Can Alcoholics Learn to Drink Less?
Among the available tools are medical alcohol deterrents -- from the old-standby Antabuse, to gentler, safer drugs like naltrexone (ReVia) and acamprosate. Already available by prescription in the U.S., naltrexone, which some believe can be used indefinitely as needed, can help curb the urge to drink and reduce alcohol intake. Acamprosate, which is expected to gain FDA approval within the year, can help weaned drinkers maintain abstinence. Unlike Antabuse, neither of these new drugs causes physical illness if taken with alcohol.
When moderation attempts fail, says Max A. Schneider, MD, clinical professor of addiction medicine at the University of California-Irvine College of Medicine, it's likely the person is among the one in 10 drinkers who are especially sensitive to alcohol's brain-altering effects.
"They may not even feel the buzz," he tells WebMD, but the brain alterations that lead to compulsive drinking "are there nonetheless." Each drink brings these individuals a step closer to addiction, he says. Schneider also is immediate past chairman of the board of directors of the National Council on Alcohol and Drug Dependence, and a past president of the American Society of Addiction Medicine.
According to Schneider, the evidence that alcoholism is a disease with genetic elements is overwhelming and undeniable. "Docs who still think [otherwise] are living in the 1950s and don't know what they're talking about," he tells WebMD. "It has nothing to do with willpower, it has to do with brain cells, and what we end up with is a disorder, a brain disease." And for these people, moderation is no more realistic a goal than trying to will oneself taller.
To help doctors and patients identify problem drinking, Schneider suggests asking the following questions, referred to as "C.A.G.E." questions, developed by John Ewing at the University of North Carolina in 1971:
- Have you ever felt that you should Cut down?
- Have you ever felt Angry because people asked about your drinking?
- Have you ever felt Guilty about your drinking?
- Have you ever needed an Eye-opener (another drink or lots of coffee to get you going) in the morning?
If you answer yes to any of these questions, "you should take that as a warning," Schneider says. "If you answer yes to two, you have a problem." The tell-tale signs of alcohol dependence or addiction include:
- a compulsion or craving to drink
- a loss of control over how much and how often you drink
- continued drinking in spite of negative life consequences, such as family trouble or physical illness
"If you lose your ability to control your drinking and your behavior associated with it, then you've got a problem," Schneider tells WebMD. "It's not so much the amount you drink -- it's what it does to you."