Alcoholics Anonymous became so well-known that Wilson and other early members of the group were invited to a dinner hosted by John D. Rockefeller, Jr., the patriarch of one of the most powerful families in American history. Despite Wilson’s requests, Rockefeller refused to finance AA, believing that the money would only corrupt the noble ambitions of the group. Instead, Rockefeller felt that the organization’s own characteristics – the personal testimonies, the word-of-mouth, and the anonymity – were key to its success and longevity.
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Morgan and his colleagues used data from the National Epidemiological Survey on Alcohol and Related Conditions, xamining the gender-specific prevalence of Axis I (clinical disorders such as depression, schizophrenia, social phobia) and Axis II (personality disorders such as paranoia, antisocial and borderline personality) disorders in 40,374 respondents (23,006 males, 17,368 females) with and without a history of paternal or maternal alcoholism.

Medications also are available that may help a recovering alcoholic avoid returning to drinking. These have been used with variable success; different medications may be more or less successful for different individuals. Disulfiram (Antabuse) is a drug which, when mixed with alcohol, causes unpleasant reactions including nausea, vomiting, diarrhea, and trembling. It was estimated that in 2008, 200,000 recovering alcoholics in the United States were taking disulfiram. Naltrexone (Depade, ReVia) helps to reduce the brain's craving for alcohol. Acamprosate (Campral) works by reducing anxiety and insomnia that often occur when habitual drinkers become abstinent. Drugs alone will not prevent relapse. They are most effective when used in conjunction with a self-help program and/or psychotherapy aimed at changing behavior.
Although all forms of problem drinking are getting worse in the US, not everyone who drinks too much meets the criteria for AUD. The CDC found, in 2014, that 90 percent of those who drink too much alcohol, even frequently, are not physically dependent on the substance to feel normal. Although one in three adults drink to excess, meeting the criteria for heavy or binge drinking, nine out of 10 do not meet the criteria for AUD from the DSM-5.

Another important point about 12 Step programs is their cost and accessibility.  What other chronic lifelong disease has an equally accessible and cost effective (free) intervention?    Like any disease, part of our job as physicians is to recommend effective treatment which our patients can both access and afford.  I'd like for my patients to be able to access and afford all useful modalities of addiction treatment, but here at least is one they can all use.   
Alcohol withdrawal can occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to four or five days later. Signs and symptoms include sweating, rapid heartbeat, hand tremors, problems sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms can be severe enough to impair your ability to function at work or in social situations.
People going through mild withdrawal are monitored to make sure that more severe symptoms do not develop. Medications usually are unnecessary. Treatment of a patient suffering more severe effects of withdrawal may require sedative medications to relieve the discomfort of withdrawal and to avoid the potentially life-threatening complications of high blood pressure, fast heart rate, and seizures. Benzodiazepine drugs may be helpful in those patients experiencing hallucinations. If the patient vomits for an extended period, fluids may need to be given through a vein (intravenously, IV). Thiamine (a vitamin) is often included in the fluids, because thiamine levels are often very low in alcohol-dependent patients, and deficiency of thiamine is responsible for the Wernicke-Korsakoff syndrome.
A genome-wide association study of more than 100,000 human individuals identified variants of the gene KLB, which encodes the transmembrane protein β-Klotho, as highly associated with alcohol consumption. The protein β-Klotho is an essential element in cell surface receptors for hormones involved in modulation of appetites for simple sugars and alcohol.[90]

It’s rare for people with alcoholism to strive for that diagnosis. No one grows up wanting to struggle with alcohol for the rest of life. But alcoholism can be sneaky, creeping into life in ways that are subtle and that can pass by unnoticed. For some, alcoholism begins with peer pressure. These people just don’t intend to start drinking, and they may not begin life even enjoying alcohol, but their peers prompt and poke them to drink alcohol. In time, as they comply with these requests from peers, they lose the ability to control how and when they drink.


