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Alcohol |
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Alcohol
Abuse
And Dependence
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Moderate alcohol use is
normal, but alcohol abuse or dependence is a serious problem. Too much alcohol affects the
central nervous system and how the brain functions. It affects perception, thinking, and
coordination. It impairs judgment, reduces inhibitions, and increases aggression. Those
who abuse alcohol are more likely than others to engage in high risk, thoughtless, or
violent behaviors.
You are strongly encouraged to seek treatment if you
develop alcohol-related problems. Some employees avoid treatment for fear that if their
alcohol problem becomes known it may affect their security clearance. Actually, it is more
likely to affect your clearance if you allow the problem to continue untreated. If your
problem surfaces solely as a result of self-referral to counseling or a treatment program,
there were no major precipitating factors such as alcohol-related arrests, and you are
making satisfactory progress, your case will normally be handled as a medical problem.
Administrative action concerning security clearance can be deferred pending satisfactory
outcome of treatment.1
Alcoholism is a term commonly
used to describe the medical disorder of alcohol dependence. Many health professionals
prefer more precise language that distinguishes between alcohol dependence and alcohol
abuse.2
Alcohol dependence is an
illness with four main features:
- Physical dependence, with a
characteristic withdrawal syndrome that is relieved by more alcohol (e.g., morning
drinking) or other drugs;
- Physiological tolerance, so
that more and more alcohol is needed to produce the desired effects;
- Difficulty in controlling how
much alcohol is consumed once drinking has begun;
- A craving for alcohol that can
lead to relapse if one tries to abstain.
Alcohol abuse is different
from alcohol dependence. Abusers are not necessarily physically addicted to alcohol, but
develop problems as a result of their alcohol consumption and poor judgment, failure to
understand the risks, or lack of concern about damage to themselves or others. Because
they are not addicted, alcohol abusers remain in control of their behavior and can change
their drinking patterns in response to explanations and warnings. An alcohol abuser
either:
- Persists in habitual drinking
or occasional binge drinking that causes or exacerbates a persistent or recurrent social,
work, financial, legal, or health problem;
- Or uses alcohol repeatedly
under circumstances which are physically dangerous, such as driving while intoxicated.
Many people who abuse alcohol
eventually become alcohol dependent.
The presence of any of the
following indicators suggests that an individual may have a serious alcohol problem or be
at high risk for developing one. Any one indicator is not conclusive evidence of a serious
problem, but it is relevant circumstantial evidence and should be noted.
- Drinking is causing or
exacerbating a persistent or recurring social, work, financial, legal, or health problem.
This is the heart of the alcohol issue.
- Individual has tried
unsuccessfully to cut down the extent of alcohol use. Or, once the person starts drinking,
he/she sometimes loses control over the amount consumed. Both are indicators of alcohol
dependence.
- Individual commonly drinks
while alone. Regular solitary drinking, as compared with social drinking, indicates
potential current or future alcohol dependence.
- Individual drinks to relax prior
to social events, as compared with using alcohol at social events. Drinking
prior to social events indicates potential current or future alcohol problems.
- Individual drinks first thing
in the morning as an "eye-opener" or to get rid of a hangover. This is a strong
indicator of dependence.
- Individual claims a high
tolerance for alcohol, for example, makes statements such as: "I can drink a lot
without its having any effect on me, so I don't have to worry." High tolerance is an
indicator of alcohol dependence -- it takes more and more to have the same effect on the
body.
- Individual uses alcohol as a
means of coping with life's problems. This indicates possible psychological or emotional
problems and greatly increases the likelihood that alcohol already is or will become a
problem. On the other hand, if motivation is experimentation, peer pressure, or adolescent
rebelliousness, this does not necessarily predict future abuse.
- There has been a recent
increase in individual's drinking. A change for the worse in drinking pattern may signal
the existence of other relevant issues.
- There is a family history of
alcohol abuse. Genetic studies indicate that alcoholism tends to run in families and that
a genetic vulnerability to alcoholism exists. The disruption of family life in an
alcoholic home also plays a role in creating vulnerability to alcoholism later in life. On
the other hand, many children react to parental alcoholism by carefully avoiding alcohol
themselves. According to one study, the chances the child will follow in the parent's
footsteps depend, in part, upon which parent is the alcoholic and the nature of the
relationship with that parent. Children of alcoholic mothers are at far greater risk than
children of alcoholic fathers.3
Alcohol problems are often manifested in the
areas of family, health or law enforcement before they affect work-related behaviors. The
problem may be far advanced before symptoms are observable in the workplace.
The most frequently encountered workplace
indicators of alcohol problems include absences, especially on Mondays, and tardiness.
Declines in quality, timeliness, and quantity of work relative to previous levels, as well
as irritability and incidents of emotional disagreement with co-workers and supervisors,
are also noted. Occasionally, an employee's use of alcohol is apparent in the length of
the lunch break and changes in mood observed in the afternoon.
These work-place indicators of possible
alcoholism overlap with the signs and symptoms of other problems, such as clinical
depression. Therefore, it is best to note these troubling workplace behaviors with concern
but reserve speculation about their underlying cause until after consultation with a
professional alcohol counselor.4
Most alcohol abusers and
alcoholics deny they have a problem. As they develop dependence on alcohol, they also
develop "blinders" -- a defense system that allows them to ignore the problem.
They want to blame their problems on something or someone else -- bad luck, a
misunderstanding spouse, a supervisor who doesn't like them, etc.
Recognizing and
accepting that an alcohol problem exists is the first, crucial step toward solving the
problem. If you have an alcohol problem, it is important to keep the following in mind. If
you are concerned about a family member, friend or co-worker who has a problem, share
these thoughts with that person.
