Recently in Alcoholism Category

Puffy, sweaty, nauseous, headachey, anxious, tired, irritable, incredibly dumb...

Hangovers. Man oh man.

It's an odd way to live - to suffer through self inflicted illness each day for poured pleasure each night.

Near-death experience survivors talk of a renewed appreciation for the simple pleasures in life, and although the act of putting down a bottle is hardly so dramatic, I think I sort of understand what they're going on about. Waking up on a Sunday morning without it being Sunday afternoon is a beautiful thing, and when I remember to think about it - I'm grateful.

Anyway, you'd think that hangovers would be a deterrent to excessive drinking (and for most people they are) but for those of us predestined to be alcoholics, hangovers don't deter didly. I drank every night - knowing full well what I had coming, and I, it seems, was not alone.

No Hangovers for 1 in 4

Some people don't get hangovers. About 23% of people report feeling almost no ill effects even after nights of hard and heavy binge drinking. Thousands of people have been surveyed, from college students to rural folk, and scientists have even mixed drinks in labs just to observe the after effects of intoxication.

The results are pretty clear and pretty consistent - about a quarter of us just don't pay a price.

You would think that people who could drink without experiencing a hangover would be more likely to overindulge. They get all of the fun with none of the pain, but it turns out that it's the opposite, and people who report consistent and heavy hangovers are more likely to be problem drinkers.

Huh?

Researchers speculate that those people who experience tough hangovers may be more prone to "the hair of the dog" solution and a few drinks the day after as a hangover remedy, and as an accelerated path into alcoholism. Researchers also admit that just as they aren't sure why certain people suffer through hangovers and others don't, they aren't entirely sure just what influence hangovers exert on the likelihood of developing an alcohol abuse problem.

More study is needed, they say. I think I'll pass.

A lot of people do things they wouldn't ordinarily do while drunk - and more than a few marriages have ended over the indiscretions of a drunken spouse. There is something magically horrible in alcohol, which makes us feel increased sexual desire, while losing the ordinary good sense to just go home at the end of the night.

But if you're wondering why alcohol makes you so weak - take some solace from the humble fruit fly - alcohol intoxication can actually turn him gay.

It's true, researchers have known that acute alcohol intoxication decreases sexual inhibition in fruit flies, but it turns out that when given repeated doses of alcohol, over a matter of days (designed to replicate the experience of alcohol abuse or alcoholism) male fruit flies, who are normally quite macho, will seek out other males for copulation.

The researchers say that fruit flies are a fairly accurate model for the neurobiological effects of alcohol on mammals, like humans, and research using them can help to explain human alcohol affected sexual behavior.

