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Facts about Alcohol

    Alcohol, the most widely used psychoactive drug in the United States, has unique pharmacological effects on the person drinking it

    Alcohol contributes to 100,000 deaths annually, making it the third leading cause of preventable mortality in the US, after tobacco and diet/activity patterns

    Among 9,484 deaths attributed to non-medical use of other drugs in 1996, 37% also involved alcohol

    More than seven percent of the population ages 18 years and older--nearly 13.8 million Americans--have problems with drinking, including 8.1 million people who are alcoholic. Almost three times as many men (9.8 million) as women (3.9 million) are problem drinkers, and prevalence is highest for both sexes in the 18-to-29-years-old age group

    About 43% of US adults--76 million people--have been exposed to alcoholism in the family: they grew up with or married an alcoholic or a problem drinker or had a blood relative who was ever an alcoholic or problem drinker

    62% of high school seniors report that they have been drunk; 31% say that have had five or more drinks in a row during the last two weeks

    People who begin drinking before age 15 are four times more likely to develop alcoholism than those who begin at age 21

    From 1985 to 1992, the economic costs of alcoholism and alcohol-related problems rose 42% to $148 billion. Two-thirds of the costs related to lost productivity, either due to alcohol-related illness (45.7%) or premature death (21.2%). Most of the remaining costs were in the form of health care expenditures to treat alcohol use disorders and the medical consquences of alcohol consumption (12.7%), property and administrative costs of alcohol-related motor vehicle crashes (9.2%), and various additional costs of alcohol-related crime (8.6%). Based on inflation and population growth, the estimated costs for 1995 total $166.5 billion

    Nearly one-fourth of all persons admitted to general hospitals have alcohol problems or are undiagnosed alcoholics being treated for the consequences of their drinking

    On average, untreated alcoholics incur general health care costs at least 100% higher than those of nonalcoholics, and this disparity may exist as long as 10 years before entry into treatment

    Based on victim reports, each year 183,000 (37%) rapes and sexual assaults involve alcohol use by the offender, as do just over 197,000 (15%) of robberies, about 661,000 (27%) aggravated assaults, and nearly 1.7 million (25%) simple assaults

    Alcohol is typically found in the offender, victim or both in about half of all homicides and serious assaults, as well as in a high percentage of sex-related crimes, robberies, and incidents of domestic violence, and alcohol-related problems are disproportionately found among both juvenile and adult criminal offenders

    Fetal alcohol syndrome (FAS), which can occur when women drink during pregnancy, is the leading known environmental cause of mental retardation in the Western World

Historical Comparison on Alcoholism

Alcoholism 30 years ago

• Little was known about he genetic basis of alcoholism or when the nervous system changes that occur as a result of heavy drinking

• Alcoholism was thought to be a disease of middle age

• Antabuse® (disulfiram) was the only medication approved for treating alcoholism. Antabuse® produces acute sensitivity to alcohol. This sensitivity causes a highly unpleasant reaction when the patient ingests even a small amount of alcohol.

• Other treatments included various behavioral approaches, mostly group counseling and referral to Alcoholics Anonymous. These treatments were only offered in intensive programs provided at specific locations separated from mainstream health care.

• Research seems to indicate relatively few people with alcoholism ever receive treatment

Alcoholism Today

• Researchers have identified genes that increase an individual’s risk for alcoholism, as well as genes that protect against alcohol problems.

• The neural basis of alcoholism was clarified. Research showing that drinking is influenced by multiple neurotransmitter systems, neuromodulators, hormones and intracellular networks provides evidence of a number of potential target sites for which new medications may be developed

• Multiple excellent animal models provide valuable tools for today’s researchers

• Clinicians have access to a wide range of treatment options that can be tailored to patient’s specific needs and a broad array of drinking problems can be effectively treated by non-specialists

• Screening and brief intervention – one to four repeated short counseling sessions focused on increasing motivation to reduce drinking has recently emerged as an effective strategy for addressing high-risk drinking

• Investigators developed screening tools that allow clinicians to quickly and reliably determine if their patients’ alcohol consumption patterns place them at risk for future adverse consequences. Studies show that brief interventions delivered in trauma units can reduce subsequent drinking and injuries.

