Alcohol Abuse and Dependence

Topic Overview

Is this topic for you?

This topic is about alcohol abuse and dependence in adults. For information about alcohol problems in teens or children, see the topic Teen Alcohol and Drug Abuse. For information about drug abuse in adults, see the topic Drug Abuse and Dependence.

What are alcohol abuse and alcohol dependence?

Alcohol abuse means having unhealthy or dangerous drinking habits, such as drinking every day or drinking too much at a time. Alcohol abuse can harm your relationships, cause you to miss work, and lead to legal problems such as driving while drunk (intoxicated). When you abuse alcohol, you continue to drink even though you know your drinking is causing problems.

If you continue to abuse alcohol, it can lead to alcohol dependence. Alcohol dependence is also called alcoholism. You are physically or mentally addicted to alcohol. You have a strong need, or craving, to drink. You feel like you must drink just to get by.

You might be dependent on alcohol if you have three or more of the following problems in a year:

• You cannot quit drinking or control how much you drink.
• You need to drink more to get the same effect.
• You have withdrawal symptoms when you stop drinking. These include feeling sick to your stomach, sweating, shakiness, and anxiety.
• You spend a lot of time drinking and recovering from drinking, or you have given up other activities so you can drink.
• You have tried to quit drinking or to cut back the amount you drink but haven't been able to.
• You continue to drink even though it harms your relationships and causes you to develop physical problems.

Alcoholism is a long-term (chronic) disease. It's not a weakness or a lack of willpower. Like many other diseases, it has a course that can be predicted, has known symptoms, and is influenced by your genes and your life situation.

How much drinking is too much?

Alcohol is part of many people's lives and may have a place in cultural and family traditions. It can sometimes be hard to know when you begin to drink too much.

You are at risk of drinking too much and should talk to your doctor if you are:¹

• A woman who has more than 3 drinks at one time or more than 7 drinks a week. A standard drink is 1 can of beer, 1 glass of wine, or 1 mixed drink.
• A man who has more than 4 drinks at one time or more than 14 drinks a week.

If you think you might have a drinking problem, take a short quiz to check your symptoms:

Interactive Tool: Do You Have a Drinking Problem?

What are some signs of alcohol abuse or dependence?

Certain behaviors may mean that you're having trouble with alcohol. These include:

• Drinking in the morning, being drunk often for long periods of time, or drinking alone.
• Changing what you drink, such as switching from beer to wine because you think it will help you drink less or keep you from getting drunk.
• Feeling guilty after drinking.
• Making excuses for your drinking or doing things to hide your drinking, such as buying alcohol at different stores.
• Not remembering what you did while you were drinking (blackouts).
• Worrying that you won't get enough alcohol for an evening or weekend.

How are alcohol problems diagnosed?

Alcohol problems may be diagnosed at a routine doctor visit or when you see your doctor for another problem. If a partner or friend thinks you have an alcohol problem, he or she may urge you to see your doctor.

Your doctor will ask questions about your symptoms and past health, and he or she will do a physical exam and sometimes a mental health assessment. The mental health assessment checks to see whether you may have a mental health problem, such as depression.

Your doctor also may ask questions or do tests to look for health problems linked to alcohol, such as cirrhosis.

How are they treated?

Treatment depends on how bad your alcohol problem is. Some people are able to cut back to a moderate level of drinking with help from a counselor. People who are addicted to alcohol may need medical treatment and may need to stay in a hospital or treatment center.

Your doctor may decide you need detoxification, or detox, before you start treatment. Detox flushes out the alcohol in your body. You need detox when you are physically addicted to alcohol. When you go through detox, you may need medicine to help with withdrawal symptoms.

After detox, you focus on staying alcohol-free, or sober. Most people receive some type of therapy, such as group counseling. You also may need medicine to help you stay sober.

When you are sober, you've taken the first step toward recovery. To gain full recovery, you need to take steps to improve other areas of your life, such as learning to deal with work and family. This makes it easier to stay sober.

You will likely need support to stay sober and in recovery. This can include counseling and support groups like Alcoholics Anonymous. Recovery is a long-term process, not something you can achieve in a few weeks.