Do you have a drinking problem? Are you an alcoholic? How can you know, and what do these terms mean anyway? If you go to the doctor, and she says you have cancer – shows you the MRI pictures, and you see a tumor – you believe it, and start thinking almost immediately about how to get better. It's black and white, cut and dry – and for the most, the decision to get treatment is an easy one. Not to belittle the challenge of cancer, but – if only it were that easy for someone with a drinking or drug problem! People diagnosed with cancer can understand their diagnosis, most will accept it as accurate, and most will accept of the need for treatment. People don’t tend to understand the true meaning of terms such as alcoholic, substance abuser or chemically dependant – although they tend to have a misguided idea in their heads about what these things mean. And they won’t tend to believe a doctor, or anyone else, if they are told that they suffer the disease of addiction. The term alcoholic is not a medically accepted diagnosis, yet has wide cultural connotations and understanding. It's a tough and problematic word. People don’t tend to understand it, yet think they do, and since two hallmarks of the disease are delusion and denial – it's all too easy to self-define alcoholism in such a way so that you don’t meet the criteria – no matter how bad your problem becomes. For example You believe that alcoholics are homeless bums – and since you still work, ergo you are not an alcoholic, no matter what drinking is doing to other areas of your life. The addicted mind, as a defense mechanism preserving the drinking, defines alcoholism as whatever you are not. And that tricky addicted mind can shift those definitions as it needs to, always ensuring that your self-definition of "alcoholic" is anything but what you yourself are. So Let's Forget About the Word "Alcoholism" Just for a second, let's forget about the term alcoholism. It is a useful term, and understanding the disease of alcoholism can help you to get better, once on a road to recovery – but if you're still drinking, don’t think you're an alcoholic, but have a small nagging voice inside your head saying there's a problem…lets look at things in a different way. Do You Have a Drinking Problem? People without drinking problems almost never experience problems because of their drinking. If drinking causes you some problems, in any area of your life, yet you still drink – then you have a drinking problem. There - it's as simple as that. If drinking causes you problems, you have a drinking problem. If you have a drinking problem, you should change your behaviors. While drinking, we tend to associate with others that also drink. While drinking heavily, we associate with others that drink heavily – and we use our associates as a way to gauge our own problem. Not a great diagnostic technique, obviously, but it's human nature to peer model, and it's also a great defense mechanism for the addicted mind. It is not normal to get drunk a lot. About half of Americans basically don’t drink at all. Forget about comparing yourself to your friends. It's tempting, but it doesn't offer you any real insight into yourself. Keep it simple. If drinking is causing you any problems, you have a drinking problem. Not sure? Write it down. On a piece of paper, make two columns describing your drinking - one for benefits, and one for costs. Start with the benefits, and in the benefit column, write down anything and everything positive that you can think of about drinking. You might say: It relaxes me I enjoy the taste of…. I enjoy socializing with friends at the bar Whatever, be thorough, and make a full list of everything good that you can think of about drinking. Now – do the same for costs, but this time, do it in a more structured way, and be honest – there is little point in the exercise of you are not being honest with yourself. Firstly, write down how many drinks you have a week. No lying, is it, 20 - 50 - 150? Health Now think about health, and think of any influence your drinking has on your health. Has your drinking affected your weight, your fitness, your heart, your blood pressure, your liver, your energy or your mind? Do you think that if you keep drinking at the level you are drinking now, you will start to experience any health problems? Social/Relationships Has drinking ever caused you personal problems? Has it ever affected your relationship with your spouse, friends, children or family? Has your drinking ever caused you to miss an important social event? Would you like to see your children drink as much as you do? Would your spouse/mom/brother be happier if you drank less? School/Career Has your drinking ever caused you to perform poorly at work or school? Do you go to work with a hangover on a regular basis (more than once a month)? Do you perform as well at work when you are hung-over? Have you ever been noticed for being hung-over or drunk at work? Do you sometimes call in sick to work due to a hang-over? Would you be a better employee if you didn't drink? Have you ever lost a job or been reprimanded due to alcohol? Legal Have you ever had any contact with law enforcement as a result of your drinking? Now Take a Look OK, that's it. Now you should have two columns. What do your columns look like? If you're feeling really brave – have someone that knows you well complete the same "costs" exercise for you. See what problems they think your drinking is causing you. If you are a social drinker, with nothing to worry about – your "costs" column will be empty. If that column aint' empty – you have something to worry about. Drinking should bring only pleasure – if it brings any kind of problem on a regular basis – and you don’t stop drinking, then you have a drinking problem, and you either need to quit on your own, or get some help so that you can. When self-diagnosing the problem, forget about the term alcoholic – and just decide if you have a drinking problem or not – and if you do – think about how much you are willing to sacrifice to keep on drinking.

Nobody walks away from years of heavy drinking unscathed, it always takes its toll; but for some heavy drinkers, a multi decade party ends in tragedy, with Wernickes-Korsakoffs Syndrome…wet brain. Wet Brain Wet brain is a tragic and often fatal syndrome of brain damage caused by years of vitamin B1 deficiency. Most people get all the vitamin B1 they need through a normal diet. Alcoholics, who may eat poorly or have damaged and ill functioning gastro intestinal systems, often do not. And the syndrome is pretty sad, with symptoms of confusion, language deficits, an ill ability to concentrate and social withdrawal just a few of many – and it can and does kill tens of thousands of Americans each year. A simple vitamin deficiency! So anyway, I was talking with my mom about wet brain, and she asked me why they didn’t just fortify beer with vitamin B1. And I had no idea. Why didn’t they? There must be some reason though right? It just seems too obvious a solution to such tragedy. So anyway, a quick peek online confirmed a couple of things. Firstly, that my mom is a pretty smart cookie, and secondly that the AMA has been recommending just such a fortification, and studies have shown that it would work. An Australian study, where researchers actually did fortify beer showed that alcoholics drinking this B1 beer showed cognitive improvements, couldn’t taste the difference, and that the vitamins could be added to beer for about 20 cents per 6000 bottles! Currently, brewers cannot legally add vitamins to beer, and some have argued that by offering vitamin enriched alcohol, some people might assume that drinking was less dangerous than it is. But hey, legislation is changeable, especially when it makes sense - when it saves lives, and I don’t think adding vitamin fortification to the small print on a case of beer is gonna' be convincing anyone to drink more than they do now. But there has got to be something else, right? I mean it can’t be this easy can it… So for now, if you drink too much, make sure you take a B12 supplement, it could save your life - and maybe one day, one day soon, that just won’t be necessary, and you'll get all you need in a few "well balanced" beers a day.

