For many people, drinking alcohol is nothing
more than a pleasant way to relax. People with alcohol-related
disorders drink to excess, endangering both themselves and those
around them. This question-and-answer fact sheet explains how
psychotherapy can help people recover from these potentially life-threatening
When does drinking become
For most adults, moderate alcohol use-no more than
two drinks a day for men and one for women and older people-is
relatively harmless. (A "drink" consists of 1.5 ounces of spirits,
5 ounces of wine or 12 ounces of beer, which contain equal amounts
of alcohol.) Moderate use, however, lies at one end of a continuum
that moves through alcohol abuse to alcohol dependence:
Alcohol abuse is a drinking pattern
that results in adverse consequences that are both significant
and recurrent. Alcohol abusers may fail to fulfill major school,
work or family obligations. They may have drinking-related
legal problems, such as drunk driving arrests. They may have
relationship problems related to their drinking.
People with alcoholism-technically known as alcohol
dependence - have become compulsive in their alcohol
use. Although they can control their drinking at times, they
are often unable to stop once they start. As their tolerance
increases, they may need more and more alcohol to achieve
the same "high." Or they may become physically dependent
on alcohol, suffering withdrawal symptoms such as nausea,
sweating, restlessness, irritability, tremors and even hallucinations
and convulsions when they stop after a period of heavy drinking.
It doesn't matter what kind of alcohol someone drinks or
even how much: alcohol dependent people simply lack reliable
control over their drinking.
According to the National Institute on Alcohol Abuse
and Alcoholism (NIAAA), one in 13 American adults is an alcohol
abuser or alcoholic at any given time. A 1997 government survey
revealed that drinking problems are also common among younger
Americans-despite the fact that most states outlaw drinking under
age 21. Almost five million youths aged 12 to 20 engage in binge
drinking, for example, with females downing at least four drinks
on a single occasion and males at least five.
What causes alcohol-related
Problem drinking has multiple causes, with genetic,
physiological, psychological and social factors all playing a
role. For some alcohol abusers, psychological traits such as impulsiveness,
low self-esteem and a need for approval prompt inappropriate drinking.
Others drink as a way of coping with emotional pain. Still others
use alcohol to "medicate" psychological disorders. Once people
begin drinking excessively, the problem can perpetuate itself.
Heavy drinking can cause physiological changes that make more
drinking the only way to avoid discomfort.
Genetic factors render some people especially vulnerable
to alcohol dependence. (Contrary to myth, being able to "hold
your liquor" means you're probably more at risk-not less.) Yet
a family history of alcoholism doesn't mean that children of alcoholics
will automatically grow up to become alcoholics themselves. Environmental
factors such as peer pressure and the easy availability of alcohol
can also play key roles. Although alcohol-related disorders can
strike anyone, poverty and physical or sexual abuse also increase
How do alcohol-related disorders
While small amounts of alcohol may have some beneficial
physical effects, heavy drinking can cause serious health problems
and even death. In fact, 100,000 Americans die from alcohol-related
causes each year. Short-term effects include distorted perceptions,
memory loss, hangovers and black-outs. Many problems aren't apparent
until they become serious, however. Over the long term, heavy
drinking can cause impotence, stomach ailments, cardiovascular
problems, cancer, central nervous system damage, serious memory
loss and liver cirrhosis. It also increases the chances of dying
from automobile accidents, homicide and suicide. Although men
are much more likely than women to develop alcoholism, women's
health suffers more even at lower levels of consumption.
Although moderate drinking may result in relaxation
and euphoria, heavy drinking also has a very negative impact on
mental health. In fact, alcohol abuse and alcoholism can worsen
existing conditions, such as depression or schizophrenia, or induce
new problems, such as serious memory loss, depression or anxiety.
People with alcohol-related disorders don't just
hurt themselves, however. According to NIAAA, more than half of
Americans have at least one close relative with a drinking problem.
The results can be devastating. Spouses are more likely to face
domestic violence. Children are more likely to develop psychological
problems, suffer physical and sexual abuse and neglect and-because
of the combination of genetic vulnerability and social learning-grow
up to be alcoholics. Women who drink during pregnancy run a serious
risk of damaging their fetuses. It's not just relatives who suffer.
Heavy drinkers often kill strangers through accidents or homicide.
When should someone seek
Because some in our society view alcohol-related
disorders as a sign of moral weakness, individuals often hide
their drinking or deny they have a problem. How can you tell if
you or someone you know is in trouble? Signs of a s possible problem
include having friends or relatives express concern, being annoyed
when people criticize your drinking, feeling guilty about your
drinking and thinking that you should cut down but finding yourself
unable to do so. Needing a morning drink to steady your nerves
or relieve a hangover is another warning sign.
Alcoholics usually can't stop drinking through willpower
alone. Most need outside help. They may need medically supervised
detoxification to avoid potentially life-threatening withdrawal
symptoms such as seizures, for instance. Depending on the problem's
severity, treatment can take place during office visits, hospital
stays or residential treatment programs. Once people are stabilized,
they need help resolving psychological issues that may be associated
with problem drinking.
How can a psychologist help?
Psychologists play a vital role in the successful
treatment of alcohol-related disorders, serving as integral members
of the multidisciplinary team that may be required to provide
care. Be sure to choose a psychologist who is experienced in working
with alcohol-related disorders. To improve the chances of recovery,
seek help early.
Using individual or group psychotherapy, psychologists
can help people address psychological issues involved in their
drinking. They can help people boost their motivation, identify
situations that trigger drinking and learn new coping methods.
They can also provide referrals to self-help groups such as Alcoholics
Anonymous, a crucial part of any recovery program. The treatment
process doesn't end once drinking does, however. To help prevent
relapses, psychologists typically keep working with people as
they begin new lives. Even after formal treatment ends, many people
seek additional support through continued involvement in self-help
Treatment can't occur in a vacuum. Because families
influence both drinking and recovery, marital and family therapy
are also key. Psychologists can help families repair relationships
and navigate the complex transitions that occur as recovery begins.
They can help families understand alcoholism and learn how to
support family members in recovery. And they can refer family
members to self-help groups such as Al-Anon and Alateen.
Does treatment really work?
Yes. Evidence strongly suggests that many people-especially
those with jobs, families and other forms of social stability-recover
after their first attempt. Not everyone is so fortunate. Some
cycle between relapse and recovery several times before achieving
long-term sobriety. What's important is for the person to stop
drinking again and get additional support.
While alcoholism is treatable, so far no cure has
been found. That means people remain susceptible to relapses even
after they've been sober for a long time. Reducing alcohol consumption
doesn't work. Most experts agree that the goal should be complete
avoidance of alcohol.
Alcohol-related disorders can severely impair
people's functioning and health. But the prospects for long-term
recovery are good for people who seek help from appropriate sources.
Qualified psychologists with experience in this area can help
those who suffer from alcohol-related disorders stop drinking
and start regaining control of their lives.
This document may be reproduced in its entirety without modifications.
A publication of the American Psychological
Association Practice Directorate
The American Psychological Association Practice
Directorate and the APA College of Professional Psychology gratefully
acknowledge the assistance of Peter E. Nathan, Ph.D., John Wallace,
Ph.D., and Joan Zwerben, Ph.D., in developing this fact sheet.