Alcohol misuse and dependence are primarily diagnosed through the use of clinical screening surveys. Several hundred such surveys exist, and they vary in the number and nature of questions they ask. Some of the more common scientifically-validated questionnaires include the Michigan Alcohol Screening Test (MAST), a shorter version called the Brief MAST, the Alcohol Use Disorders Identification Test (AUDIT), and a commonly employed, quick survey called the CAGE questionnaire. These surveys ask a range of questions about frequency of drinking, problems that result, and ability to stop.
To share their method, Wilson and other members wrote the initially-titled book, Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism,[21] from which AA drew its name. Informally known as "The Big Book" (with its first 164 pages virtually unchanged since the 1939 edition), it suggests a twelve-step program in which members admit that they are powerless over alcohol and need help from a "higher power". They seek guidance and strength through prayer and meditation from God or a Higher Power of their own understanding; take a moral inventory with care to include resentments; list and become ready to remove character defects; list and make amends to those harmed; continue to take a moral inventory, pray, meditate, and try to help other alcoholics recover. The second half of the book, "Personal Stories" (subject to additions, removal and retitling in subsequent editions), is made of AA members' redemptive autobiographical sketches. [22]
People who struggle with AUD may begin drinking because of social situations or anxiety about being around people; however, signs of a potential AUD include changes in friend groups, especially geared toward friends who drink versus those who don’t, and avoiding social situations to drink instead. Those who have a family member who struggles with AUD are more likely to suffer from high stress, emotional and physical abuse, and mental health or substance abuse problems later in life.