Treatment doesn't focus on alcohol use alone. It addresses other parts of your life, like your relationships, work, medical problems, and living situation. Treatment and recovery support you in making positive changes so you can live without alcohol.

What can you do if you or another person has a problem with alcohol?

If you feel you have an alcohol problem, get help. Even if you are successful in other areas of your life, visit a doctor or go to a self-help group. The earlier you get help, the easier it will be to cut back or quit.

Helping someone with an alcohol problem is hard. If you're covering for the person, you need to stop. For example, don't make excuses for the person when he or she misses work.

You may be able to help by talking to the person about what his or her drinking does to you and others. Talk to the person in private, when the person is not using drugs or alcohol and when you are both calm. If the person agrees to get help, call for an appointment right away. Don't wait.

Health Tools

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	Alcohol problems: Helping someone get treatment
	Alcohol problems: How to stop drinking
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	Interactive Tool: Do You Have a Drinking Problem?

Frequently Asked Questions

Cause

It's not clear why some people abuse alcohol or become addicted to it and others do not. Alcoholism often runs in families (genetic), but your drinking habits also are influenced by your environment and life situations, such as friends or stress levels.

Just because you have a family history of alcohol problems doesn't mean you'll have a drinking problem. A child of a parent with alcoholism will not always develop alcoholism. And a person with no family history of alcoholism can become alcohol-dependent. See the What Increases Your Risk section for more information.

Symptoms

You might not realize that you have a drinking problem. You might not drink every day, or you might not drink large amounts when you drink. You might go for days or weeks between drinking episodes. You might say you're a "social drinker."

But even if you don't drink very often, it's still possible to be abusing alcohol and to be at risk for becoming addicted to it.

Symptoms of alcohol abuse in children and teens sometimes are different from adult symptoms. For more information, see the topic Teen Alcohol and Drug Abuse.

Signs of alcohol abuse

Watch for the following signs of alcohol abuse:

• You have problems at work or school because of your drinking. These may include being late or absent, being injured at work, and not doing your job or schoolwork as well as you can.
• You drink in dangerous situations, such as before or while driving a car.
• You have blackouts. This means that after a drinking episode you cannot remember what happened while you were drinking.
• You have legal problems because of your drinking, such as being arrested for harming someone or driving while drunk (intoxicated).
• You get hurt or you hurt someone else when you are drinking.
• You continue to drink despite health problems that are caused or made worse by alcohol use, such as liver disease (cirrhosis).
• Your friends or family members are worried about your drinking.

Signs of alcohol dependence or addiction

Watch for the following signs of alcohol dependence or addiction:

• You cannot quit drinking or control how much you drink. You drink more often than you want to, or you drink larger amounts than you want to.
• You need to drink more to get the same effect.
• You have withdrawal symptoms when you stop drinking. These include feeling sick to your stomach, sweating, shakiness, and anxiety.
• You spend a lot of time drinking and recovering from drinking, or you have given up other activities so you can drink.
• You have tried unsuccessfully to quit drinking or to cut back the amount you drink.
• You continue to drink even though it harms your relationships and causes you to develop physical problems.

Other signs of possible trouble with alcohol include the following:

• You drink in the morning, are drunk often for long periods of time, or drink alone.
• You change what you drink, such as switching from beer to wine because you think that doing this will help you drink less or keep you from getting drunk.
• You feel guilty after drinking.
• You make excuses for your drinking or do things to hide your drinking, such as buying alcohol at different stores.
• You worry that you won't get enough alcohol for an evening or weekend.
• You have physical signs of alcohol dependence, such as weight loss, a sore or upset stomach (gastritis), or redness of the nose and cheeks.

If you think you might have a drinking problem, take a short quiz to check your symptoms:

Interactive Tool: Do You Have a Drinking Problem?

Symptoms of withdrawal

If you are dependent on alcohol and you stop drinking, you may have withdrawal symptoms. Common withdrawal symptoms include feeling sick to your stomach and vomiting, sweating, nervousness, and shaking.

