Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
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]
There are many clues which can lead a doctor to suspect a patient is alcohol dependent, and will not usually require a physical examination. For example, a doctor may suspect alcohol dependence if a patient often asks for a medical certificate for time off work, has a mental health problem (e.g. depression) or physical conditions associated with alcohol consumption (especially liver cirrhosis). In such cases, a good doctor will ask the patient questions about their alcohol consumption patterns, or ask them to complete a questionnaire about alcohol, to assess whether or not their alcohol consumption is presenting a health risk.
Acamprosate may stabilise the brain chemistry that is altered due to alcohol dependence via antagonising the actions of glutamate, a neurotransmitter which is hyperactive in the post-withdrawal phase.[132] By reducing excessive NMDA activity which occurs at the onset of alcohol withdrawal, acamprosate can reduce or prevent alcohol withdrawal related neurotoxicity.[133] Acamprosate reduces the risk of relapse amongst alcohol-dependent persons.[134][135]

What's to know about alcoholic liver disease? Alcoholic liver disease is the primary cause of chronic liver disease in the U.S. and can be fatal. It occurs as a result of chronic excessive consumption of alcohol. The first step of treatment will be to remove alcohol from the diet, but a liver transplant may also be necessary. Learn more about the disease here. Read now
Alcohol use disorder is a potentially fatal disease, characterized by cravings, tolerance (needing more), physical dependence, and loss of control over consuming alcohol.  Alcohol intoxication may or may not be obvious to observers. Even in highly functional alcoholics, chronic alcoholism can lead to physical problems. Most common is damage to your liver, which over time can lead to cirrhosis (scarred liver). Other risks include depression, stomach bleeds, pancreatitis, high blood pressure, heart failure, numbness and tingling in your feet and changes in your brain. Alcoholism can also increase your risk for infections including pneumonia, tuberculosis, and chronic gastritis.
Issues with retention and completion rates. Despite how ingrained the 12-Step program is as the standard for alcoholism recovery, the hard numbers tell a different story. According to several studies, the 12-Step Program has been found to be effective for about 20 percent of those that try it, with the other 80 percent usually stopping after just one month. At any given time, only five percent of those still attending AA has been there for a year.
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Prevention of alcoholism may be attempted by regulating and limiting the sale of alcohol, taxing alcohol to increase its cost, and providing inexpensive treatment.[17] Treatment may take several steps.[7] Due to medical problems that can occur during withdrawal, alcohol detoxification should be carefully controlled.[7] One common method involves the use of benzodiazepine medications, such as diazepam.[7] These can be either given while admitted to a health care institution or occasionally while a person remains in the community with close supervision.[7] Mental illness or other addictions may complicate treatment.[18] After detoxification, support such as group therapy or support groups are used to help keep a person from returning to drinking.[6][19] One commonly used form of support is the group Alcoholics Anonymous.[20] The medications acamprosate, disulfiram or naltrexone may also be used to help prevent further drinking.[8]
The illness of the spiritual dimension, or "spiritual malady," is considered in all twelve-step groups to be self-centeredness.[17][18] The process of working the steps is intended to replace self-centeredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action.[18] In twelve-step groups, this is known as a spiritual awakening not a religious experience.[21] This should not be confused with abreaction, which produces dramatic, but ephemeral, changes.[22] In twelve-step fellowships, "spiritual awakening" is believed to develop, most frequently, slowly over a period of time.[23]
I am still surprised and disappointed by professionals who focus on the all or nothing, right vs wrong approach to treatment.  I think we owe to all our lie RS and the treatment community to learn about the different options our clients may encounter and professionally guide them to the best match for them on the present.  Why do some addicts have years of solid recovery with one approach over another probably won't have definitive explanation other than every addict is unique. We support them. We I still response single hope and help them explore options.  We do not decide or judge.  They have family friends and society doing enough.   I regret how judgmental I've been trying to push a client and may have created more resistance and fear. 