• Several behavioral approaches, such as motivational enhancement therapy, cognitive-behavioral therapy and 12-step facilitation are effective in treating alcoholism, offering the patient and therapist a choice of approach. Brief counseling by a health care professional combined with medication recently was found to be as effective as specialized counseling. Thus, it may be possible to provide access to effective treatment to many p more people in primary care and mental health clinics

• When used in conjunction with behavioral therapies, medications improve the chance for recovery and the lives of those who suffer from alcoholism

Alcohol Addiction

·         Addiction researchers and treatment professionals have long known that drug addiction and alcohol abuse are closely associated. In the last decade, research has broadened our understanding of many behavioral mechanisms common to both disorders. Yet, while two in five patients are addicted to both drugs and alcohol, the treatment they are likely to receive will target only one disorder. A lack of science-based information on alcohol and addiction treatment of drug and alcohol abuse limits the ability of treatment professionals to provide the comprehensive treatment these patients need.

·         Recent research suggests some medications developed to treat addiction or alcohol abuse may be useful for treating both alcohol and addiction. This information, along with our increased understanding of the underlying factors that drive drug and alcohol abuse, provides a strong rationale for a coordinated research effort to meet the critical need for treatments for people suffering from both disorders. Toward that end, NIDA and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have issued a joint program announcement to spur both drug and alcohol abuse researchers to investigate all aspects of pharmacological treatment for dually addicted patients.

·         Coordinated research on addiction and alcohol patients will address the needs of the overwhelming number of Americans who abuse both alcohol and illicit drugs. More than 2.4 million of the 5.6 million people who abused illicit drugs in 2001 also abused alcohol, according to the National Household Survey on Drug Abuse. In fact, the more heavily someone abused alcohol, the more likely he or she was to use illicit drugs, the survey found. In 2001, nearly two of every three American teenagers, ages 12 to 17, who engaged in frequent drinking binges also abused drugs. In comparison, only 1 in 20 young people who didn't drink at all used drugs.

·         The substantial portion of addiction and alcohol abusing patients in community treatment programs provides additional evidence of the need for science-based information on treating dual addiction. Patients who abuse both drugs and alcohol accounted for more than 42 percent of admissions to substance abuse treatment facilities reported by State agencies in 2000, the last year for which these data are published. Alcohol abuse is even more likely among patients who abuse certain drugs, such as cocaine, methamphetamine, and marijuana. For example, more than half of cocaine-abusing patients who entered treatment in 2000 also abused alcohol.

·         To develop effective treatments for patients who have addiction and alcohol dependence, we need to understand why so many people do so. Part of the answer probably has to do with genes--underlying genetic variations that may play a role in common brain mechanisms that fuel both disorders. NIDA-supported brain imaging studies conducted at Brookhaven National Laboratory in Upton, New York, have documented similarities in the structure and function of the brains of alcoholics and chronic cocaine abusers that appear to be implicated in the abuse of both substances. Individuals with either disorder have low levels of dopamine D2 receptors in the brain's reward pathways that may impair their capacity to derive pleasure from normally rewarding activities. This deficit may make them more vulnerable to the rewarding effects of alcohol and cocaine.

·         Individuals with addiction and alcohol dependence also may combine alcohol and illicit drugs because of interactions between abused substances in the body. Because both drugs and alcohol activate brain areas involved in reward, combining substances may increase these effects. Other alcohol-drug interactions may counter unpleasant effects that often accompany or follow substance abuse. Clinical reports suggest that cocaethylene, a combined cocaine-alcohol metabolite that is formed in the body following concurrent alcohol and cocaine use, appears to reduce the anxiety that can accompany cocaine use. Recent research in rats confirms that cocaethylene plasma levels remain high as cocaine levels fall, producing a delayed, relatively long-lasting rewarding effect that may counter the aversive effect induced when cocaine plasma levels recede.

·         While the perceived benefits of combining alcohol and drug addiction may play a big part in the high percentages of people who do so, the addictive effects and harmful consequences of both substances increase when they are used together. Dually addicted patients are more likely to drop out of treatment and have poorer results than patients who abuse only one substance. However, since most studies on treating drug and alcohol abuse have examined these disorders separately, drug and alcohol treatment counselors now have little science-based information on which to base their treatment of these patients.

