The most common substance abuse is the misuse of alcohol and cigarettes which are both legal.  In addition, alcohol and drug abuse combined affect approximately twenty five million Americans.  Very often a distinction is made between substance abuse and substance dependence.   Substance abuse involves the inability to control the use of alcohol or other drugs.  The individual becomes intoxicated on a regular basis.  Usually daily, however, weekend or binge use is also common.   Often, the drug is often needed for normal functioning.  In addition there may be repeated attempts to stop using alcohol, which fail.  Even though the individual knows that the use of alcohol interferes with family life, social relationships, etc. he or she is unable to stop.  Alcohol dependence victims, on the other hand, suffer all of the symptoms of abuse plus an increasing tolerance for the alcohol.  As a result, increased amounts are necessary for the desired effect.  Continued alcohol use eventually leads to physical dependence as well and the individual will develop withdrawal symptoms when attempting to stop use of the drug.


Alcoholism is a progressive addiction that generally appears between the ages of twenty and forty, although children and teenagers can become alcoholics.  Alcohol dependence tends to cluster in families and current research indicates that tendencies toward alcohol addiction are inherited.  Alcohol dependence can be a sign of depression, however, depression typically is a consequence of the drinking rather than the cause.  On the average, it takes between five and fifteen years for an adult to develop alcoholism.  An adolescent, however, can become an alcoholic in as little as six months and in most cases alcoholism develops between six to eighteen months in an adolescent who is drinking heavily.  Generally, abuse of alcohol  occurs in one of three pattern:

  1. Regular daily intoxication.
  2. Use of large amounts of alcohol at specific times,  such as every weekend.
  3. Long periods of sobriety interspersed with binge drinking that last for several days, weeks, or even months.

As drinking continues dependency increases and the alcoholic begins to develop severe withdrawal symptoms, when he tries to stop drinking.  Long term heavy drinking can also cause dementia, and the individual may lose memory, thinking ability, and may experience trembling, delusion, hallucinations, and even be unable to recall the names of common objects.

Physical consequences of chronic alcohol dependence include: cirrhosis of the liver, hepatitis, altered brain cell functioning, nerve damage, gastritis, premature aging, impotence, and infertility.

Research indicates that hormonal imbalances caused by alcohol  dependence, actually trick the body into shutting off it’s normal  supply of natural pleasure causing chemicals (endorphins).  This leads to increased use in order to enhance the individual’s sense of  well-being and pleasure. This further complicates the physical consequence  of alcoholism since use of  alcohol  causes the individual to become more depressed.  Current research also indicates that chronic alcohol dependence increases the risk and severity of  heart disease, pneumonia, tuberculosis, and a variety of neurological disorders. Alcohol has long been suspected of having a biological  basis.  Sociological studies have shown that certain groups,  nationalities,  or races have a higher incidence of alcoholism.  For  example,  Native Americans have one of the highest incidences of  alcoholism.    Recent research has uncovered biological “markers” that could potentially  identify alcoholics. Alcoholism is recognized as a multifaceted disorder involving psychological, environmental, biological,  and cultural factors.   Treatment programs for alcoholism tend to vary in emphasis.  Most programs, however include a variety of programs involving abstinence and are designed to approach the illness from a variety of perspectives.  Psychotherapy, support groups  such as Alcoholics Anonymous, and in some cases the use of prescribed medications  such as Antabuse (disulfiram) which induces a violent physiological reaction when alcohol is consumed also help discourage drinking.


Recovery form alcohol addiction is possible; although, treatment usually tends to be long term.  The craving for the drug can be long lasting and difficult to overcome.  The first step in treatment is admission by the alcoholic that he or she has a problem.  This is often the biggest obstacle to treatment.  Denial is a very powerful force with alcoholics.  If denial persists, it may be necessary for the family to take serious steps to force a loved one into treatment.  Many professional therapists recommend a method called a family action intervention.  After several meetings with an experienced drug counselor, psychologist or, social worker, the family confronts the alcoholic.  Each member openly communicates how the users behavior has effected him or her personally.   This at times can become very emotional, and the alcoholic is forced to confront the effects of his or her alcohol abuse.  While family members are normally present, other participants in the intervention can include: friends, and co-workers.   During the actual confrontation, the alcoholic is made to choose between them, and their continued use of alcohol.  The intervention is intended to catch the alcoholic of guard, and to overcome the denial.   A crucial part of the program is presenting treatment alternatives that can be started immediately after the intervention meeting.  Very often, attempts are made to take the individual directly to the hospital from the meeting.

Usually, residential treatment is necessary.  The standard residential stay is 28 days.  Initially the individual goes through detoxification, which is the process of ridding the body of alcohol.  This can take several days, and should not be done outside of a hospital or treatment setting.  Very often antidepressant drugs are needed to relieve the depression and associated cravings, which accompany the withdrawal.  The goal of the treatment is to improve the alcoholic’s self-image, and to promote healthful, alcohol free living.  

Continued strength and support by family members is also crucial to a recovering individual.  It is also important for the alcoholic to continue outpatient treatment, and to become involved with a self help group on a regular basis, such as Alcoholics Anonymous, Narcotics Anonymous, or Cocaine Anonymous.   Professional support from these organizations is also available to family members, who very often themselves need therapy to help deal with the consequences of the addict’s behavior.  As a adjunct to post residential outpatient treatment, the drug Antabuse may also be used.  This drug causes the alcoholic to become severely ill, if he or she uses alcohol while taking it.  The administration needs to be monitored by a family member, however, since alcoholics who self administer the drug tend to voluntarily go off the drug and binge, while attempting to hide this from family members.  For more information, the National Institute on Drug Abuse can be contacted at 1-800-662-HELP.