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Alcoholism

Synopsis: Katherine E. Nelson, N.D. David Edward Newton, Ed.D. Laurie Fundukian

Source Citation: "Alcoholism." Katherine E. Nelson, N.D. and David Edward Newton, Ed.D. The Gale Encyclopedia of Alternative Medicine. Ed. Laurie Fundukian. 3rd ed. Detroit: Gale, 2009. 4 vols.

Table of Contents

Definition | Description | Causes And Symptoms | Diagnosis | Treatment | Allopathic Treatment | Expected Results | Prevention | Key Terms | For More Information

Definition

Alcoholism is the layman's term for alcohol dependence and alcohol abuse. According to the Diagnostic and Statistical Manual of Mental Disorders , published by the American Psychiatric Association and commonly called DSM-IV, the essential feature of substance abuse (in this instance, alcohol abuse) is maladaptive use of the substance with recurrent and significant adverse consequences related to its repeated use. Dependence is a physical addiction with psychological, social, and genetic components. Despite damage to health, finances, reputations, and relationships, the alcohol dependent person continues to drink unless successful intervention occurs. Abuse is distinguished from dependence by the individual's retaining some control over the use of alcohol. Nevertheless both conditions result in many of the same consequences over time, and abuse increases risk of dependence.

In the 2000s, alcohol abuse and alcohol dependence are often associated with abuse of, or dependence on, other substances, including nicotine, marijuana, cocaine, heroin, amphetamines, sedatives, and anxiolytics (anti-anxiety drugs). Alcoholism is more common in males than in females, with an estimated male-to-female ratio as high as five-to-one. A U.S. study conducted between 1990 and 1991, using DSM standards, found that 14% of the adult population (ages 15-54) had, at some time, met the criteria for alcohol dependence; and 7% had been alcohol-dependent in the past year. An earlier, similar study showed that about 5% of Americans qualified for a diagnosis of alcohol abuse at some point during their life. In 2006, the Substance Abuse and Mental Health Services Administration reported that 18.2 million Americans over the age of 12 met the criteria for alcohol abuse or dependence in the preceding year. Although it is difficult to develop accurate statistics worldwide, experts know that the incidence of what is called alcoholism has been steadily rising around the globe for several years.

Description

The effects of alcoholism are quite far-reaching. Alcoholism affects every body system, causing a wide range of drinking-related health problems, including lower testosterone, shrinking gonads, erectile dysfunction, interference with reproductive fertility, weak bones, memory disorders, difficulty with balance and walking, liver disease (including cirrhosis and hepatitis), high blood pressure, weakness of muscles (including the heart), disturbances of heart rhythm, anemia, clotting disorders, weak immunity to infections, inflammation and irritation of the entire gastrointestinal system, acute and chronic problems with the pancreas, low blood sugar, high blood fat content, and poor nutrition.

The mental health implications of alcoholism include marital and other relationship difficulties, depression, unemployment, poor performance at school or work, spouse and child abuse, and general family dysfunction. Alcoholism causes or contributes to a variety of severe social problems, such as homelessness, murder, suicide, injury, and violent crime. Alcohol is a contributing factor in half of all deaths from motor vehicle accidents. In fact, 50% of the 100,000 deaths that occur each year due to the effects of alcohol are due to injuries of some sort. By some estimates, alcohol-related problems cost the United States over [dollar]150 billion yearly in lost productivity and alcohol-related medical expense.

Causes and symptoms

A physical dependence on alcohol develops insidiously, over time. The body is a magnificent adaptor; therefore, with persistent use, many adaptations occur physically and psychologically, resulting in both a higher tolerance to and increased need for alcohol. The physical adaptation to alcohol involves changing levels and altered balances of neurotransmitters, chemicals in the brain which not only affect physical abilities such as muscle coordination, but also an individual's mood. The abuse of alcohol is associated with a desire to feel better and to avoid feeling poorly. Initially a stimulant, it eventually acts as a central nervous system (CNS) depressant and is used in a majority of societies or cultures in the world as an accepted part of dealing with life events, except where religious opposition bans, discourages, or prohibits its use, as in most Muslim communities. It is included in celebrations and, ironically, its use is perceived as an appropriate response to sadness and loss, such as at wakes.