Withdrawal symptoms usually don't occur until about 24 hours after you stop drinking. Symptoms are at their worst about 3 days after you stop drinking.

What Happens

Alcohol abuse or dependence can develop very quickly or happen gradually over years.

In the beginning, your drinking might not seem to be any different from the way other people drink. You may drink only with friends or at parties. It may stay like this, or you may begin to drink more. Your drinking might become a way for you to feel normal or to cope with life's problems.

You might think that you can quit drinking at any time. Many people who have alcohol problems quit for days, weeks, or even months before they start drinking again. But unless you can consistently keep your drinking under control and not fall back into unhealthy patterns, you need help.

Almost half of all people with drinking problems also have mental health problems such as depression, bipolar disorder, panic disorder, or anxiety disorders.² When you have a drinking problem and a mental health problem, it's called a dual diagnosis.

Drinking makes symptoms of mental health problems worse. It's very important to treat all mental health problems. You may drink less when mental health problems are treated.

Complications

Long-term heavy drinking harms your liver, nervous system, heart, and brain. It can cause health problems or make them worse. These problems include:

• Cirrhosis or pancreatitis.
• High blood pressure.
• Osteoporosis.
• Certain types of cancer, including breast cancer.
• Stroke.
• Gallstones.
• Wernicke-Korsakoff syndrome.

Alcohol abuse also can contribute to stomach problems, interactions between medicines and alcohol, and sexual problems. It can lead to violence, accidents, social isolation, and problems at work, school, or home. You also may have legal problems, such as traffic tickets or accidents, as a result of drinking.

Drinking alcohol can cause unique problems for teens, older adults, pregnant women, and people with other health conditions. If you are pregnant, you should not drink any alcohol, because it may harm your baby.

What Increases Your Risk

People don't drink to become alcoholic. And many people drink alcohol throughout their lives without a problem. Why do some people abuse alcohol and become dependent on it, while others don't?

Certain things make an alcohol problem more likely. These are called risk factors.

Risk factors you can't change include:^{3, 4}

• Genes . People with alcohol problems often have a family history of alcohol abuse and dependence.
• Gender. A man is 3 times more likely to develop problems with alcohol than a woman is.
• Early use. The younger you were when you first started drinking alcohol, the higher your risk is for developing alcohol problems later as an adult.

Risk factors you can change include:^{3, 4}

• Mental health. If you have mental health problems, such as depression, bipolar disorder, schizophrenia, or anxiety disorders, you are more likely to use alcohol. It's common to use alcohol to ease the pain of these conditions.⁵
• Use of other substances. You are more likely to abuse alcohol if you abuse other things, such as tobacco, illegal drugs, or prescription medicines.
• Environment. If you live in an area where alcohol is easy to get, people drink a lot, or heavy drinking is accepted as part of life, you are more likely to drink.
• Friends. Your friends may influence you to drink by directly urging you to or by drinking when you're around them.
• Problems with others. You may be more likely to drink when you are having problems in your family or with friends.
• Not having purpose or satisfaction in your life. If you have no activities that give you a sense of purpose, you may be more likely to drink. A satisfying job or schoolwork or volunteer activities can give your life purpose and meaning.

Just because you have risk factors for alcohol problems doesn't mean you'll have a drinking problem. A person with many risk factors won't always develop alcoholism. And a person with no risk factors can become dependent on alcohol.

When to Call a Doctor

Call 911 or other emergency services if you or someone else:

• Has the symptoms of alcohol poisoning. These can include vomiting, coughing up blood, gasping for breath, passing out, and seizures.
• Has a history of heavy drinking and is having severe withdrawal symptoms but is not willing to get treatment.
• Has delirium tremens (DTs), which can lead to death. Symptoms can include seizure, shaking, a fast heartbeat, and seeing or hearing things that aren't there (hallucinations).
• Is thinking or talking about suicide or harming others. For more information, see the warning signs of suicide.

Call a doctor right away if you or someone you care about:

• Has withdrawal symptoms, such as confusion and trembling.
• Agrees to be seen for possible treatment. You need to call right away because people who agree to get help often don't follow through with making the appointment.
• Has stopped drinking but starts drinking again (has a relapse).
• Has severe stomach pain.

