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Alcohol Abuse
And Dependence

Abuse vs. Dependence Security Concerns
Warning Signs Treatment
Workplace Indicators Sources for More Information
Getting Beyond Denial

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Moderate alcohol use is normal, but alcohol abuse or dependence is a serious problem. Too much alcohol affects the central nervous system and how the brain functions. It affects perception, thinking, and coordination. It impairs judgment, reduces inhibitions, and increases aggression. Those who abuse alcohol are more likely than others to engage in high risk, thoughtless, or violent behaviors.

bullet You are strongly encouraged to seek treatment if you develop alcohol-related problems. Some employees avoid treatment for fear that if their alcohol problem becomes known it may affect their security clearance. Actually, it is more likely to affect your clearance if you allow the problem to continue untreated. If your problem surfaces solely as a result of self-referral to counseling or a treatment program, there were no major precipitating factors such as alcohol-related arrests, and you are making satisfactory progress, your case will normally be handled as a medical problem. Administrative action concerning security clearance can be deferred pending satisfactory outcome of treatment.1

Abuse vs. Dependence

Alcoholism is a term commonly used to describe the medical disorder of alcohol dependence. Many health professionals prefer more precise language that distinguishes between alcohol dependence and alcohol abuse.2

Alcohol dependence is an illness with four main features:

  • Physical dependence, with a characteristic withdrawal syndrome that is relieved by more alcohol (e.g., morning drinking) or other drugs;
  • Physiological tolerance, so that more and more alcohol is needed to produce the desired effects;
  • Difficulty in controlling how much alcohol is consumed once drinking has begun;
  • A craving for alcohol that can lead to relapse if one tries to abstain.

Alcohol abuse is different from alcohol dependence. Abusers are not necessarily physically addicted to alcohol, but develop problems as a result of their alcohol consumption and poor judgment, failure to understand the risks, or lack of concern about damage to themselves or others. Because they are not addicted, alcohol abusers remain in control of their behavior and can change their drinking patterns in response to explanations and warnings. An alcohol abuser either:

  • Persists in habitual drinking or occasional binge drinking that causes or exacerbates a persistent or recurrent social, work, financial, legal, or health problem;
  • Or uses alcohol repeatedly under circumstances which are physically dangerous, such as driving while intoxicated.

Many people who abuse alcohol eventually become alcohol dependent. 

Warning Signs

The presence of any of the following indicators suggests that an individual may have a serious alcohol problem or be at high risk for developing one. Any one indicator is not conclusive evidence of a serious problem, but it is relevant circumstantial evidence and should be noted.

  • Drinking is causing or exacerbating a persistent or recurring social, work, financial, legal, or health problem. This is the heart of the alcohol issue.
  • Individual has tried unsuccessfully to cut down the extent of alcohol use. Or, once the person starts drinking, he/she sometimes loses control over the amount consumed. Both are indicators of alcohol dependence.
  • Individual commonly drinks while alone. Regular solitary drinking, as compared with social drinking, indicates potential current or future alcohol dependence.
  • Individual drinks to relax prior to social events, as compared with using alcohol at social events. Drinking prior to social events indicates potential current or future alcohol problems.
  • Individual drinks first thing in the morning as an "eye-opener" or to get rid of a hangover. This is a strong indicator of dependence.
  • Individual claims a high tolerance for alcohol, for example, makes statements such as: "I can drink a lot without its having any effect on me, so I don't have to worry." High tolerance is an indicator of alcohol dependence -- it takes more and more to have the same effect on the body.
  • Individual uses alcohol as a means of coping with life's problems. This indicates possible psychological or emotional problems and greatly increases the likelihood that alcohol already is or will become a problem. On the other hand, if motivation is experimentation, peer pressure, or adolescent rebelliousness, this does not necessarily predict future abuse.
  • There has been a recent increase in individual's drinking. A change for the worse in drinking pattern may signal the existence of other relevant issues.
  • There is a family history of alcohol abuse. Genetic studies indicate that alcoholism tends to run in families and that a genetic vulnerability to alcoholism exists. The disruption of family life in an alcoholic home also plays a role in creating vulnerability to alcoholism later in life. On the other hand, many children react to parental alcoholism by carefully avoiding alcohol themselves. According to one study, the chances the child will follow in the parent's footsteps depend, in part, upon which parent is the alcoholic and the nature of the relationship with that parent. Children of alcoholic mothers are at far greater risk than children of alcoholic fathers.3 

Workplace Indicators

Alcohol problems are often manifested in the areas of family, health or law enforcement before they affect work-related behaviors. The problem may be far advanced before symptoms are observable in the workplace.