"Learning basic Twelve Step philosophy and language can open the lines of communication," continued Cathy. "Once you understand some Twelve Step principles, concepts such as powerlessness, spiritual awakening, higher power and making amends, they will seem less like cult mantras and more like the simple guides they are intended to be." A Twelve Step program is one that adapts the Twelve Steps of AA to fit the particular needs of a mutual-help group. Narcotics Anonymous, Al-Anon, Alateen, Gamblers Anonymous, Nicotine Anonymous, and Adult Children of Alcoholics are examples of groups with a Twelve Step foundation.
With each drink, you give away your humanity and freedom to a lie that will take from you until you have nothing left to give. Has this happened to you? If you’re reading this, you already know that alcohol is not the way. You don’t need temporary relief. You need complete healing. That’s what we do here at The Recovery Village. Call 352.771.2700 now. You don’t have to be afraid, ashamed or alone anymore.
Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are common; approximately 10 percent of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia.[40] Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time.[41] Social skills are significantly impaired in people suffering from alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The social skills that are impaired by alcohol abuse include impairments in perceiving facial emotions, prosody perception problems and theory of mind deficits; the ability to understand humour is also impaired in alcohol abusers.[42] Psychiatric disorders are common in alcoholics, with as many as 25 percent suffering severe psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence.[43] Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia.[44] Panic disorder can develop or worsen as a direct result of long-term alcohol misuse.[45][46]
The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study suggests the transition from use to dependence was highest for nicotine users, followed by cocaine, alcohol, and cannabis users. [10] An increased risk of transition to dependence among minorities and those with psychiatric or dependence comorbidity highlights the importance of promoting outreach and treatment of these populations.
With a U.S. economy inching laboriously back from recession with a flagging job market in tow, we should be sensitive to hidden costs of this “lifestyle choice.” In a perfect world, we would weigh the right to drink excessively against the $94.2 billion in tax dollars that we spend every year to pay the costs of alcoholism. We should weigh the collective choice against the 1.9 million public school teachers we could hire with that $94.2 billion — or the million public parks that money could build for communities across the country, or the million students we could put through school. And we’d think hard about what cultural shift could moderate this “lifestyle choice” before it becomes disease.
Alcohol dependency occurs on a continuum. Many Australians are only moderately or mildly dependent on alcohol (e.g. they may find it difficult to stop drinking once they start). They do not exhibit physical withdrawals like those with severe alcohol dependence, and do not consider their drinking patterns problematic. This may be because the major health and social consequences of alcohol dependence (with the exclusion of violence) do not begin when an individual first becomes alcohol dependent. For example, it may take years for an individual who is alcohol dependent to have financial or relationship problems as a result of drinking. In many cases chronic excessive drinking may have no immediate health and social consequences.
Start there. Afterward, check into a facility regardless. If you are on the fence about doing so, then outpatient is for you. If you know you have a problem that needs curing, check into an inpatient facility. Both are facilities that focus on helping people who are currently abusing alcohol and/or drugs. Also, more intensive options exist, such as partial hospitalization.
In professional and research contexts, the term "alcoholism" sometimes encompasses both alcohol abuse and alcohol dependence,[97] and sometimes is considered equivalent to alcohol dependence. Talbot (1989) observes that alcoholism in the classical disease model follows a progressive course: if a person continues to drink, their condition will worsen. This will lead to harmful consequences in their life, physically, mentally, emotionally and socially.[98] Johnson (1980) explores the emotional progression of the addict’s response to alcohol. He looks at this in four phases. The first two are considered "normal" drinking and the last two are viewed as "typical" alcoholic drinking.[98] Johnson's four phases consist of:
Al-Anon and Alateen. Al-Anon is an organization comprised of support groups targeted towards friends and family of individuals suffering from alcoholism. In these groups, family members and friends are able to share their personal experiences, discuss difficulties and find effective ways to deal with problems—regardless of whether the alcohol abusing individual in their lives have completed an addiction recovery program. Alateen is a fellowship that is specifically targeted towards younger Al-Anon members, particularly teenagers.
Having more than one drink a day for women or two drinks for men increases the risk of heart disease, high blood pressure, atrial fibrillation, and stroke.[29] Risk is greater in younger people due to binge drinking, which may result in violence or accidents.[29] About 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol each year.[11] Alcoholism reduces a person's life expectancy by around ten years[22] and alcohol use is the third leading cause of early death in the United States.[29] No professional medical association recommends that people who are nondrinkers should start drinking wine.[29][30] Long-term alcohol abuse can cause a number of physical symptoms, including cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic ulcers[31] and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and several cancers. Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption.[32][33] A 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.[34]
Steps 1-9 set up a strong spiritual foundation and a new way of life without drugs and alcohol. With Step 10, individuals are seeking daily accountability for their actions. Recovery is ongoing, and individuals continue to examine how their thoughts, words, behaviors, and actions impact daily life and how to keep themselves in line with their faith and God’s will. Individuals are asked to take inventory every day and immediately correct any wrongs that are apparent. This may be accomplished by keeping a journal or devising another method of self-examination each evening, for instance. By understanding how certain things may make a person feel and therefore act, individuals can become more aware of themselves and their behaviors. Step 10 involves personal reflections and a kind of spot-checking to keep oneself balanced emotionally.
In order to effectively recover from an addiction, professional help in the field of substance abuse is only part of the equation. Often times, recovering individuals additionally need the support of others who are also recovering from addiction. This is where support groups can provide a critical element needed to bring success to an individual's recovery process.
"We will comprehend the word serenity and we will know peace." (Alcoholics Anonymous, p. 84)          Just For Today          Life takes on new meaning in A.A. To watch people recover, to see them help others, to watch loneliness vanish, to see a fellowship grow up about you, to have a host of friends - this is an experience not to be missed. (from the 12&12 and Alcoholics Anonymous)          
Alcoholism often reduces a person's life expectancy by around ten years.[22] The most common cause of death in alcoholics is from cardiovascular complications.[155] There is a high rate of suicide in chronic alcoholics, which increases the longer a person drinks. Approximately 3–15 percent of alcoholics commit suicide,[156] and research has found that over 50 percent of all suicides are associated with alcohol or drug dependence. This is believed to be due to alcohol causing physiological distortion of brain chemistry, as well as social isolation. Suicide is also very common in adolescent alcohol abusers, with 25 percent of suicides in adolescents being related to alcohol abuse.[157] Among those with alcohol dependence after one year, some met the criteria for low-risk drinking, even though only 25.5 percent of the group received any treatment, with the breakdown as follows: 25 percent were found to be still dependent, 27.3 percent were in partial remission (some symptoms persist), 11.8 percent asymptomatic drinkers (consumption increases chances of relapse) and 35.9 percent were fully recovered—made up of 17.7 percent low-risk drinkers plus 18.2 percent abstainers.[158] In contrast, however, the results of a long-term (60-year) follow-up of two groups of alcoholic men indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."[159] There was also "return-to-controlled drinking, as reported in short-term studies, is often a mirage."
AA says it is "not organized in the formal or political sense",[25] and Bill Wilson called it a "benign anarchy".[26] In Ireland, Shane Butler said that AA “looks like it couldn’t survive as there’s no leadership or top-level telling local cumanns what to do, but it has worked and proved itself extremely robust.” Butler explained that "AA’s 'inverted pyramid' style of governance has helped it to avoid many of the pitfalls that political and religious institutions have encountered since it was established here in 1946."[27]
SMART Recovery: (Self Management for Addiction Recovery): SMART Recovery is a 4-point program based on cognitive behavioral therapy and seeks to empower the individual through education and practical techniques. It is present-focused and does not use the term “disease” when referring to addiction. Attendees may use medications, which are not encouraged in AA.
The long-term effects of alcohol use disorder can be devastating and even life-threatening. Chronic excessive alcohol consumption can negatively affect virtually every organ system. Specific examples of alcohol-use disorder effects on the body include everything from general effects like poor coordination, thiamine deficiency, and other forms of poor nutrition, cardiovascular effects like hypertension and irregular heartbeat, reproductive effects like impotence and irregular menses, as well as gastrointestinal problems like jaundice, cirrhosis of the liver, and pancreatitis. Alcohol-use disorder complications that involve the brain include, but are by no means limited to, strokes, confusion, and amnesia. Thiamine deficiency that is associated with alcohol use disorder can progress to the point that the sufferer develops vision problems, confusion, and trouble walking (Wernicke's encephalopathy), eventually followed by trouble caring for themselves and memory problems that the person tries to cover for by making things up/confabulating information (Korsakoff syndrome).
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Alcohol addiction is a gradual process that occurs within the human brain. When alcohol is consumed, it alters the levels of certain chemicals in the brain, mainly gamma-aminobutyric acid, or GABA, and dopamine. GABA monitors and controls a person's impulsivity, and frequently drinking copious amounts of alcohol alters this chemical's production, often making people more impulsive and less aware of what they are doing. Dopamine is one of the chemicals in the brain that, when released, causes pleasurable feelings like happiness, joy, or even euphoria. As more and more alcohol is consumed on a frequent basis, the brain begins to grow accustomed to this chemical imbalance. If an alcoholic tries to stop drinking, then the brain is deprived of the alcohol's effect, which results in unpleasant withdrawal symptoms such as sweating, shaking, tremors, or even hallucination.
We, of ALCOHOLICS ANONYMOUS, know thousands of men and women who were once just as hopeless as Bill. Nearly all have recovered. They have solved the drink problem. We are average Americans. All sections of this country and many of its occupations are represented, as well as many political, economic, social, and religious backgrounds. We are people who normally would not mix. But there exists among us a fellowship, a friendliness, and an understanding which is indescribably wonderful....
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Choosing to seek help for an alcohol addiction is one of the biggest decisions you will face. There are different forms of treatment available based on frequency and severity of alcohol abuse. Recovering from alcohol addiction is a process that continues long after rehab. It takes commitment to practice and apply the techniques you learn in rehab, counseling, support groups and other types of therapy.

