Alcoholism#Treatment

The risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of drinking larger amounts on an occasion, to the point of intoxication, which is sometimes called binge drinking. Binge drinking is the most common pattern of alcoholism. It has different definitions and one of this defines it as a pattern of drinking when a male has five or more drinks on an occasion or a female has at least four drinks on an occasion.{{cite web |title=Binge Drinking |url=https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm#:~:text=Binge%20drinking%20is%20the%20most,on%20an%20occasion%20for%20women |website=Center For Disease Control and Prevention |date=28 February 2024 |access-date=28 February 2024 |archive-date=12 May 2013 |archive-url=https://web.archive.org/web/20130512044035/http://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm#:~:text=Binge%20drinking%20is%20the%20most,on%20an%20occasion%20for%20women |url-status=live }}

File:Possible long-term effects of ethanol.svg an individual may develop. Additionally, in pregnant women, alcohol can cause fetal alcohol syndrome.]]

Alcoholism is characterized by an increased tolerance to alcohol – which means that an individual can consume more alcohol – and physical dependence on alcohol, which makes it hard for an individual to control their consumption. The physical dependency caused by alcohol can lead to an affected individual having a very strong urge to drink alcohol. These characteristics play a role in decreasing the ability to stop drinking of an individual with an alcohol use disorder.{{cite journal | vauthors = Hoffman PL, Tabakoff B | title = Alcohol dependence: a commentary on mechanisms | journal = Alcohol and Alcoholism | volume = 31 | issue = 4 | pages = 333–40 | date = July 1996 | pmid = 8879279 | doi = 10.1093/oxfordjournals.alcalc.a008159 | doi-access = free }} Alcoholism can have adverse effects on mental health, contributing to psychiatric disorders and increasing the risk of suicide. A depressed mood is a common symptom of heavy alcohol drinkers.{{cite journal | vauthors = Dunn N, Cook CC | title = Psychiatric aspects of alcohol misuse | journal = Hospital Medicine | volume = 60 | issue = 3 | pages = 169–72 | date = March 1999 | pmid = 10476237 | doi = 10.12968/hosp.1999.60.3.1060 }}{{cite book | vauthors = Wilson R, Kolander CA |title=Drug abuse prevention: a school and community partnership |year=2003 |publisher=Jones and Bartlett |location=Sudbury, MA |url={{google books |plainurl=y |id=Cm1MfcBSucUC}} |isbn=978-0-7637-1461-1 |pages=40–45}}

Warning signs of alcoholism include the consumption of increasing amounts of alcohol and frequent intoxication, preoccupation with drinking to the exclusion of other activities, promises to quit drinking and failure to keep those promises, the inability to remember what was said or done while drinking (colloquially known as "blackouts"), personality changes associated with drinking, denial or the making of excuses for drinking, the refusal to admit excessive drinking, dysfunction or other problems at work or school, the loss of interest in personal appearance or hygiene, marital and economic problems, and the complaint of poor health, with loss of appetite, respiratory infections, or increased anxiety.{{cite book|title=The Volume Library|publisher=The Southwestern Company|chapter-url={{google books |plainurl=y |id=RE9OwGtvDMACf}}|year=2009|isbn=978-0-87197-208-8|volume=1|location=Nashville, TN|page=29|chapter=Biology}}{{Dead link|date=May 2023 |bot=InternetArchiveBot |fix-attempted=yes }}

{{Main|Short-term effects of alcohol consumption}}

Drinking enough to cause a blood alcohol concentration (BAC) of 0.03–0.12% typically causes an overall improvement in mood and possible euphoria (intense feelings of well-being and happiness), increased self-confidence and sociability, decreased anxiety, a flushed, red appearance in the face and impaired judgment and fine muscle coordination. A BAC of 0.09% to 0.25% causes lethargy, sedation, balance problems and blurred vision. A BAC of 0.18% to 0.30% causes profound confusion, impaired speech (e.g. slurred speech), staggering, dizziness and vomiting. A BAC from 0.25% to 0.40% causes stupor, unconsciousness, anterograde amnesia, vomiting (death may occur due to inhalation of vomit while unconscious) and respiratory depression (potentially life-threatening). A BAC from 0.35% to 0.80% causes a coma (unconsciousness), life-threatening respiratory depression and possibly fatal alcohol poisoning. With all alcoholic beverages, drinking while driving, operating an aircraft or heavy machinery increases the risk of an accident; many countries have penalties for drunk driving.

{{See also|Long-term effects of alcohol consumption}}

Having more than one drink a day for women or two drinks for men increases the risk of heart disease, high blood pressure, atrial fibrillation, and stroke.{{cite journal|vauthors=O'Keefe JH, Bhatti SK, Bajwa A, DiNicolantonio JJ, Lavie CJ|date=March 2014|title=Alcohol and cardiovascular health: the dose makes the poison…or the remedy|journal=Mayo Clinic Proceedings|volume=89|issue=3|pages=382–93|doi=10.1016/j.mayocp.2013.11.005|pmid=24582196|doi-access=free}} Risk is greater with binge drinking, which may also result in violence or accidents. About 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol each year. Alcoholism reduces a person's life expectancy by around ten years and alcohol use is the third leading cause of early death in the United States. Long-term alcohol misuse can cause a number of physical symptoms, including cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic ulcers{{cite book |last=American Medical Association |title=Complete Medical Encyclopedia |url=https://books.google.com/books?id=WGURAQAAMAAJ |year=2003 |publisher=Random House Reference |location=New York |isbn=978-0-8129-9100-0 |edition=First |chapter=Duodenal Ulcer |veditors=Leiken JS, Lipsky MS |page=485 |access-date=1 July 2024 |archive-date=14 January 2023 |archive-url=https://web.archive.org/web/20230114105316/https://books.google.com/books?id=WGURAQAAMAAJ |url-status=live }} and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and several cancers such as breast cancer and head and neck cancer.{{Cite journal |last1=Gormley |first1=Mark |last2=Creaney |first2=Grant |last3=Schache |first3=Andrew |last4=Ingarfield |first4=Kate |last5=Conway |first5=David I. |date=2022-11-11 |title=Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors |journal=British Dental Journal|volume=233 |issue=9 |pages=780–786 |doi=10.1038/s41415-022-5166-x |issn=0007-0610 |pmc=9652141 |pmid=36369568}} Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption.{{cite journal | vauthors = Müller D, Koch RD, von Specht H, Völker W, Münch EM | title = [Neurophysiologic findings in chronic alcohol abuse] | language = de | journal = Psychiatrie, Neurologie, und Medizinische Psychologie | volume = 37 | issue = 3 | pages = 129–32 | date = March 1985 | pmid = 2988001 }}{{cite journal | vauthors = Testino G | title = Alcoholic diseases in hepato-gastroenterology: a point of view | journal = Hepato-Gastroenterology | volume = 55 | issue = 82–83 | pages = 371–7 | year = 2008 | pmid = 18613369 }} A wide range of immunologic defects can result and there may be a generalized skeletal fragility, in addition to a recognized tendency to accidental injury, resulting in a propensity for bone fractures.[http://pubs.niaaa.nih.gov/publications/10report/intro.pdf 10th Special Report to the U.S. Congress on Alcohol and Health] {{webarchive|url=https://web.archive.org/web/20120913074727/http://pubs.niaaa.nih.gov/publications/10report/intro.pdf |date=13 September 2012 }}, 2000, U.S. Department of Health and Human Services, Public Health Service National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism.

Women develop long-term complications of alcohol dependence more rapidly than do men; women also have a higher mortality rate from alcoholism than men. Examples of long-term complications include brain, heart, and liver damage and an increased risk of breast cancer. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, problems or irregularity of the menstrual cycle, and early menopause. Alcoholic ketoacidosis can occur in individuals who chronically misuse alcohol and have a recent history of binge drinking.{{cite journal | vauthors = Mihai B, Lăcătuşu C, Graur M | title = [Alcoholic ketoacidosis] | journal = Revista Medico-Chirurgicala a Societatii de Medici Si Naturalisti Din Iasi | volume = 112 | issue = 2 | pages = 321–6 | date = April–June 2008 | pmid = 19294998 }}{{cite journal | vauthors = Sibaï K, Eggimann P | title = [Alcoholic ketoacidosis: not rare cause of metabolic acidosis] | journal = Revue Médicale Suisse | volume = 1 | issue = 32 | pages = 2106, 2108–10, 2112–5 | date = September 2005 | doi = 10.53738/REVMED.2005.1.32.2106 | pmid = 16238232 }} The amount of alcohol that can be biologically processed and its effects differ between sexes. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs), since women generally have a lower weight and higher percentage of body fat and therefore a lower volume of distribution for alcohol than men.{{cite journal | vauthors = Cederbaum AI | title = Alcohol metabolism | journal = Clinics in Liver Disease | volume = 16 | issue = 4 | pages = 667–85 | date = November 2012 | pmid = 23101976 | pmc = 3484320 | doi = 10.1016/j.cld.2012.08.002 }}

Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are common; approximately 10% of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia.{{cite web |url=http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php |title=Alcoholism-associated molecular adaptations in brain neurocognitive circuits | vauthors = Bakalkin G |date=8 July 2008 |website=Eurekalert.org |access-date=11 January 2012 |url-status=live |archive-url=https://web.archive.org/web/20111130152434/http://www.eurekalert.org/pub_releases/2008-07/econ-ma070808.php |archive-date=30 November 2011 }} Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time.{{cite journal | vauthors = Oscar-Berman M, Marinkovic K | title = Alcoholism and the brain: an overview | journal = Alcohol Research & Health | volume = 27 | issue = 2 | pages = 125–33 | year = 2003 | pmid = 15303622 | pmc = 6668884 }} Social skills are significantly impaired in people with alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The social skills that are impaired by alcohol use disorder include impairments in perceiving facial emotions, prosody, perception problems, and theory of mind deficits; the ability to understand humor is also impaired in people who misuse alcohol.{{cite journal | vauthors = Uekermann J, Daum I | title = Social cognition in alcoholism: a link to prefrontal cortex dysfunction? | journal = Addiction | volume = 103 | issue = 5 | pages = 726–35 | date = May 2008 | pmid = 18412750 | doi = 10.1111/j.1360-0443.2008.02157.x }} Psychiatric disorders are common in people with alcohol use disorders, with as many as 25% also having severe psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence.{{cite journal | vauthors = Wetterling T, Junghanns K | title = Psychopathology of alcoholics during withdrawal and early abstinence | journal = European Psychiatry | volume = 15 | issue = 8 | pages = 483–8 | date = December 2000 | pmid = 11175926 | doi = 10.1016/S0924-9338(00)00519-8 | s2cid = 24094651 }} Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia.{{cite journal | vauthors = Schuckit MA | title = Alcoholism and other psychiatric disorders | journal = Hospital & Community Psychiatry | volume = 34 | issue = 11 | pages = 1022–7 | date = November 1983 | pmid = 6642446 | doi = 10.1176/ps.34.11.1022 }} Panic disorder can develop or worsen as a direct result of long-term alcohol misuse.{{cite journal | vauthors = Cowley DS | title = Alcohol abuse, substance abuse, and panic disorder | journal = The American Journal of Medicine | volume = 92 | issue = 1A | pages = 41S–48S | date = January 1992 | pmid = 1346485 | doi = 10.1016/0002-9343(92)90136-Y }}{{cite journal | vauthors = Cosci F, Schruers KR, Abrams K, Griez EJ | title = Alcohol use disorders and panic disorder: a review of the evidence of a direct relationship | journal = The Journal of Clinical Psychiatry | volume = 68 | issue = 6 | pages = 874–80 | date = June 2007 | pmid = 17592911 | doi = 10.4088/JCP.v68n0608 }}

The co-occurrence of major depressive disorder and alcoholism is well documented.{{cite journal | vauthors = Grant BF, Harford TC | title = Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey | journal = Drug and Alcohol Dependence | volume = 39 | issue = 3 | pages = 197–206 | date = October 1995 | pmid = 8556968 | doi = 10.1016/0376-8716(95)01160-4 | url = https://zenodo.org/record/1258497 | access-date = 1 July 2024 | archive-date = 28 November 2020 | archive-url = https://web.archive.org/web/20201128214542/https://zenodo.org/record/1258497 | url-status = live }}{{cite journal | vauthors = Kandel DB, Huang FY, Davies M | title = Comorbidity between patterns of substance use dependence and psychiatric syndromes | journal = Drug and Alcohol Dependence | volume = 64 | issue = 2 | pages = 233–41 | date = October 2001 | pmid = 11543993 | doi = 10.1016/S0376-8716(01)00126-0 | author-link1 = Denise Kandel }}{{cite book | vauthors = Cornelius JR, Bukstein O, Salloum I, Clark D | title = Recent Developments in Alcoholism | chapter = Alcohol and psychiatric comorbidity | series = Recent Dev Alcohol | volume = 16 | pages = [https://archive.org/details/recentdevelopment00gala/page/361 361–74] | year = 2003 | pmid = 12638646 | doi = 10.1007/0-306-47939-7_24 | chapter-url = https://archive.org/details/recentdevelopment00gala/page/361 | isbn = 978-0-306-47258-9 | issn = 0738-422X | publisher = Kluwer Academic/Plenum Publishers }} Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes).{{cite journal | vauthors = Schuckit MA, Tipp JE, Bergman M, Reich W, Hesselbrock VM, Smith TL | title = Comparison of induced and independent major depressive disorders in 2,945 alcoholics | journal = The American Journal of Psychiatry | volume = 154 | issue = 7 | pages = 948–57 | date = July 1997 | pmid = 9210745 | doi = 10.1176/ajp.154.7.948 | doi-access = free }}{{cite journal | vauthors = Schuckit MA, Tipp JE, Bucholz KK, Nurnberger JI, Hesselbrock VM, Crowe RR, Kramer J | title = The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls | journal = Addiction | volume = 92 | issue = 10 | pages = 1289–304 | date = October 1997 | pmid = 9489046 | doi = 10.1111/j.1360-0443.1997.tb02848.x | s2cid = 14958283 }}{{cite journal | vauthors = Schuckit MA, Smith TL, Danko GP, Pierson J, Trim R, Nurnberger JI, Kramer J, Kuperman S, Bierut LJ, Hesselbrock V | title = A comparison of factors associated with substance-induced versus independent depressions | journal = Journal of Studies on Alcohol and Drugs | volume = 68 | issue = 6 | pages = 805–12 | date = November 2007 | pmid = 17960298 | doi = 10.15288/jsad.2007.68.805 | s2cid = 17528609 }} Additional use of other drugs may increase the risk of depression.{{cite journal | vauthors = Schuckit M | title = Alcoholic patients with secondary depression | journal = The American Journal of Psychiatry | volume = 140 | issue = 6 | pages = 711–4 | date = June 1983 | pmid = 6846629 | doi = 10.1176/ajp.140.6.711 }} Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with alcohol-use disorders more often have a co-occurring diagnosis of narcissistic or antisocial personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention deficit/hyperactivity disorder (ADHD).{{cite journal| vauthors = Karrol BR |s2cid=73186615 |title=Women and alcohol use disorders: a review of important knowledge and its implications for social work practitioners |journal=Journal of Social Work |volume=2 |issue=3 |pages=337–56 |year=2002 |doi=10.1177/146801730200200305 }} Women with alcohol use disorder are more likely to experience physical or sexual assault, abuse, and domestic violence than women in the general population, which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.