·         Drug addiction and alcohol abuse wreak incalculable damage on individuals, families, and communities. When they occur together, these disorders double the challenge to researchers and treatment providers. Now, NIDA and NIAAA have launched a concerted scientific response to address these challenges. Ultimately, this expanded research will fuel the development of new treatments that will enable substance abuse treatment programs to more effectively meet the needs of the many patients who abuse both alcohol and illicit drugs.

·         The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH) , a component of the U.S. Department of Health and Human Services.

·         Alcohol Treatment

       New Advances in Alcohol Treatment
More than 700,000 Americans receive alcohol treatment on any given day. However, the techniques of alcoholism therapy have traditionally been based on clinical experience and intuition, with little rigorous validation of their effectiveness. Over the past 20 years, modern methods of evaluating medical therapies have been increasingly applied to alcoholism treatment. These methods include the use of control groups for comparison purposes, random assignment of study participants to different treatment groups and, to the greatest extent possible, follow-up of all patients who entered the study. This issue focuses on the results of recent controlled clinical studies on the effectiveness of self-help groups, psychosocial approaches, and medications in achieving and maintaining abstinence.

       Twelve-Step Self-Help Alcohol Treatment Programs
Self-help groups are the most commonly sought source of help for alcohol-related problems. Alcoholics Anonymous (AA), one of the most commonly known self-help groups, outlines 12 consecutive activities, or steps, that alcoholics should achieve during the recovery process. Alcoholics can become involved with AA before entering professional treatment, as a part of it, or as aftercare following professional treatment. Although AA appears to produce positive outcomes in many of its members, its efficacy has rarely been assessed in randomized clinical trials.

       One randomized study of patients entering employee assistance programs compared inpatient treatment combined with AA with referral to AA alone. This study found that inpatient treatment, a combination of professional treatment and AA, will achieve better results for more people than AA alone. Ouimette and colleagues, as part of a nonrandomized observational study involving 3,000 patients in Department of Veterans Affairs hospitals, compared predominantly 12-step programs with predominantly cognitive-behavioral programs as well as with courses of therapy that combined both approaches. In cognitive-behavioral therapy, the therapist helps the client learn new skills to cope with problems and to change harmful behavior patterns, such as alcohol abuse. One year after completion of treatment, the three types of programs had produced comparable improvements on measures of alcohol consumption and related problems. However, participants in the 12-step programs achieved more sustained abstinence and higher rates of employment compared with participants in the other two programs. Interpretation of these results is complicated by the nonrandom assignment of patients to the different treatment types.

       The beneficial effects of AA may be attributable in part to the replacement of the participant's social network of drinking friends with a fellowship of AA members who can provide motivation and support for maintaining abstinence. In addition, AA's approach often results in the development of coping skills, many of which are similar to those taught in more structured psychosocial treatment settings, thereby leading to reductions in alcohol consumption.

       Psychosocial Therapy
The following sections deal with selected recent approaches or considerations relevant to the psychosocial treatment of alcohol problems.

       Alcohol Treatment using Motivational Enhancement Therapy
Developed specifically for Project MATCH, motivational enhancement therapy begins with the assumption that the responsibility and capacity for change lie within the client. The therapist begins by providing individualized feedback about the effects of the patient's drinking. Working closely together, therapist and patient explore the benefits of abstinence, review treatment options, and design a plan to implement treatment goals. Analysis suggests that MET may be one of the most cost-effective of available treatment methods. In one study, the motivational interviewing technique-a key component of MET-was shown to overcome patients' reluctance to enter treatment more effectively than did conventional techniques.

       Alcohol Treatment for Couples Therapy
Evidence indicates that involvement of a nonalcoholic spouse in an alcohol treatment program can improve patient participation rates and increase the likelihood that the patient will alter drinking behavior after treatment ends. There are various approaches to marital family therapy. Behavioral-marital therapy combines a focus on drinking with efforts to strengthen the marital relationship through shared activities and the teaching of communication and conflict evaluation skills. O'Farrell and colleagues combined couples therapy with the learning and rehearsal of a relapse prevention plan. Among alcoholics with severe marital and drinking problems, the combination approach produced improved marital relations and higher abstinence rates through 30 months of follow-up compared with patients undergoing only BMT.

