Among older patients with alcoholism, from one third to one half develop alcoholism after age 60 years. This group is harder to recognize. A population-based study found that problem drinking (>3 drinks/d) was observed in 9% of older men and in 2% of older women. Alcohol levels are higher in elderly patients for a given amount of alcohol consumed than in younger patients.
As with similar substances with a sedative-hypnotic mechanism, such as barbiturates and benzodiazepines, withdrawal from alcohol dependence can be fatal if it is not properly managed.[55][61] Alcohol's primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. When alcohol consumption is stopped too abruptly, the person's nervous system suffers from uncontrolled synapse firing. This can result in symptoms that include anxiety, life-threatening seizures, delirium tremens, hallucinations, shakes and possible heart failure.[62][63] Other neurotransmitter systems are also involved, especially dopamine, NMDA and glutamate.[25][64]

The same survey showed that AA received 32% of its membership from other members, another 32% from treatment facilities, 30% were self-motivated to attend AA, 12% of its membership from court–ordered attendance, and only 1% of AA members decided to join based on information obtained from the Internet. People taking the survey were allowed to select multiple answers for what motivated them to join AA.[64]

As dependence increases, individuals are more likely to experience health and social consequences. The consumption of alcohol in moderation has health benefits for some (e.g. it reduces the risk of cardiovascular disease in older people). On the other hand, excessive alcohol consumption, especially when it is caused by alcohol dependence, is associated with an increased risk of numerous health problems. These include:

Alcoholism is characterised by an increased tolerance to alcohol–which means that an individual can consume more alcohol–and physical dependence on alcohol, which makes it hard for an individual to control their consumption. The physical dependency caused by alcohol can lead to an affected individual having a very strong urge to drink alcohol. These characteristics play a role decreasing an alcoholic's ability to stop drinking.[25] Alcoholism can have adverse effects on mental health, causing psychiatric disorders and increasing the risk of suicide. A depressed mood is a common symptom of heavy alcohol drinkers.[26][27]


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.

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Dangerous behaviors common among alcoholics include impaired judgment and coordination, falling asleep at the wheel, falling asleep with lit cigarettes, aggressive outbursts, drinking to the point of vomiting, hangover, or alcohol poisoning — and these are just the ones most alcoholics experience in the course of their disease. All of these behaviors will eventually hit the system, in the form of health care costs, criminal justice costs, motor vehicle crash costs, and workplace productivity
In the case of expectant mothers who drink, future healthcare costs double, now including both the mother and child. For example, a child born with fetal alcohol syndrome could require special schooling. Not only is this a personal and unnecessary family tragedy but also it stands to impact the social system financially in the form of healthcare and education for years.
One review of AA warned of detrimental iatrogenic effects of twelve-step philosophy and concluded that AA uses many methods that are also used by cults.[93] A subsequent study concluded, however, that AA's program bore little resemblance to religious cults because the techniques used appeared beneficial.[94] Another study found that the AA program's focus on admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity.[95] A survey of group members, however, found they had a bicultural identity and saw AA's program as a complement to their other national, ethnic, and religious cultures.[96]

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.
It's interesting to read the comments, pro and con about AA and other 12 step programs. Much of which I agree with. What I did not see mentioned is that AA doesn't enter into this debate about how 'successful or effective' their program is; because they aren't selling or promoting anything. Period. AA offers a spiritually based program to help one find a connection with a higher power that many have found helpful in staying sober. Period. All this other chatter and debate is not what AA is about or even pretends to offer. This debate about the success of a program that is a voluntary offering of a chance to live sober is, frankly, ridiculous. It's truly a take it or leave it kind of deal. If the court orders you to go to AA and you feel you're rights are being violated then you might be better served taking that up with the court then blaming AA. There are three facts that are not legitimately debatable: 1) Many people have gone to AA, got sober and remain that way. 2) Many people have gone to AA and decided they didn't want to go back. 3) Addiction will kill some people who are afflicted regardless of the best efforts of the best of us.
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The twelve Step programs are well known for their use in recovering from addictive and dysfunctional behaviors. The first 12 step program began with Alcoholics Anonymous (A.A.) in the 1930s and has since grown to be the most widely used approach in dealing not only with recovery from alcoholism, but also from drug abuse and various other addictive and dysfunctional behaviors.