{{See also|Drug-related crime}}

Serious social problems arise from alcohol use disorder; these dilemmas are caused by the pathological changes in the brain and the intoxicating effects of alcohol. Alcohol misuse is associated with an increased risk of committing criminal offences, including child abuse, domestic violence, rape, burglary and assault.{{cite book | last1 = Isralowitz | first1 = Richard | title = Drug use: a reference handbook | url = https://books.google.com/books?id=X0mxxfbIbp4C | year = 2004 | publisher = ABC-CLIO | location = Santa Barbara, CA | isbn = 978-1-57607-708-5 | pages = 122–23 | access-date = 1 July 2024 | archive-date = 14 January 2023 | archive-url = https://web.archive.org/web/20230114105315/https://books.google.com/books?id=X0mxxfbIbp4C | url-status = live }} Alcoholism is associated with loss of employment,{{cite book | last1 = Langdana | first1 = Farrokh K. | title = Macroeconomic Policy: Demystifying Monetary and Fiscal Policy | url = https://books.google.com/books?id=GCYWQn79JYwC | year = 2009 | publisher = Springer | edition = 2nd | isbn = 978-0-387-77665-1 | page = 81 | access-date = 1 July 2024 | archive-date = 14 January 2023 | archive-url = https://web.archive.org/web/20230114105316/https://books.google.com/books?id=GCYWQn79JYwC | url-status = live }} which can lead to financial problems. Drinking at inappropriate times and behavior caused by reduced judgment can lead to legal consequences, such as criminal charges for drunk driving{{cite book| last1 = Gifford | first1 = Maria | title = Alcoholism (Biographies of Disease) | year=2009 | publisher = Greenwood Press | url = {{google books |plainurl=y |id=2OJV12astRUC|page=89}} | isbn = 978-0-313-35908-8 | pages = 89–91 }} or public disorder, or civil penalties for tortious behavior. An alcoholic's behavior and mental impairment while drunk can profoundly affect those surrounding him and lead to isolation from family and friends. This isolation can lead to marital conflict and divorce, or contribute to domestic violence. Alcoholism can also lead to child neglect, with subsequent lasting damage to the emotional development of children of people with alcohol use disorders.{{cite book |last1=Schadé |first1=Johannes Petrus |title=The Complete Encyclopedia of Medicine and Health |year=2006 |publisher=Foreign Media Books |url={{google books |plainurl=y |id=j8DuEHxSCU4C|page=132}} |isbn=978-1-60136-001-4 |pages=132–33 }} For this reason, children of people with alcohol use disorders can develop a number of emotional problems. For example, they can become afraid of their parents, because of their unstable mood behaviors. They may develop shame over their inadequacy to liberate their parents from alcoholism and, as a result of this, may develop self-image problems, which can lead to depression.{{cite web |last=Gold |first=Mark |title=Children of Alcoholics |url=http://psychcentral.com/lib/2006/children-of-alcoholics/ |publisher=Psych Central |access-date=27 November 2011 |url-status=live |archive-url=https://web.archive.org/web/20111116010950/http://psychcentral.com/lib/2006/children-of-alcoholics/ |archive-date=16 November 2011 }}

{{Main|Alcohol withdrawal syndrome}}

{{See also|Kindling (sedative-hypnotic withdrawal)}}

File:A maniacal man is visited in prison by his children, all rui Wellcome V0019408.jpg. Reproduction of an etching by G. Cruikshank, 1847.]]

As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and benzodiazepines, withdrawal from alcohol dependence can be fatal if it is not properly managed.{{cite book |last1=Galanter |first1=Marc |last2=Kleber |first2=Herbert D. |title=The American Psychiatric Publishing Textbook of Substance Abuse Treatment |url=https://books.google.com/books?id=6wdJgejlQzYC&pg=PA58 |edition=4th |year=2008 |publisher=American Psychiatric Publishing Inc |isbn=978-1-58562-276-4 |page=58 |access-date=1 July 2024 |archive-date=5 February 2023 |archive-url=https://web.archive.org/web/20230205013806/https://books.google.com/books?id=6wdJgejlQzYC&pg=PA58 |url-status=live }} Alcohol's primary effect is the increase in stimulation of the GABA_A receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. When alcohol consumption is stopped too abruptly, the person's nervous system experiences uncontrolled synapse firing. This can result in symptoms that include anxiety, life-threatening seizures, delirium tremens, hallucinations, shakes and possible heart failure.{{cite book|last1=Dart |first1=Richard C. |title=Medical Toxicology |url={{google books |plainurl=y |id=qDf3AO8nILoC|page=139}} |edition=3rd |year=2003 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-2845-4 |pages=139–40}}{{cite journal | vauthors = Idemudia SO, Bhadra S, Lal H | title = The pentylenetetrazol-like interoceptive stimulus produced by ethanol withdrawal is potentiated by bicuculline and picrotoxinin | journal = Neuropsychopharmacology | volume = 2 | issue = 2 | pages = 115–22 | date = June 1989 | pmid = 2742726 | doi = 10.1016/0893-133X(89)90014-6 | doi-broken-date = 16 May 2025 }} Other neurotransmitter systems are also involved, especially dopamine, NMDA and glutamate.{{cite journal | vauthors = Chastain G | s2cid = 40043433 | title = Alcohol, neurotransmitter systems, and behavior | journal = The Journal of General Psychology | volume = 133 | issue = 4 | pages = 329–35 | date = October 2006 | pmid = 17128954 | doi = 10.3200/GENP.133.4.329-335 }}

Severe acute withdrawal symptoms such as delirium tremens and seizures rarely occur after 1-week post cessation of alcohol. The acute withdrawal phase can be defined as lasting between one and three weeks. In the period of 3–6 weeks following cessation, anxiety, depression, fatigue, and sleep disturbance are common.{{cite journal | vauthors = Heilig M, Egli M, Crabbe JC, Becker HC | title = Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked? | journal = Addiction Biology | volume = 15 | issue = 2 | pages = 169–84 | date = April 2010 | pmid = 20148778 | pmc = 3268458 | doi = 10.1111/j.1369-1600.2009.00194.x }} Similar post-acute withdrawal symptoms have also been observed in animal models of alcohol dependence and withdrawal.{{cite book | last1 = Johnson | first1 = Bankole A. | title = Addiction medicine: science and practice | url = {{google books |plainurl=y |id=zvbr4Zn9S9MC|page=342}} | year = 2011 | publisher = Springer | location = New York | isbn = 978-1-4419-0337-2 | pages = 301–03 | url-status = live | archive-url = https://web.archive.org/web/20151201092622/https://books.google.com/books?id=zvbr4Zn9S9MC&pg=PA342 | archive-date = 1 December 2015 }}

A kindling effect also occurs in people with alcohol use disorders whereby each subsequent withdrawal syndrome is more severe than the previous withdrawal episode; this is due to neuroadaptations which occur as a result of periods of abstinence followed by re-exposure to alcohol. Individuals who have had multiple withdrawal episodes are more likely to develop seizures and experience more severe anxiety during withdrawal from alcohol than alcohol-dependent individuals without a history of past alcohol withdrawal episodes. The kindling effect leads to persistent functional changes in brain neural circuits as well as to gene expression.{{cite journal | vauthors = Breese GR, Sinha R, Heilig M | title = Chronic alcohol neuroadaptation and stress contribute to susceptibility for alcohol craving and relapse | journal = Pharmacology & Therapeutics | volume = 129 | issue = 2 | pages = 149–71 | date = February 2011 | pmid = 20951730 | pmc = 3026093 | doi = 10.1016/j.pharmthera.2010.09.007 }} Kindling also results in the intensification of psychological symptoms of alcohol withdrawal. There are decision tools and questionnaires that help guide physicians in evaluating alcohol withdrawal. For example, the CIWA-Ar objectifies alcohol withdrawal symptoms in order to guide therapy decisions which allows for an efficient interview while at the same time retaining clinical usefulness, validity, and reliability, ensuring proper care for withdrawal patients, who can be in danger of death.{{cite journal | vauthors = Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM | title = Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar) | journal = British Journal of Addiction | volume = 84 | issue = 11 | pages = 1353–7 | date = November 1989 | pmid = 2597811 | doi = 10.1111/j.1360-0443.1989.tb00737.x | url = http://www.medicine.nevada.edu/residency/lasvegas/internalmed/documents/CIWA-ARBJA.pdf | access-date = 25 October 2017 | citeseerx = 10.1.1.489.341 | archive-url = https://web.archive.org/web/20130810022242/http://www.medicine.nevada.edu/residency/lasvegas/internalmed/documents/ciwa-arbja.pdf | archive-date = 10 August 2013 }}

File:Mental health as a risk factor for alcohol dependency or abuse, OWID.svg

File:William Hogarth - Gin Lane.jpg Gin Lane, 1751]]

A complex combination of genetic and environmental factors influences the risk of the development of alcoholism.{{cite journal | vauthors = Enoch MA | title = Genetic and environmental influences on the development of alcoholism: resilience vs. risk | journal = Annals of the New York Academy of Sciences | volume = 1094 | issue = 1 | pages = 193–201 | date = December 2006 | pmid = 17347351 | doi = 10.1196/annals.1376.019 | url = https://zenodo.org/record/1235882 | bibcode = 2006NYASA1094..193E | s2cid = 248697 | access-date = 1 July 2024 | archive-date = 25 July 2020 | archive-url = https://web.archive.org/web/20200725015737/https://zenodo.org/record/1235882 | url-status = live }} Genes that influence the metabolism of alcohol also influence the risk of alcoholism, as can a family history of alcoholism.{{cite journal | vauthors = Edenberg HJ, McClintick JN | title = Alcohol Dehydrogenases, Aldehyde Dehydrogenases, and Alcohol Use Disorders: A Critical Review | journal = Alcoholism: Clinical and Experimental Research | volume = 42 | issue = 12 | pages = 2281–2297 | date = December 2018 | pmid = 30320893 | pmc = 6286250 | doi = 10.1111/acer.13904 }} There is compelling evidence that alcohol use at an early age may influence the expression of genes which increase the risk of alcohol dependence. These genetic and epigenetic results are regarded as consistent with large longitudinal population studies finding that the younger the age of drinking onset, the greater the prevalence of lifetime alcohol dependence.{{cite journal | vauthors = Agrawal A, Sartor CE, Lynskey MT, Grant JD, Pergadia ML, Grucza R, Bucholz KK, Nelson EC, Madden PA, Martin NG, Heath AC | title = Evidence for an interaction between age at first drink and genetic influences on DSM-IV alcohol dependence symptoms | journal = Alcoholism: Clinical and Experimental Research | volume = 33 | issue = 12 | pages = 2047–56 | date = December 2009 | pmid = 19764935 | pmc = 2883563 | doi = 10.1111/j.1530-0277.2009.01044.x }}{{cite journal|vauthors=Crews FT, Vetreno RP, Broadwater MA, Robinson DL| title=Adolescent Alcohol Exposure Persistently Impacts Adult Neurobiology and Behavior. | journal=Pharmacol Rev | year= 2016 | volume= 68 | issue= 4 | pages= 1074–1109 | pmid=27677720 | doi=10.1124/pr.115.012138 | pmc=5050442 }}

Severe childhood trauma is also associated with a general increase in the risk of drug dependency. Lack of peer and family support is associated with an increased risk of alcoholism developing. Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol misuse. Cortical degeneration due to the neurotoxic effects increases impulsive behaviour, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage.{{cite journal | vauthors = Crews FT, Boettiger CA | title = Impulsivity, frontal lobes and risk for addiction | journal = Pharmacology, Biochemistry, and Behavior | volume = 93 | issue = 3 | pages = 237–47 | date = September 2009 | pmid = 19410598 | pmc = 2730661 | doi = 10.1016/j.pbb.2009.04.018 }} The use of cannabis was associated with later problems with alcohol use.{{cite journal | vauthors = Weinberger AH, Platt J, Goodwin RD | title = Is cannabis use associated with an increased risk of onset and persistence of alcohol use disorders? A three-year prospective study among adults in the United States | journal = Drug and Alcohol Dependence | volume = 161 | pages = 363–7 | date = April 2016 | pmid = 26875671 | pmc = 5028105 | doi = 10.1016/j.drugalcdep.2016.01.014 }} Alcohol use was associated with an increased probability of later use of tobacco and illegal drugs such as cannabis.{{cite journal | vauthors = Kirby T, Barry AE | title = Alcohol as a gateway drug: a study of US 12th graders | journal = The Journal of School Health | volume = 82 | issue = 8 | pages = 371–9 | date = August 2012 | pmid = 22712674 | doi = 10.1111/j.1746-1561.2012.00712.x | url = http://www.mamacultiva.org/wp-content/uploads/2015/pdf/A8%20-%20Alcohol%20as%20a%20Gateway%20Drug%20A%20Study%20of%20US%2012th%20Graders.pdf | url-status = live | archive-url = https://web.archive.org/web/20160604012851/http://www.mamacultiva.org/wp-content/uploads/2015/pdf/A8%20-%20Alcohol%20as%20a%20Gateway%20Drug%20A%20Study%20of%20US%2012th%20Graders.pdf | archive-date = 4 June 2016 }}