At the end of the day – whether or not a person wants to drink too much, or use drugs, is pretty much a personal decision – right? It's their body, it's their life – it's their decision. Maybe – it's certainly something that a concerned family may hear when attempting to convince an addict to get help. It's certainly something someone trapped in the self-delusion of the disease might spout – and even believe. But is it true? If you drink alone, hermit like in a remote cabin, never seeing another soul - then OK, it's your business. You hurt no one but yourself, and it's no one's business but yours. So alcoholic hermits aside… If you drink to a stupor each night in front of your family, in front of your kids – even if you do no immediate wrongs – you model something terrible. Do you have the right? Does it become the family's business at that point? If your substance use prevents you from getting or keeping a job, from providing for yourself and your family – do those that would subsidize your existence have the right to tell you what you can and cannot put in your body? We live together, as family, as a community, and our actions and choices affect those around us. Those that drink or drug heavily impact the rest of us, whether painfully in the family, or through social costs in the community. We have the right to demand change – it is our business, it's everyone's business. We don’t have the right to demand impossible change though. Addiction is a disease, entrenched and enduring, and you can't just will it away. We can demand change in the family, we can demand change in the community, but first, we must provide a means for change. We, as a society, can say that alcoholic drinking is unacceptable. It does harm to more than just the individual, and we are not going to stand for it anymore. We can divert some of the ludicrous quantities of money going into our prison system (we now incarcerate 1 in 100) and build 1000 new treatment centers – and we can make people use them. If we can put someone in jail for the possession of a small quantity of crack – why can't we save through enforced healthcare those that would abuse even legal drugs, such as alcohol? It would save money in the long run – it would save lives right away. Sure it's an ethical minefield, and committing people to hospitals does sound a bit scary – a bit too "One Flew Over the Cuckoos Nest" for comfort. It wouldn't be easy. But we could do it and maybe we should.

There's a small voice nagging inside the heads of most alcoholics, it's the voice of addiction, and it tells us what we need to hear to keep on pouring in the booze.

• It tells us (in whatever words we like to hear) that alcohol isn’t the problem, the job-wife-neighbors-whatever are the problem, and that good old alcohol is the only real solution.
• It tells us that we don’t have a problem we can’t handle, and if we wanted to quit we could, and that maybe we will someday, but not quite yet, anyway.
• It also reminds us that until we shoot down stiff drink or two, we're just not that interesting. Alcohol, it tells us, makes us funnier, better looking – just plain-old more fun to be around.

Of course, it doesn't, none of this is true - but that's what we believe. Maybe it did help to some degree once. Maybe a couple of drinks at that party loosened us up enough to relax, to crack a few jokes, to flirt shamelessly – to be the center of attention. Maybe it did, once, have some effects we liked. But we cling to these memories as if they were fact, all the while not noticing that now, we're not funny…we're sloppy. Not noticing that now the only people that really enjoy spending time with us when we're loaded – are just as loaded as we are, and somehow overlooking what alcohol has been doing to our appearance. I quit drinking, and now, for the most part, I cringe to remember the ass I made of myself, on so so many occasions. I can tell you that a lot of those people observing the spectacle that was me weren't thinking about how debonair and charming I was! Oddly, it wasn't till after I quit drinking that I made this realization. If you’re an alcoholic, you would be funnier, better company, and surely better looking if you stopped. That voice inside your head – it's lying.

While far from perfect, and only to be used as a part of a more comprehensive drug treatment program, acamprosate or a combination of acamprosate and naltrexone offers some protection against relapse through a reduction in experienced cravings, and a reduction in withdrawal symptoms during the first few months of sobriety.