The most frequently encountered workplace indicators of alcohol problems include absences, especially on Mondays, and tardiness. Declines in quality, timeliness, and quantity of work relative to previous levels, as well as irritability and incidents of emotional disagreement with co-workers and supervisors, are also noted. Occasionally, an employee's use of alcohol is apparent in the length of the lunch break and changes in mood observed in the afternoon.

These work-place indicators of possible alcoholism overlap with the signs and symptoms of other problems, such as clinical depression. Therefore, it is best to note these troubling workplace behaviors with concern but reserve speculation about their underlying cause until after consultation with a professional alcohol counselor.4

Getting Beyond Denial

Most alcohol abusers and alcoholics deny they have a problem. As they develop dependence on alcohol, they also develop "blinders" --a defense system that allows them to ignore the problem. They want to blame their problems on something or someone else -- bad luck, a misunderstanding spouse, a supervisor who doesn't like them, etc.5

Recognizing and accepting that an alcohol problem exists is the first, crucial step toward solving the problem. If you have an alcohol problem, it is important to keep the following in mind. If you are concerned about a family member, friend or co-worker who has a problem, share these thoughts with that person.

  • Alcoholism is an illness, not a moral weakness. Blaming yourself, blaming others, or feeling ashamed about your drinking are all stumbling blocks to receiving help.
  • You are not alone. The National Institute on Alcohol Abuse and Alcoholism estimates 14 million Americans -- one of every 13 adults -- either abuse alcohol or are alcoholics. Each year about 600,000 patients enter treatment for alcoholism.
  • Don't push away the messengers. People who worry or complain about your drinking can be a key to your recovery. They care enough about you to be concerned. If you are an alcoholic, you'll need their support.
  • The earlier the treatment, the more successful it is likely to be. Don't wait until the health effects are irreversible, you have lost your job, or your marriage has suffered to the point of breaking up.
  • Heavy drinking has serious health consequences.  It increases the risk of cancer and causes liver damage, immune system problems, brain damage and harm to the fetus during pregnancy. It also increases the risk of accidents and mental problems.6

Security Concern

Alcohol abuse or dependence is a security concern when:

  • It affects an individual's ability to exercise the care, judgment and discretion necessary to protect classified information. There have been many cases in which excessive drinking has increased the risk of accidental, careless or even deliberate disclosure of classified information. For example, see Ames: Too Many Problems.
  • It is part of a pattern of impulsive, immature, sensation-seeking, hostile, or antisocial behavior. An alcohol problem is more serious when it is part of a broader pattern of undesirable behavior. It may indicate an underlying psychological disorder that will cause future problems and resist treatment. One study found that within the general population, 44% of males and 65% of females diagnosed as alcohol abusers or alcohol dependent also had some form of psychiatric disorder.7

The key security question is how alcohol use affects a person's judgment and ability to control his/her behavior. How the person behaves under the influence of alcohol is more important than how much or how often subject drinks, and even whether or not subject is formally diagnosed as an alcoholic.

Treatment

Alcohol abuse or dependence is a treatable illness, but successful treatment requires the active participation of the employee, a professional alcohol counselor, the employee's supervisor, and family members or friends. Treatment may involve one to four weeks of intense rehabilitation at an outpatient or inpatient treatment facility following by six to twelve months of "aftercare" consisting of periodic individual, group, or family counseling. The recovery process typically requires the employee's regular participation in a community-based self-help group such as Alcoholics Anonymous.

One key to successful treatment is admission of the problem and motivation to beat it. Studies of U.S. military treatment programs show that completion of the full aftercare program is the strongest predictor of treatment success.8

Relapse is a common occurrence after all addiction treatment, but the risk of relapse diminishes with the passage of time and continued abstinence. The first relapse occurs most commonly during the first three months after completion of treatment. One study of alcohol treatment outcomes for military personnel found that if one gets through the first three months without relapse, the chances for long-term abstinence improve dramatically, and the chance of a relapse that affects work performance is small.9

Remission of drinking problems without treatment is common as young drinkers mature and the lifestyle, stress, or other circumstances that prompted the drinking change. The likelihood of spontaneous remission without treatment is relatively high among young men in their 20s, but relatively low among men in their 40s or older.10

Sources for More Information

Your Employee Assistance Program, family doctor or local alcohol treatment center can provide additional information on alcohol abuse and treatment options.

