{"id":196,"date":"2021-02-18T16:06:12","date_gmt":"2021-02-18T16:06:12","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/?post_type=chapter&p=196"},"modified":"2021-02-18T16:08:10","modified_gmt":"2021-02-18T16:08:10","slug":"alcoholism","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/chapter\/alcoholism\/","title":{"raw":"Alcoholism","rendered":"Alcoholism"},"content":{"raw":"Alcoholism<\/b>\u00a0is, broadly, any drinking of\u00a0alcohol<\/a>\u00a0that results in significant\u00a0mental<\/a>\u00a0or physical\u00a0health<\/a>\u00a0problems.[14]<\/a><\/sup>\u00a0Alcoholism is not a recognized diagnostic entity. Predominant diagnostic classifications are\u00a0alcohol use disorder<\/b>[2]<\/a><\/sup>\u00a0(DSM-5<\/a>)[4]<\/a><\/sup>\u00a0or\u00a0alcohol dependence<\/a>\u00a0(ICD-11<\/a>).[15]<\/a><\/sup>\r\n

Signs and symptoms<\/span><\/h2>\r\n
\r\n
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\"File:What<\/div>\r\n
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<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\nThe risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of\u00a0drinking larger amounts on an occasion<\/a>, to the point of intoxication, which is sometimes called \"binge drinking\".\r\n

Alcohol misuse<\/span><\/h2>\r\n
\r\n
\r\n\r\n[caption id=\"\" align=\"alignright\" width=\"350\"]\"\"<\/a> Effects of alcohol on the body[\/caption]\r\n\r\n
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<\/div>\r\nSome of the possible\u00a0long-term effects of ethanol<\/a>\u00a0an individual may develop. Additionally, in pregnant women, alcohol can cause\u00a0fetal alcohol syndrome<\/a>.\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\nAlcoholism is characterised by an increased\u00a0tolerance<\/a>\u00a0to alcohol\u00a0\u2013 which means that an individual can consume more alcohol\u00a0\u2013 and\u00a0physical dependence<\/a>\u00a0on 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 an alcoholic's ability to stop drinking.[29]<\/a><\/sup>\u00a0Alcoholism can have adverse effects on mental health, contributing to psychiatric disorders and increasing the risk of suicide. A\u00a0depressed mood<\/a>\u00a0is a common symptom of heavy alcohol drinkers.[30]<\/a><\/sup>[31]<\/a><\/sup>\r\n
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watch<\/h3>\r\n[embed]https:\/\/youtu.be\/mfMBCBLVCvY[\/embed]\r\n\r\n<\/div>\r\n \r\n

Warning signs<\/span><\/h3>\r\nWarning 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.[32]<\/a><\/sup>\r\n