While both alcohol abuse and alcoholism are included in the alcohol use disorder diagnosis and involve engaging in maladaptive behaviors in the use of alcohol, abuse of this substance does not include the person having withdrawal symptoms or needing more and more amounts to achieve intoxication (tolerance) unless the person has developed alcoholism.
The risk of developing alcoholism has a definite genetic component. Studies have demonstrated that close relatives of people with alcoholism are more likely to become alcoholics themselves. This risk exists even for children adopted away from their biological families at birth and raised in a non-alcoholic adoptive family with no knowledge of their biological family's alcohol use. However, no specific gene for alcoholism has been found, and environmental factors (e.g., stress) and social factors (e.g., peer behavior) are thought to play a role in whether a person becomes alcohol dependent.
People going through mild withdrawal are monitored to make sure that more severe symptoms do not develop. Medications usually are unnecessary. Treatment of a patient suffering more severe effects of withdrawal may require sedative medications to relieve the discomfort of withdrawal and to avoid the potentially life-threatening complications of high blood pressure, fast heart rate, and seizures. Benzodiazepine drugs may be helpful in those patients experiencing hallucinations. If the patient vomits for an extended period, fluids may need to be given through a vein (intravenously, IV). Thiamine (a vitamin) is often included in the fluids, because thiamine levels are often very low in alcohol-dependent patients, and deficiency of thiamine is responsible for the Wernicke-Korsakoff syndrome.
In collaboration with University of Texas Southwestern (UTSW) psychiatrists, we provide truly integrated care for mental and behavioral health and substance abuse issues. Our expert team is led by Dr. David Atkinson, a full-time psychiatrist who is dually board certified in child adolescent psychiatry and addiction psychiatry. His addiction fellowship training at Mayo Clinic helped him understand the addiction treatment process and its connection to many teens’ mental health issues.
For people in the first stage of alcohol use (having access but not having yet used alcohol), preventive measures are used. Therefore, limiting access to alcohol or other drugs, addressing any risk factors of the alcohol consumer or family, as well as optimal parental supervision for youth and expression regarding expectations are often recommended. The approach to those who have experimented with alcohol should not be minimized by mental health professionals, since infrequent use can progress to the more serious stages of alcohol use if not addressed. Therefore, professionals recommend that the alcohol-consuming individual be thoroughly educated about the effects and risks of alcohol, that fair but firm limits be set on the use of alcohol, and that the user be referred for brief counseling, a self-help group, and/or family support group. People who have progressed to the more advanced stages of alcoholism are typically treated intensively, using a combination of the medical, individual, and familial interventions already described.
Recovery from alcoholism is a life-long process. The potential for relapse remains present and must be acknowledged and respected. Many individuals stop drinking and then relapse multiple times before attaining extended periods of sobriety. Statistics suggest that, among middle-class alcohol-dependent individuals in stable financial and family situations who have undergone treatment, 60% or more successfully stop drinking for at least one year.
Alcohol biomarkers are physiologic indicators of alcohol exposure or ingestion and may reflect the presence of an alcohol use disorder. These biomarkers are not meant to be a substitute for a comprehensive history and physical examination. Indirect alcohol biomarkers, which suggest heavy alcohol use by detecting the toxic effects of alcohol, include the following [4] :
Some people don’t like or are not interested in the 12-Step model, even with the variations above or through organizations that facilitate the 12-Step model. Some people don’t like basing their recovery on the idea that they cannot control their addiction, when there is evidence that there are ways of practicing internal control over the recovery process.
Prior to entering any inpatient or outpatient rehabilitation program for alcohol use disorder, the possibility that the person with this disorder could suffer from physical symptoms of alcohol withdrawal needs to be addressed. People who have a pattern of extensive alcohol abuse are at risk for developing a potentially fatal set of withdrawal symptoms (delirium tremens or DTs) that may include irregular heartbeat, sweating, high fever, shaking/tremors, hallucinations, and even fatal seizures, three days after withdrawal symptoms begin. Those individuals will need to enter a detoxification (detox) program that includes the use of close medical support, monitoring, and prescription of medications like chlordiazepoxide (Librium) or clonazepam (Klonopin) to help prevent and ease the symptoms of alcohol withdrawal.
This is the big one. Many scientific arguments for hereditary alcoholism have been made. In fact, we have an extensive article on the topic, worth the read. While less than 20% of alcohol users actually become alcoholics, there are over 930 genes associated with alcohol use, and there is absolutely a genetic factor in risk for alcoholism. Perhaps the one-fifth of drinkers that do develop a disorder is genetically predisposed somehow. More research must be done to say for sure.