The 12-Step philosophy pioneered by Alcoholics Anonymous is used by about 74 percent of treatment centers. The basic premise of this model is that people can help one another achieve and maintain abstinence from substances of abuse, but that healing cannot come about unless people with addictions surrender to a higher power. The 12-Step movement can be a force for good for many people, but some struggle with what they interpret as a strong religious element of the program. Many addiction treatment programs offer alternatives to 12-Step methodology for those who prefer a more secular foundation for treatment.
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According to the National Survey on Drug Use and Health, approximately 15 million American adults misuse alcohol or are alcohol dependent. In the United States, nearly 20% of patients treated in general medical practices report drinking at levels considered "risky" or "hazardous." According to NIAAA, less than 10% of patients with alcohol use disorder receive treatment.

Research and population surveys have shown that persons under stress , particularly chronic stress, tend to exhibit more unhealthy behaviors than less-stressed persons. Stressed people drink more alcohol, smoke more, and eat less nutritious foods than non-stressed individuals. Many people report drinking alcohol in response to various types of stress, and the amount of drinking in response to stress is related to the severity of the life stressors and the individuals' lack of social support networks.
While admitting that the oft-cited success rate of 5 percent “isn’t great,” Dr. Drew Pinsky, a celebrity doctor and addiction medicine specialist argued that “the fact it, [Alcoholics Anonymous] does work when people do it,” saying the real success rate is as high as 12 percent. The American Society of Addiction Medicine speculated that approximately 10 percent of the people who become part of a 12-Step program enjoy long-term success in their recovery. In 2014, AA self-reported that 27 percent of the 6,000 members who participated in an internal study were sober for less than a year; 24 percent retained their sobriety for up to five years, and 13 percent lasted for as long as a decade. Fourteen percent of the study’s participants stayed sober between 10 and 20 years, and 22 percent reported remaining sober for more than two decades.
alcohol dependence = alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink.[99] The term "alcoholism" was split into "alcohol abuse" and "alcohol dependence" in 1980's DSM-III, and in 1987's DSM-III-R behavioral symptoms were moved from "abuse" to "dependence".[100] It has been suggested that DSM-V merge alcohol abuse and alcohol dependence into a single new entry,[101] named "alcohol-use disorder".[102]
Alcohol dependence is a legitimate health problem. Health professionals can provide advice, support and in some cases medication to help reduce alcohol dependence. You may feel embarrassed talking to a doctor about drinking too much, but remember that doctors and other health workers are there to help fix health problems, not to judge or berate their patients. A good doctor will encourage their patients to drink in moderation or perhaps abstain for periods of time, not make their patients feel guilty or bad for drinking drink too much alcohol.