No single known factor causes some people to be alcohol-dependent and others not. Some genetic studies have demonstrated that close biological relatives of an alcoholic are four times as likely to become alcoholics themselves. Furthermore, this risk holds true even for children who were adopted away from their biological families at birth and raised in non-alcoholic homes, without knowledge of their biological family's difficulties with alcohol. Factors that increase the risk of experiencing problems with alcohol include: being male; being the child of an alcoholic parent or parents; having an extended family history and being of Irish (Celtic), Scandinavian, German, Polish, Russian, or Native American ancestry; beginning drinking as a teenager; and being depressed or highly anxious. Further research may determine if genetic factors are accountable, in part, for differences in alcohol metabolism and increase the risk of an individual's becoming an alcoholic. Other factors contributing to the development of alcoholism include high levels of stress and turmoil or pain, and having drinking friends, drinking partners, and enablers--people who facilitate a drinker's habits and denial mechanisms. Ample advertising that makes drinking appear to be sexy or the basis of a good time also contributes. For example, numerous televised sporting events are sponsored heavily by alcohol-related companies.

One of the classic symptoms of alcoholism is denial of a problem with alcohol. An addicted person, under the influence of the addictive substance, is physically and psychologically motivated to perpetuate the addiction. Therefore, intervention often starts when loved ones, recognizing the signs and symptoms, bring attention to the problem and call for help. Occasionally, an intervention requires a whole family unit and outside assistance.

Signs and symptoms of alcohol dependence and abuse may include the following:

• not remembering conversations or commitments
• losing interest in activities that were once pleasurable
• ritualized drinking, before, with, and after dinner and being upset if the pattern is interrupted
• becoming irritable as the so-called happy hour approaches, especially if alcohol is not available
• drinking alone or secretly
• hiding alcohol in unusual places
• ordering doubles, drinking quickly, and drinking to intentionally become drunk
• focusing attention on the source of one's next drink
• unstable relationships, financial, legal, and employment difficulties

Physical symptoms of alcoholism can be divided into two major categories: symptoms of acute alcohol use and symptoms of long-term alcohol use.

Immediate (acute) effects of alcohol use

Although the initial reaction to alcohol may be stimulatory, ultimately alcohol exerts a depressive, uninhibiting effect on the brain. The blood-brain barrier does not prevent alcohol from entering the brain, so the brain alcohol level quickly becomes equivalent to the blood alcohol level. Alcohol's depressive effects result in impaired thinking, feeling, and judgment; short term memory loss; muscle weakness; difficulty in walking; poor balance; slurred speech; and generally poor coordination (accounting for the increased likelihood of injury and alcohol-related injury statistics). At higher alcohol levels, a person's breathing and heart rate slows. Vomiting may occur, with a high risk of vomitus aspiration (inhaling vomit into the lungs), and may result in further complications, including pneumonia. Still higher alcohol levels may result in coma and death.

Effects of long-term (chronic) alcoholism

Alcohol is considered a lethal poison, requiring continuous detoxification by the liver. As drinking continues and alcohol overwhelms the liver's ability to detoxify, long-term consequences to health occur, affecting virtually every organ system of the body.

Nervous system

Experts estimate that 30-40% of all men in their teens and twenties have experienced alcoholic blackout (loss of consciousness) as a result of drinking a large quantity of alcohol. In an alcoholic blackout, all memory of time and behavior surrounding the episode of drinking is lost. Alcohol causes sleep disturbances, thus affecting overall sleep quality. Numbness and tingling may occur in the arms and legs. Two conditions that may occur either together or separately are Wernicke's and Korsakoff's syndromes. Both are due to the depleted thiamine levels found in alcoholics. Wernicke's syndrome results in disordered eye movements, very poor balance, and difficulty walking, whereas Korsakoff's syndrome severely affects one's memory, preventing new learning from taking place.

Gastrointestinal system

Alcohol causes a loosening of the muscular ring (the cardiac sphincter) that prevents the stomach's contents from reentering the esophagus. As a result, acid from the stomach flows upward into the esophagus, burning those tissues and causing pain and bleeding, or gastro-esophageal reflux disease (GERD). Inflammation of the stomach can also result in bleeding and pain as well as a decreased desire to eat. A major cause of severe, uncontrollable bleeding (hemorrhage) in an alcoholic is the development in the esophagus of enlarged (dilated) blood vessels, which are called esophageal varices (varicose veins of the esophagus). These varices actually develop in response to the toxic effect of alcohol on the liver and are extremely prone to bursting and hemorrhage.