The program’s emphasis on negative feelings of powerlessness and guilt. Continuing in that train of thought, while the idea behind the 12 Steps may have been revolutionary at the time, for many they can feel outdated and even counterproductive. The 12-Step program demands that those in it break themselves down to be built back up, focusing on the notion that you are incapable of taking responsibility not just for your alcoholism but for yourself as well, that there is something wrong with you, and instilling what can feel more like shame than motivation.


AA meetings do not exclude other alcoholics, though some meetings cater to specific demographics such as gender, profession, age, sexual orientation,[44][45] or culture.[46][47] Meetings in the United States are held in a variety of languages including Armenian, English, Farsi, Finnish, French, Japanese, Korean, Russian, and Spanish.[48][45] While AA has pamphlets that suggest meeting formats,[49][50] groups have the autonomy to hold and conduct meetings as they wish "except in matters affecting other groups or AA as a whole".[4] Different cultures affect ritual aspects of meetings, but around the world "many particularities of the AA meeting format can be observed at almost any AA gathering".[51]
To be diagnosed with AUD, individuals must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Under DSM–5, the current version of the DSM, anyone meeting any two of the 11 criteria during the same 12-month period receives a diagnosis of AUD. The severity of AUD—mild, moderate, or severe—is based on the number of criteria met.

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.
Benzodiazepines, while useful in the management of acute alcohol withdrawal, if used long-term can cause a worse outcome in alcoholism. Alcoholics on chronic benzodiazepines have a lower rate of achieving abstinence from alcohol than those not taking benzodiazepines. This class of drugs is commonly prescribed to alcoholics for insomnia or anxiety management.[139] Initiating prescriptions of benzodiazepines or sedative-hypnotics in individuals in recovery has a high rate of relapse with one author reporting more than a quarter of people relapsed after being prescribed sedative-hypnotics. Those who are long-term users of benzodiazepines should not be withdrawn rapidly, as severe anxiety and panic may develop, which are known risk factors for relapse into alcohol abuse. Taper regimes of 6–12 months have been found to be the most successful, with reduced intensity of withdrawal.[140][141]
The User Interface of this free tool wouldn’t let you down either with a file-recovery wizard and an application manual mode available to your disposal which provides color coding (indicating the probability of the recovery of a file) along with the ability to preview files before undeleting them. Recuva’s data recovery solution is definitely a notch above all others and undoubtedly the most complete and reliable free data recovery software available today.

Twelve-step programs approach alcoholism and drug addiction as diseases that can only be managed by surrendering one’s will to a higher power. In spite of their reliance on the disease model of addiction, 12-step groups offer rewarding experiences that reinforce healthy, sober behaviors. In this sense, the 12 steps reflect the principles of positive psychology, notes the Journal of Substance Abuse Treatment. Positive psychology is based on the belief that gratifying experiences will encourage the individual to repeat a healthy behavior, such as attending meetings or reading AA literature, rather than reverting to a self-destructive behavior, such as drinking or using drugs.

Substance abuse A condition characterized by a pathologic pattern of alcohol use causing a serious impairment in social or occupational functioning; also defined as a '…primary, chronic, disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by … distortions in thinking, most notably denial'; alcoholism is characterized by the regular intake of ≥ 75 g/day of alcohol Chronic effects Co-morbidity due to portal HTN, hepatic failure, hyperestrogenemia, infections–especially pneumonia, which may be due to alcohol-induced suppression of various immune defenses, psychosocial disruption, transient hyperparathyroidism with ↓ Ca2+, ↓ Mg2+, osteoporosis. See Blood alcohol levels, Standard drink.


The twelve steps of the program are listed above and on the steps page in generic form. Other groups who have adopted the 12 steps to address their own particular addictive or dysfunctional behavior have similar ideas, usually with only minor variations. These steps are meant to be worked sequentially as a process of getting rid of addictive behaviors and should result in a growth in freedom and happiness, as outlined in the Promises. The general governing approach for A.A. groups was originally laid out in the Twelve Traditions, and they remain the guiding principles for most 12 step groups today.
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