chronic alcohol consumption.  Alcohol can cause cancer, liver disease, heart attacks and brain damage, to name a few.  Because many alcoholics also smoke, the health risks are further compounded.

Hangovers

One of the most unpleasant short-term effects of binge drinking for some people is the hangover.  The term hangover refers to a constellation of unpleasant and painful symptoms that can develop after drinking too much alcohol.  Those symptoms can range from mild discomfort to very severe symptoms.

Issues for Women

Simply put, alcohol affects women in more negative ways and quicker than it does men, according to a vast amount of scientific research.  Even women who drink less than men get more intoxicated, become addicted faster and suffer the consequences of abuse-related illnesses sooner than their male counterparts.

Health Risks for Teens

Because the brains and bodies of adolescents are still developing, drinking alcohol and using illicit drugs can have serious consequences.  Binge drinking and substance abuse can have long-lasting effects that may not be evident until much later in adulthood.

Prevention Tips

The time to prevent alcohol and drug abuse is before it starts -- and these days, that means very early childhood.  It is never too early to begin talking to your children about drugs and alcohol.  Research has shown that brief conversations and involvement by parents can still have a positive effect on kids, even in today's society.

Drunk Driving

Almost every state now has laws that require anyone convicted of drunk driving to undergo an evaluation to determine the extent of their alcohol consumption.  That is because drunk driving itself is considered a symptom of a drinking problem.  Many states now require some kind of alcohol treatment before allowing convicted drunk drivers back on the highways.

Substance Abuse in the Workplace

Lost productivity, injuries and increased health insurance costs are some of the problems that alcohol abuse causes businesses in the United States, and it's a growing problem.  Research shows that most heavy drinkers hold full-time jobs, and some may be your co-workers.

Alcohol and Nutrition

Nutrition is a process that serves two purposes: to provide energy and to maintain body structure and function.  Food supplies energy and provides the building blocks needed to replace worn or damaged cells and the nutritional components needed for body function.  Alcoholics often eat poorly, limiting their supply of essential nutrients and affecting both energy supply and structure maintenance.  Furthermore, alcohol interferes with the nutritional process by affecting digestion, storage, utilization, and excretion of nutrients(1).

Impairment of Nutrient Digestion and Utilization

Once ingested, food must be digested (broken down into small components) so it is available for energy and maintenance of body structure and function.  Digestion begins in the mouth and continues in the stomach and intestines, with help from the pancreas.  The nutrients from digested food are absorbed from the intestines into the blood and carried to the liver.  The liver prepares nutrients either for immediate use or for storage and future use.

Alcohol inhibits the breakdown of nutrients into usable molecules by decreasing secretion of digestive enzymes from the pancreas (2).  Alcohol impairs nutrient absorption by damaging the cells lining the stomach and intestines and disabling transport of some nutrients into the blood (3).  In addition, nutritional deficiencies themselves may lead to further absorption problems.  For example, folate deficiency alters the cells lining the small intestine, which in turn impairs absorption of water and nutrients including glucose, sodium, and additional folate (3).

Even if nutrients are digested and absorbed, alcohol can prevent them from being fully utilized by altering their transport, storage, and excretion (4).  Decreased liver stores of vitamins such as vitamin A (5), and increased excretion of nutrients such as fat, indicate impaired utilization of nutrients by alcoholics (3).

Alcohol and Energy Supply

The three basic nutritional components found in food -- carbohydrates, proteins, and fats -- are used as energy after being converted to simpler products.  Some alcoholics ingest as much as 50 percent of their total daily calories from alcohol, often neglecting important foods (3,6).  When large amounts of alcohol are consumed, the body senses that its caloric needs have been met.  This produces a decreased demand for other foods.

Even when food intake is adequate, alcohol can impair the mechanisms by which the body controls blood glucose levels, resulting in either increased or decreased blood glucose (glucose is the body's principal sugar) (7).  In non-diabetic alcoholics, increased blood sugar, or hyperglycemia -- caused by impaired insulin secretion -- is usually temporary and without consequence.  Decreased blood sugar, or hypoglycemia, can cause serious injury even if this condition is short lived.  Hypoglycemia can occur when a fasting or malnourished person consumes alcohol.  When there is no food to supply energy, stored sugar is depleted, and the products of alcohol metabolism inhibit the formation of glucose from other compounds such as amino acids (7).  As a result, alcohol causes the brain and other body tissue to be deprived of glucose needed for energy and function.

Although alcohol is an energy source, how the body processes and uses the energy from alcohol is more complex than can be explained by a simple calorie conversion value (8).  For example, alcohol provides an average of 20 percent of the calories in the diet of the upper third of drinking Americans, and we might expect many drinkers who consume such amounts to be obese.  Instead, national data indicate that, despite higher caloric intake, drinkers are no more obese than nondrinkers (9,10).  Also, when alcohol is substituted for carbohydrates, calorie for calorie, subjects tend to lose weight, indicating that they derive less energy from alcohol than from food (summarized in 8).

The mechanisms accounting for the apparent inefficiency in converting alcohol to energy are complex and incompletely understood (11), but several mechanisms have been proposed.  For example, chronic drinking triggers an inefficient system of alcohol metabolism, the microsomal ethanol-oxidizing system (MEOS) (1).  Much of the energy from MEOS-driven alcohol metabolism is lost as heat rather than used to supply the body with energy.

Alcohol and the Maintenance of Cell Structure and Function

Structure

Because cells are made mostly of protein, an adequate protein diet is important for maintaining cell structure, especially if cells are being damaged.  Research indicates that alcohol affects protein nutrition by causing impaired digestion of proteins to amino acids, impaired processing of amino acids by the small intestine and liver, impaired synthesis of proteins from amino acids, and impaired protein secretion by the liver (3).