Alcohol is the most available, widely consumed, and widely misused recreational drug. Beer alone is the world's most widely consumed{{cite web|title=Volume of World Beer Production|website=European Beer Guide|url=http://www.europeanbeerguide.net/eustats.htm#production|access-date=17 October 2006| archive-url= https://web.archive.org/web/20061028165040/http://www.europeanbeerguide.net/eustats.htm| archive-date= 28 October 2006 | url-status= live}} alcoholic beverage; it is the third-most popular drink overall, after water and tea.{{cite book|url=https://books.google.com/books?id=6xul0O_SI1MC&pg=PA1|title=The Barbarian's Beverage: A History of Beer in Ancient Europe|year=2005|publisher=Routledge|location=Abingdon, Oxon|isbn=978-0-415-31121-2|page=1|access-date=21 September 2010|last=Nelson|first=Max|archive-date=14 January 2023|archive-url=https://web.archive.org/web/20230114105316/https://books.google.com/books?id=6xul0O_SI1MC&pg=PA1|url-status=live}} It is thought by some to be the oldest fermented beverage.{{cite book|title=The Alchemy of Culture: Intoxicants in Society|first=Richard|last=Rudgley |isbn=978-0-7141-1736-2|year=1993|pages=411|url={{google books |plainurl=y |id=5baAAAAAMAAJ}}|publisher=British Museum Press|location=London|access-date=13 January 2012}}{{cite book|title=Origin and History of Beer and Brewing: From Prehistoric Times to the Beginning of Brewing Science and Technology|first=John P |last=Arnold |isbn=978-0-9662084-1-2|year=2005|page=411|url={{google books |plainurl=y |id=O5CPAAAACAAJ}} |publisher=BeerBooks |location=Cleveland, OH|access-date=13 January 2012}}Joshua J. Mark (2011). "[https://www.worldhistory.org/Beer/ Beer]". Ancient History Encyclopedia. {{webarchive|url=https://web.archive.org/web/20140703005835/http://www.ancient.eu.com/Beer/ |date=3 July 2014 }}.{{cite book|first1=Ben|last1= McFarland |url={{google books |plainurl=y |id=SHh-4M_QxEsC|page=10}}|title=World's Best Beers: One Thousand |publisher=Sterling Publishing Company, Inc.|isbn=978-1-4027-6694-7 |year=2009 }}

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Based on combined data in the US from SAMHSA's 2004–2005 National Surveys on Drug Use & Health, the rate of past-year alcohol dependence or misuse among persons aged 12 or older varied by level of alcohol use: 44.7% of past month heavy drinkers, 18.5% binge drinkers, 3.8% past month non-binge drinkers, and 1.3% of those who did not drink alcohol in the past month met the criteria for alcohol dependence or misuse in the past year. Males had higher rates than females for all measures of drinking in the past month: any alcohol use (57.5% vs. 45%), binge drinking (30.8% vs. 15.1%), and heavy alcohol use (10.5% vs. 3.3%), and males were twice as likely as females to have met the criteria for alcohol dependence or misuse in the past year (10.5% vs. 5.1%)."Gender differences in alcohol use and alcohol dependence or abuse: 2004 or 2005." The NSDUH Report. Retrieved 22 June 2012. However, because females generally weigh less than males, have more fat and less water in their bodies, and metabolize less alcohol in their esophagus and stomach, they are likely to develop higher blood alcohol levels per drink. Women may also be more vulnerable to liver disease.{{cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |date=2013 |publisher=American psychiatric association |location=Washington |isbn=978-0-89042-555-8 |edition=5th}}

{{See also|Addiction#Genetic factors}}

There are genetic variations that affect the risk for alcoholism.{{cite journal |vauthors=Kranzler HR, Zhou H, Kember RL, Vickers Smith R, Justice AC, Damrauer S, Tsao PS, Klarin D, Baras A, Reid J, Overton J, Rader DJ, Cheng Z, Tate JP, Becker WC, Concato J, Xu K, Polimanti R, Zhao H, Gelernter J |title=Genome-wide association study of alcohol consumption and use disorder in 274,424 individuals from multiple populations |journal=Nature Communications |volume=10 |issue=1 |pages=1499 |date=April 2019 |pmid=30940813 |pmc=6445072 |doi=10.1038/s41467-019-09480-8 |bibcode=2019NatCo..10.1499K}} Some of these variations are more common in individuals with ancestry from certain areas; for example, Africa, East Asia, the Middle East and Europe. The variants with strongest effect are in genes that encode the main enzymes of alcohol metabolism, ADH1B and ALDH2. These genetic factors influence the rate at which alcohol and its initial metabolic product, acetaldehyde, are metabolized. They are found at different frequencies in people from different parts of the world.{{cite journal |vauthors=Eng MY, Luczak SE, Wall TL |title=ALDH2, ADH1B, and ADH1C genotypes in Asians: a literature review |journal=Alcohol Research & Health |volume=30 |issue=1 |pages=22–7 |year=2007 |pmid=17718397 |pmc=3860439}}{{cite journal |vauthors=Ehlers CL |title=Variations in ADH and ALDH in Southwest California Indians |journal=Alcohol Research & Health |volume=30 |issue=1 |pages=14–7 |year=2007 |pmid=17718395 |pmc=3860438}} The alcohol dehydrogenase allele ADH1B*2 causes a more rapid metabolism of alcohol to acetaldehyde, and reduces risk for alcoholism; it is most common in individuals from East Asia and the Middle East. The alcohol dehydrogenase allele ADH1B*3 also causes a more rapid metabolism of alcohol. The allele ADH1B*3 is only found in some individuals of African descent and certain Native American tribes. African Americans and Native Americans with this allele have a reduced risk of developing alcoholism.{{cite journal |vauthors=Scott DM, Taylor RE |title=Health-related effects of genetic variations of alcohol-metabolizing enzymes in African Americans |journal=Alcohol Research & Health |volume=30 |issue=1 |pages=18–21 |year=2007 |pmid=17718396 |pmc=3860436}} Native Americans, however, have a significantly higher rate of alcoholism than average; risk factors such as cultural environmental effects (e.g. trauma) have been proposed to explain the higher rates.{{cite journal |vauthors=Szlemko WJ, Wood JW, Thurman PJ |s2cid=43082343 |title=Native Americans and alcohol: past, present, and future |journal=The Journal of General Psychology |volume=133 |issue=4 |pages=435–51 |date=October 2006 |pmid=17128961 |doi=10.3200/GENP.133.4.435-451}}{{cite journal |vauthors=Spillane NS, Smith GT |title=A theory of reservation-dwelling American Indian alcohol use risk |journal=Psychological Bulletin |volume=133 |issue=3 |pages=395–418 |date=May 2007 |pmid=17469984 |doi=10.1037/0033-2909.133.3.395}} The aldehyde dehydrogenase allele ALDH2*2 greatly reduces the rate at which acetaldehyde, the initial product of alcohol metabolism, is removed by conversion to acetate; it greatly reduces the risk for alcoholism.

A genome-wide association study (GWAS) of more than 100,000 human individuals identified variants of the gene KLB, which encodes the transmembrane protein β-Klotho, as highly associated with alcohol consumption. The protein β-Klotho is an essential element in cell surface receptors for hormones involved in modulation of appetites for simple sugars and alcohol.{{cite journal |vauthors=Schumann G, Liu C, O'Reilly P, Gao H, Song P, Xu B, Ruggeri B, Amin N, Jia T, Preis S, Segura Lepe M, Akira S, Barbieri C, Baumeister S, Cauchi S, Clarke TK, Enroth S, Fischer K, Hällfors J, Harris SE, Hieber S, Hofer E, Hottenga JJ, Johansson Å, Joshi PK, Kaartinen N, Laitinen J, Lemaitre R, Loukola A, Luan J, Lyytikäinen LP, Mangino M, Manichaikul A, Mbarek H, Milaneschi Y, Moayyeri A, Mukamal K, Nelson C, Nettleton J, Partinen E, Rawal R, Robino A, Rose L, Sala C, Satoh T, Schmidt R, Schraut K, Scott R, Smith AV, Starr JM, Teumer A, Trompet S, Uitterlinden AG, Venturini C, Vergnaud AC, Verweij N, Vitart V, Vuckovic D, Wedenoja J, Yengo L, Yu B, Zhang W, Zhao JH, Boomsma DI, Chambers J, Chasman DI, Daniela T, de Geus E, Deary I, Eriksson JG, Esko T, Eulenburg V, Franco OH, Froguel P, Gieger C, Grabe HJ, Gudnason V, Gyllensten U, Harris TB, Hartikainen AL, Heath AC, Hocking L, Hofman A, Huth C, Jarvelin MR, Jukema JW, Kaprio J, Kooner JS, Kutalik Z, Lahti J, Langenberg C, Lehtimäki T, Liu Y, Madden PA, Martin N, Morrison A, Penninx B, Pirastu N, Psaty B, Raitakari O, Ridker P, Rose R, Rotter JI, Samani NJ, Schmidt H, Spector TD, Stott D, Strachan D, Tzoulaki I, van der Harst P, van Duijn CM, Marques-Vidal P, Vollenweider P, Wareham NJ, Whitfield JB, Wilson J, Wolffenbuttel B, Bakalkin G, Evangelou E, Liu Y, Rice KM, Desrivières S, Kliewer SA, Mangelsdorf DJ, Müller CP, Levy D, Elliott P |title=KLB is associated with alcohol drinking, and its gene product β-Klotho is necessary for FGF21 regulation of alcohol preference |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=113 |issue=50 |pages=14372–14377 |date=December 2016 |pmid=27911795 |pmc=5167198 |doi=10.1073/pnas.1611243113 |bibcode=2016PNAS..11314372S |s2cid=4060021 |doi-access=free}} Several large GWAS have found differences in the genetics of alcohol consumption and alcohol dependence, although the two are to some degree related.{{cite journal |vauthors=Walters RK, Polimanti R, Johnson EC, McClintick JN, Adams MJ, Adkins AE, Aliev F, Bacanu SA, Batzler A, Bertelsen S, Biernacka JM, Bigdeli TB, Chen LS, Clarke TK, Chou YL, Degenhardt F, Docherty AR, Edwards AC, Fontanillas P, Foo JC, Fox L, Frank J, Giegling I, Gordon S, Hack LM, Hartmann AM, Hartz SM, Heilmann-Heimbach S, Herms S, Hodgkinson C, Hoffmann P, Jan Hottenga J, Kennedy MA, Alanne-Kinnunen M, Konte B, Lahti J, Lahti-Pulkkinen M, Lai D, Ligthart L, Loukola A, Maher BS, Mbarek H, McIntosh AM, McQueen MB, Meyers JL, Milaneschi Y, Palviainen T, Pearson JF, Peterson RE, Ripatti S, Ryu E, Saccone NL, Salvatore JE, Sanchez-Roige S, Schwandt M, Sherva R, Streit F, Strohmaier J, Thomas N, Wang JC, Webb BT, Wedow R, Wetherill L, Wills AG, Boardman JD, Chen D, Choi DS, Copeland WE, Culverhouse RC, Dahmen N, Degenhardt L, Domingue BW, Elson SL, Frye MA, Gäbel W, Hayward C, Ising M, Keyes M, Kiefer F, Kramer J, Kuperman S, Lucae S, Lynskey MT, Maier W, Mann K, Männistö S, Müller-Myhsok B, Murray AD, Nurnberger JI, Palotie A, Preuss U, Räikkönen K, Reynolds MD, Ridinger M, Scherbaum N, Schuckit MA, Soyka M, Treutlein J, Witt S, Wodarz N, Zill P, Adkins DE, Boden JM, Boomsma DI, Bierut LJ, Brown SA, Bucholz KK, Cichon S, Costello EJ, de Wit H, Diazgranados N, Dick DM, Eriksson JG, Farrer LA, Foroud TM, Gillespie NA, Goate AM, Goldman D, Grucza RA, Hancock DB, Harris KM, Heath AC, Hesselbrock V, Hewitt JK, Hopfer CJ, Horwood J, Iacono W, Johnson EO, Kaprio JA, Karpyak VM, Kendler KS, Kranzler HR, Krauter K, Lichtenstein P, Lind PA, McGue M, MacKillop J, Madden PA, Maes HH, Magnusson P, Martin NG, Medland SE, Montgomery GW, Nelson EC, Nöthen MM, Palmer AA, Pedersen NL, Penninx BW, Porjesz B, Rice JP, Rietschel M, Riley BP, Rose R, Rujescu D, Shen PH, Silberg J, Stallings MC, Tarter RE, Vanyukov MM, Vrieze S, Wall TL, Whitfield JB, Zhao H, Neale BM, Gelernter J, Edenberg HJ, Agrawal A |title=Transancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders |journal=Nature Neuroscience |volume=21 |issue=12 |pages=1656–1669 |date=December 2018 |pmid=30482948 |pmc=6430207 |doi=10.1038/s41593-018-0275-1}}{{cite journal |last1=Zhou |first1=Hang |last2=Sealock |first2=Julia M. |last3=Sanchez-Roige |first3=Sandra |last4=Clarke |first4=Toni-Kim |last5=Levey |first5=Daniel F. |last6=Cheng |first6=Zhongshan |last7=Li |first7=Boyang |last8=Polimanti |first8=Renato |last9=Kember |first9=Rachel L. |last10=Smith |first10=Rachel Vickers |last11=Thygesen |first11=Johan H. |year=2020 |title=Genome-wide meta-analysis of problematic alcohol use in 435,563 individuals yields insights into biology and relationships with other traits |journal=Nature Neuroscience |volume=23 |issue=7 |pages=809–818 |doi=10.1038/s41593-020-0643-5 |issn=1097-6256 |pmc=7485556 |pmid=32451486}}

Alcohol-induced DNA damage, when not properly repaired, may have a key role in the neurotoxicity induced by alcohol.{{cite journal |last1=Kruman |first1=Inna I. |last2=Henderson |first2=George I. |last3=Bergeson |first3=Susan E. |date=July 2012 |title=DNA damage and neurotoxicity of chronic alcohol abuse |journal=Experimental Biology and Medicine |volume=237 |issue=7 |pages=740–747 |doi=10.1258/ebm.2012.011421 |pmc=3685494 |pmid=22829701}} Metabolic conversion of ethanol to acetaldehyde can occur in the brain and the neurotoxic effects of ethanol appear to be associated with acetaldehyde induced DNA damages including DNA adducts and crosslinks. In addition to acetaldehyde, alcohol metabolism produces potentially genotoxic reactive oxygen species, which have been demonstrated to cause oxidative DNA damage.