       Brief Alcohol Treatment Interventions
Many persons with alcohol-related problems receive counseling from primary care physicians or nursing staff in the context of five or fewer standard office visits. Such treatment, known as brief intervention, generally consists of straightforward information on the negative consequences of alcohol consumption along with practical advice on strategies and community resources to achieve moderation or abstinence. Two controlled trials in the United States and Canada demonstrated that this approach reduced drinking, alcohol-related problems and patients' use of health care services. Most brief interventions are designed to help those at risk for developing alcohol-related problems to reduce their alcohol consumption. Alcohol-dependent patients are encouraged to enter specialized treatment with the goal of complete abstinence.

       The brief intervention approach has also been successfully applied outside the primary care setting. Evidence suggests that 25 to 40 percent of trauma patients may be alcohol dependent. Gentilello and colleagues conducted a randomized controlled study among patients in a trauma center who had detectable blood alcohol levels at the time of admission. The researchers found that a single motivational interview at or near the time of discharge reduced drinking levels and re-admission for trauma during 6 months of follow-up. Monti and colleagues conducted a similar randomized controlled study among youth ages 18 to 19 admitted to an emergency room with alcohol-related injuries. After 6 months, although all participants had decreased their alcohol consumption, the group receiving brief intervention had a significantly lower incidence of drinking and driving, traffic violations, alcohol-related injuries, and alcohol-related problems.

       Brief intervention among freshman college students previously identified as being at high risk for harmful consequences of heavy drinking has been shown to result in a significant decline in alcohol-related problems.

       Treatment of Alcohol and Nicotine Addiction Together
Nicotine and alcohol interact in the brain, each drug possibly affecting vulnerability to dependence on the other. Consequently, some researchers postulate that treating both addictions simultaneously might be an effective, even essential, way to help reduce dependence on both. A recent study by Hurt and colleagues showed that treatment for nicotine dependence did not interfere with abstinence from alcohol or other drugs. Furthermore, such concurrent treatment not only enhanced cessation from smoking, it also did not induce already abstinent smokers to relapse to drinking.

       Alcohol Treatment utilizing Pharmacotherapy
More recently, research has focused on the development of medications for blocking alcohol-brain interactions that might promote alcoholism. In 1995 the U.S. Food and Drug Administration approved the use of the medication naltrexone (ReViaTM) as an aid in preventing relapse among recovering alcoholics who are simultaneously undergoing psychosocial therapy. This approval was based largely on two randomized controlled studies that showed decreased alcohol consumption for longer periods in naltrexone-treated patients compared with those who received a placebo.

       As is the case with all diseases, however, naltrexone is only effective if taken on a regular basis (34). Like all medications, naltrexone has side effects. One recent study reported a high rate of side effects, which probably explains why this study, in contrast with most other studies, failed to find naltrexone effective.

       Acamprosate showed promise in treating alcoholism in several randomized controlled European trials involving more than 3,000 alcoholic subjects who were also undergoing psychosocial treatment. Analysis of combined results showed that more than twice as many alcoholics receiving acamprosate remained abstinent up to 1 year compared with subjects receiving psychosocial treatment alone.

       Research suggests that some medications may be more effective for certain types of alcoholics. For example, when ondansetron (Zofran®) was combined with psychotherapy, alcoholics who had begun drinking heavily before age 25 (i.e., early-onset alcoholics) decreased their alcohol consumption and increased their number of abstinent days, but later onset alcoholics did not Sertraline (Zoloft®), in contrast, appears to reduce drinking in late-onset, but not early-onset, alcoholics (38). However, fluoxetine (Prozac®), a medication related to sertraline, has not been found to be effective in late-onset alcoholism.

       In conclusion, research supports the concept of using medications as an adjunct to the psychosocial therapy of alcohol abuse and alcoholism. However, additional clinical trials are required to identify those patients most likely to benefit from such an approach, to determine the most appropriate medications for different patient types, to establish optimal dosages, and to develop strategies for enhancing patient compliance with medication regimens.