A malnourished state arises from the loss of appetite for food--due to caloric substitution of alcohol and its effects on blood sugar levels--and interference with the absorption of nutrients throughout the intestinal tract. Inflammation of the pancreas (pancreatitis) is a serious and painful problem in alcoholics that disrupts carbohydrate and fat digestion and increases the risk of insulin resistance, weight gain, hyperlipidemia, diabetes, and pancreatic cancer. Diarrhea is also a common symptom of chronic alcohol use, due to alcohol's effect on the pancreas.

Liver

Because alcohol is broken down (metabolized) within the liver, that organ is severely affected by constant levels of alcohol. Alcohol interferes with the large number of important chemical processes that occur in the liver. As alcohol converts to blood sugar, which in turn converts to blood fat, the liver begins to enlarge, filling with fat, a condition called fatty liver. Cirrhosis, a potentially deadly complication, develops when fibrous tissue, while trying to support the extra burden placed on the liver by the accumulation of fat and liver cell weakness, interferes with the liver's normal structure and function. The liver may also become inflamed, a condition called hepatitis, producing jaundice, fatigue, and elevated liver enzymes indicative of liver cell death and destruction. Because of the liver's important role in digestion, metabolism, and immunity, damage to the liver takes a serious toll throughout the body.

Blood

Alcohol can cause changes to any of the types of blood cells. Red blood cells become abnormally large. White blood cells (important for fighting infections) decrease in number, resulting in a weakened immune system. This condition places alcoholics at increased risk for infections and is thought to account in part for an alcoholic's increased risk of cancer (ten times greater than normal). Platelets and blood clotting factors are affected, causing an increased risk of bleeding and hemorrhage, especially when coupled with vascular weaknesses, varices, or aneurism.

Heart and circulatory system

Small amounts of alcohol cause a drop in blood pressure, but increased use begins to raise blood pressure dangerously. Increased blood pressure negatively affects the kidneys. While some studies demonstrate that one to two alcoholic drinks per night improves heart disease risk values, higher amounts and chronic intake produce high levels of circulating fats, which increases the risk of heart disease. Heavy drinking results in an enlarged heart, coronary arterial disease (CAD), peripheral vascular disease, weakening of the heart muscle, abnormal heart rhythms, a risk of blood clots forming within the chambers of the heart, and a greatly increased risk of stroke. Strokes result when a blood clot from the heart enters the circulatory system, goes to the brain, and blocks a blood vessel. Stroke may also result from a hemorrhage within the brain, as weakened vessel walls give way and platelet deficient blood pours through.

Reproductive system

Heavy drinking has a negative effect on fertility in both men and women, decreasing testicular and ovarian size, interfering with sperm and egg production and viability, disrupting menstrual cycles, and reducing libido. When pregnancy is achieved reduced quality of sperm and egg may significantly and permanently affect the quality of life, pre-, peri-, and postnatally, of the child. A child born to a woman who abuses alcohol is at risk of being born with fetal alcohol syndrome, which causes distinctive cranial and facial defects, including a smaller head size, shortening of the eyelids, and a lowered IQ. Developmental disabilities, heart defects, and behavioral problems are also more likely.

Diagnosis

The DSM-IV divides substance abuse into specific criteria that can be of aid in diagnosing a substance abuse problem. These criteria are paraphrased here to relate to alcoholism. At least one of the following must have manifested itself within a 12-month period to qualify for a diagnosis of alcohol abuse:

• Recurrent alcohol use that results in failure to fulfill major role obligations at work, school, or home. Specific examples are repeated absences from work or poor work performance related to alcohol use; alcohol-related absences, suspensions, or expulsions from school; and neglect of children or household.
• Recurrent alcohol use in situations in which it is physically hazardous. Specific examples are driving an automobile and operating a machine while impaired by alcohol use.
• Recurrent alcohol-related legal problems, such as arrests for alcohol-related disorderly conduct.
• Continued alcohol use despite having persistent and recurring social or interpersonal problems caused or exacerbated by the effects of the alcohol. Examples include arguments with a spouse about the consequences of intoxication and alcohol-related physical fights.

A diagnosis of alcohol dependence requires habitual, long-term tolerance for and heavy consumption of alcohol as well as the development of symptoms of withdrawal when the amount of alcohol in the system is substantially lowered or completely stopped. Once a pattern of compulsive alcohol use has developed, alcohol-dependent people may devote large portions of their time to the procurement and drinking of alcohol.