Call a doctor if you or someone you care about has an alcohol problem or signs of one. Signs include:

• Having to drink more to get the same effect or having withdrawal symptoms when drinking stops.
• Refusing to admit to an alcohol problem or being too sick to seek help.
• Having blackouts, which means not remembering what happened during a drinking episode.
• Continuing to drink alcohol despite having poor health.
• Not being able to take care of everyday duties because of drinking alcohol.

Watchful Waiting

Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next.

Watchful waiting is not a good choice for alcohol abuse and dependence. If you have alcohol problems, or if you believe that your health or other areas of your life are being affected by drinking alcohol, you need to take steps to cut back on or quit drinking.

Watchful waiting also is not a good choice if you or other people are being hurt by another person's drinking. It's important to seek help for yourself and other people, even if the person who is drinking doesn't seek treatment. Early treatment for all people affected by drinking makes recovery more likely.

If you have concerns about your drinking or the drinking of someone you care about, talk to your doctor.

Who to See

Health professionals who can diagnose and treat symptoms of withdrawal from alcohol and provide support during recovery include:

• Family medicine doctors.
• General practitioners.
• Nurse practitioners.
• Physician assistants.
• Internists.
• Psychiatrists.

After withdrawal symptoms have been treated, health professionals who can provide support during recovery include:

• Psychiatrists and other doctors who specialize in addiction medicine.
• Psychologists.
• Licensed mental health counselors.
• Social workers.

Some health professionals might have chemical dependency certification (CDC) or be certified alcoholism counselors (CAC).

Support groups can also help you and your family with alcohol problems:

• Alcoholics Anonymous (AA) or similar support groups are for people with alcohol abuse or dependence.
• Al-Anon or Alateen (for teenagers) is for families and friends affected by someone's drinking.

Exams and Tests

Alcohol use problems may be diagnosed during a routine doctor visit or when you see your doctor for another problem. If your partner or a friend thinks you have an alcohol problem, he or she may urge you to see your doctor.

Your doctor will ask about your medical history and do a physical exam. He or she also may ask questions or do tests to look for health problems linked to alcohol problems, such as cirrhosis. Many people don't go to a doctor for alcohol problems but for problems that result from long-term alcohol use.

If you think you or someone you care about might have a drinking problem, use this short quiz to check for symptoms:

Interactive Tool: Do You Have a Drinking Problem?

Drinking and mental health problems

People who drink also may have mental health problems. These may include depression, anxiety disorders, or post-traumatic stress disorder (PTSD). If your doctor thinks this may be true for you, he or she may do a mental health assessment.

If you have a drinking problem and a mental health problem, it's called a dual diagnosis. A dual diagnosis can make treatment for an alcohol problem harder. If you don't get treatment, one problem can make the other one worse. If you treat only one problem, treatment may not work well. When you treat both problems, you have a better chance for a full recovery and less chance of drinking again.

Treatment Overview

Treatment for alcohol abuse and dependence usually includes group therapy, one or more types of counseling, and alcohol education. You also may need medicine. A 12-step program often is part of treatment and continues after treatment ends.

Treatment doesn't just deal with alcohol. It will help you manage problems in your daily life so you don't have to depend on alcohol. You'll learn good reasons to quit drinking.

Treatment helps you overcome dependence, but it doesn't happen all at once. Recovery from alcohol abuse or dependence-staying sober-is a lifelong process that takes commitment and effort. You may be in group therapy or counseling for a year or more.

Recovery helps you stay sober and adjust to life without alcohol. It helps you avoid a relapse, which happens when you slip up and drink again. Most people relapse, so it's best to accept it and move on.

Your family and friends are affected by your treatment. They can benefit from education, family therapy, and Al-Anon or other self-help support groups.

Can you quit on your own?

If you are abusing alcohol and not dependent on it, you may be able to cut back or quit on your own. But most people need help when they quit drinking.

If you want to quit, talk to your doctor. If your doctor thinks you can quit on your own, he or she can help you find support and give you medicine that will help you safely withdraw from alcohol. Your doctor also may prescribe medicines to help you stay sober. When you get a doctor's help, treatment for alcohol abuse or dependence is safer, less painful, and quicker.