For a list of Internet sites that can be helpful, go to www.yahoo.com, click on Health, then click on Mental Health, Addiction and Recovery, Substance Abuse, and finally Alcoholism. If you are a spouse or close friend of someone who suffers from this problem, also go to Health, Mental Health, Addiction and Recovery, and then Codependency.

Phone numbers for Alcoholics Anonymous, alcohol abuse hotlines and alcohol treatment centers are in your local telephone book.

Your library or bookstore will have books on this subject, most likely filed under Alcoholism, Substance Abuse, Recovery or Self-Help. Some recent titles include:

  • Alcohol: How to Give It Up and Be Glad You Did, by Philip Tate.  See Sharp Press, 1996
  • Addiction, Change and Choice: The New View of Alcoholism, by Vincent Fox.  See Sharp Press, 1993.
  • I'll Quit Tomorrow: A Practical Guide to Alcoholism Treatment, by Vernon E. Johnson. Harper San Francisco, 1990.
  • When AA Doesn't Work for You: Rational Steps to Quitting Alcohol, by Albert Ellis & Emmett Velten. Barricade Books, 1992.
  • Moderate Drinking: The Moderation Management Guide for People Who Want to Reduce Their Drinking, by Audrey Kishline. Crown Publications, 1996.
  • Addictive Thinking: Understanding Self-Deception, by Abraham J. Twerski. Hazelden/Rosen, 1997.

Related Topics:  Standards of Personal Conduct, Reporting Improper, Unreliable or Suspicious Behavior.

References
1. Parts of this topic are based on the automated Adjudicative Desk Reference (ADR), developed by Defense Security Service, Security Research Center..
2.
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), (Washington, DC: Author, 1995).
3.
National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert No. 9, "Children of Alcoholics: Are They Different?" July 1990. J. McCord, (1988). Identifying developmental paradigms leading to alcoholism. Journal of Studies of Alcohol, 49, 357-362. E. E. Werner (1986). Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal of Studies of Alcohol, 47, 34-40. N. El-Guebaly & D. R. Offord (1979). On being the offspring of an alcoholic: An update. Alcoholism (NY), 3, 148-157.
4.
This section is based on "A Manager's Guide to Recognizing and Dealing with Alcohol Abuse and Dependence in the Workplace," produced by the CIA Employee Assistance Program.
5.
This section is based on the Mayo Clinic Internet site, www.mayo.ivi.com and comments by Dr. Robert M. Morse, a Mayo Clinic psychiatrist who specializes in diagnosis and treatment of alcoholism.
6. National Institute on Alcohol Abuse and Alcoholism (1993). Eighth Special Report to the U.S. Congress on Alcohol and Health. Washington, DC: U.S. Department of Health and Human Services, Section III: Consequences of Alcoholism, Alcohol Use and Abuse.

7. J. Helzer & T. R. Pryzbeck (1988). The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. Journal of Studies of Alcohol, 49(3), 219-224. For a more detailed discussion of this subject, see National Institute on Alcohol Abuse and Alcoholism (1993). Eighth Special Report to the U.S. Congress on Alcohol and Health. Washington, DC: U.S. Department of Health and Human Services, Chapter 2: Psychiatric Comorbidity with Alcohol Use Disorders.
8. L. K. Trent (1995) Predictors of outcome one year after a Navy residential alcohol treatment program. (Report No. 95-42) San Diego, CA: Naval Health Research Center. Also C. Wright, D. M. Grodin & P. T. Harig (1990). Occupational outcome after military treatment for alcoholism. Journal of Occupational Medicine, 32(1), 24-32.
9. C. Wright, D. M. Grodin & P. T. Harig (1990). Occupational outcome after military treatment for alcoholism. Journal of Occupational Medicine, 32(1), 24-32.
10. J. A. Hermos, J. S. LoCastro, R. J. Glynn, G. R. Bouchard & L. O. DeLabry (1988). Predictors of reduction and cessation of drinking in community-dwelling men: Results from the normative aging study. Journal of Studies on Alcohol, 49, 363-368. K. Fillmore & L. Midanik (1984). Chronicity of drinking problems among men: A longitudinal study. Journal of Studies on Alcohol, 45(3). K. Fillmore (1987). Women's drinking across the adult life course as compared to men's. British Journal of Addiction, 82, 801-811.

 

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