       New Advances in Alcohol Treatment
Alcoholism clinicians have access today to a wide range of treatment options for their patients. Some of these treatments, such as 12-step self-help programs, have been around a long time. Others-including brief intervention and various therapies borrowed from other fields, such as motivational enhancement therapy and couples therapy-are relatively new concepts that have been shown to be effective in reducing the risk for alcohol-related problems. The key change that has occurred, of course, is the advent of alcoholism clinical research, which over the past 15 years or so has made significant progress toward rigorous evaluation of both existing therapies and newly developed therapies for use in treating alcohol-related problems. Finally, continued research on alcohol's effects in the brain and on the links between brain and behavior, which has already led to the development of medications to reduce craving, is likely to provide clinicians with a range of highly specific medications that will, when used in conjunction with behavioral therapies, improve the chance for recovery-and the lives-of those who suffer from alcohol abuse and dependence. 

       Alcohol Treatment using Naltrexone
The medication naltrexone and up to 20 sessions of alcohol counseling by a behavioral specialist are equally effective treatments for alcohol dependence when delivered with structured medical management, according to results from "Combining Medications and Behavioral Interventions for Alcoholism" (The COMBINE Study). Results from the National Institutes of Health-supported study show that patients who received naltrexone, specialized alcohol counseling, or both demonstrated the best drinking outcomes after 16 weeks of outpatient treatment. All patients also received Medical Management (MM), an intervention consisting of nine brief, structured outpatient sessions provided by a health care professional. Contrary to expectations, the researchers found no effect on drinking of the medication acamprosate and no additive benefit from adding acamprosate to naltrexone.

       NIH's National Institute on Alcohol Abuse and Alcoholism (NIAAA) launched COMBINE in 2001 to identify the most effective current treatments and treatment combinations for alcohol dependence. The largest clinical trial ever conducted of pharmacologic and behavioral treatments for alcohol dependence, COMBINE was carried out at 11 academic sites that recruited and randomly assigned 1383 recently abstinent alcohol dependent patients to one of nine treatment groups.

       During the 16 weeks of treatment and 1 year after the treatment, the researchers assessed the patients for the percentage of days abstinent  from alcohol and time to the first heavy drinking day, defined as 4 or more drinks per day for women and 5 or more drinks per day for men. They also assessed the odds of good clinical outcome, defined as abstinence or moderate drinking without alcohol-related problems. As in other large clinical trials, the researchers found that most patients showed substantial improvement during treatment and that both the overall level of improvement and the differences between treatment groups diminished during the follow-up period. In the COMBINE study, however, naltrexone continued to show a small advantage for preventing relapse at 1 year after the end of active treatment..

       "These results demonstrate that either naltrexone or specialized alcohol counseling--with structured medical management--is an effective option for treating alcohol dependence," said Mark L. Willenbring, M.D., Director, Division of Treatment and Recovery Research, NIAAA. "Although MM is somewhat more intensive than the alcohol dependence interventions offered in most of today's health care settings, it is not unlike other patient care models such as initiating insulin therapy in patients with diabetes mellitus. MM's application in primary care and general mental health care settings would expand access to effective treatment dramatically, while offering patients greater choice."

       "The COMBINE results provide guidance for applying today's treatment tools. NIAAA continues to explore new treatment tools in more than 50 current medication trials, studies to better understand the mechanisms of action in behavioral treatments, and our search for new molecular targets and novel compounds for clinical testing," according to Raye Z. Litten, Ph.D., Combines’ government director and co-leader of NIAAA medications development team.

Alcohol Rehab

Alcohol rehab (rehabilitation) is defined here as the process of treatment for alcohol abuse and dependency, alcoholism. Each different level of care is designed to offer a unique type of program or medical service. A person participating in the process of recovery from their alcoholism needs some combination of these services, also known as levels of rehab care.

The following six levels of rehab care are offered by the alcohol recovery industry;

1.    Alcohol Detox
Also known as inpatient, alcohol detox (detoxification) is the initial, mandatory phase in the alcohol rehab process. It can be defined as the process of having all of the alcohol out of a person’s body. Also known as withdrawal, to insure the patient’s safety, must always be done under proper medical supervision.

2.  Outpatient Alcohol Rehab
Outpatient therapy (intensive outpatient program), is considered an intermediate level of alcohol rehab care. They offer a viable alternative to 30 day residential programs. Strictly done as group therapy, they meet 3 to 5 times per week, for 2 to 3 hours per session.