Alcohol problems: How to stop drinking

If you can't stop drinking alcohol on your own, a treatment program can help you get through the first cravings for alcohol and learn how to stay sober.

Getting started

You might start treatment with your family doctor, or your doctor may recommend that you enter a treatment facility. A friend may bring you to a self-help group, such as Alcoholics Anonymous, or you might go to a clinic that deals with alcohol abuse. You may just decide you drink too much and want to cut back or quit on your own.

You may have a treatment team to help you. This team may include a psychologist or psychiatrist, counselors, doctors, social workers, nurses, and a case manager. A case manager helps plan and manage your treatment.

When you first seek treatment, you may be asked questions about your drinking, health problems, work, and living situation. Be open and honest to get the best treatment possible. Your treatment team may write a treatment plan, which includes your treatment goals and ways to reach those goals. This helps you stay on track.

Do you need detox?

Detoxification, or detox, flushes alcohol out of your body. You may need detox before you start treatment if you are physically addicted to alcohol. This means that when you stop drinking, you have physical withdrawal symptoms, such as feeling sick to your stomach or intense anxiety.

Detox helps get you ready for treatment. It doesn't help you with the mental, social, and behavior changes you have to make to get and stay sober.

Whether you need detox and whether you can go through it at home or need to go to a clinic or other facility depends on how severe your withdrawal symptoms are. Most people don't need to stay at a clinic but do need to check in with a doctor or other health professional. Whether you need to spend time in a clinic (called inpatient care) also depends on other problems you may have, such as a mental health problem.

Your doctor may give you medicines to help reduce withdrawal symptoms. These include:

• Antianxiety medicines (such as diazepam), which treat withdrawal symptoms such as delirium tremens (DTs).
• Seizure medicines, which are used to reduce or stop severe withdrawal symptoms during detox.

What's the best treatment program for you?

Treatment programs can be outpatient, inpatient, or residential. They offer similar therapies, but how long they last and your level of medical care may vary. Your doctor can help you decide which type of program is best for you.

• In outpatient treatment, you regularly go to a mental health clinic, counselor's office, hospital clinic, or local health department for treatment.
• In inpatient treatment, you stay at a facility and have therapies during the day or evening. This usually lasts 1 to 6 weeks. You most likely will then go to outpatient therapy.
• Residential treatment provides a place for you to live while you recover. This may be a good option if you have a long history of alcohol or drug use, have a bad home situation, or don't have social support. These programs may last for months.

If you are thinking about going into a treatment program, here are some questions to ask.

What does a treatment program include?

Treatment programs usually include counseling, such as:

• Individual and group therapy, where you talk about your recovery with a counselor or with other people who are trying to quit. You can get support from others who have struggled with alcohol.
• Cognitive-behavioral therapy (CBT), where you learn to change thoughts and actions that make you more likely to use alcohol. A counselor teaches you ways to deal with cravings and avoid going back to alcohol.
• Motivational interviewing (MI), where you resolve mixed feelings about quitting and getting treatment. A counselor helps you find personal motivation to change.
• Motivational enhancement therapy (MET), which uses motivational interviewing to help you find motivation to quit. It usually lasts for two to four sessions.
• Brief intervention therapy, which provides feedback, advice, and goal-setting.
• Couples and family therapy, which can help you become and stay sober and keep good relationships within your family.

A treatment program may include medicines that can help keep you sober during recovery. These include:

• Disulfiram (Antabuse), which makes you sick to your stomach when you drink.
• Naltrexone (ReVia, Vivitrol), which interferes with the pleasure you get from drinking. ReVia is a pill you take every day. Vivitrol is a once-a-month injection used to treat alcohol dependence.
• Acamprosate (Campral), which may reduce your craving for alcohol.
• Topiramate (Topamax), which is a medicine used to treat seizures. One recent study shows that it might also help treat alcohol problems.⁶ Experts are studying how this medicine, and medicines like it, might help with recovery from alcohol abuse and addiction.