File:Emil Mayer 024.jpg.]]

Because there is disagreement on the definition of the word alcoholism, it is not a recognized diagnosis, and the use of the term alcoholism is discouraged due to its heavily stigmatized connotations. It is classified as alcohol use disorder in the DSM-5 or alcohol dependence in the ICD-11.{{cite web|date=September 2020|title=6C40.2 Alcohol dependence|url=https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1580466198|access-date=6 December 2020|website=ICD-11 for Mortality and Morbidity Statistics|archive-date=1 August 2018|archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1580466198|url-status=live}} In 1979, the World Health Organization discouraged the use of alcoholism due to its inexact meaning, preferring alcohol dependence syndrome.{{cite web |url=https://www.who.int/substance_abuse/terminology/who_lexicon/en/ |title=Lexicon of alcohol and drug terms published by the World Health Organization |publisher=World Health Organization |archive-url=https://web.archive.org/web/20130205230313/http://www.who.int/substance_abuse/terminology/who_lexicon/en/ |archive-date=5 February 2013 }}

Misuse, problem use, abuse, and heavy use of alcohol refer to improper use of alcohol, which may cause physical, social, or moral harm to the drinker.{{cite book| author= American Heritage Dictionaries | title = The American Heritage dictionary of the English language | url = {{google books |plainurl=y |id=uPCFIQAACAAJ}} | year=2006 |publisher = Houghton Mifflin | location = Boston | edition = 4 |quote = To use wrongly or improperly; misuse: abuse alcohol | isbn = 978-0-618-70172-8 }} The Dietary Guidelines for Americans, issued by the United States Department of Agriculture (USDA) in 2005, defines "moderate use" as no more than two alcoholic beverages a day for men and no more than one alcoholic beverage a day for women.{{cite web |url=http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm |title=Dietary Guidelines for Americans 2005 |year=2005 |publisher=health.gov |archive-url=https://web.archive.org/web/20070701174135/http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm |archive-date=1 July 2007 |access-date=28 November 2009 }} Dietary Guidelines The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as the amount of alcohol leading to a blood alcohol content (BAC) of 0.08, which, for most adults, would be reached by consuming five drinks for men or four for women over a two-hour period. According to the NIAAA, men may be at risk for alcohol-related problems if their alcohol consumption exceeds 14 standard drinks per week or 4 drinks per day, and women may be at risk if they have more than 7 standard drinks per week or 3 drinks per day. It defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits.{{cite journal |date=April 2006 |title=Young Adult Drinking |url=http://pubs.niaaa.nih.gov/publications/aa68/aa68.htm |url-status=live |journal=Alcohol Alert |archive-url=https://web.archive.org/web/20130213205702/http://pubs.niaaa.nih.gov/publications/aa68/aa68.htm |archive-date=13 February 2013 |access-date=18 February 2013 |number=68}} Despite this risk, a 2014 report in the National Survey on Drug Use and Health found that only 10% of either "heavy drinkers" or "binge drinkers" defined according to the above criteria also met the criteria for alcohol dependence, while only 1.3% of non-binge drinkers met the criteria. An inference drawn from this study is that evidence-based policy strategies and clinical preventive services may effectively reduce binge drinking without requiring addiction treatment in most cases.{{cite journal | vauthors = Esser MB, Hedden SL, Kanny D, Brewer RD, Gfroerer JC, Naimi TS | title = Prevalence of alcohol dependence among US adult drinkers, 2009–2011 | journal = Preventing Chronic Disease | volume = 11 | pages = E206 | date = November 2014 | pmid = 25412029 | pmc = 4241371 | doi = 10.5888/pcd11.140329 }}

The term alcoholism is commonly used amongst laypeople, but the word is poorly defined. Despite the imprecision inherent in the term, there have been attempts to define how the word alcoholism should be interpreted when encountered. In 1992, it was defined by the National Council on Alcoholism and Drug Dependence (NCADD) and ASAM as "a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking."{{cite journal |vauthors=Morse RM, Flavin DK |title=The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism |journal=JAMA |volume=268 |issue=8 |pages=1012–1014 |date=August 1992 |pmid=1501306 |doi=10.1001/jama.1992.03490080086030}} MeSH has had an entry for alcoholism since 1999, and references the 1992 definition.{{MeshName|Alcoholism}}

The WHO calls alcoholism "a term of long-standing use and variable meaning", and use of the term was disfavored by a 1979 WHO expert committee.

In professional and research contexts, the term alcoholism is not currently favored, but rather alcohol abuse, alcohol dependence, or alcohol use disorder are used. Talbot (1989) observes that alcoholism in the classical disease model follows a progressive course: if people continue to drink, their condition will worsen. This will lead to harmful consequences in their lives, physically, mentally, emotionally, and socially.{{cite book |last=Thombs |first=Dennis L |title=Introduction To Addictive Behaviors 2ed|url={{google books |plainurl=y |id=Aze4azm9XkQCIntroduction}}|year=1999|publisher=The Guildford Press|location=London|pages=64–65}}{{Dead link|date=May 2023 |bot=InternetArchiveBot |fix-attempted=yes}} Johnson (1980) proposed that the emotional progression of the addicted people's response to alcohol has four phases. The first two are considered "normal" drinking and the last two are viewed as "typical" alcoholic drinking. Johnson's four phases consist of:

1. Learning the mood swing. People are introduced to alcohol (in some cultures this can happen at a relatively young age), and they enjoy the happy feeling it produces. At this stage, there is no emotional cost.
2. Seeking the mood swing. People will drink to regain that happy feeling in phase 1; the drinking will increase as more alcohol is required to achieve the same effect. Again at this stage, there are no significant consequences.
3. At the third stage there are physical and social consequences such as hangovers, family problems, and work problems. People will continue to drink excessively, disregarding the problems.
4. The fourth stage can be detrimental with a risk for premature death. People in this phase now drink to feel normal and block out the feelings of overwhelming guilt, remorse, anxiety, and shame they experience when sober.

In the United States, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most common diagnostic guide for substance use disorders, whereas most countries use the International Classification of Diseases (ICD) for diagnostic (and other) purposes. The two manuals use similar but not identical nomenclature to classify alcohol problems.

Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol use disorder. This is more of a barrier for women than men.{{Why|date=May 2022}} Fear of stigmatization may lead women to deny that they have a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know has alcohol use disorder.{{cite journal | vauthors = Blum LN, Nielsen NH, Riggs JA | title = Alcoholism and alcohol abuse among women: report of the Council on Scientific Affairs. American Medical Association | journal = Journal of Women's Health | volume = 7 | issue = 7 | pages = 861–71 | date = September 1998 | pmid = 9785312 | doi = 10.1089/jwh.1998.7.861 }} In contrast, reduced fear of stigma may lead men to admit that they are having a medical condition, to display their drinking publicly, and to drink in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is someone with an alcohol use disorder.

Screening is recommended among those over the age of 18.{{cite journal | vauthors = Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB | title = Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 320 | issue = 18 | pages = 1899–1909 | date = November 2018 | pmid = 30422199 | doi = 10.1001/jama.2018.16789 | doi-access = free }} Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self-reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.{{cite journal | vauthors = Kahan M | title = Identifying and managing problem drinkers | journal = Canadian Family Physician | volume = 42 | pages = 661–71 | date = April 1996 | pmid = 8653034 | pmc = 2146411 }}

The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.

{{Blockquote|Two "yes" responses indicate that the respondent should be investigated further.

The questionnaire asks the following questions:

1. Have you ever felt you needed to cut down on your drinking?
2. Have people annoyed you by criticizing your drinking?
3. Have you ever felt guilty about drinking?
4. Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?{{cite journal | vauthors = Ewing JA | title = Detecting alcoholism. The CAGE questionnaire | journal = JAMA | volume = 252 | issue = 14 | pages = 1905–7 | date = October 1984 | pmid = 6471323 | doi = 10.1001/jama.1984.03350140051025 }}{{cite web|url=http://www.whoguidemhpcuk.org/downloads/primary_care/11-1_CAGE_questionnaire.pdf |title=CAGE questionnaire – screen for alcohol misuse |url-status=usurped |archive-url=https://web.archive.org/web/20110728175054/http://www.whoguidemhpcuk.org/downloads/primary_care/11-1_CAGE_questionnaire.pdf |archive-date=28 July 2011 }}}}

:The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol-related problems; however, it has limitations in people with less severe alcohol-related problems, white women and college students.{{cite journal | vauthors = Dhalla S, Kopec JA | title = The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies | journal = Clinical and Investigative Medicine | volume = 30 | issue = 1 | pages = 33–41 | year = 2007 | pmid = 17716538 | doi = 10.25011/cim.v30i1.447 | doi-access = free }}

Other tests are sometimes used for the detection of alcohol dependence, such as the Alcohol Dependence Data Questionnaire, which is a more sensitive diagnostic test than the CAGE questionnaire. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.{{cite web |url=http://www.emcdda.europa.eu/html.cfm/index3556EN.html |title=Alcohol Dependence Data Questionnaire (SADD) | vauthors = Raistrick D, Dunbar G, Davidson R |year=1983 |publisher=European Monitoring Centre for Drugs and Drug Addiction |url-status=live |archive-url=https://web.archive.org/web/20160721101929/http://www.emcdda.europa.eu/html.cfm/index3556EN.html |archive-date=21 July 2016 }} The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,{{cite web |url=http://www.ncadd-sfv.org/symptoms/mast_test.html |title=Michigan Alcohol Screening Test |publisher=The National Council on Alcoholism and Drug Dependence |archive-url=https://web.archive.org/web/20060906123532/http://www.ncadd-sfv.org/symptoms/mast_test.html |archive-date=6 September 2006 }} driving under the influence being the most common. The Alcohol Use Disorders Identification Test (AUDIT), a screening questionnaire developed by the World Health Organization, is unique in that it has been validated in six countries and is used internationally. Like the CAGE questionnaire, it uses a simple set of questions – a high score earning a deeper investigation.{{cite web |url=http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf |title=The Alcohol Use Disorders Identification Test; Guidelines for Use in Primary Care |first1=Thomas F. |last1=Babor |first2=John C. |last2=Higgins-Biddle |first3=John B. |last3=Saunders |first4=Maristela G. |last4=Monteiro |year=2001 |publisher=World Health Organization |archive-url=https://web.archive.org/web/20060502132711/http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf |archive-date=2 May 2006 }} The Paddington Alcohol Test (PAT) was designed to screen for alcohol-related problems amongst those attending Accident and Emergency departments. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.{{cite journal | vauthors = Smith SG, Touquet R, Wright S, Das Gupta N | title = Detection of alcohol misusing patients in accident and emergency departments: the Paddington alcohol test (PAT) | journal = Journal of Accident & Emergency Medicine | volume = 13 | issue = 5 | pages = 308–12 | date = September 1996 | pmid = 8894853 | pmc = 1342761 | doi = 10.1136/emj.13.5.308 }}

There are biological markers for the use of alcohol, one common test being that of blood alcohol content (BAC).{{cite journal | vauthors = Jones AW | s2cid = 11117640 | title = Urine as a biological specimen for forensic analysis of alcohol and variability in the urine-to-blood relationship | journal = Toxicological Reviews | volume = 25 | issue = 1 | pages = 15–35 | year = 2006 | pmid = 16856767 | doi = 10.2165/00139709-200625010-00002 }} Monitoring levels of gamma-glutamyl transpeptidase (GGT) is sometimes used to assess continued alcohol intake. But levels of GGT are elevated in only half of men with alcohol use disorder, and it is less commonly elevated in women and younger people. GGT levels remain persistently elevated for many weeks with continued drinking, with a half life of 2–3 weeks, making the GGT level a useful assessment of continued and chronic alcohol use. However, elevated levels of GGT may also be seen in non-alcohol related liver diseases, diabetes, obesity or overweight, heart failure, hyperthyroidism and some medications. Phosphatidylethanol is a biomarker that is present in the red blood cells for several weeks after drinking, with its levels grossly corresponding to amount of alcohol consumed, and a detection limit as long as 5 weeks, making it a useful test to assess continued alcohol use.

Ethyl glucuronide may be measured to assess recent alcohol intake, with levels being detected in urine up to 48 hours after alcohol intake. However, it is a poor measure of the amount of alcohol consumed. Measurement of ethanol levels in the blood, urine and breath are also used to assess recent alcohol intake, often in the emergency setting.