3.  Partial Hospitalization
Partial hospitalization, also known as PHP, the patient continues to reside at home, but commutes to a treatment center up to seven days a week. They are either all morning or all afternoon alcohol rehab sessions, including both group and individual counseling.

4.  Residential Alcohol Rehab Care
Alcohol rehab often needs time spend in treatment on a full time basis. The length of stay is generally 30 days. This allows the individual time in a safe, structured environment, where therapy is done daily and considered to be enough time to begin to form new habits.

5.  Extended Alcohol Rehab Care
Long term, or extended alcohol rehab is time in a full time residential environment for longer than 30 days. They are up to a maximum of 90 days. This is often recommended for people who have been through lower levels of care and been unsuccessful.

6.  Sober Living
Sober living, also known as half-way houses or sober houses are the final step in the alcohol rehab process. Clients are usually required to have a job, attend meetings and live in a structured lifestyle for up to one year.

Finding the right level and the best facility for alcohol rehab can be difficult. Usually, the right first step is to have a complete assessment and evaluation done. For more information about alcohol rehab, fill out the form below. A professional counselor will respond immediately

Teens and Alcohol

Some abuse alcohol by drinking frequently or by binge drinking--often defined as having five or more drinks* in a row. A minority of teens may meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for alcohol dependence. The progression of drinking from use to abuse to dependence is associated with biological and psychosocial factors. This Alcohol Alert examines some of these factors that put youth at risk for drinking and for alcohol-related problems and considers some of the consequences of their drinking.

Thirteen- to fifteen-year-olds are at high risk to begin drinking. According to results of an annual survey of students in 8th, 10th, and 12th grades, 26 percent of 8th graders, 40 percent of 10th graders, and 51 percent of 12th graders reported drinking alcohol within the past month. Binge drinking at least once during the 2 weeks before the survey was reported by 16 percent of 8th graders, 25 percent of 10th graders, and 30 percent of 12th graders.

Males report higher rates of daily drinking and binge drinking than females, but these differences are diminishing. White students report the highest levels of drinking, blacks report the lowest, and Hispanics fall between the two.

A survey focusing on the alcohol-related problems experienced by 4,390 high school seniors and dropouts found that within the preceding year, approximately 80 percent reported either getting "drunk," binge drinking, or drinking and driving. More than half said that drinking had caused them to feel sick, miss school or work, get arrested, or have a car crash.

Some teens that drink later abuse alcohol and may develop alcoholism. Although these conditions are defined for adults in the DSM, research suggests that separate diagnostic criteria may be needed for youth.

While drinking may be a singular problem behavior for some, research suggests that for others it may be an expression of general teen turmoil that includes other problem behaviors and that these behaviors are linked to unconventionality, impulsiveness, and sensation seeking.

Teens and Alcohol - Teenage Binge Drinking

Binge drinking, often beginning around age 13, tends to increase during adolescence, peak in young adulthood (ages 18-22), then gradually decrease. In a 1994 national survey, binge drinking was reported by 28 percent of high school seniors, 41 percent of 21- to 22-year-olds, but only 25 percent of 31- to 32-year-olds. Individuals who increase their binge drinking from age 18 to 24 and those who consistently binge drink at least once a week during this period may have problems attaining the goals typical of the transition from adolescence to young adulthood (e.g., marriage, educational attainment, employment, and financial independence).

Consequences of Teens Using Alcohol

Of the nearly 8,000 drivers’ ages 15-20 involved in fatal crashes in 1995, 20 percent had blood alcohol concentrations above zero.

Surveys of teenagers suggest that alcohol use is associated with risky sexual behavior and increased vulnerability to coercive sexual activity. Among adolescents surveyed in New Zealand, alcohol misuse was significantly associated with unprotected intercourse and sexual activity before age 16. Forty-four percent of sexually active Massachusetts teenagers said they were more likely to have sexual intercourse if they had been drinking, and 17 percent said they were less likely to use condoms after drinking.

Survey results from a nationally representative sample of 8th and 10th graders indicated that alcohol use was significantly associated with both risky behavior and victimization and that this relationship was strongest among the 8th-grade males, compared with other students.

High doses of alcohol have been found to delay puberty in female and male rats, and large quantities of alcohol consumed by young rats can slow bone growth and result in weaker bones. However, the implications of these findings for young people are not clear.