A significant number of illnesses categorized in DSM-IV as alcohol-induced disorders has come into being as a result of alcohol abuse and dependence, illustrating the negative impacts of alcoholism on physical and mental health. Among the psychiatric diagnoses that are included in alcohol-induced disorders are:

• dementia
• amnestic disorder
• psychotic disorder
• mood disorder
• anxiety disorder
• sexual dysfunction
• sleep disorder

As previously mentioned, due to the strong element of denial and a need, usually, for intervention, diagnosis is often brought about because family members call an alcoholic's difficulties to the attention of a physician. A physician may become suspicious when a patient suffers repeated injuries or begins to experience medical problems that are related to the use of alcohol. In fact, some estimates suggest that about 20% of a physician's patients are alcoholics, a percentage which is higher than the general population and lower than the increased risk to health posed by alcoholism. In other words, alcohol-related illness may prompt alcoholics to see medical counsel, but their illness may not be recognized as alcohol-related until the disease toll is quite advanced.

Questionnaires that try to determine what aspects of a person's life may be affected by use of alcohol can be an effective diagnostic aid. Determining the exact quantity of alcohol that individuals drink is much less important than determining how their drinking affects health, relationships, jobs, educational goals, and family life. In fact, because the metabolism of alcohol (how the body breaks down and processes alcohol) is so individual, the quantity of alcohol consumed is not part of the criteria list for diagnosing either alcohol dependence or alcohol abuse.

One very simple tool for beginning the diagnosis of alcoholism is called the CAGE questionnaire. It consists of four questions, with the first letter of each key word spelling out the word CAGE:

• Have you ever tried to Cut down on your drinking?
• Have you ever been Annoyed by anyone's comments about your drinking?
• Have you ever felt Guilty about your drinking?
• Do you ever need an Eye-opener (a morning drink of alcohol) to start the day?

Other, longer lists of questions may help determine the severity and effects of a person's alcohol use. A thorough physical examination may reveal the physical signs suggestive of alcoholism, such as an enlarged liver, a visible network of enlarged veins just under the skin around the navel (called caput medusae or herniated umbilicus), fluid in the abdomen (ascites), yellowish tone to the skin (jaundice), decreased testicular size or gynecomastia (breast enlargement in men), osteoporosis, physical deterioration, loss of teeth, evidence of old injuries, and poor nutritional status. Diagnostic testing may include cardiovascular, CNS, GI, general chemistry, and liver function tests (LFTs) that reveal poor stress test performance, arterial disease, congestive heart failure, palsy, loss of coordination, reflux disease or history of stomach ulcer, irritable bowel syndrome, an increased red blood cell size and anemia, abnormal white blood cells (cells responsible for fighting infection) counts or characteristics, abnormal platelets (particles responsible for clotting), and increased liver enzymes. Given the genetic risk factors for alcoholism, determinations of familiar alcoholism related illness and death may be additive.

Treatment

Alternative treatments can be a helpful adjunct for the alcoholic patient once the medical danger of withdrawal has passed. Because many alcoholics have very stressful lives (because of, or leading to, the alcoholism), many of the treatments for alcoholism involve dealing with and relieving stress. These include massage, meditation, and hypnotherapy. A list from the Mayo Clinic also includes acupuncture (may reduce craving, anxiety, depression, tremor, fatigue, and the symptoms of withdrawal), biofeedback (monitoring of internal systems for stress reduction), behavioral therapy motivational enhancement therapy (problem acknowledgment), and aversion therapy (may involve simultaneous use of medications the cause nausea or vomiting with relapse).

Nutritionally oriented practitioners may be consulted to address the malnutrition associated with long-term alcohol use. Careful and remedial attention toward a healthier diet and lifestyle, including use of nutritional supplements, such as vitamins A, B complex, and C; certain fatty acids; amino acids; zinc; magnesium; and selenium--supplements that support antioxidant, detoxifying, restorative and corrective deficiencies--may further enhance recovery and lessen the likelihood of relapse.

Herbal treatments include milk thistle ( Silybum marianum ), which is thought to protect the liver against damage. Other herbs are thought to be helpful for the patient suffering through withdrawal. Some of these include the antidepressive attributes of lavender (Lavandula officinalis ), the calming and restorative nerve tonifying effects of skullcap (Scutellaria lateriflora ), chamomile (Matricaria recutita ), and valerian (Valeriana officinalis ), the stimulating and GI helpful effects of peppermint (Mentha piperita ), and the bladder aid, yarrow (Achillea millefolium ).