Most programs provide education about alcohol abuse and dependence. Understanding alcohol problems can help you and your family know how to overcome them. Some programs also offer job or career training.

Treatment programs often include going to a support group, such as Alcoholics Anonymous (AA). Your family members also might want to attend a support group such as Al-Anon or Alateen.

What to think about

Alcohol abuse can cause your body to become low in certain vitamins and minerals, especially thiamine (vitamin B1). You might need to take thiamine supplements to improve your nutrition during recovery. Thiamine helps prevent Wernicke-Korsakoff syndrome, which causes brain damage.⁷

You also might need supplements to help replace fluids and electrolytes.

Acupuncture has been used to treat some people with alcohol problems. Although acupuncture might be helpful for some people, there is no scientific proof that it is effective for alcohol problems.

People with alcohol problems often have other special considerations:

• If you have an alcohol problem and a mental health problem, such as depression, you will need treatment for both problems. Doctors call this a dual diagnosis.
• Older adults may have alcohol problems, and alcohol generally affects them more strongly than younger adults.
• Alcohol abuse in the military can interfere with military readiness.
• Some people are sent to alcohol treatment because of a court decision. This may happen if you have an alcohol problem and you commit a crime. A court may require treatment and keep track of your progress. Treatment often is available in prison.

Medications

Medicines can be used to help treat alcohol abuse and dependence. Some medicines reduce withdrawal symptoms during detoxification. Other medicines help you stay sober during the long process of recovery.

Medication Choices

Medicines most often used to treat withdrawal symptoms during detoxification include:

• Antianxiety medicines (benzodiazepines such as diazepam), which treat withdrawal symptoms such as delirium tremens (DTs).
• Seizure medicines to reduce or stop severe withdrawal symptoms during detoxification.

Medicines used to help you stay sober include:

• Disulfiram (Antabuse), which reduces the pleasure alcohol produces and makes you sick to your stomach when you drink.
• Naltrexone (ReVia, Vivitrol), which interferes with the pleasure you get from drinking. Vivitrol is a once-a-month injection used to treat alcohol dependence.
• Acamprosate (Campral), which may reduce your craving for alcohol.
• Topiramate (Topamax), a medicine used to treat seizures. One recent study shows that it also might help treat alcohol problems.⁶ Experts are studying how this medicine, and medicines like it, might help with recovery from alcohol abuse and addiction.

What to Think About

Alcohol abuse can cause your body to become low in certain vitamins and minerals, especially thiamine (vitamin B1). You might need to take thiamine supplements to improve your nutrition during recovery. Thiamine helps prevent Wernicke-Korsakoff syndrome, which causes brain damage.⁷

You also might need supplements to help replace fluids and electrolytes.

The U.S. Food and Drug Administration (FDA) has issued an advisory about injectable forms of naltrexone. You may have a skin reaction at the injection site, the place where the shot is given. Call your doctor if you notice any skin change at the injection site, such as swelling, tenderness, redness, or pain, that does not improve or gets worse within 2 weeks.

Recovery

Recovery from alcohol abuse or dependence means finding a way to stay sober while changing your attitudes and behaviors. You will work to restore relationships with your family and friends and people at your job or school. You will need to find meaning and happiness in a healthy lifestyle that doesn't include alcohol.

Recovery is not a cure. It is a lifelong process. It begins in treatment, but it doesn't end when your treatment ends. There are 10 principles of recovery (What is a PDF document?) that can help you reach your goals and learn new things to help yourself. They help you gain self-confidence and respect for yourself. They make clear that you're in charge of your recovery. How far you go is up to you.

To stay sober after treatment, focus on your goals. Find things to do, such as sports or volunteer work. Learn how to say no to alcohol and drugs.

Support

An important part of recovery is being sure you have support. You can:

• Develop and use social support and support groups. Support comes in many forms. You can find it in seminars and groups led by professionals, 12-step groups made up of others with drinking problems, and your relationships with family and friends. You can make support groups more helpful by being an active member.
• Connect with family and friends. They can help you stop drinking and stay sober by encouraging positive steps. For them to do this, you have to be honest with them about your problems and help them by trying.
• Take part in recovery group activities. You may have used alcohol to make friends or be with a social group. Your counselor or doctor can help you learn skills to make friends without drinking. For example, your counselor may help you find a social skills training class.
• Find a sponsor and work with this person. A sponsor is someone who has been in recovery for a long time and helps you stay alcohol-free.