Friends and family members of alcoholic individuals have often developed a codependent relationship with the substance abuser. Specifically, they often feel compelled to either help their loved one secure alcohol or to repair situations caused by the alcoholic's alcohol use. Social control involves family members and other significant others of the alcoholic in treatment.


Warning 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.[28]
For older versions of Windows, click on the Windows Start icon in the lower left of the Desktop. Next click on Control Panel and then click on Programs. Under Programs and Features click on Uninstall a program. Find Seagate Recovery Suite in the list of installed programs and click on it. At the top of the window in the Organize bar click Uninstall. Follow the prompts to complete the uninstall.
 In addition, every federal court in the land that has examined the issue has held that 12-Step programs -- despite their claims to the contrary -- are sufficiently religious that coerced attendance (for example, when a court or probation officer orders mandatory attendance at AA meetings) violates the Establishment Clause of the First Amendment of the U.S. Constitution.  This is explicitly the law in the 2nd, 7th, and 9th federal circuits, as well as the states of New York and Tennessee.
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Alcoholics Anonymous (AA) was the first 12-step program established and many other support groups have branched off from AA using this model. AA is an organization that unites people who have struggled with alcohol dependency, providing strength and faith in one another to overcome addiction. Its mission is to “stay sober and help other alcoholics to achieve sobriety” without judgment or segregation. AA founders Bill Wilson and Dr. Bob Smith developed the 12 steps based on concepts from Carl Jung’s theories as influenced by Eastern philosophy, and from spiritual values such as those rooted in the principles of the Oxford Group.
LifeRing Secular Recovery: For people who would prefer a recovery program without the spiritual aspects of the AA and the 12-Step program, LifeRing is not based on any ideas of a higher power. Instead, they focus on the belief that each person has the power within them to control their alcoholism, having its member visualize themselves as two people: the Addict Self and the Sober Self, and work on weakening the former and strengthening the latter. LifeRing does this by connected Sober Selves through in-person and online group meetings to create a strong network of support without any kind of structured stages, steps, or sponsors. Instead, they emphasize that the best person to design an effective sobriety program is you since you will know what does and doesn’t work for you personally.

Environmental factors and genetics are two components associated with alcoholism, with about half the risk attributed to each.[3] Someone with a parent or sibling with alcoholism is three to four times more likely to become an alcoholic themselves.[3] Environmental factors include social, cultural and behavioral influences.[14] High stress levels and anxiety, as well as alcohol's inexpensive cost and easy accessibility, increase the risk.[3][5] People may continue to drink partly to prevent or improve symptoms of withdrawal.[3] After a person stops drinking alcohol, they may experience a low level of withdrawal lasting for months.[3] Medically, alcoholism is considered both a physical and mental illness.[15][16] Questionnaires and certain blood tests may both detect people with possible alcoholism.[3] Further information is then collected to confirm the diagnosis.[3]
Babies who are born to mothers who are heavy drinkers are more at risk for being born with significant medical, developmental, behavioral, and emotional problems, including fetal alcohol syndrome (FAS). However, many babies whose mothers consumed even minimal amounts of alcohol during pregnancy have been born with such problems. Therefore, there is no amount of alcohol intake that has been proven to be safe during pregnancy.
We have found in clinical treatment that the 12-Step philosophy is a vital part of permanent sobriety. When a person maintains a 12-Step practice, including getting a sponsor and working with others, recovery is about more than relapse prevention – it is a pathway to an existence that is happy, joyous, and free. The 12-Step program a gateway into longterm recovery. By focusing attention on the 12-Steps, we set our patients up for long-term success. We engage patients in this paradigm because:
My Treatment Lender is the only recovery-based lending company in the country. We provide loans to people who are in need of behavioral health, substance abuse and/or eating disorder treatment. We can help clients cover the cost of co-pays, high deductibles, or their entire stay. We believe that people don't have to suffer from mental health issues, alcoholism, drug addiction or eating disorders. There is a solution. By providing loans for treatment, we hope to be able to give people who want to recover the best chance possible.
Within the medical and scientific communities, there is a broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."[111] Alcoholism has a higher prevalence among men, though, in recent decades, the proportion of female alcoholics has increased.[36] Current evidence indicates that in both men and women, alcoholism is 50–60 percent genetically determined, leaving 40–50 percent for environmental influences.[153] Most alcoholics develop alcoholism during adolescence or young adulthood.[69] 31 percent of college students show signs of alcohol abuse, while six percent are dependent on alcohol. Under the DSM's new definition of alcoholics, that means about 37 percent of college students may meet the criteria.[154]