"When I first told my family I was going into treatment, they were stunned," said Cathy, a recovering alcoholic. "I wanted to talk, needed to talk, but none of us had the right words yet. Now, five years later, I realize that it doesn't really matter how perfectly you say something. You have to risk saying the wrong thing and just start communicating.


This final step is the service aspect, and it asks individuals to give back to others who are also struggling with addiction. After coming to God or a higher power, individuals are then taught to share this spirituality with others and support them in recovery. During Step 12, individuals are often asked to share their stories, testimonies, and struggles with others in order to provide hope and encouragement.
Smith and Wilson left the Oxford Group in 1937 to focus on developing Alcoholics Anonymous, and by 1938, they had successfully brought the message to almost a hundred alcoholics in the Ohio and New York areas. Looking to capitalize on their momentum, they decided to document the group in a book. Wilson took the lead on the project, naming the resulting publication, Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. He included 12 guidelines that, if followed, would grow the individual’s spirit to the point of overcoming the temptation to drink, and help the person make reparations for all the damage done during the days of drinking. These became known as the 12 Steps, and the book’s popularity led to Wilson’s group adopting the name of the book itself.
In most parts of the world, alcohol is legal for adults to both purchase and consume. As a result, beverages that contain alcohol are available almost everywhere, and clearly, many adults partake. Since use is so common, it might seem hard to determine who is drinking alcohol in an appropriate manner and who is drinking in a manner that could lead to alcohol abuse or alcoholism. Experts suggest there are key signs to look for.
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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.
Increased incidence of domestic violence, sexual assault and rape, and associated health consequences (including post-traumatic stress disorder). These crimes are often committed by people who are intoxicated by alcohol. People who depend on alcohol regularly drink until they are drunk and are thus frequently in states which increase the likelihood of these experiences.

Denial is one of the biggest obstacles to getting help for alcohol abuse and alcoholism. The desire to drink is so strong that the mind finds many ways to rationalize drinking, even when the consequences are obvious. By keeping you from looking honestly at your behavior and its negative effects, denial also exacerbates alcohol-related problems with work, finances, and relationships.
Drinking too much damages the circulation by causing consistent high blood pressure. It also causes cardiomyopathy, or drooping of the heart muscle, which reduces the ability of the heart to effectively pump blood throughout the body. Nutrient deficiency can lead to anemia. Other problems with blood can lead to clots, causing strokes or heart attacks.
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Short-term effects of alcohol abuse can be just as dangerous as long-term effects. For instance, drinking can impact your reaction time, causing you to have slow reflexes and coordination. That’s why drinking and driving is extremely dangerous. Getting behind the wheel of a car can alter your perception of speed and distance, putting yourself and others at risk.
Following detoxification, social support to abstain from or moderate drinking is needed for an extended period of time. It is useful for individuals who are recovering from alcohol dependence to identify people who can support them through the process, as it can still be very difficult not to drink alcohol, or to drink in moderation following detoxification. People who have difficulty may wish to investigate whether there is medication which can help them stay away from alcohol. There are range of prescription medicines which might assist some people. Talk to a doctor before taking any medication.

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 some individuals whose circumstances or conditions don't require a full-time, residential recovery process, outpatient recovery may be a viable recovery option. In an outpatient recovery program, individuals undergo addiction rehabilitation while living at their own homes. They are able to schedule regular check-ins at a clinic or treatment center for medication and counseling on a regular basis.
The first step in the treatment of alcoholism, called detoxification, involves helping the person stop drinking and ridding his or her body of the harmful (toxic) effects of alcohol. Because the person's brain and body has become accustomed to alcohol, the alcohol-dependent person will most likely develop withdrawal symptoms and need to be supported through them. Withdrawal will be different for different individuals, depending on the severity of the alcoholism as measured by the quantity of alcohol ingested daily and the length of time the patient has been alcohol dependent.