Allopathic treatment

Allopathic treatment of alcoholism has two parts. The first phase is the treatment of acute effects of alcoholism, called detoxification. The second phase involves learning how to live with the disease of alcoholism.

Withdrawal

Detoxification, or withdrawal, involves helping individuals to rid their bodies of alcohol as well as the harmful physical effects of the alcohol. Because their bodies have become accustomed to alcohol, individuals need care and monitoring during withdrawal. Withdrawal is an individual experience, depending on the severity of the alcoholism as measured by the quantity of alcohol ingested daily and the length of time individuals have been drinking (the adaptation factor). Withdrawal symptoms can range from mild to life threatening. Mild withdrawal symptoms include nausea, achiness, diarrhea, difficulty sleeping, excessive sweating, anxiety, and trembling. This phase may last from three to seven days. More severe effects of withdrawal may include hallucinations (in which individuals see, hear, or feel something that is not real), seizures, an unbearable craving for more alcohol, confusion, fever, fast heart rate, high blood pressure, and delirium (a fluctuating level of consciousness). Patients at highest risk for the most severe symptoms of withdrawal (referred to as delirium tremens or DTs) are those with other medical problems, such as malnutrition, liver disease, or Wernicke's syndrome. Delirium tremens usually begins about three to five days after the patient's last drink and may last a number of days. Withdrawal usually progresses from the more mild symptoms to the more severe ones.

Patients going through only mild withdrawal, monitored carefully to make sure that more severe symptoms do not develop, may not require medication; however, fluids are encouraged to facilitate detoxifying the person's system. Patients suffering more severe effects of withdrawal may need to be given sedative medications, benzodiazepines such as Valium or Librium, to relieve discomfort and to avoid the potentially life-threatening complications of high blood pressure, fast heart rate, and seizures. Because of the patient's nausea, fluids may need to be given intravenously (through a vein), along with some necessary sugars and salts (electrolyte pushes). It is crucial that thiamine be included in the fluids because it is usually quite low in alcoholic patients, and deficiency of thiamine is responsible for the Wernicke and Korsakoff syndromes. In-patient treatment is usually short-term (three to seven days), though longer rehabilitation programs lasting weeks or even months are sometimes needed. Any treatment is usually followed by longer-term outpatient treatment.

Recovery

After the physical problems associated with alcohol withdrawal have been treated, the more difficult task begins: helping individuals recognize the nature and severity of their illness. This is done on both an in-patient and outpatient basis. Alcoholism is a disease of denial; as members of Alcoholics Anonymous put it, it is "the only disease that keeps telling you that you do not have a disease." Alcoholics can be made aware of their condition through what is called an intervention, a meeting with family and/or significant people who describe for the alcoholic the symptoms of alcoholism that they have witnessed and how these symptoms have affected them. This is important because alcoholics who are actively drinking are often not aware of what they do, nor do they remember later what they have done. (Interventions are sometimes done before the problem becomes serious enough to require detoxification from alcohol.) Essential to recovery is the awareness of powerlessness over the disease, acceptance of having the disease, and abstinence from the substance that perpetuates the disease.

There is no cure for alcoholism. Sessions led by peers, such as Alcoholics Anonymous (AA) meetings, are often part of in-patient hospital treatment. AA meetings, in which recovering alcoholics meet regularly and provide support for each other's recovery, are considered among the best methods of preventing a return to drinking (relapse). The AA program is based on a twelve-step program, involving recognizing the destructive power that alcohol has held over the alcoholic's life, looking to a Higher Power for help in overcoming the problem, reflecting on the ways in which the use of alcohol has hurt others, and if possible, making amends to those people. The final step involves carrying the message of hope and recovery to other sick and suffering alcoholics. The Serenity Prayer becomes an ally: "God grant me the strength to accept the things I cannot change, the courage to change the things I can change, and the wisdom to know the difference."

The best programs incorporate the alcoholic's family or loved ones in the therapy because loved ones have undoubtedly been severely affected by the drinking. Many therapists believe that families, in an effort to deal with the alcoholic's drinking problem, develop patterns of behavior that unwittingly support or enable the patient's drinking. This situation is referred to as co-dependency. The twelve-step programs of Al Anon and Adult Children of Alcoholics can be successful in helping the families or loved ones of alcoholics.