Lapse and relapse

Stopping alcohol use is very hard. It's not unusual to have setbacks, even years later. Very few people succeed the first time they try. Many people who are trying to recover from alcohol addiction will have lapses or relapses along the way.

• A lapse is the first time you use alcohol again after you have quit or brief episodes of alcohol use at later points.
• A relapse is not being able to stay sober over time. It can occur if you have a series of lapses close together or a lapse that leads to heavier alcohol use over a longer period.

A lapse or relapse doesn't mean you or your treatment has failed. It may mean that you just slipped up. If this is true for you, accept the mistake and move on. Try to find out why you relapsed and make changes in your life so that it won't happen again. You also may need more treatment or another type of treatment or more time in support groups such as Alcoholics Anonymous.

A relapse is most likely to occur in the first few months after you stop drinking. It's smart to plan for a relapse before it happens. Your doctor, family, and friends can help you do this.

Coping with stress

Some people find that relieving stress helps them during recovery. Although there is little research to show that managing stress helps you stay sober, you may find that it helps you feel better overall.

Here are some things you can try:

• Write. Expressing yourself in writing can be a good way to reduce your stress level.
• Share your feelings. Talking, laughing, crying, and expressing anger are normal parts of the emotional healing process and help relieve stress.
• Do something you enjoy. A hobby or other healthy leisure activity can help you relax. Volunteer work or work that helps others also can be a powerful stress-buster and help you stay sober.
• Relax physically. This includes breathing exercises, massage, aromatherapy, yoga, and traditional Chinese relaxation exercises, such as tai chi and qi gong.
• Relax mentally. This includes imagery exercises, listening to relaxing music, self-hypnosis, meditation, and humor.

For more information on stress reduction, see the topic Stress Management.

A healthy lifestyle

When you abuse or are dependent on alcohol, you often get away from some of the basics of good health. Part of recovery is finding your way back to a healthy lifestyle.

• Exercise and be active. This may give you something to do instead of thinking about alcohol, and it also can help reduce stress. People who are fit usually have less anxiety, depression, and stress than people who aren't active.⁸
• Get enough sleep.
• Eat a balanced diet. This helps your body deal with tension and stress. Whole grains, dairy products, fruits, vegetables, and protein are part of a balanced diet.

Family and Community

Alcohol abuse or dependence can harm your relationships with family and friends. You and your family may feel you have turned against each other. You may be angry at your family and friends, and they may be angry at you.

If you can, talk with your family and friends about your drinking problem and recovery. Your family and friends need to know that they did not cause your alcohol problem, but they can help you during recovery.

• Try to be open and honest with loved ones about your drinking. This will help them understand what you're going through and how they can help. Many treatment programs offer counseling for families to help you solve problems at home.
• Talk about what may cause a relapse and your relapse plan.

For family and friends: Encourage treatment

It can be very hard to live with a family member who has a drinking problem. It's best not to try to control, excuse, or cover up the person's drinking. Instead, encourage your family member to seek treatment. You may be able to do this by:

• No longer making excuses, such as covering up for missed work or missed activities with children. Don't lie or stretch the truth to help the person.
• Finding a good time to talk to the person. Say clearly how the person's drinking is harming you and that you will take action if he or she doesn't seek help. For example, you could say that alcohol use is causing money problems and that you will cancel credit cards if it continues. Be prepared to follow through.
• Being ready and able to help when a decision is made to get treatment.

Alcohol problems: Helping someone get treatment

For family and friends: Help with treatment and recovery

If someone close to you has had a drinking problem, you know how hard it can be. You know how living or dealing with someone who abuses or is dependent on alcohol can change and even destroy your life.