"When I first told my family I was going into treatment, they were stunned," said Cathy, a recovering alcoholic. "I wanted to talk, needed to talk, but none of us had the right words yet. Now, five years later, I realize that it doesn't really matter how perfectly you say something. You have to risk saying the wrong thing and just start communicating.


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]
NIAAA says a relapse typically follows a predictable path. The person in recovery is placed in a high-risk situation, and the person isn’t able to handle that situation effectively. That lack of effectiveness can prompt the person to feel somehow vulnerable or weak, and it can lead to a craving for alcohol. After a weak moment, people just begin to attribute life’s good things to alcohol. They then have a lapse and drink just a bit. In time, they start to drink more and more.
Most of the warning signs and symptoms of alcoholism are not difficult to pinpoint. However, there are some that are obvious. Often, an alcoholic will not admit that there is a problem. This could be due to denial, or a true belief no problem exists. Generally speaking, the last person to realize that there is a problem is the alcoholic. He or she will likely deny the existence of a problem until irreparable damage is done. This is why the symptoms of alcoholism are important to recognize.
Naltrexone is a competitive antagonist for opioid receptors, effectively blocking the effects of endorphins and opioids. Naltrexone is used to decrease cravings for alcohol and encourage abstinence. Alcohol causes the body to release endorphins, which in turn release dopamine and activate the reward pathways; hence in the body reduces the pleasurable effects from consuming alcohol.[136] Evidence supports a reduced risk of relapse among alcohol-dependent persons and a decrease in excessive drinking.[135] Nalmefene also appears effective and works in a similar manner.[135]
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:
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I agree with many of the earlier comments highlighting the drawbacks of 12-Step for many folks seeking recovery.  Although the program claims to be "spiritual" and "not religious," it's roots are in the Oxford Group, an early evangelical Protestant organization, and the 12 Steps (12, because there were 12 apostles) are taken directly from Oxford Group, which maintained that people were "powerless over sin."  Bill W. simply replaced "sin" with "alcohol" and kept the rest unchanged.
Information provided is for the purpose of locating meetings of Alcoholics Anonymous and to procure information about A.A. in Southern California. No other use is authorized and printing is prohibited. Groups listed in the meeting directory are not funded or managed by Los Angeles Central Office. Groups are registered at their request and listed because they are organized in alignment with the guidelines to list a meeting in our directory and they attest they receive no support from outside their group . That we list a group in our directory does not constitute or imply Los Angeles Central Office approves or endorses a group's approach to or practice of the A.A. program of recovery. Each group is autonomous, Los Angeles Central Office does not govern.
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During Step 8, people commonly resort to writing lists again, and this step is about forgiveness. Often, two lists are formed during this step: The first is a list of those who the person needs to forgive and the second is a list of those from whom they need to seek forgiveness. There will likely be crossover people on both lists. Individuals are encouraged to be honest and write down names of anyone who elicits strong emotions like resentment, shame, guilt, anger, fear, etc.
Alcoholism is the most severe form of alcohol abuse and involves the inability to manage drinking habits. It is also commonly referred to as alcohol use disorder. Alcohol use disorder is organized into three categories: mild, moderate and severe. Each category has various symptoms and can cause harmful side effects. If left untreated, any type of alcohol abuse can spiral out of control.
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The first female member, Florence Rankin, joined AA in March 1937,[6][7] and the first non-Protestant member, a Roman Catholic, joined in 1939.[8] The first Black AA group was established in 1945 in Washington DC by Jim S., an African-American physician from Virginia.[9][10] AA membership has since spread internationally "across diverse cultures holding different beliefs and values", including geopolitical areas resistant to grassroots movements.[11] Close to 2 million people worldwide are members of AA as of 2016.[12]
Treatment of alcoholism often is a combination of inpatient and outpatient therapy depending on the individual's alcohol history and physical condition. The person with alcoholism often resists the idea that he or she has an alcohol problem and needs to stop drinking. Treatment cannot be forced on adults unless it is a condition imposed by a court of law. However, if the person is a danger to him- or herself or to others, immediate hospitalization may be possible without the individual's consent.