There are also medications that may help an alcoholic avoid returning to drinking. These have been used with variable success. Disulfiram (Antabuse) is a drug that, when mixed with alcohol, causes a very unpleasant reaction which includes nausea and vomiting, diarrhea, and trembling. Naltrexone (a drug that blocks a narcotic high and may reduce the urge to drink) and acamprosate seem to be helpful in limiting the effects of a relapse. Naltrexone, found to produce liver damaging side effects, may be an option used only as a last resort. None of these medications has been found to be helpful unless individuals are also willing to work hard to change their behavior.

Expected results

As noted, there is no cure for alcoholism. Recovery from alcoholism is a lifelong process. In fact, people who have suffered from alcoholism are encouraged to refer to themselves ever after as recovering alcoholics, never as recovered alcoholics. Alcoholism can only be arrested--by abstaining from the drug, alcohol. The potential for relapse (returning to illness) is always there, and it must be acknowledged and respected. Statistics suggest that among middle-class alcoholics in stable financial and family situations who have undergone treatment, 60% or more can successfully stop drinking for at least a year, and many for a lifetime.

Prevention

Prevention is primarily related to education and early intervention. In a culture in which alcohol is so widely accepted and used, education about the dangers of this drug is vitally important, even in early childhood. Since alcohol is one of the easiest and cheapest drugs to obtain and one commonly used by teens, the first instance of intoxication (drunkenness) with alcohol usually occurs during the teenage years. It is particularly important that teenagers who are at high risk for alcoholism be made aware of this danger. Those at high risk include those with a family history of alcoholism, an early or frequent use of alcohol, a tendency to drink to drunkenness, alcohol use that interferes with schoolwork, a poor family environment, or a history of domestic violence. Peers are often the best people to provide this education, and groups such as SADD (Students Against Drunk Driving, a Marlborough, Massachusetts-based organization), appear effective. Courts and schools sometimes provide education through local substance abuse programs, as well. Setting a good example, developing and practicing communication skills with youngsters, and having frank discussions about the consequences of drinking, are all encouraged as ways to prevent alcoholism-related problems. Developing alternative coping skills to life's problems is also essential, as is encouraging an objective perspective on the pervasive advertising that deceptively promotes alcohol's health-reducing glamour.

Key Terms

For More Information

Books

·         Baye, Douglas R. New Research on Alcoholism. Hauppauge, NY: Nova Science, 2007.

·         Maltzman, Irving M. Alcoholism: Its Treatments and Mistreatments. Singapore: World Scientific, 2008.

·         Prentiss, Chris. The Alcoholism and Addiction Cure: A Holistic Approach to Total Recovery. Malibu, CA: Power Press, 2007.

·         Wyborny, Sheila. Alcoholism. Farmington Hills, MI: Lucent Books, 2007.

Periodicals

·         Amodeo, Maryann, et al. "Coping with Stressful Events: Influence of Parental Alcoholism and Race in a Community Sample of Women." Health and Social Work (November 2007): 247-257.

·         Cherpitel, Cheryl. "Alcohol and Injuries: A Review of International Emergency Room Studies since 1995." Drug and Alcohol Review (March 2007): 201-214.

·         Knop, J., et al. "Paternal Alcoholism Predicts the Occurrence but Not the Remission of Alcoholic Drinking: A 40-year Follow-up." Acta Psychiatrica Scandinavica (November 2007): 386-393.

·         Lawrence, Andrew. "Therapeutics for Alcoholism: What's the Future?" Drug and Alcohol Review (January 2007): 3-8.

Other

·         "Alcoholism." MayoClinic.com. (February 9, 2008)http://www.mayoclinic.com/print/alcoholism/DS00340/DSECTION=all&METHOD=print .

·         "Alcoholism." Medline Plus. National Library of Medicine. (February 9, 2008)http://www.nlm.nih.gov/medlineplus/alcoholism.html .

·         Thompson, Warren. "Alcoholism." eMedicine. (February 9, 2008)http://www.emedicine.com/med/topic98.htm .

Organizations

Alcoholics

Anonymous, AA World Services, Inc 
 PO Box 459
 New

York, NY 10163
 Phone:  (212) 870-3400
 Website:

 http://www.alcoholics-anonymous.org/ 

Substance Abuse & Mental Health Services Administration 
  
  

 1 Choke Cherry Road
  Rockville, MD 20857
 Website:

 http://www.samhsa.gov/ 

Record Number: DU2603000147

© Copyright  2010  Gale Cengage Learning