Other laboratory markers of chronic alcohol misuse include:{{cite journal |last1=Gough |first1=Gina |last2=Heathers |first2=Laura |last3=Puckett |first3=Deonna |last4=Westerhold |first4=Chi |last5=Ren |first5=Xiaowei |last6=Yu |first6=Zhangsheng |last7=Crabb |first7=David W. |last8=Liangpunsakul |first8=Suthat |title=The Utility of Commonly Used Laboratory Tests to Screen for Excessive Alcohol Use in Clinical Practice |journal=Alcoholism: Clinical and Experimental Research |date=August 2015 |volume=39 |issue=8 |pages=1493–1500 |doi=10.1111/acer.12780|pmid=26110815 |pmc=4515204 |hdl=1805/12848 |hdl-access=free }}

• Macrocytosis (enlarged MCV)
• Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1
• High carbohydrate deficient transferrin (CDT)

With regard to alcoholism, BAC is useful to judge alcohol tolerance, which in turn is a sign of alcoholism. Electrolyte and acid-base abnormalities including hypokalemia, hypomagnesemia, hyponatremia, hyperuricemia, metabolic acidosis, and respiratory alkalosis are common in people with alcohol use disorders.

However, none of these blood tests for biological markers are as sensitive as screening questionnaires.

{{further|Alcohol education}}

The World Health Organization, the European Union and other regional bodies, national governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism.{{cite web |url=https://www.who.int/topics/alcohol_drinking/en/ |title=Alcohol |publisher=World Health Organization |year=2010 |url-status=live |archive-url=https://web.archive.org/web/20100226094205/http://www.who.int/topics/alcohol_drinking/en/ |archive-date=26 February 2010 }}{{cite web|url=http://www.euro.who.int/document/mediacentre/fs1005e.pdf |title=Alcohol policy in the WHO European Region: current status and the way forward |date=12 September 2005 |publisher=World Health Organization |archive-url=https://web.archive.org/web/20100123105252/http://www.euro.who.int/document/mediacentre/fs1005e.pdf |archive-date=23 January 2010 }}

Increasing the age at which alcohol can be purchased, and banning or restricting alcohol beverage advertising are common methods to reduce alcohol use among adolescents and young adults in particular, see Alcoholism in adolescence. Another common method of alcoholism prevention is taxation of alcohol products – increasing price of alcohol by 10% is linked with reduction of consumption of up to 10%.{{cite journal | vauthors = Elder R, Lawrence B, Ferguson A, Naimi T, Brewer R, Chattopadhyay S, Toomey T, Fielding J | title = The Effectiveness of Tax Policy Interventions for Reducing Excessive Alcohol Consumption and Related Harms | journal = American Journal of Preventive Medicine | volume = 38 | issue = 2 |year = 2010 | pages = 217–229 | issn = 0749-3797 | doi = 10.1016/j.amepre.2009.11.005| pmid = 20117579 | pmc = 3735171 }}

Credible, evidence-based educational campaigns in the mass media about the consequences of alcohol misuse have been recommended. Guidelines for parents to prevent alcohol misuse amongst adolescents, and for helping young people with mental health problems have also been suggested.{{cite journal | vauthors = Crews F, He J, Hodge C | s2cid = 6925448 | title = Adolescent cortical development: a critical period of vulnerability for addiction | journal = Pharmacology, Biochemistry, and Behavior | volume = 86 | issue = 2 | pages = 189–99 | date = February 2007 | pmid = 17222895 | doi = 10.1016/j.pbb.2006.12.001 | pmc = 11646682 }}

Because alcohol is often used for self-medication of conditions like anxiety temporarily, prevention of alcoholism may be attempted by reducing the severity or prevalence of stress and anxiety in individuals.

Treatments are varied because there are multiple perspectives of alcoholism. Those who approach alcoholism as a medical condition or disease recommend differing treatments from, for instance, those who approach the condition as one of social choice. Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. Much of the treatment community for alcoholism supports an abstinence-based zero tolerance approach popularized by the 12 step program of Alcoholics Anonymous; however, some prefer a harm-reduction approach.{{cite book| last1 = Gabbard | first1 = Glen O. | title = Treatments of psychiatric disorders | year = 2001 | publisher = American Psychiatric Press | location = Washington, DC | url = {{google books |plainurl=y |id=hLVrAAAAMAAJ}} |edition=3| isbn = 978-0-88048-910-2 }}

{{Main|Alcohol detoxification}}

Medical treatment for alcohol detoxification usually involves administration of a benzodiazepine, in order to ameliorate alcohol withdrawal syndrome's adverse impact.{{cite journal|last1=Holleck|first1=Jürgen L.|last2=Merchant|first2=Naseema|last3=Gunderson|first3=Craig G.|year=2019|title=Symptom-Triggered Therapy for Alcohol Withdrawal Syndrome: a Systematic Review and Meta-analysis of Randomized Controlled Trials|journal=Journal of General Internal Medicine|volume=34|issue=6|pages=1018–1024|doi=10.1007/s11606-019-04899-7|issn=1525-1497|pmc=6544709|pmid=30937668}}{{cite journal|last1=Long|first1=Drew|last2=Long|first2=Brit|last3=Koyfman|first3=Alex|year=2017|title=The emergency medicine management of severe alcohol withdrawal|journal=The American Journal of Emergency Medicine|volume=35|issue=7|pages=1005–1011|doi=10.1016/j.ajem.2017.02.002|issn=1532-8171|pmid=28188055|s2cid=42361581|doi-access=free}} The addition of phenobarbital improves outcomes if benzodiazepine administration lacks the usual efficacy, and phenobarbital alone might be an effective treatment.{{cite journal|last1=Hammond|first1=Drayton A.|last2=Rowe|first2=Jordan M.|last3=Wong|first3=Adrian|last4=Wiley|first4=Tessa L.|last5=Lee|first5=Kristen C.|last6=Kane-Gill|first6=Sandra L.|year=2017|title=Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review|journal=Hospital Pharmacy|volume=52|issue=9|pages=607–616|doi=10.1177/0018578717720310|issn=0018-5787|pmc=5735736|pmid=29276297}} Propofol also might enhance treatment for individuals showing limited therapeutic response to a benzodiazepine.{{cite journal|last1=Brotherton|first1=Amy L.|last2=Hamilton|first2=Eric P.|last3=Kloss|first3=H. Grace|last4=Hammond|first4=Drayton A.|year=2016|title=Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature|journal=Pharmacotherapy|volume=36|issue=4|pages=433–442|doi=10.1002/phar.1726|issn=1875-9114|pmid=26893017|s2cid=25910118}}{{cite journal|last1=Schmidt|first1=Kyle J.|last2=Doshi|first2=Mitesh R.|last3=Holzhausen|first3=Jenna M.|last4=Natavio|first4=Allycia|last5=Cadiz|first5=Megan|last6=Winegardner|first6=Jim E.|year=2016|title=Treatment of Severe Alcohol Withdrawal|journal=The Annals of Pharmacotherapy|volume=50|issue=5|pages=389–401|doi=10.1177/1060028016629161|issn=1542-6270|pmid=26861990|s2cid=40312054}} Individuals who are only at risk of mild to moderate withdrawal symptoms can be treated as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions can be treated as inpatients. Direct treatment can be followed by a treatment program for alcohol dependence or alcohol use disorder to attempt to reduce the risk of relapse. Experiences following alcohol withdrawal, such as depressed mood and anxiety, can take weeks or months to abate while other symptoms persist longer due to persisting neuroadaptations.

File:Alcoholics Anonymous Regional Service Center by David Shankbone.jpg]]

Various forms of group therapy or psychotherapy are sometimes used to encourage and support abstinence from alcohol, or to reduce alcohol consumption to levels that are not associated with adverse outcomes. Mutual-aid group-counseling is an approach used to facilitate relapse prevention. Alcoholics Anonymous was one of the earliest organizations formed to provide mutual peer support and non-professional counseling, however the effectiveness of Alcoholics Anonymous is disputed.{{cite journal |last1=Ferri |first1=Marcia |last2=Amato |first2=Laura |last3=Davoli |first3=Marina |title=Alcoholics Anonymous and other twelve-step programmes for alcohol dependence |journal=Cochrane Database of Systematic Reviews |issue=3 |pages=CD005032 |date=19 July 2006 |pmid=16856072 |doi=10.1002/14651858.CD005032.pub2|quote=no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems}} A 2020 Cochrane review concluded that Twelve-Step Facilitation (TSF) probably achieves outcomes such as fewer drinks per drinking day, however evidence for such a conclusion comes from low to moderate certainty evidence "so should be regarded with caution".{{Cite journal |last1=Kelly |first1=John F |last2=Humphreys |first2=Keith |last3=Ferri |first3=Marica |date=2020-03-11 |editor-last=Cochrane Drugs and Alcohol Group |title=Alcoholics Anonymous and other 12-step programs for alcohol use disorder |journal=The Cochrane Database of Systematic Reviews|volume=2020 |issue=3 |pages=CD012880 |doi=10.1002/14651858.CD012880.pub2 |issn=1469-493X |pmc=7065341 |pmid=32159228}} Others include LifeRing Secular Recovery, SMART Recovery, Women for Sobriety, and Secular Organizations for Sobriety.{{cite web|url=http://www.helpguide.org/articles/addiction/self-help-groups-for-alcohol-addiction.htm|title=Self-Help Groups for Alcohol Addiction| vauthors = Smith M, Saisan J |year=2016|url-status=live|archive-url=https://web.archive.org/web/20150521163926/http://www.helpguide.org/articles/addiction/self-help-groups-for-alcohol-addiction.htm|archive-date=21 May 2015}}

Manualized{{cite web|title=APA Dictionary of Psychology|url=https://dictionary.apa.org/|access-date=26 January 2022|website=dictionary.apa.org|quote=manualized therapy – interventions that are performed according to specific guidelines for administration, maximizing the probability of therapy being conducted consistently across settings, therapists, and clients. Also called manual-assisted therapy; manual-based therapy.|archive-date=27 April 2018|archive-url=https://web.archive.org/web/20180427011428/https://dictionary.apa.org/|url-status=live}} Twelve Step Facilitation (TSF) interventions (i.e. therapy which encourages active, long-term Alcoholics Anonymous participation) for Alcohol Use Disorder lead to higher abstinence rates, compared to other clinical interventions and to wait-list control groups.{{cite journal | vauthors = Kelly JF, Humphreys K, Ferri M | title = Alcoholics Anonymous and other 12-step programs for alcohol use disorder | journal = The Cochrane Database of Systematic Reviews | volume = 3 | pages = CD012880 | date = March 2020 | issue = 3 | pmid = 32159228 | pmc = 7065341 | doi = 10.1002/14651858.CD012880.pub2 | type = Systematic review }}

{{See also|Managed alcohol program}}

Moderate drinking amongst people with alcohol dependence—often termed 'controlled drinking'—has been subject to significant controversy.{{cite web |last1=Ashton |first1=Mike |last2=Davies |first2=Natalie |title='Dangerous data': drinking after dependence |url=https://findings.org.uk/PHP/dl.php?file=cont_drink.hot |website=findings.org.uk |access-date=3 March 2023|archive-date=6 October 2022 |archive-url=https://web.archive.org/web/20221006213255/https://findings.org.uk/PHP/dl.php?file=cont_drink.hot |url-status=live }} Indeed, much of the skepticism toward the viability of moderate drinking goals stems from historical ideas about 'alcoholism', now replaced with 'alcohol use disorder' or alcohol dependence in most scientific contexts. A 2021 meta-analysis and systematic review of controlled drinking covering 22 studies concluded controlled drinking was a 'non-inferior' outcome to abstinence for many drinkers.{{cite journal |last1=Henssler |first1=Jonathan |last2=Müller |first2=Martin |last3=Carreira |first3=Helena |last4=Bschor |first4=Tom |last5=Heinz |first5=Andreas |last6=Baethge |first6=Christopher |title=Controlled drinking—non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta-analysis and meta-regression |journal=Addiction |date=August 2021 |volume=116 |issue=8 |pages=1973–1987 |doi=10.1111/add.15329 |pmid=33188563 |s2cid=226948754|issn=0965-2140|doi-access=free }}

Rationing and moderation programs such as Moderation Management and DrinkWise do not mandate complete abstinence. While most people with alcohol use disorders are unable to limit their drinking in this way, some return to moderate drinking. A 2002 US study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. This group, however, showed fewer initial symptoms of dependency.{{cite journal | vauthors = Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ | s2cid = 19679025 | title = Recovery from DSM-IV alcohol dependence: United States, 2001–2002 | journal = Addiction | volume = 100 | issue = 3 | pages = 281–92 | date = March 2005 | pmid = 15733237 | doi = 10.1111/j.1360-0443.2004.00964.x | url = http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm | url-status = live | archive-url = https://web.archive.org/web/20110719104620/http://pubs.niaaa.nih.gov/publications/arh29-2/131-142.htm | archive-date = 19 July 2011 | doi-access = free }}