Function

Nutrients are essential for proper body function; proteins, vitamins, and minerals provide the tools that the body needs to perform properly.  Alcohol can disrupt body function by causing nutrient deficiencies and by usurping the machinery needed to metabolize nutrients.

Vitamins:  Vitamins are essential to maintaining growth and normal metabolism because they regulate many physiological processes.  Chronic heavy drinking is associated with deficiencies in many vitamins because of decreased food ingestion and, in some cases, impaired absorption, metabolism, and utilization (1,12).  For example, alcohol inhibits fat absorption and thereby impairs absorption of Vitamin A, Vitamin E, and Vitamin D that are normally absorbed along with dietary fats (12,13).  Vitamin A deficiency can be associated with night blindness, and Vitamin D deficiency is associated with softening of the bones (6).

Vitamins A, C, D, E, K, and the B vitamins, also deficient in some alcoholics, are all involved in wound healing and cell maintenance (14).  In particular, because vitamin K is necessary for blood clotting, deficiencies of that vitamin can cause delayed clotting and result in excess bleeding.  Deficiencies of other vitamins involved in brain function can cause severe neurological damage.

Minerals:  Deficiencies of minerals such as calcium, magnesium, iron, and zinc are common in alcoholics, although alcohol itself does not seem to affect the absorption of these minerals (15).  Rather, deficiencies seem to occur secondary to other alcohol-related problems: decreased calcium absorption due to fat malabsorption; magnesium deficiency due to decreased intake, increased urinary excretion, vomiting, and diarrhea (16); iron deficiency related to gastrointestinal bleeding (3,15); and zinc malabsorption or losses related to other nutrient deficiencies (17).  Mineral deficiencies can cause a variety of medical consequences from calcium-related bone disease to zinc-related night blindness and skin lesions.

Alcohol Malnutrition, and Medical Complications

• Liver Disease

Although alcoholic liver damage is caused primarily by alcohol itself, poor nutrition may increase the risk of alcohol-related liver damage.  For example, nutrients normally found in the liver, such as carotenoids, which are the major sources of Vitamin A, and Vitamin E compounds, are known to be affected by alcohol consumption (18,19).  Decreases in such nutrients may play some role in alcohol-related liver damage.

• Pancreatitis

Research suggests that malnutrition may increase the risk of developing alcoholic pancreatitis (20,21), but some research performed outside the United States links pancreatitis more closely with overeating (21).  Preliminary research suggests that alcohol's damaging effect on the pancreas may be exacerbated by a protein-deficient diet (22).

• Brain Function

Nutritional deficiencies can have severe and permanent effects on brain function.  Specifically, thiamine deficiencies, often seen in alcoholics, can cause severe neurological problems such as impaired movement and memory loss seen in Wernicke/Korsakoff syndrome (23).

• Pregnancy

Alcohol has direct toxic effects on fetal development, causing alcohol-related birth defects, including fetal alcohol syndrome.  Alcohol itself is toxic to the fetus, but accompanying nutritional deficiency can affect fetal development, perhaps compounding the risk of developmental damage (24,25).

The nutritional needs during pregnancy are 10 to 30 percent greater than normal; food intake can increase by as much as 140 percent to cover the needs of both mother and fetus (24).  Not only can nutritional deficiencies of an alcoholic mother adversely affect the nutrition of the fetus, but alcohol itself can also restrict nutrition flow to the fetus (24,25).

Nutritional Status of Alcoholics

Techniques for assessing nutritional status include taking body measurements such as weight, height, mass, and skin fold thickness to estimate fat reserves, and performing blood analysis to provide measurements of circulating proteins, vitamins, and minerals.  These techniques tend to be imprecise, and for many nutrients, there is no clear "cut-off" point that would allow an accurate definition of deficiency (4).  As such, assessing the nutritional status of alcoholics is hindered by the limitations of the techniques.  Dietary status may provide inferential information about the risk of developing nutritional deficiencies.  Dietary status is assessed by taking patients' dietary histories and evaluating the amount and types of food they are eating.

A threshold dose above which alcohol begins to have detrimental effects on nutrition is difficult to determine.  In general, moderate drinkers (two drinks or less per day) seem to be at little risk for nutritional deficiencies.  Various medical disorders begin to appear at greater levels.

Research indicates that many alcoholics who are hospitalized for medical complications of alcoholism experience severe malnutrition (1,12).  Because alcoholics tend to eat poorly -- often eating less than the amounts of food necessary to provide sufficient carbohydrates, protein, fat, vitamins A and C, the B-complex vitamins, and minerals such as calcium and iron (6,9,26) -- a major concern is that alcohol's effects on the digestion of food and utilization of nutrients may shift a mildly malnourished person toward severe malnutrition.

A Commentary on Alcohol and Nutrition:
by NIAAA Director Enoch Gordis, M.D.

The combination of an adequate diet and abstention from alcohol is the best way to treat malnourished alcoholic patients.  Nutritional supplements have been used to replace nutrients deficient in malnourished alcoholics in an attempt to improve their overall health.  Dosages of nutritional supplements such as vitamin A that exceed normally prescribed levels may result in overdose over time, but only after prolonged periods of high dosages.  Initial short-term treatments of high-dosage nutritional supplements will re-build the stores quickly and then the dosage can be reduced to the normal recommendations.

Renewed research attention to the nutritional aspects of alcohol abuse suggests a role for nutritional therapy in alcoholism treatment may be quite beneficial.

References:
Mayo Clinic
About Alcoholism Withdrawls
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*** As set down by the Food and Drug Administration, vitamin supplement products cannot be advertised as intended to diagnose, treat, cure or prevent any disease. ***