There are few things as poorly understood as the remarkable complexity of the human brain, and addiction as a function of the brain is only very minimally understood at the neuronal level. Thankfully continuing research initiatives continue to uncover ever increasing pieces of this complicated puzzle, but for now, existing pharmacological interventions for addictions recovery remain imperfect.

Three of the most commonly used medications in the treatment of alcohol addiction, are disulfiram, naltrexone, and the newest medication, acamprosate.

Disulfiram works by making recovering alcoholics very ill if they consume alcohol concurrently with the medication, and naltrexone works by reducing the pleasurable rewards of drinking. Acamprosate works by stabilizing brain activity altered by abuse, and reducing the compulsions to abuse.

Acamprosate has its mechanism of action within the GABA neurotransmitter systems of the brain, and it is this damaged GABA system that results in dangerous tremors or convulsions during acute alcohol withdrawal, and also seems to continue to influence cravings to abuse. Alcohol is a natural GABA inhibitor and acamprosate also inhibits the neurotransmitter, allowing brain activity levels to stabilize naturally and slowly over time, with less experienced discomfort, or cravings back to abuse.

Acamprosate is no magic solution, and a significant percentage of people treated with acamprosate during the initial months of alcohol recovery will relapse back to drinking, but it does work significantly better than nothing, and some research indicates that when the drugs acamprosate and naltrexone are combined, the greatest possible efficacy is achieved.

Acamprosate can reduce some of the anxiety associated with the initial period of abstinence, and also seems to help people sleep better during initial recovery, which is important as insomnia during initial recovery is a significant predictor of relapse and further abuse. Acamprosate also seems to diminish the strength of cravings, at least in the very initial few months of recovery; allowing recovering alcoholics enough time of sobriety to regulate brain activity naturally, and develop natural motivations and strategies to continued relapse avoidance.

Acamprosate also gives addictions professionals another drug in the arsenal against relapse, particularly for alcoholics suffering liver damage, as since it is not significantly metabolized in the liver; it is safe even for cirrhotic patients.

The drug seems to be very well tolerated, and side effects most commonly experienced are headache or nausea. The drug is not intended to be used as a stand alone treatment to alcoholism, but as a part of a comprehensive drug treatment program, including significant psychosocial and behavioral components.

This is a prescription medication, and there some people who cannot take it. As with any prescription drug, you should only take the medication on a doctor's advice, and under professional care and supervision.

Although acamprosate doesn’t cure alcoholism, it does offer some efficacy during the very tough initial few months of sobriety, and can make those few months just a little more comfortable for people suffering from a legacy of addiction, and resultant brain deficits. The risks of use seem very low when compared with the possible benefits; and when acamprosate is combined therapeutically with naltrexone, it seems to offer significant protection against relapse.

Alcoholism is a serious, stubborn and lasting disease, and while acamprosate certainly won't cure it; anything that helps to improve the odds of recovery is to my mind a very good thing. If you are struggling with sobriety, speak with your doctor about the risks and benefits of adding acamprosate, or acamprosate and naltrexone, to your medication regimen.

We need to use everything at our disposal to give people the best chance of beating addictions, and living better lives of sobriety.

Women are at a greater risk to develop addictions, to succumb to acute alcohol poisoning, and to develop a host of physical and mental deficits. Women are more likely to die from cirrhosis, and more likely to get certain cancers and more likely to experience alcohol induced cardiac disease. All people abusing alcohol need treatment help, but women abusers seem especially needy of timely intervention and treatment.

It's well known that because of a reduced body weight and a reduced volume of water in the body to dilute the concentration of alcohol, women get drunk quicker than men, and are more at risk for the acute effects of binge drinking, including the risk of fatal overdose; but the dangers to women drinkers a not only acute in nature, and alcoholic women are at greater risk for a number of health disorders than are alcoholic men.

Heavy drinking women are more susceptible to developing addictions, and they also seem predisposed to start feeling the negative effects of chronic alcohol abuse faster than men.

A greater percentage of alcoholic women than alcoholic men will develop often fatal cirrhosis of the liver, and women are also more at risk for malnutrition, anemia and high blood pressure, particularly during very heavy drinking. Women alcoholics also suffer more cardiac damage than do men with equivalent drinking histories.