A follow-up study, using the same subjects that were judged to be in remission in 2001–2002, examined the rates of return to problem drinking in 2004–2005. The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics.{{cite journal | vauthors = Dawson DA, Goldstein RB, Grant BF | title = Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up | journal = Alcoholism: Clinical and Experimental Research | volume = 31 | issue = 12 | pages = 2036–45 | date = December 2007 | pmid = 18034696 | doi = 10.1111/j.1530-0277.2007.00536.x | url = https://zenodo.org/record/1230663 | access-date = 1 July 2024 | archive-date = 25 July 2020 | archive-url = https://web.archive.org/web/20200725020723/https://zenodo.org/record/1230663 | url-status = live }} There was also a 1973 study showing chronic alcoholics drinking moderately again,{{cite journal|doi=10.1016/S0005-7894(73)80074-7|title=Individualized behavior therapy for alcoholics|journal=Behavior Therapy|volume=4|pages=49–72|year=1973|last1=Sobell|first1=Mark B.|last2=Sobell|first2=Linda C. }} but a 1982 follow-up showed that 95% of subjects were not able to maintain drinking in moderation over the long term.{{cite journal | vauthors = Pendery ML, Maltzman IM, West LJ | title = Controlled drinking by alcoholics? New findings and a reevaluation of a major affirmative study | journal = Science | volume = 217 | issue = 4555 | pages = 169–75 | date = July 1982 | pmid = 7089552 | doi = 10.1126/science.7089552 | bibcode = 1982Sci...217..169P }}{{cite news|url=https://www.nytimes.com/1982/06/28/us/alcholism-study-under-new-attack.html|title=Alcoholism Study Under New Attack|work=The New York Times|date=28 June 1982|quote=The new article will say that, 10 years later, four of the 20 had died from alcohol-related causes. Eight others were still drinking excessively, six were abstinent but in most cases after multiple hospitalizations, and one was drinking moderately. The alcohol dependence of that last case was also questioned. Another subject, who could not be found, was reported gravely disabled.|access-date=1 July 2024|archive-date=24 June 2020|archive-url=https://web.archive.org/web/20200624055207/https://www.nytimes.com/1982/06/28/us/alcholism-study-under-new-attack.html|url-status=live}} Another study was a long-term (60 year) follow-up of two groups of alcoholic men which concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."{{cite journal | vauthors = Vaillant GE | title = A 60-year follow-up of alcoholic men | journal = Addiction | volume = 98 | issue = 8 | pages = 1043–51 | date = August 2003 | pmid = 12873238 | doi = 10.1046/j.1360-0443.2003.00422.x | s2cid = 12835128 }} Internet based measures appear to be useful at least in the short term.{{cite journal | vauthors = Riper H, Hoogendoorn A, Cuijpers P, Karyotaki E, Boumparis N, Mira A, Andersson G, Berman AH, Bertholet N, Bischof G, Blankers M, Boon B, Boß L, Brendryen H, Cunningham J, Ebert D, Hansen A, Hester R, Khadjesari Z, Kramer J, Murray E, Postel M, Schulz D, Sinadinovic K, Suffoletto B, Sundström C, de Vries H, Wallace P, Wiers RW, Smit JH | title = Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials | journal = PLOS Medicine | volume = 15 | issue = 12 | pages = e1002714 | date = December 2018 | pmid = 30562347 | pmc = 6298657 | doi = 10.1371/journal.pmed.1002714 | doi-access = free }}

In the United States there are four approved medications for alcoholism: acamprosate, two methods of using naltrexone and disulfiram.{{cite journal |title=Alcohol and Other Drugs|url=http://pubs.niaaa.nih.gov/publications/AA76/AA76.htm |url-status=live |publisher=National Institute on Alcohol Abuse and Alcoholism |archive-url=https://web.archive.org/web/20130728134244/http://pubs.niaaa.nih.gov/publications/aa76/aa76.htm |archive-date=28 July 2013 |access-date=11 July 2013 |number=76|date=July 2008|journal=Alcohol Alert}}

• Acamprosate may stabilise the brain chemistry that is altered due to alcohol dependence via antagonising the actions of glutamate, a neurotransmitter which is hyperactive in the post-withdrawal phase.{{cite journal |vauthors=Mason BJ, Heyser CJ |s2cid=25810236 |title=The neurobiology, clinical efficacy and safety of acamprosate in the treatment of alcohol dependence |journal=Expert Opinion on Drug Safety |volume=9 |issue=1 |pages=177–88 |date=January 2010 |pmid=20021295 |doi=10.1517/14740330903512943}} By reducing excessive NMDA activity which occurs at the onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol withdrawal related neurotoxicity.{{cite journal |vauthors=Mason BJ, Heyser CJ |title=Acamprosate: a prototypic neuromodulator in the treatment of alcohol dependence |journal=CNS & Neurological Disorders Drug Targets |volume=9 |issue=1 |pages=23–32 |date=March 2010 |pmid=20201812 |pmc=2853976 |doi=10.2174/187152710790966641}} Acamprosate reduces the risk of relapse amongst alcohol-dependent persons.{{cite journal |vauthors=Rösner S, Hackl-Herrwerth A, Leucht S, Lehert P, Vecchi S, Soyka M |title=Acamprosate for alcohol dependence |journal=The Cochrane Database of Systematic Reviews |volume=128 |issue=9 |pages=CD004332 |date=September 2010 |pmid=20824837 |doi=10.1002/14651858.CD004332.pub2 |url=http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802010000600014 |veditors=Rösner S |type=Submitted manuscript |access-date=1 July 2024 |archive-date=8 July 2020 |archive-url=https://web.archive.org/web/20200708231654/https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802010000600014 |url-status=live}}{{cite journal |vauthors=Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, Kim MM, Shanahan E, Gass CE, Rowe CJ, Garbutt JC |title=Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis |journal=JAMA |volume=311 |issue=18 |pages=1889–900 |date=May 2014 |pmid=24825644 |doi=10.1001/jama.2014.3628 |doi-access=free}} Acamprosate is not recommended in those with advanced, decompensated liver cirrhosis due to the risk of liver toxicity.{{cite journal |last1=Haber |first1=Paul S. |title=Identification and Treatment of Alcohol Use Disorder |journal=New England Journal of Medicine |date=16 January 2025 |volume=392 |issue=3 |pages=258–266 |doi=10.1056/NEJMra2306511|pmid=39813644 }}
• Naltrexone is a competitive antagonist for opioid receptors, effectively blocking the effects of endorphins and opioids. Naltrexone may be given as a daily oral tablet or as a monthly intramuscular injection. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence in the body Naltrexone reduces the pleasurable effects from consuming alcohol.{{cite journal |vauthors=Soyka M, Rösner S |title=Opioid antagonists for pharmacological treatment of alcohol dependence – a critical review |journal=Current Drug Abuse Reviews |volume=1 |issue=3 |pages=280–91 |date=November 2008 |pmid=19630726 |doi=10.2174/1874473710801030280}} Evidence supports a reduced risk of relapse among alcohol-dependent persons and a decrease in excessive drinking. Naltrexone should not be used in those with advanced liver disease due to the risk of liver toxicity. Nalmefene also appears effective and works in a similar manner.
• Disulfiram prevents the elimination of acetaldehyde by inhibiting the enzyme acetaldehyde dehydrogenase. Acetaldehyde is a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is acute discomfort when alcohol is ingested characterized by flushing, nausea, a rapid heart rate and low blood pressure. Disulfiram should not be used in those with advanced liver disease due to the risk of life-threatening liver toxicity.

Several other drugs are also used and many are under investigation.

• Benzodiazepines are a first line medication in the management of acute alcohol withdrawal, however their use outside of the acute withdrawal period is not recommended. Benzodiazepines with a shorter half life, such as lorazepam or oxazepam are preferred in the treatment of alcohol withdrawal as their shorter half lives and less active metabolites have a lower risk of confusion in those with liver disease. If used long-term, they can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for alcohol use disorder relapse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.{{cite book |last1=Gitlow |first1=Stuart |title=Substance Use Disorders: A Practical Guide |url=https://books.google.com/books?id=rbrSdWVerBUC |edition=2nd |year=2006 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-6998-3 |pages=52, 103–21 |access-date=1 July 2024 |archive-date=14 January 2023 |archive-url=https://web.archive.org/web/20230114105317/https://books.google.com/books?id=rbrSdWVerBUC |url-status=live}}{{cite journal |vauthors=Kushner MG, Abrams K, Borchardt C |title=The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings |journal=Clinical Psychology Review |volume=20 |issue=2 |pages=149–71 |date=March 2000 |pmid=10721495 |doi=10.1016/S0272-7358(99)00027-6}}
• Calcium carbimide works in the same way as disulfiram; it has an advantage in that the occasional adverse effects of disulfiram, hepatotoxicity and drowsiness, do not occur with calcium carbimide.{{cite journal |vauthors=Ogborne AC |title=Identifying and treating patients with alcohol-related problems |journal=CMAJ |volume=162 |issue=12 |pages=1705–8 |date=June 2000 |pmid=10870503 |pmc=1232509}}
• Ondansetron and topiramate are supported by tentative evidence in people with certain genetic patterns.{{cite journal |vauthors=Cservenka A, Yardley MM, Ray LA |title=Review: Pharmacogenetics of alcoholism treatment: Implications of ethnic diversity |journal=The American Journal on Addictions |volume=26 |issue=5 |pages=516–525 |date=August 2017 |pmid=28134463 |pmc=5484746 |doi=10.1111/ajad.12463}} Evidence for ondansetron is stronger in people who have recently started to abuse alcohol.{{cite journal |vauthors=Soyka M, Müller CA |title=Pharmacotherapy of alcoholism – an update on approved and off-label medications |journal=Expert Opinion on Pharmacotherapy |volume=18 |issue=12 |pages=1187–1199 |date=August 2017 |pmid=28658981 |doi=10.1080/14656566.2017.1349098 |s2cid=23092076}} Topiramate is a derivative of the naturally occurring sugar monosaccharide D-fructose. Review articles characterize topiramate as showing "encouraging", "promising", "efficacious",{{cite journal |vauthors=Hammond CJ, Niciu MJ, Drew S, Arias AJ |title=Anticonvulsants for the treatment of alcohol withdrawal syndrome and alcohol use disorders |journal=CNS Drugs |volume=29 |issue=4 |pages=293–311 |date=April 2015 |pmid=25895020 |pmc=5759952 |doi=10.1007/s40263-015-0240-4}} and "insufficient"{{cite journal |vauthors=Pani PP, Trogu E, Pacini M, Maremmani I |title=Anticonvulsants for alcohol dependence |journal=The Cochrane Database of Systematic Reviews |volume=2014 |issue=2 |pages=CD008544 |date=February 2014 |pmid=24523233 |doi=10.1002/14651858.CD008544.pub2 |pmc=10585425 |quote=At the current stage of research, evidence supporting the clinical use of anticonvulsants to treat alcohol dependence is insufficient. Results are conditioned by heterogeneity and by the low number and quality of studies comparing anticonvulsants versus other medications. The uncertainty associated with these results leaves to clinicians the need to balance the possible benefits/risks of treatment with anticonvulsants versus other medications as supported by evidence of efficacy.}} results in the treatment of alcohol use disorders.

Evidence does not support the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), antipsychotics, or gabapentin.

Topiramate, a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiveness of topiramate concluded that the results of published trials are promising, however as of 2008, data was insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence.{{cite journal|author=Olmsted CL, Kockler DR |title=Topiramate for alcohol dependence|journal=Ann Pharmacother |volume=42 |issue=10 |pages=1475–80 |date=October 2008 |pmid=18698008 |doi=10.1345/aph.1L157 |s2cid=27071889|issn=1060-0280}} A 2010 review found that topiramate may be superior to existing alcohol pharmacotherapeutic options. Topiramate effectively reduces craving and alcohol withdrawal severity as well as improving quality-of-life-ratings.{{cite journal| last1 = Kenna | first1 = GA. | last2 = Lomastro | first2 = TL. |last3 = Schiesl | first3 = A. | last4 = Leggio | first4 = L. | last5 = Swift | first5 = RM. | title = Review of topiramate: an antiepileptic for the treatment of alcohol dependence | journal = Curr Drug Abuse Rev | volume = 2 | issue = 2 | pages = 135–42 |date=May 2009 | doi = 10.2174/1874473710902020135| pmid = 19630744 }}

Baclofen, a GABA_B receptor agonist, is under study for the treatment of alcoholism.{{cite journal|last=Leggio|first=L|author2=Garbutt, JC|author3= Addolorato, G|title=Effectiveness and safety of baclofen in the treatment of alcohol dependent patients.|journal=CNS & Neurological Disorders Drug Targets|date=March 2010|volume=9|issue=1|pages=33–44|pmid=20201813|doi=10.2174/187152710790966614}} According to a 2017 Cochrane Systematic Review, there is insufficient evidence to determine the effectiveness or safety for the use of baclofen for withdrawal symptoms in alcoholism.{{cite journal |last1=Liu |first1=Jia |last2=Wang |first2=Lu-Ning |date=20 August 2017 |title=Baclofen for alcohol withdrawal |journal=The Cochrane Database of Systematic Reviews |volume=8 |issue=8 |pages=CD008502 |doi=10.1002/14651858.CD008502.pub5 |issn=1469-493X |pmc=6483686 |pmid=28822350}} Psilocybin-assisted psychotherapy is under study for the treatment of patients with alcohol use disorder.{{cite web |last=Sullivan |first=Kaitlin |date=24 August 2022 |title=Does psilocybin change your brain? How the ingredient in magic mushrooms may ease addiction |url=https://www.nbcnews.com/health/mental-health/psilocybin-mushroom-help-people-alcohol-use-disorder-rcna44180 |access-date=7 September 2022 |publisher=NBC News|archive-date=6 September 2022 |archive-url=https://web.archive.org/web/20220906184507/https://www.nbcnews.com/health/mental-health/psilocybin-mushroom-help-people-alcohol-use-disorder-rcna44180 |url-status=live }}{{cite journal |last=Bogenschutz |date=24 August 2022 |title=Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder – A Randomized Clinical Trial |journal=JAMA Psychiatry |volume=79 |issue=10 |pages=953–962 |doi=10.1001/jamapsychiatry.2022.2096 |pmid=36001306 |pmc=9403854 |s2cid=251766399 }}

Alcoholics may also require treatment for other psychotropic drug addictions and drug dependencies. The most common dual dependence syndrome with alcohol dependence is benzodiazepine dependence, with studies showing 10–20% of alcohol-dependent individuals had problems of dependence and/or misuse problems of benzodiazepine drugs such as diazepam or clonazepam. These drugs are, like alcohol, depressants. Benzodiazepines may be used legally, if they are prescribed by doctors for anxiety problems or other mood disorders, or they may be purchased as illegal drugs. Benzodiazepine use increases cravings for alcohol and the volume of alcohol consumed by problem drinkers.{{cite journal | vauthors = Poulos CX, Zack M | s2cid = 23040302 | title = Low-dose diazepam primes motivation for alcohol and alcohol-related semantic networks in problem drinkers | journal = Behavioural Pharmacology | volume = 15 | issue = 7 | pages = 503–12 | date = November 2004 | pmid = 15472572 | doi = 10.1097/00008877-200411000-00006 }} Benzodiazepine dependency requires careful reduction in dosage to avoid benzodiazepine withdrawal syndrome and other health consequences. Dependence on other sedative-hypnotics such as zolpidem and zopiclone as well as opiates and illegal drugs is common in alcoholics. Alcohol itself is a sedative-hypnotic and is cross-tolerant with other sedative-hypnotics such as barbiturates, benzodiazepines and nonbenzodiazepines. Dependence upon and withdrawal from sedative-hypnotics can be medically severe and, as with alcohol withdrawal, there is a risk of psychosis or seizures if not properly managed.{{cite journal | vauthors = Johansson BA, Berglund M, Hanson M, Pöhlén C, Persson I | title = Dependence on legal psychotropic drugs among alcoholics | journal = Alcohol and Alcoholism | volume = 38 | issue = 6 | pages = 613–8 | date = November 2003 | pmid = 14633651 | doi = 10.1093/alcalc/agg123 | doi-access = free }}

File:Alcohol use disorders world map-DALYs per million persons-WHO2012.svg for alcohol use disorders per million inhabitants in 2012

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The World Health Organization estimates that {{as of|2016|lc=y}} there are about 380 million people with alcoholism worldwide (5.1% of the population over 15 years of age), with it being most common among males and young adults. Geographically, it is least common in Africa (1.1% of the population) and has the highest rates in Eastern Europe (11%).