Physical<\/span><\/h4>\r\n
Short-term effects<\/span><\/h5>\r\n
Main article:\u00a0Short-term effects of alcohol consumption<\/a><\/div>\r\nDrinking enough to cause a\u00a0blood alcohol concentration<\/a>\u00a0(BAC) of 0.03\u20130.12% typically causes an overall improvement in mood and possible\u00a0euphoria<\/a>\u00a0(a \"happy\" feeling), increased self-confidence and sociability, decreased anxiety, a\u00a0flushed, red appearance in the face<\/a>\u00a0and impaired judgment and fine muscle coordination. A BAC of 0.09% to 0.25% causes\u00a0lethargy<\/a>,\u00a0sedation<\/a>, 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\u00a0stupor<\/a>, unconsciousness,\u00a0anterograde amnesia<\/a>, vomiting (death may occur due to\u00a0inhalation of vomit<\/a>\u00a0while unconscious) and\u00a0respiratory depression<\/a>\u00a0(potentially life-threatening). A BAC from 0.35% to 0.80% causes a\u00a0coma<\/a>\u00a0(unconsciousness), life-threatening respiratory depression and possibly fatal\u00a0alcohol poisoning<\/a>. With all alcoholic beverages,\u00a0drinking while driving<\/a>, operating an aircraft or heavy machinery increases the risk of an accident; many countries have penalties for drunk driving.\r\n
Long-term effects<\/span><\/h5>\r\n
See also:\u00a0Long-term effects of alcohol consumption<\/a><\/div>\r\nHaving more than one drink a day for women or two drinks for men increases the risk of heart disease,\u00a0high blood pressure<\/a>,\u00a0atrial fibrillation<\/a>, and\u00a0stroke<\/a>.[33]<\/a><\/sup>\u00a0Risk is greater with\u00a0binge drinking<\/a>, which may also result in violence or accidents. About 3.3\u00a0million deaths (5.9% of all deaths) are believed to be due to alcohol each year.[13]<\/a><\/sup>\u00a0Alcoholism reduces a person's life expectancy by around ten years[26]<\/a><\/sup>\u00a0and alcohol use is the third leading cause of early death in the United States.[33]<\/a><\/sup>\u00a0No professional medical association recommends that people who are nondrinkers should start drinking.[33]<\/a><\/sup>[34]<\/a><\/sup>\u00a0Long-term alcohol misuse can cause a number of physical symptoms, including\u00a0cirrhosis<\/a>\u00a0of the liver,\u00a0pancreatitis<\/a>,\u00a0epilepsy<\/a>,\u00a0polyneuropathy<\/a>,\u00a0alcoholic dementia<\/a>, heart disease, nutritional deficiencies,\u00a0peptic ulcers<\/a>[35]<\/a><\/sup>\u00a0and\u00a0sexual dysfunction<\/a>, and can eventually be fatal. Other physical effects include an increased risk of developing\u00a0cardiovascular disease<\/a>,\u00a0malabsorption<\/a>,\u00a0alcoholic liver disease<\/a>, and several\u00a0cancers<\/a>. Damage to the\u00a0central nervous system<\/a>\u00a0and\u00a0peripheral nervous system<\/a>\u00a0can occur from sustained alcohol consumption.[36]<\/a><\/sup>[37]<\/a><\/sup>\u00a0A 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 a propensity to bone fractures.[38]<\/a><\/sup>\r\n\r\nWomen develop long-term complications of alcohol dependence more rapidly than do men. Additionally, women have a higher mortality rate from alcoholism than men.[39]<\/a><\/sup>\u00a0Examples of long-term complications include brain, heart, and liver damage[40]<\/a><\/sup>\u00a0and an\u00a0increased risk of breast cancer<\/a>. 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\u00a0anovulation<\/a>, decreased ovarian mass, problems or irregularity of the\u00a0menstrual cycle<\/a>, and early\u00a0menopause<\/a>.[39]<\/a><\/sup>\u00a0Alcoholic\u00a0ketoacidosis<\/a>\u00a0can occur in individuals who chronically misuse alcohol and have a recent history of\u00a0binge drinking<\/a>.[41]<\/a><\/sup>[42]<\/a><\/sup>\u00a0The 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\u00a0blood alcohol concentrations<\/a>\u00a0(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.[43]<\/a><\/sup>\r\n

Psychiatric<\/span><\/h4>\r\nLong-term misuse of alcohol can cause a wide range of\u00a0mental health<\/a>\u00a0problems. Severe\u00a0cognitive<\/a>\u00a0problems are common; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of\u00a0dementia<\/a>.[44]<\/a><\/sup>\u00a0Excessive alcohol use causes\u00a0damage to brain function<\/a>, and psychological health can be increasingly affected over time.[45]<\/a><\/sup>\u00a0Social skills<\/a>\u00a0are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the\u00a0prefrontal cortex<\/a>\u00a0area of the brain. The social skills that are impaired by alcohol use disorder include impairments in perceiving facial emotions,\u00a0prosody<\/a>, perception problems, and\u00a0theory of mind<\/a>\u00a0deficits; the ability to understand humor is also impaired in people who misuse alcohol.[46]<\/a><\/sup>\u00a0Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe psychiatric disturbances. The most prevalent psychiatric symptoms are\u00a0anxiety<\/a>\u00a0and\u00a0depression<\/a>\u00a0disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence.[47]<\/a><\/sup>\u00a0Psychosis<\/a>,\u00a0confusion<\/a>, and\u00a0organic brain syndrome<\/a>\u00a0may be caused by alcohol misuse, which can lead to a misdiagnosis such as\u00a0schizophrenia<\/a>.[48]<\/a><\/sup>\u00a0Panic disorder<\/a>\u00a0can develop or worsen as a direct result of long-term alcohol misuse.[49]<\/a><\/sup>[50]<\/a><\/sup>\r\n\r\nThe co-occurrence of\u00a0major depressive disorder<\/a>\u00a0and alcoholism is well documented.[51]<\/a><\/sup>[52]<\/a><\/sup>[53]<\/a><\/sup>\u00a0Among those with\u00a0comorbid<\/a>\u00a0occurrences, 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).[54]<\/a><\/sup>[55]<\/a><\/sup>[56]<\/a><\/sup>\u00a0Additional use of other drugs may increase the risk of depression.[57]<\/a><\/sup>\u00a0Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as\u00a0major depression<\/a>,\u00a0anxiety<\/a>,\u00a0panic disorder<\/a>,\u00a0bulimia<\/a>,\u00a0post-traumatic stress disorder<\/a>\u00a0(PTSD), or\u00a0borderline personality disorder<\/a>. Men with alcohol-use disorders more often have a co-occurring diagnosis of\u00a0narcissistic<\/a>\u00a0or\u00a0antisocial personality disorder<\/a>,\u00a0bipolar disorder<\/a>,\u00a0schizophrenia<\/a>,\u00a0impulse disorders<\/a>\u00a0or\u00a0attention deficit\/hyperactivity disorder<\/a>\u00a0(ADHD).[58]<\/a><\/sup>\u00a0Women with alcohol use disorder are more likely to experience physical or\u00a0sexual assault<\/a>, abuse, and\u00a0domestic violence<\/a>\u00a0than women in the general population,[58]<\/a><\/sup>\u00a0which can lead to higher instances of psychiatric disorders and greater dependence on alcohol.\r\n