Women alcoholics suffer proportionally more brain damage and memory loss as a result of drinking behaviors as well, and a recent study comparing men and women with similar histories and durations of use saw women exhibit 11% more "brain shrinkage" (a sign of brain cell death) than men.

Heavy drinking greatly increases the gastro intestinal cancer risk in both men and women, but alcoholic women also suffer a hugely elevated risk for breast cancer; and Women who drink heavily are almost 50% more likely to get breast cancer.

The likelihood of developing alcohol related problems increases later in life, and more women develop drinking problems in late adulthood than do men, at a time when they are a greatest risk to suffer the consequences of their dependency.

Alcohol is physically devastating to all, but women are unfairly susceptible to some of its most dangerous effects; and any woman struggling with alcohol use and dependency needs to consider professional treatment help to lessen the risks of a great many serious and possibly fatal disorders.

Our sisters our mothers and our friends need and deserve intervention and treatment, and because each continuing day of abuse increases the risks of so many serious or even lethal disorders, intervention needs to occur as soon as is possible.

Seems sort of like the Holy Grail to many of us. We drink at a level that causes us (and those around us) real problems; and we watch with envy how others seem to be able to enjoy the pleasures of alcohol without feeling the pains. Could we learn to be like them?!? Firstly, we, most of us anyways, like to drink. That's why we got into trouble in the first place. Few of us quit drinking because we all of a sudden stopped enjoying feeling high - we stopped (or are thinking about stopping) because the negatives associated with our drinking have escalated to a point that makes continuing to drink heavily a very bad idea. But what if we could somehow learn to drink in moderation? Learn how to stop after a drink or two, drink only in social situations, and never again need to experience serious problems from our use. For many of us, this would be ideal. I have just finished reading Dr. Michael S. Levy's (Cambridge Medical & Harvard Medical School) book "Control Your Drinking and You Might Not Need to Quit". Dr. Levy is a clinical psychologist with more than 20 years of clinical experience counseling people with alcohol problems, and a pioneer in the field of moderation for substance abusers. A very interesting book…and a book that rang very true with me. I am not one of those people that can achieve stable moderate drinking. I know this, and I have no desire to change a course away from the abstinence that has been working so well for me. Substance abuse and addiction remains somewhat poorly understood. We do not yet have all the answers, and although terms like alcoholism do seem to have a basis in fact, they remain somewhat abstract, and it can be tough to diagnose someone with certainty as an alcoholic. Alcoholics, so the story goes, can never learn to drink moderately, and the only course for them is to abstain for life. Alcoholics can rarely quit on their own, we are also told. Problematically, research shows that many people who would almost certainly be classified as "alcoholics" tend to do both of those things, and in fairly large numbers as well. More people with drinking problems quit on their own without any outside help than by any other method, and a lot of these people who have managed to quit drinking, and often for many years, do manage later in life to drink with moderation, and keep it in moderation. Alcoholism is clearly not a one size fits all moniker for the problem (and problems caused) by drinking too much. Also problematic is that the vast majority of those people classified as alcohol abusers or alcohol addicts never get any help for their drinking, and many never change their ways. There are of course many reasons why someone might choose not to get help or make an effort at quitting, but when alcoholics are polled, the single biggest reason for not stopping is simply not being ready to give up alcohol! People like drinking, and it can be hard for a lot of people to even imagine a life without drinking, forever. Moderate Drinking – The Advantages Moderate drinking, as a therapeutic solution to alcohol abuse and alcohol addiction, is not going to work for everyone. Some people, with lengthy histories of abuse, with severe addictions, or with co-occurring mental health challenges or very weak social support, are unlikely going to have much luck with anything other than abstinence. But it doesn’t matter! Firstly, beginning a program of moderate and controlled drinking sure sounds a lot more inviting and a whole lot less scary than beginning that long journey of abstinence. Many people, who might not consider quitting completely, may find the idea of learning how to drink responsibly very attractive, and if having a more flexible approach to the problem gets more people thinking about and working on their drinking, this is surely a very positive thing. Secondly, there is real value in even trying to adhere to a structured program of moderate drinking (the key word is structured…more later) and value even in failing at it. Those people who make an honest and structured attempt to limit their alcohol consumption, and fail, have at least begun a journey towards recovery, and gained self awareness about what they need to do, no doubt about it, if they want their lives to get better. How does it work? For moderate drinking to work, it has to be very structured. Informally just trying to drink less will not work. There is a distinction made between a social drinker, and a moderate drinker. A social drinker does not have an issue with alcohol, and doesn't need to think about it much - it's just never a problem. A moderate drinker is not a social drinker. A moderate drinker does have to work at it, and although the goal is to mimic the ways a social drinker might drink, it has to be conscious, controlled and planned. Here are the steps of the program as outlined by Dr. Levy. The point is to take a shot at this thing, and it might just work. It's quite important to stick to the plan absolutely. No bending of the rules, ever, and if you can't seem to do this, moderate drinking is not going to work for you. 1…Think about the problems alcohol is causing in your life, and think about how your life will improve if you didn't have a problem with alcohol. Write these things down – be thorough and be honest. 2…Take a couple of weeks off from alcohol, completely. 3…Draw up a contract for your moderate drinking. The rules are: *Never more than 3 drinks (2 drinks for women) per day. *Never drink more than 4 days per week. What days will they be? *Never drink in situations that you know are problematic for you…better to avoid these situations completely. You need to plan exactly what situations you will allow yourself to drink in, and what situations you won't. If you tend to drink too much watching sports on TV, you cannot allow yourself to drink at all in these situations. *Never drink a form of alcohol that you have a problem with. If you're a whiskey drinker, switch to wine or beer, it will make things easier. 4…Follow your contract to the letter for at least three months. If you can't, and find yourselves consistently breaking or even bending the rules, moderate drinking is not going to work, and over time, you will be back where you started. 5…After a few months, you may be able to make some small changes, but only small increases, and you must always stick to the rules. 6…A drinking contract is forever. You will never again be able to drink healthily, without thought and planning. Moderate Drinking Can Work – Sometimes For some people, people serious about making a change and willing to work at moderate drinking as the most important thing in life…it works. Some people, even those people able to follow the plan, find the whole thing so stressful and miserable, that abstinence is surely the better choice. Now, if you are already sober, and happy, and it's working, YOU WOULD BE CRAZY to read this and think about beginning a program of moderate drinking. Don’t risk your hard earned sobriety for the few pleasures found in a bottle. If you are reading this, and think that although you need to make a change and that your drinking is getting out of control, you just can’t consider giving up alcohol entirely; maybe moderate drinking is a good place to start your road to recovery. We're all different, what works for one won’t work for another, and there are no clear and universal solutions to the societal and personal tragedies of alcoholism and addiction. Drinking less is better than drinking more. It might work for you.