Stereotypes of alcoholics are often found in fiction and popular culture. The "town drunk" is a stock character in Western popular culture. Stereotypes of drunkenness may be based on racism or xenophobia, as in the fictional depiction of the Irish as heavy drinkers.[171] Studies by social psychologists Stivers and Greeley attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.[172] Alcohol consumption is relatively similar between many European cultures, the United States, and Australia. In Asian countries that have a high gross domestic product, there is heightened drinking compared to other Asian countries, but it is nowhere near as high as it is in other countries like the United States. It is also inversely seen, with countries that have very low gross domestic product showing high alcohol consumption.[173] In a study done on Korean immigrants in Canada, they reported alcohol was even an integral part of their meal, and is the only time solo drinking should occur. They also believe alcohol is necessary at any social event as it helps conversations start.[174]
At the end of an intervention, the stage is set for entry into addiction treatment programs. There are many different options out there. Some facilities, for example, offer inpatient treatment for addiction. These programs allow people to step away from their day-to-day concerns and tackle an addiction around the clock, every single day. For some people, that tight focus is an ideal setup for healing. But outpatient centers can be ideal for those who want to stay at home, surrounded by family, while they work on addictions to alcohol. It’s a personal decision that families can make in consultation with the person who needs help.
Most Twelve Step participants view addiction as a lifelong disease and see the Twelve Steps as their new design for living. When people whose lives have been affected by addiction work the Twelve Steps, they can better sort out the things which they have no control over, and the things for which they are responsible. Group meetings offer a safe place to share one's experience, strength and hope, and to receive support and fellowship.

Jump up ^ Morse, RM; Flavin, DK (August 1992). "The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism". JAMA: The Journal of the American Medical Association. 268 (8): 1012–4. doi:10.1001/jama.1992.03490080086030. ISSN 0098-7484. PMID 1501306.
Attitudes and social stereotypes can create barriers to the detection and treatment of alcohol abuse. This is more of a barrier for women than men. Fear of stigmatization may lead women to deny that they are suffering from a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know is an alcoholic.[35] In contrast, reduced fear of stigma may lead men to admit that they are suffering from a medical condition, to display their drinking publicly, and to drink in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is an alcoholic.[54]

In a closed AA meeting, the only people who may attend are those who are recovering addicts (or those interested in learning more about overcoming their addiction). Open meetings allow the attendance of friends, spouses and family members. Whether you decide to go to a closed or open meeting depends exclusively on what you’re comfortable with. Some people would rather keep their recovery separate from the rest of their life. Others thrive on the support that loved ones can provide during meetings.
Risk factors for developing a drinking problem include depression, anxiety, or another mood problem in the individual, as well as having parents with addiction. Low self-esteem and feeling out of place are other risk factors for developing alcohol dependence. In women, antisocial behaviors and impulsivity are associated with the development of severe alcohol use disorder. Both men and women are more likely to develop alcoholism if they have a childhood history of being physically or sexually abused. Children and teens who have their first drink of alcohol between 11 and 14 years of age are more at risk for developing a drinking alcohol problems than those who do so when either younger or older.
The Twelve Traditions encourage members to practice the spiritual principle of anonymity in the public media and members are also asked to respect each other's confidentiality.[39] This is a group norm,[39] however, and not legally mandated; there are no legal consequences to discourage those attending twelve-step groups from revealing information disclosed during meetings.[40] Statutes on group therapy do not encompass those associations that lack a professional therapist or clergyman to whom confidentiality and privilege might apply. Professionals and paraprofessionals who refer patients to these groups, to avoid both civil liability and licensure problems, have been advised that they should alert their patients that, at any time, their statements made in meetings may be disclosed.[40]
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