Social effects<\/span><\/h4>\r\n
See also:\u00a0Drug-related crime<\/a><\/div>\r\nSerious social problems arise from alcohol use disorder; these dilemmas are caused by the pathological changes in the brain and the intoxicating effects of alcohol.[44]<\/a><\/sup>[59]<\/a><\/sup>\u00a0Alcohol misuse is associated with an increased risk of committing criminal offences, including\u00a0child abuse<\/a>,\u00a0domestic violence<\/a>,\u00a0rape<\/a>,\u00a0burglary<\/a>\u00a0and\u00a0assault<\/a>.[60]<\/a><\/sup>\u00a0Alcoholism is associated with\u00a0loss of employment<\/a>,[61]<\/a><\/sup>\u00a0which 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\u00a0drunk driving<\/a>[62]<\/a><\/sup>\u00a0or public disorder, or civil penalties for\u00a0tortious<\/a>\u00a0behavior. 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\u00a0marital conflict<\/a>\u00a0and\u00a0divorce<\/a>, or contribute to\u00a0domestic violence<\/a>. Alcoholism can also lead to\u00a0child neglect<\/a>, with subsequent lasting damage to the emotional development of the alcoholic's children.[63]<\/a><\/sup>\u00a0For this reason, children of alcoholic parents can develop a number of emotional problems. For example, they can become afraid of their parents, because of their unstable mood behaviors. In addition, they can develop considerable amount of shame over their inadequacy to liberate their parents from alcoholism. As a result of this failure, they develop wretched self-images, which can lead to depression.[64]<\/a><\/sup>\r\n

Alcohol withdrawal<\/span><\/h3>\r\n
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As with similar substances with a sedative-hypnotic mechanism, such as\u00a0<\/span>barbiturates<\/a>\u00a0and\u00a0<\/span>benzodiazepines<\/a>, withdrawal from alcohol dependence can be fatal if it is not properly managed.<\/span>[59]<\/a><\/sup>[65]<\/a><\/sup>\u00a0Alcohol's primary effect is the increase in stimulation of the\u00a0<\/span>GABAA<\/sub>\u00a0receptor<\/a>, promoting\u00a0<\/span>central nervous system<\/a>\u00a0depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in\u00a0<\/span>tolerance<\/a>\u00a0and\u00a0<\/span>physical dependence<\/a>. When alcohol consumption is stopped too abruptly, the person's nervous system suffers from uncontrolled\u00a0<\/span>synapse<\/a>\u00a0firing. This can result in symptoms that include\u00a0<\/span>anxiety<\/a>, life-threatening\u00a0<\/span>seizures<\/a>,\u00a0<\/span>delirium tremens<\/a>, hallucinations, shakes and possible\u00a0<\/span>heart failure<\/a>.<\/span>[66]<\/a><\/sup>[67]<\/a><\/sup>\u00a0Other neurotransmitter systems are also involved, especially\u00a0<\/span>dopamine<\/a>,\u00a0<\/span>NMDA<\/a>\u00a0and\u00a0<\/span>glutamate<\/a>.<\/span>[29]<\/a><\/sup>[68]<\/a><\/sup><\/div>\r\n<\/div>\r\n<\/div>\r\nSevere acute withdrawal symptoms such as\u00a0delirium tremens<\/a>\u00a0and 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\u20136 weeks following cessation, anxiety, depression, fatigue, and sleep disturbance are common.[69]<\/a><\/sup>\u00a0Similar post-acute withdrawal symptoms have also been observed in animal models of alcohol dependence and withdrawal.[70]<\/a><\/sup>\r\n\r\nA\u00a0kindling effect<\/a>\u00a0also occurs in alcoholics 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\u00a0gene expression<\/a>.[71]<\/a><\/sup>\u00a0Kindling also results in the intensification of psychological symptoms of alcohol withdrawal.[69]<\/a><\/sup>\u00a0There 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.[72]<\/a><\/sup>\r\n