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Thank you dr Miller, very important part of recovery of addiction and important tool for our patients that should not be "a dying art". I have heard international lecturer and professional in addiction treatment, state that "Minnesota Model" is one treatment that has been shown ineffective (evidence based medicine... Many correlate that with Twelve step facilitation. Can you help with references to support or counteract that?


...more and more, Bill discovered that new adherents could get sober by believing in each other and in the strength of this group. Men [no women were members yet] who had proven over and over again, by extremely painful experience, that they could not get sober on their own had somehow become more powerful when two or three of them worked on their common problem. This, then—whatever it was that occurred among them—was what they could accept as a power greater than themselves. They did not need the Oxford Group.
When it comes to behavior disorders, the notion of causality (cause and effect) can be a major factor between one disorder and another. Drug abuse is often linked to depression, alcoholism is often linked to PTSD and so on. But what about eating disorders? Can THEY be related to alcoholism? They certainly can be. This relationship between substance abuse and a mental health disorder is what’s referred to as a co-occurring disorder. For some people, the substance abuse disorder causes the mental health disorder, while for others, it’s the other way around. The reasons for the co-occurrence of alcoholism and eating disorders vary for each person, but there are certain common denominators involved. These include low self-esteem, poor self-image and depression, which often lead to self-medicating behaviors. Many people who abuse alcohol consume it in place of food, becoming “drunkorexic” as a result. Drunkorexia can also involve combining binge eating and purging in addition with alcohol abuse. The good news is, there are many treatment facilities in the country that can treat alcoholism AND co-occurring disorders like bulimia, anorexia and binge eating. If you or someone you know is struggling with both alcoholism and an eating disorder, help is just a phone call away.
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.
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As is true with virtually any mental health diagnosis, there is no one test that definitively indicates that someone has an alcohol-use disorder. Screening tools, including online or other tests may help identify individuals who are at risk for having a drinking problem. Therefore, health care professionals diagnose alcohol abuse or dependence by gathering comprehensive medical, family, and mental health information. The practitioner will also either perform a physical examination or request that the individual's primary care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might have mental health symptoms.
Moderate alcohol consumption (1–2 drinks/d) reduces the risk of cardiovascular disease in men and women by approximately 30%. [13, 14, 15] The effect of heavy alcohol consumption on the risk of cardiovascular disease varies in different studies. The person's drinking pattern appears to have an effect on cardiovascular disease. Drinking with meals may reduce the risk, while binge drinking increases risk (even in otherwise moderate drinkers).
Alcohol Use Disorder is a pattern of disordered drinking that can involve interference in daily tasks, withdrawal symptoms, discord in relationships, and risky decisions that place oneself or others in harm's way. More than 15 million American adults struggle with this condition, according to the National Institute on Alcohol Abuse and Alcoholism. Like all addictions, alcohol use disorder is inextricably linked to a complex matrix of biological, social, and psychological factors. Research highlights a genetic component to the disease, as about half of one's predisposition to alcoholism can be attributed to his or her genetic makeup. As a psychological malady, people may turn to alcohol to cope with trauma or other co-occurring mental disorders. Socially, alcoholism may be tied to familial dysfunction or a culture embedded with binge drinking. The brain's reward pathways also play an essential role: Alcohol consumption is associated with increased dopamine activity, which corresponds with pleasure, craving, and habit formation.
observations The most frequent medical consequences of alcoholism are central nervous system depression and cirrhosis. The severity of each may be greater in the absence of food intake. Alcoholic patients also may suffer from alcoholic gastritis, peripheral neuropathies, auditory hallucinations, and cardiac problems. Abrupt withdrawal of alcohol in addiction causes weakness, sweating, and hyperreflexia. The severe form of alcohol withdrawal is delirium tremens.

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