{{as of|2015}} in the United States, about 17 million (7%) of adults and 0.7 million (2.8%) of those age 12 to 17 years of age are affected.{{cite web|title=Alcohol Facts and Statistics|work=National Institute on Alcohol Abuse and Alcoholism (NIAAA) |date=14 September 2011 |url=http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics|access-date=9 May 2015|url-status=live|archive-url=https://web.archive.org/web/20150518081638/http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics|archive-date=18 May 2015}} About 12% of American adults have had an alcohol dependence problem at some time in their life.{{cite journal |vauthors=Hasin DS, Stinson FS, Ogburn E, Grant BF |title=Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions |journal=Archives of General Psychiatry |volume=64 |issue=7 |pages=830–42 |date=July 2007 |pmid=17606817 |doi=10.1001/archpsyc.64.7.830 |doi-access=free}}

In the United States and Western Europe, 10–20% of men and 5–10% of women at some point in their lives will meet criteria for alcoholism.{{cite encyclopedia |url=https://www.britannica.com/EBchecked/topic/13448/alcoholism |title=alcoholism |year=2010 |encyclopedia=Encyclopædia Britannica |url-status=live |archive-url=https://web.archive.org/web/20101202043009/https://www.britannica.com/EBchecked/topic/13448/alcoholism |archive-date=2 December 2010}} In England, the number of "dependent drinkers" was calculated as over 600,000 in 2019.{{cite web|url=https://www.gov.uk/government/publications/alcohol-dependence-prevalence-in-england|title=Alcohol dependence prevalence in England|date=18 March 2021|website=GOV.UK|access-date=1 July 2024|archive-date=1 May 2024|archive-url=https://web.archive.org/web/20240501215857/https://www.gov.uk/government/publications/alcohol-dependence-prevalence-in-england|url-status=live}} Estonia had the highest death rate from alcohol in Europe in 2015 at 8.8 per 100,000 population.{{cite book|vauthors=Ballas D, Dorling D, Hennig B|title=The Human Atlas of Europe|url={{google books |plainurl=y |id=z1ClDgAAQBAJThe}}|date=2017|publisher=Policy Press|location=Bristol|isbn=978-1-4473-1354-0|page=73}}{{dead link|date=May 2023 |bot=InternetArchiveBot |fix-attempted=yes}} In the United States, 30% of people admitted to hospital have a problem related to alcohol.{{cite journal |vauthors=Vonghia L, Leggio L, Ferrulli A, Bertini M, Gasbarrini G, Addolorato G |title=Acute alcohol intoxication |journal=European Journal of Internal Medicine |volume=19 |issue=8 |pages=561–7 |date=December 2008 |pmid=19046719 |doi=10.1016/j.ejim.2007.06.033}}

Within the medical and scientific communities, there is a broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."{{cite web|last=Volkow|first=Nora|title=Science of Addiction|url=http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf|url-status=live|archive-url=https://web.archive.org/web/20110629022654/http://www.ama-assn.org/ama1/pub/upload/mm/388/sci_drug_addiction.pdf|archive-date=29 June 2011|publisher=American Medical Association}} Alcoholism has a higher prevalence among men, though, in recent decades, the proportion of female alcoholics has increased.{{cite journal |vauthors=Walter H, Gutierrez K, Ramskogler K, Hertling I, Dvorak A, Lesch OM |s2cid=6972064 |title=Gender-specific differences in alcoholism: implications for treatment |journal=Archives of Women's Mental Health |volume=6 |issue=4 |pages=253–8 |date=November 2003 |pmid=14628177 |doi=10.1007/s00737-003-0014-8}} Current evidence indicates that in both men and women, alcoholism is 50–60% genetically determined, leaving 40–50% for environmental influences.{{cite journal |vauthors=Dick DM, Bierut LJ |s2cid=10535003 |title=The genetics of alcohol dependence |journal=Current Psychiatry Reports |volume=8 |issue=2 |pages=151–7 |date=April 2006 |pmid=16539893 |doi=10.1007/s11920-006-0015-1 }} Most alcoholics develop alcoholism during adolescence or young adulthood.

[[File:Alcohol use disorders world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.3|Alcohol use disorders deaths per million persons in 2012

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Alcoholism often reduces a person's life expectancy by around ten years. The most common cause of death in alcoholics is from cardiovascular complications.{{cite journal | vauthors = Zuskin E, Jukić V, Lipozencić J, Matosić A, Mustajbegović J, Turcić N, Poplasen-Orlovac D, Bubas M, Prohić A | title = [Alcoholism—how it affects health and working capacity] | journal = Arhiv Za Higijenu Rada I Toksikologiju | volume = 57 | issue = 4 | pages = 413–26 | date = December 2006 | pmid = 17265681 }} There is a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. Approximately 3–15% of alcoholics die by suicide,{{cite book|title=American Psychiatric Association practice guidelines for the treatment of psychiatric disorders|date=2006|publisher=American Psychiatric Association|location=Arlington, VA|isbn=978-0-89042-385-1|page=1346|url={{google books |plainurl=y |id=zql0AqtRSrYC|page=1346}}|url-status=live|archive-url=https://web.archive.org/web/20160529103328/https://books.google.com/books?id=zql0AqtRSrYC&pg=PA1346|archive-date=29 May 2016}} and research has found that over 50% of all suicides are associated with alcohol or drug dependence. This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also common in adolescent alcohol abusers. Research in 2000 found that 25% of suicides in adolescents were related to alcohol abuse.{{cite book | last1 = O'Connor | first1 = Rory | last2 = Sheehy | first2 = Noel | title = Understanding suicidal behaviour | url = https://books.google.com/books?id=79hEYGdDA3oC | date = 29 January 2000 | publisher = BPS Books | location = Leicester | isbn = 978-1-85433-290-5 | pages = 33–37 | access-date = 1 July 2024 | archive-date = 13 January 2023 | archive-url = https://web.archive.org/web/20230113005830/https://books.google.com/books?id=79hEYGdDA3oC | url-status = live }}

Among those with alcohol dependence after one year, some met the criteria for low-risk drinking, even though only 26% of the group received any treatment, with the breakdown as follows: 25% were found to be still dependent, 27% were in partial remission (some symptoms persist), 12% asymptomatic drinkers (consumption increases chances of relapse) and 36% were fully recovered – made up of 18% low-risk drinkers plus 18% abstainers.{{cite web|url=http://www.nih.gov/news/pr/jan2005/niaaa-18.htm |title=2001–2002 Survey Finds That Many Recover From Alcoholism |last1=The National Institute on Alcohol Abuse and Alcoholism |last2=U.S. Department of Health and Human Services, NIH News |date=18 January 2005 |publisher=National Institutes of Health |archive-url=https://web.archive.org/web/20060818230335/http://www.nih.gov/news/pr/jan2005/niaaa-18.htm |archive-date=18 August 2006 }} In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence....return-to-controlled drinking, as reported in short-term studies, is often a mirage."

File:Adriaen Brouwer - Inn with drunken peasants.jpg, Inn with Drunken Peasants, 1620s]]

File:1904 Claim of Alcoholism Being Disease4.jpg

Historically the name dipsomania was coined by German physician C. W. Hufeland in 1819 before it was superseded by alcoholism.{{cite book| last1 = Peters | first1 = Uwe Henrik | title = Lexikon Psychiatrie, Psychotherapie, Medizinische Psychologie|url={{google books |plainurl=y |id=qY6_DQAAQBAJ}} | year = 2007 | publisher = Urban Fischer bei Elsev | isbn = 978-3-437-15061-6 }}{{cite book | last = Valverde | first = Mariana | title = Diseases of the Will | page = 48 | url = https://books.google.com/books?id=Kl5ugmvDgH0C&pg=PA4848 | publisher = Cambridge University Press | location = Cambridge | year = 1998 | isbn = 978-0-521-64469-3 | access-date = 1 July 2024 | archive-date = 14 January 2023 | archive-url = https://web.archive.org/web/20230114105317/https://books.google.com/books?id=Kl5ugmvDgH0C&pg=PA4848 | url-status = live }} That term now has a more specific meaning.{{cite book |last1=Tracy | first1 = Sarah J. | title = Alcoholism in America: from reconstruction to prohibition | url = {{google books |plainurl=y |id=JkYyd4qmme0C|page=31}} | year= 2005 | publisher = Johns Hopkins University Press | location = Baltimore | isbn = 978-0-8018-8119-0 | pages = 31–52 }} The term alcoholism was first used by Swedish physician Magnus Huss in an 1852 publication to describe the systemic adverse effects of alcohol.

Alcohol has a long history of use and misuse throughout recorded history. Biblical, Egyptian and Babylonian sources record the history of abuse and dependence on alcohol. In some ancient cultures alcohol was worshiped and in others, its misuse was condemned. Excessive alcohol misuse and drunkenness were recognized as causing social problems even thousands of years ago. However, the defining of habitual drunkenness as it was then known as and its adverse consequences were not well established medically until the 18th century. In 1647 a Greek monk named Agapios was the first to document that chronic alcohol misuse was associated with toxicity to the nervous system and body which resulted in a range of medical disorders such as seizures, paralysis, and internal bleeding. In the 1910s and 1920s, the effects of alcohol misuse and chronic drunkenness boosted membership of the temperance movement and led to the prohibition of alcohol in many countries in North America and the Nordic countries, nationwide bans on the production, importation, transportation, and sale of alcoholic beverages that generally remained in place until the late 1920s or early 1930s; these policies resulted in the decline of death rates from cirrhosis and alcoholism.{{cite journal | vauthors = Blocker JS | title = Did prohibition really work? Alcohol prohibition as a public health innovation | journal = American Journal of Public Health | volume = 96 | issue = 2 | pages = 233–43 | date = February 2006 | pmid = 16380559 | pmc = 1470475 | doi = 10.2105/AJPH.2005.065409 | quote = Nevertheless, once Prohibition became the law of the land, many citizens decided to obey it. Referendum results in the immediate post-Volstead period showed widespread support, and the Supreme Court quickly fended off challenges to the new law. Death rates from cirrhosis and alcoholism, alcoholic psychosis hospital admissions, and drunkenness arrests all declined steeply during the latter years of the 1910s, when both the cultural and the legal climate were increasingly inhospitable to drink, and in the early years after National Prohibition went into effect. }} In 2005, alcohol dependence and misuse was estimated to cost the US economy approximately 220 billion dollars per year, more than cancer and obesity.{{cite book|last1=Potter |first1= James V.|volume=2 |title=Substances of Abuse |url={{google books |plainurl=y |id=WU73eJAIDI4C|page=1}} |year= 2008 |publisher=AFS Publishing Co |isbn=978-1-930327-46-7 |pages=1–13 }}

Alcoholism is an incredibly complex and difficult problem to understand and solve in our society. The evolutionary perspective is often overlooked but is a key perspective in understanding this disease. The evolution of alcoholism is thought to originate at the consumption of fermented fruits.{{Cite journal |last=Dudley |first=Robert |date=March 2000 |title=Evolutionary Origins of Human Alcoholism in Primate Frugivory |url=https://www.journals.uchicago.edu/doi/10.1086/393255 |journal=The Quarterly Review of Biology |volume=75 |issue=1 |pages=3–15 |doi=10.1086/393255 |pmid=10721531 |issn=0033-5770}} Those that are able to find and successfully consume ripe fruit had an advantage because of the additional source of nutrients. This led to an association of ethanol (found in fermenting fruits) with energy. Ethanol is produced inside of ripening fruits which contain significant amounts of nutrients and high caloric value. Natural selection favoring primates attracted to alcohol, even if the benefits were not direct, is one hypothesis for why some people are more susceptible to alcoholism than others.{{Cite journal |last1=Clites |first1=Benjamin L. |last2=Hofmann |first2=Hans A. |last3=Pierce |first3=Jonathan T. |date=2023 |title=The Promise of an Evolutionary Perspective of Alcohol Consumption |journal=Neuroscience Insights |volume=18 |pages=26331055231163589 |doi=10.1177/26331055231163589 |issn=2633-1055 |pmc=10084549 |pmid=37051560}}  This is an example of Darwinian medicine, and is part of the explanation for why some people may be more susceptible, the whole story about who is more susceptible to alcoholism also includes, genetics, environment, family background, and other stressors, all of which are important and tend to be studied more than the evolutionary aspect. Alcoholism is a disease of nutritional excess, similar to obesity. Early human consumption of ethanol was a byproduct as well as a source of nutrients, but in an industrial society where there is an excess amount of alcohol, this consumption can become a problem.