There are four drugs currently FDA approved for the treatment of alcoholism, and of those four, naltrexone and acamprosate are the most commonly prescribed. A recent multi disciplinary study sponsored by the National Institute on Alcoholism and Addiction, The COMBINE study, has shown that naltrexone does influence a small but still significant betterment in relapse rates, but acamprosate was ineffective. But researchers out of the Yale University School of Medicine say that such a gross understanding of the effectiveness of the drugs is actually misleading, and to truly use these drugs effectively, we need to have a better understanding of how well they work on distinct subgroups of alcoholics. In controlled laboratory studies, the Yale researchers examined the comparative effectiveness of Naltrexone on two distinct subgroups of alcoholics, those with a family history of the disease, and those without a genetic background of alcoholism. The drinking levels of the two groups were compared on a number of different dosage strength of naltrexone. It works for some…a disaster for others The researchers were pleased to see that naltrexone did have significant betterment effect on the hereditary alcoholics, and the higher the dose given, the less these alcoholics drank. Contrarily, the drug did not work for those without a family history of alcoholism, and when given in higher does, these alcoholics even drank more! The study leaders conclude that naltrexone may have more value than limited success rates calculated from large field trials may indicate, and with a better understanding of the effects of the drug on different sub groups of alcoholics, the drug may be prescribed in a more targeted and more effective manner. More research is clearly needed Hopefully, as researchers gain a broader understanding of the different manifestations of subgroups of alcoholic use, treatments in general will evolve to better match the needs of the individual alcoholics. The results of the study indicate a promising role for naltrexone, and it's obviously very beneficial to know that when prescribed to non hereditary alcoholics, it seems to worsen the problem! The study further indicates how powerfully influential the genetic component to alcoholism is, and although still poorly understood, many of the secrets to effective treatments may well emerge as scientists better understand the genetic predisposition to alcohol abuse and alcoholism.