Causes<\/span><\/h2>\r\n
\r\n
\r\n\r\n\"\"<\/a>\r\n
\r\n
A complex combination of genetic and environmental factors influences the risk of the development of alcoholism. Drinking excessive alcohol during childhood or adolescence, is a risk factor, or to have low autoestime, thus to be someone with antisocial, addictive or wrathful behaviour, so as also minimize or naturalize so much alcohol misuse,\u00a0<\/span>alcohol dependence<\/a>\u00a0and the\u00a0<\/span>long-term effects of alcohol<\/a>\u00a0or also the\u00a0<\/span>short-term effects of alcohol consumption<\/a>\u00a0in the human body, is very known that some people depending of their life perspective or outlook can have more or less probabilities of to have drinking problems\u00a0<\/span>[73]<\/a><\/sup>\u00a0Genes that influence the metabolism of alcohol also influence the risk of alcoholism, as can a family history of alcoholism.<\/span>[74]<\/a><\/sup>\u00a0There is compelling evidence that alcohol use at an early age may influence the\u00a0<\/span>expression of genes<\/a>\u00a0which increase the risk of alcohol dependence. These genetic and\u00a0<\/span>epigenetic<\/a>\u00a0results 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.<\/span>[75]<\/a><\/sup>[76]<\/a><\/sup><\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\nSevere childhood trauma<\/a>\u00a0is also associated with a general increase in the risk of drug dependency.[73]<\/a><\/sup>\u00a0Lack of peer and family support is associated with an increased risk of alcoholism developing.[73]<\/a><\/sup>\u00a0Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol use.\u00a0Cortical<\/a>\u00a0degeneration 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.[77]<\/a><\/sup>\u00a0The use of cannabis was associated with later problems with alcohol use.[78]<\/a><\/sup>\u00a0Alcohol use was associated with an increased probability of later use of tobacco and illegal drugs such as cannabis.[79]<\/a><\/sup>\r\n

Screening<\/span><\/h3>\r\nScreening is recommended among those over the age of 18.[111]<\/a><\/sup>\u00a0Several tools may be used to detect a loss of control of alcohol use. These tools are mostly\u00a0self-reports<\/a>\u00a0in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.[112]<\/a><\/sup>\r\n
\r\n\r\nThe\u00a0CAGE questionnaire<\/a>, named for its four questions, is one such example that may be used to screen patients quickly in a doctor's office.\r\n
Two \"yes\" responses indicate that the respondent should be investigated further.\r\n\r\nThe questionnaire asks the following questions:\r\n
    \r\n \t
  1. Have you ever felt you needed to\u00a0C<\/b>ut down on your drinking?<\/li>\r\n \t
  2. Have people\u00a0A<\/b>nnoyed you by criticizing your drinking?<\/li>\r\n \t
  3. Have you ever felt\u00a0G<\/b>uilty about drinking?<\/li>\r\n \t
  4. Have you ever felt you needed a drink first thing in the morning (E<\/b>ye-opener) to steady your nerves or to get rid of a hangover?<\/sup><\/li>\r\n<\/ol>\r\n<\/blockquote>\r\n
    \r\n \t
    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.<\/sup><\/dd>\r\n<\/dl>\r\n<\/div>\r\n
    <\/dl>\r\nOther tests are sometimes used for the detection of alcohol dependence, such as the\u00a0Alcohol Dependence Data Questionnaire<\/a>, which is a more sensitive diagnostic test than the\u00a0CAGE questionnaire<\/a>. It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.[116]<\/a><\/sup>\u00a0The\u00a0Michigan Alcohol Screening Test<\/a>\u00a0(MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,[117]<\/a><\/sup>\u00a0driving under the influence<\/a>\u00a0being the most common. The\u00a0Alcohol Use Disorders Identification Test<\/a>\u00a0(AUDIT), a screening questionnaire developed by the\u00a0World Health Organization<\/a>, 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 \u2013 a high score earning a deeper investigation.[118]<\/a><\/sup>\u00a0The\u00a0Paddington Alcohol Test<\/a>\u00a0(PAT) was designed to screen for alcohol-related problems amongst those attending\u00a0Accident and Emergency departments<\/a>. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.[119]<\/a><\/sup>\r\n