Early humans regularly ingested ethanol which was made from yeast - based fermentation of naturally occurring fruit sugars.{{Cite journal |last=Dudley |first=Robert |date=2002 |title=Fermenting fruit and the historical ecology of ethanol ingestion: is alcoholism in modern humans an evolutionary hangover? |url=https://onlinelibrary.wiley.com/doi/10.1046/j.1360-0443.2002.00002.x |journal=Addiction |language=en |volume=97 |issue=4 |pages=381–388 |doi=10.1046/j.1360-0443.2002.00002.x |pmid=11964055 |issn=1360-0443}} The sugars found in fruit are an incentive for dispersers to consume and then eventually disperse seeds; the fruit pulp also serves as the base for ethanol production. The development of ethanol in fruits occurs during the ripening process which leaves fruits more available for consumption by dispersers. Unripe fruits contain seeds that have not matured, and if those seeds were to be eaten and dispersed it would be maladaptive. Unripe fruits are also less available to microbes to consume. The ripening of fruit can be seen as a race between dispersers and microbes.Ethanol inhibits the growth of microbes but it also typically makes fruit inedible to vertebrates as well. So, when an organism is able to consume alcohol, those fruits are available to them and not others. There is also an additional advantage to ethanol consumption which is the high caloric value of ethanol. The caloric value of ethanol is 7.1 kcal/g which is nearly twice that of carbohydrates which is 4.1 kcal/g.

Humans originate from a primarily frugivorous (fruit eater) lineage of primates. A large part of primate evolution occurred in warm equatorial climates where fruit fermentation occurred quickly and regularly. The ancestors of human and nonhuman primates were routinely exposed to low levels of ethanol through their fruit eating. This led to corresponding adaptation and preference for ethanol that has been preserved in modern humans.

The Hormetic effect or Hormesis is another aspect of the ancestral relationship humans have with alcohol. The Homertic effect is the idea that low concentrations to stressors, in this case ethanol, can be beneficial, but higher concentrations are stressful and cause harm. The evolutionary explanation for hormesis is based on the assumption that natural selection maximises relative fitness. This is an explanation for why organisms developed the metabolic machinery to consume ethanol in order to maximise its benefits. The Homertic effect in relation to alcohol consumption has not been studied thoroughly in humans but has in the fruit fly genus, Drosophila. The longevity of Drosophila is enhanced at very low concentrations of ethanol but is decreased at higher concentrations. Additionally, the ability to produce an abundant amount of offspring increases in the low concentration presence of ethanol. Other organisms whose diet consists of fermenting fruit share these same characteristics and this may also include humans, seeing as we do have the ability and metabolic equipment to have hormetic advantages from ethanol at low concentrations.

Humans have a far reaching frugivorous dietary heritage. Frugivorous adaptations among primates is thought to have started at least 40 million years ago, though likely earlier. Our closest relatives, the chimpanzees, have a predominantly frugivorous diet which supports the idea of our common ancestor’s frugivorous dietary heritage. Additionally, gibbons and orangutans are almost exclusively frugivory, while gorillas which are partially frugivory. Because of this shared evolutionary history, nonhuman primates have been used as models to understand alcoholism. Researchers have used macaques to test whether natural selection supports genes for traits that lead to excessive alcohol consumption because these same traits may enhance fitness in other contexts.{{Cite journal |last1=Gerald |first1=Melissa S. |last2=Higley |first2=J. Dee |date=2002 |title=Evolutionary underpinnings of excessive alcohol consumption |url=https://onlinelibrary.wiley.com/doi/10.1046/j.1360-0443.2002.00023.x |journal=Addiction |language=en |volume=97 |issue=4 |pages=415–425 |doi=10.1046/j.1360-0443.2002.00023.x |pmid=11964058 |issn=1360-0443}} Because of our close lineages, this may be true as well for humans.

In our prehistoric ancestry, there were advantages to our consumption of ethanol in fermenting fruits. But as the world changed and our living conditions turned to resemble our current modern industrial society, our access to ethanol changed as well. Similar to sugars and fats, ethanol was only found in very low concentrations and because of its tie to fruit sugars, our consumption of it was necessary. So, just like we crave sugar and fat because prehistorically they are only minimally obtainable and necessary for bodily functions, ethanol can also be craved and be over consumed. In our society sugar, fats and ethanol are readily available and in combination with our craving for it, both obesity and alcoholism can be considered diseases of nutritional excess.

{{see also|List of deaths through alcohol}}

The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society; for example, money due to lost labor-hours, medical costs due to injuries due to drunkenness and organ damage from long-term use, and secondary treatment costs, such as the costs of rehabilitation facilities and detoxification centers. Alcohol use is a major contributing factor for head injuries, motor vehicle injuries (27%), interpersonal violence (18%), suicides (18%), and epilepsy (13%).{{cite web |title=Alcohol and health |url=https://www.who.int/substance_abuse/infographic_alcohol_2018.pdf?ua=1 |publisher=World Health Organization |access-date=3 May 2020 |archive-date=25 July 2020 |archive-url=https://web.archive.org/web/20200725015946/https://www.who.int/substance_abuse/infographic_alcohol_2018.pdf?ua=1 |url-status=live }} Beyond the financial costs that alcohol consumption imposes, there are also significant social costs to both the alcoholic and their family and friends.{{cite book |last1=McCully |first1=Chris |title=Goodbye Mr. Wonderful. Alcohol, Addition and Early Recovery |url=http://www.jkp.com/catalogue/book/9781843102656/contents |year=2004 |publisher=Jessica Kingsley Publishers |location=London |isbn=978-1-84310-265-6 |url-status=live |archive-url=https://web.archive.org/web/20091121091734/http://www.jkp.com/catalogue/book/9781843102656/contents |archive-date=21 November 2009 }} For instance, alcohol consumption by a pregnant woman can lead to an incurable and damaging condition known as fetal alcohol syndrome, which often results in cognitive deficits, mental health problems, an inability to live independently and an increased risk of criminal behaviour, all of which can cause emotional stress for parents and caregivers.{{cite book | last1 = Streissguth | first1 = Ann Pytkowicz | title = Fetal alcohol syndrome: a guide for families and communities | year = 2018 | publisher = Paul H Brookes Pub. | url = https://books.google.com/books?id=kptHAAAAMAAJ | location = Baltimore | isbn = 978-1-55766-283-5 | access-date = 1 July 2024 | archive-date = 14 January 2023 | archive-url = https://web.archive.org/web/20230114105318/https://books.google.com/books?id=kptHAAAAMAAJ | url-status = live }}{{cite web |url=https://www.cdc.gov/ncbddd/fasd/documents/FAS_guidelines_accessible.pdf |title=Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis |first1=Julie Louise |last1=Gerberding |first2=José |last2=Cordero |first3=R. Louise |last3=Floyd |date=May 2005 |publisher=US Centers for Disease Control and Prevention |url-status=live |archive-url=https://web.archive.org/web/20140611110732/http://www.cdc.gov/ncbddd/fasd/documents/FAS_guidelines_accessible.pdf |archive-date=11 June 2014 }} Estimates of the economic costs of alcohol misuse, collected by the World Health Organization, vary from 1–6% of a country's GDP.{{cite web| publisher=World Health Organization | url=https://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf | title=Global Status Report on Alcohol 2004 | access-date=3 January 2007 | archive-url= https://web.archive.org/web/20061230103251/http://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf| archive-date= 30 December 2006 | url-status= live}} One Australian estimate pegged alcohol's social costs at 24% of all drug misuse costs; a similar Canadian study concluded alcohol's share was 41%.{{cite web|publisher=World Health Organization Global Alcohol Database |url=https://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2 |access-date=3 January 2007 |title=Economic cost of alcohol consumption |archive-url=https://web.archive.org/web/20080118052306/http://www.who.int/globalatlas/dataQuery/objectInterface.asp?objID=359&boCat=&p=null&lvl=0&catID=520700000000&level=2 |archive-date=18 January 2008 }} One study quantified the cost to the UK of all forms of alcohol misuse in 2001 as £18.5–20 billion.{{cite news | publisher=BBC | url=http://news.bbc.co.uk/1/hi/health/3122244.stm | title=Q&A: The costs of alcohol | date=19 September 2003 | url-status=live | archive-url=https://web.archive.org/web/20061019030402/http://news.bbc.co.uk/1/hi/health/3122244.stm | archive-date=19 October 2006 }} All economic costs in the United States in 2006 have been estimated at $223.5 billion.{{cite journal | vauthors = Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD | title = Economic costs of excessive alcohol consumption in the U.S., 2006 | journal = American Journal of Preventive Medicine | volume = 41 | issue = 5 | pages = 516–24 | date = November 2011 | pmid = 22011424 | doi = 10.1016/j.amepre.2011.06.045 | url = http://www.sertox.com.ar/img/item_full/Bouchery_2011.pdf | access-date = 12 December 2017 | citeseerx = 10.1.1.460.5582 | archive-url = https://web.archive.org/web/20180721201648/https://www.sertox.com.ar/img/item_full/Bouchery_2011.pdf | archive-date = 21 July 2018 }}

{{anchor|Hitting rock bottom}}The idea of hitting rock bottom refers to an experience of stress that can be attributed to alcohol misuse.{{cite web |title=hit rock bottom |url=https://idioms.thefreedictionary.com/hit+rock+bottom |access-date=16 July 2022 |website=TheFreeDictionary.com |archive-date=16 July 2022 |archive-url=https://web.archive.org/web/20220716163516/https://idioms.thefreedictionary.com/hit+rock+bottom |url-status=live }} There is no single definition for this idea, and people may identify their own lowest points in terms of lost jobs, lost relationships, health problems, legal problems, or other consequences of alcohol misuse.{{cite journal | vauthors = Kirouac M, Witkiewitz K | title = Identifying 'Hitting Bottom' Among Individuals with Alcohol Problems: Development and Evaluation of the Noteworthy Aspects of Drinking Important to Recovery (NADIR) | journal = Substance Use & Misuse | volume = 52 | issue = 12 | pages = 1602–1615 | date = October 2017 | pmid = 28557550 | pmc = 6107067 | doi = 10.1080/10826084.2017.1293104 }} The concept is promoted by 12-step recovery groups and researchers using the transtheoretical model of motivation for behavior change. The first use of this slang phrase in the formal medical literature appeared in a 1965 review in the British Medical Journal, which said that some men refused treatment until they "hit rock bottom", but that treatment was generally more successful for "the alcohol addict who has friends and family to support him" than for impoverished and homeless addicts.{{cite journal | title = Treatment of Alcohol Addiction | journal = British Medical Journal | volume = 2 | issue = 5455 | pages = 184–5 | date = July 1965 | pmid = 20790596 | pmc = 1846501 | doi = 10.1136/bmj.2.5455.184 }}

Stereotypes of alcoholics are often found in fiction and popular culture. The "town drunk" is a stock character in Western popular culture. Stereotypes of drunkenness may be based on racism or xenophobia, as in the fictional depiction of the Irish as heavy drinkers.{{cite web | url=http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm | title=World/Global Alcohol/Drink Consumption | year=2009 | publisher=Finfacts Ireland | url-status=live | archive-url=https://web.archive.org/web/20150512161159/http://www.finfacts.ie/Private/bestprice/alcoholdrinkconsumptionpriceseurope.htm | archive-date=12 May 2015 }} Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.{{cite book| last1 = Stivers | first1 = Richard | title = Hair of the dog: Irish drinking and its American stereotype |year=2000| publisher = Continuum | location = New York |url={{google books |plainurl=y |id=MH3aAAAAMAAJ}} | isbn = 978-0-8264-1218-8 }} Alcohol consumption is relatively similar between many European cultures, the United States, and Australia. In Asian countries that have a high gross domestic product, there is heightened drinking compared to other Asian countries, but it is nowhere near as high as it is in other countries like the United States. It is also inversely seen, with countries that have very low gross domestic product showing high alcohol consumption.{{cite journal | vauthors = Chen CC, Yin SJ | s2cid = 24571763 | title = Alcohol abuse and related factors in Asia | journal = International Review of Psychiatry | volume = 20 | issue = 5 | pages = 425–33 | date = October 2008 | pmid = 19012127 | doi = 10.1080/09540260802344075 }} In a study done on Korean immigrants in Canada, they reported alcohol was typically an integral part of their meal but is the only time solo drinking should occur. They also generally believe alcohol is necessary at any social event, as it helps conversations start.{{cite journal | vauthors = Kim W | s2cid = 28478567 | title = Drinking culture of elderly Korean immigrants in Canada: a focus group study | journal = Journal of Cross-Cultural Gerontology | volume = 24 | issue = 4 | pages = 339–53 | date = December 2009 | pmid = 19823926 | doi = 10.1007/s10823-009-9104-z }}

Peyote, a psychoactive agent, has even shown promise in treating alcoholism. Alcohol had actually replaced peyote as Native Americans' psychoactive agent of choice in rituals when peyote was outlawed.{{cite journal | vauthors = French L | s2cid = 143549807 | year = 2008 | title = Psychoactive agents and Native American spirituality: Past and present | journal = Contemporary Justice Review | volume = 11 | issue = 2| pages = 155–63 | doi=10.1080/10282580802058270}}

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• Addictive personality
• Alcohol-related traffic crashes in the United States
• Alcoholism in family systems
• Collaborative Study on the Genetics of Alcoholism
• CRAFFT Screening Test
• Disulfiram-like drug
• High-functioning alcoholic
• Holiday heart syndrome
• List of countries by alcohol consumption

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{{Notelist}}

{{Reflist}}

{{Sister project links|wikt=alcoholism|b=no|q=Alcoholism|s=no|commons=Category:Alcoholism|n=no|v=no|species=no|position=}}

{{Medical condition classification and resources

| DiseasesDB =

| ICD11 = {{ICD11|6C40.2}}

| ICD10 = {{ICD10|F10.2}}

| ICD9 = {{ICD9|303}}

| ICDO =

| OMIM = 103780

| MedlinePlus = 000944

| eMedicineSubj = article

| eMedicineTopic = 285913

| MeshID = D000437

}}

{{Addiction}}

{{alcohealth}}

{{Psychoactive substance use}}

{{Alcoholics Anonymous |state=collapsed}}

{{Authority control}}

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