Once the choice for treatment has been made, you play an important part. You can help your loved one stop drinking and help repair the damage done to your family or relationship. Here are some things you can do:

• If you drink, decide if you want to keep alcohol in the house or not. Having alcohol in your home might make it harder for your loved one to stay sober.
• Be involved and patient. Attend recovery meetings with your loved one and be supportive. Know that it may take a long time for you to trust and forgive the person and for the person to forgive himself or herself.
• Be aware that your loved one may seem like a different person once he or she is sober. You may find it hard to get used to this person. You may need to rebuild your relationship.
• Understand that you have the right to know how recovery is going, but ask about it in a respectful way.
• Help your loved one plan for a relapse. Most people relapse after treatment. This doesn't mean the treatment failed. Try to help your loved one see relapse as a chance to do better and keep working on skills to avoid drinking.
• Focus on the positive actions your loved one is making.

For family and friends: Take care of yourself

Taking care of yourself while you help your loved one is important. You probably will feel relief and happiness when the person decides to get help. But treatment and recovery mean changes in your life too. Your emotions may become more complicated. You may:

• Resent what the person did to you in the past.
• Not trust the person. You may not want to give the person the house key, the car key, or money. You also may feel guilty about not trusting the person.
• Find it hard to give up or share your family role. For example, if you took over child-rearing when your partner was drinking, you may resent him or her becoming involved again. If you managed money, you may resent having to make shared decisions on how to spend money.
• Resent that the person is spending more time at meetings or with others in recovery than with you.
• Worry so much about relapse that you avoid anything you feel may upset the person. You also may resent this feeling.

These feelings are normal. You've been through a bad period of your life, and what happened is not easy to forget. Nor is it easy to forgive the person. Keep in mind that recovery is the road to a better life and that you can help your loved one get there.

Find your own support. Al-Anon and similar programs are for people with family members or friends with alcohol problems. Other support groups are specially designed for certain age groups, such as Alateen for teens and Alatot for younger children.

These programs help you recover from the effects of being around someone who abused or was dependent on alcohol. You also may try family therapy.

Other Places To Get Help

Organizations

Related Information

• Alcohol Effects on a Fetus
• Bipolar Disorder
• Cirrhosis
• Depression
• Drug Abuse and Dependence
• Early Disease Detection
• Panic Attacks and Panic Disorder
• Peptic Ulcer Disease
• Social Anxiety Disorder
• Stress Management
• Teen Alcohol and Drug Abuse

References

Citations

1. National Institute on Alcohol Abuse and Alcoholism (2005, revised 2007). Helping Patients Who Drink Too Much: A Clinician's Guide (NIH Publication No. 07-3769). Washington, DC: National Institutes of Health. Also available online: http://www.niaaa.nih.gov/guide.

2. O'Connor PG (2005). Alcohol abuse and dependency. In DC Dale, DD Federman, eds., ACP Medicine, section 13, chap. 3. New York: WebMD.

3. Grant BF, Dawson DA (1997). Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: Results from a longitudinal alcohol epidemiologic survey. Journal of Substance Abuse, 9: 103-110.

4. Schuckit MA (2005). Alcohol-related disorders section of Substance-related disorders. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed, vol. 1, pp. 1168-1188. Philadelphia: Lippincott Williams and Wilkins.

5. Shivani R, et al. (2002). Alcoholism and psychiatric disorders. Alcohol Research and Health, 26(2): 90-98.

6. Johnson BA, et al. (2003). Oral topiramate for the treatment of alcohol dependence: A randomised, controlled trial. Lancet, 361(9370): 1677-1685.

7. Sadock BJ, Sadock VA (2003). Alcohol-related disorders section of Substance-related disorders. In Kaplan and Sadock's Synopsis of Psychiatry, 9th ed., pp. 395-413. Philadelphia: Lippincott Williams and Wilkins.

8. Buchner DM (2008). Physical activity. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 23rd ed., pp. 64-67. Philadelphia: Saunders.

Other Works Consulted

• Schuckit MA, et al. (2001). Five-year clinical course associated with DSM-IV alcohol abuse or dependence in a large group of men and women. American Journal of Psychiatry, 158(7): 1084-1090.

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