I'm sober since 1999, with AA and by the grace of my Higher Power. No religion for me. Meetings, sponsor, litterature and 12 steps every day if possible. I live a wonderful life, quiet and stable. My only enemy is my ego. He often try to bring me back to the "Old Me"... but AA, my sponsor, my sponsees and other members are always there to help me. And I'm there for them.
Like many chronic diseases, alcoholism cannot be cured; however, effective treatment is available to help individuals who suffer from alcoholism remain sober. Treatment usually consists primarily of group therapy, one or more types of counseling, and alcohol education. Participants must acknowledge that they have a drinking problem and have a strong desire to stop drinking. Once the decision has been made, they may check into a treatment center for a brief period of time to rehabilitate as they stop drinking. The treatment center (and/or doctor) counsels patients, gives them support, and helps them get through their initial symptoms and safely withdraw from the alcohol. In some cases, short-term medications such as benzodiazepines (Valium or similar drugs) are used to help alleviate some of the symptoms of alcohol dependence.
Is Twelve-Step Recovery an antiquated concept or intervention? Many addiction specialist physicians contend that while the majority of continuing medical education in addiction, aimed at sharing novel breakthroughs and improving practice and outcomes, addresses pharmacotherapies, it is the psychosocial therapies which warrant at least equal attention. Some addiction medicine physicians are concerned that not only do biological interventions predominate in continuing education curriculums, but they dominate graduate medical education in addiction, and some of these physicians are concerned that fellowship training programs in addiction as well as residency programs in primary care, psychiatry, and other medical specialties should include training about and in Twelve Step Facilitation and on Twelve-Step Recovery in order for the physician to have an appropriately well-rounded educational experience and a full skill and knowledge base in the rapidly-growing specialty of addiction medicine.
"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.
Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for AA membership; we are self-supporting through our own contributions. AA is not allied with any sect, denomination, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.
In 1939, High Watch Farm in Kent, Connecticut was founded by Bill Wilson and Marty Mann. Sister Francis who owned the farm tried to gift the spiritual retreat for alcoholics to Alcoholics Anonymous, however citing the sixth tradition Bill W. turned down the gift but agreed to have a separate non-profit board run the facility composed of AA members. Bill Wilson and Marty Mann served on the High Watch board of directors for many years. High Watch was the first and therefore the oldest 12 step based treatment center in the world still operating today.
A chronic, progressive behavioral disorder characterized by a strong urge to consume ethanol and an inability to limit the amount of drinking despite adverse consequences, which may include social or occupational impairment and deterioration of physical health. Both physical dependence (withdrawal symptoms such as nausea, sweating, tremors, and delirium resulting from abstinence) and tolerance (the need to increase alcohol intake to achieve the desired effect) occur.

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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?
Excessive alcohol consumption is correlated with increased risk of stroke, liver disease, and decreased life expectancy. In fact, binge drinking during only the weekends is still enough to damage the liver, studies show, and moderate drinking interferes with sleep quality by interrupting circadian rhythms and REM sleep. However, a number of different treatment options are available to address alcoholic dysfunction.
Diabetes: There is a high risk of developing diabetes type 2, and people with diabetes have a high chance of complications if they regularly consume more alcohol than is recommended. Alcohol prevents the release of glucose from the liver, resulting in hypoglycemia. If a person with diabetes is already using insulin to lower their blood sugar levels, hypoglycemia could have serious consequences.
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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.
Alcoholics Anonymous (AA) is a global organization that was created, and is designed, to help former alcoholics through the process of learning to live their lives without the crutch of alcohol abuse. People who attend AA groups have made the decision to stop drinking and stay sober. Some of them join voluntarily; some attend as a continuation of their therapy; some are required to be there because of a court order. Whatever brings them there, the other members of the group act as a support network, explains the American Journal of Public Health; they share success stories and honest accounts of setbacks, and use this emotional connectedness to inspire and encourage each other to keep going.
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