    Management<\/span><\/h2>\r\nTreatments 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\u00a0zero tolerance<\/a>\u00a0approach; however, some prefer a\u00a0harm-reduction<\/a>\u00a0approach.[125]<\/a><\/sup>\r\n

    Detoxification<\/span><\/h3>\r\n
    Main article:\u00a0Alcohol detoxification<\/a><\/div>\r\nAlcohol detoxification<\/a>\u00a0or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs, such as\u00a0benzodiazepines<\/a>, that have similar effects to prevent\u00a0alcohol withdrawal<\/a>. Individuals who are only at risk of mild to moderate withdrawal symptoms can be detoxified as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions are generally treated as inpatients. Detoxification does not actually treat alcoholism, and it is necessary to follow up detoxification with an appropriate treatment program for alcohol dependence or alcohol use disorder to reduce the risk of relapse.[9]<\/a><\/sup>\u00a0Some symptoms of alcohol withdrawal such as depressed mood and anxiety typically take weeks or months to abate while other symptoms persist longer due to persisting neuroadaptations.[69]<\/a><\/sup>\u00a0Alcoholism has serious adverse effects on brain function; on average it takes one year of abstinence to recover from the cognitive deficits incurred by chronic alcohol misuse.[126]<\/a><\/sup>\r\n

    Psychological<\/span><\/h3>\r\n
    \r\n
    \r\n\r\n[caption id=\"\" align=\"alignleft\" width=\"220\"]\"\"<\/a> A regional service center for\u00a0Alcoholics Anonymous.[\/caption]\r\n\r\n
    \r\n
    Various forms of\u00a0<\/span>group therapy<\/a>\u00a0or\u00a0<\/span>psychotherapy<\/a>\u00a0can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills. The mutual-help group-counseling approach is one of the most common ways of helping alcoholics maintain sobriety.<\/span>[8]<\/a><\/sup>\u00a0<\/span>Alcoholics Anonymous<\/a>\u00a0was one of the first organizations formed to provide mutual, nonprofessional counseling, and it is still the largest. Others include\u00a0<\/span>LifeRing Secular Recovery<\/a>,\u00a0<\/span>SMART Recovery<\/a>,\u00a0<\/span>Women for Sobriety<\/a>, and\u00a0<\/span>Secular Organizations for Sobriety<\/a>.<\/span>[127]<\/a><\/sup>\u00a0Alcoholics Anonymous and\u00a0<\/span>twelve-step programs<\/a>\u00a0appear more effective than cognitive behavioral therapy or abstinence.<\/span>[128]<\/a><\/sup><\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n

    <\/h3>\r\n

    Moderate drinking<\/span><\/h3>\r\nRationing and moderation programs such as\u00a0Moderation Management<\/a>\u00a0and DrinkWise do not mandate complete abstinence. While most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 US study by the\u00a0National Institute on Alcohol Abuse and Alcoholism<\/a>\u00a0(NIAAA) showed that 17.7 percent 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.[129]<\/a><\/sup>\r\n\r\nA follow-up study, using the same subjects that were judged to be in remission in 2001\u20132002, examined the rates of return to problem drinking in 2004\u20132005. The study found abstinence from alcohol was the most stable form of remission for recovering alcoholics.[130]<\/a><\/sup>\u00a0There was also a 1973 study showing chronic alcoholics drinking moderately again,[131]<\/a><\/sup>\u00a0but a 1982 follow-up showed that 95% of subjects were not able to moderately drink over the long term.[132]<\/a><\/sup>[133]<\/a><\/sup>\u00a0Another 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.\"[134]<\/a><\/sup>\u00a0Internet based measures appear to be useful at least in the short term.[135]<\/a><\/sup>\r\n

    Medications<\/span><\/h3>\r\n

    Disulfiram-like drug<\/a><\/span><\/h2>\r\nIn the United States there are four approved medications for alcoholism: acamprosate, two methods of using naltrexone and disulfiram.[136]<\/a><\/sup>\r\n