- Alcoholism is an illness, not
a moral weakness. Blaming yourself, blaming others, or feeling ashamed about your drinking
are all stumbling blocks to receiving help.
- You are not alone. The
National Institute on Alcohol Abuse and Alcoholism estimates 14 million Americans -- one
of every 13 adults -- either abuse alcohol or are alcoholics. Each year about 600,000
patients enter treatment for alcoholism.
- Don't push away the messengers. People who
worry or complain about your drinking can be a key to your recovery. They care enough
about you to be concerned. If you are an alcoholic, you'll need their support.
- The earlier the treatment, the more successful
it is likely to be. Don't wait until the health effects are irreversible, you have lost
your job, or your marriage has suffered to the point of breaking up.
- Heavy drinking has serious health
consequences. It increases the risk of cancer and causes liver damage, immune system
problems, brain damage and harm to the fetus during pregnancy. It also increases the risk
of accidents and mental problems.6
Alcohol abuse or
dependence is a security concern when:
- It affects an individual's
ability to exercise the care, judgment and discretion necessary to protect classified
information. There have been many cases in which excessive drinking has increased the risk
of accidental, careless or even deliberate disclosure of classified information. For
example, see Ames: Too Many Problems.
- It is part of a pattern of
impulsive, immature, sensation-seeking, hostile, or antisocial behavior. An alcohol
problem is more serious when it is part of a broader pattern of undesirable behavior. It
may indicate an underlying psychological disorder that will cause future problems and
resist treatment. Several studies have found that within the
general population nearly half of all those diagnosed as alcohol abusers
or alcohol dependent also have some form of psychiatric disorder such as
major depression or post-traumatic stress disorder.7
The key security question is
how alcohol use affects a person's judgment and ability to control his/her behavior. How
the person behaves under the influence of alcohol is more important than how much or how
often subject drinks, and even whether or not subject is formally diagnosed as an
alcoholic.
Alcohol abuse or
dependence is a treatable illness, but successful treatment requires the active
participation of the employee, a professional alcohol counselor, the employee's
supervisor, and family members or friends. Treatment may involve one
to four weeks of intense rehabilitation at an outpatient or inpatient treatment facility
following by six to twelve months of "aftercare" consisting of periodic
individual, group, or family counseling. The recovery process typically requires the
employee's regular participation in a community-based self-help group such as Alcoholics
Anonymous.
One key to successful
treatment is admission of the problem and motivation to beat it. Studies of U.S. military
treatment programs show that completion of the full aftercare program is the strongest
predictor of treatment success.8
Relapse is a common
occurrence after all addiction treatment, but the risk of relapse diminishes with the
passage of time and continued abstinence. The first relapse occurs most commonly during
the first three months after completion of treatment. One study of alcohol treatment
outcomes for military personnel found that if one gets through the first three months
without relapse, the chances for long-term abstinence improve dramatically, and the chance
of a relapse that affects work performance is small.9
Remission of drinking
problems without treatment is common as young drinkers mature and the lifestyle, stress,
or other circumstances that prompted the drinking change. The likelihood of spontaneous
remission without treatment is relatively high among young men in their 20s, but
relatively low among men in their 40s or older.10
Your Employee Assistance
Program, family doctor or local alcohol treatment center can provide additional
information on alcohol abuse and treatment options. Extensive information is
also available on the Internet. Search under addiction and recovery,
alcoholism or alcohol abuse and, for a problem with a spouse or family
member, under codependency.
Phone numbers for Alcoholics
Anonymous, alcohol abuse hotlines and alcohol treatment centers are in your local
telephone book.
Your library or bookstore
will have books on this subject, most likely filed under Alcoholism, Substance Abuse,
Recovery or Self-Help. Some recent titles include:
- Sober for Good: New Solutions for Drinking Problems -- Advice from
Those Who Have Succeeded, by Anne M. Fletcher.
Houghton Mifflin, 2002.
- Responsible Drinking: A Moderation Management Approach for Problem
Drinkers, by Frederick Rotgers, Marc F. Kern, Rudy Hoeltzel. New
Harbinger Publications, 2002.
- Alcohol: How to Give It Up
and Be Glad You Did, by Philip Tate. Sharp Press, 1996
- Addictive Thinking:
Understanding Self-Deception, by Abraham J.
Twerski. Hazelden/Rosen, 1997.
Related Topics: Standards of Personal Conduct, Reporting Improper, Unreliable or
Suspicious Behavior.
References
1. Parts of this topic are based on the automated Adjudicative Desk
Reference (ADR), developed by Defense Personnel Security Research Center..
2. American Psychiatric Association, Diagnostic
and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), (Washington, DC:
Author, 1995).
3.
National Institute on Alcohol
Abuse and Alcoholism, Alcohol Alert No. 9, "Children of Alcoholics: Are They
Different?" July 1990. J. McCord, (1988). Identifying developmental paradigms leading
to alcoholism. Journal of Studies of Alcohol, 49, 357-362. E. E. Werner (1986).
Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal
of Studies of Alcohol, 47, 34-40. N. El-Guebaly & D. R. Offord (1979). On being
the offspring of an alcoholic: An update. Alcoholism (NY), 3, 148-157.
4.
This section is based on "A
Manager's Guide to Recognizing and Dealing with Alcohol Abuse and Dependence in the
Workplace," produced by the CIA Employee Assistance Program.
6. National Institute on Alcohol Abuse and Alcoholism (1993). Eighth
Special Report to the U.S. Congress on Alcohol and Health. Washington, DC: U.S.
Department of Health and Human Services, Section III: Consequences of Alcoholism, Alcohol
Use and Abuse.
7.
Petrakis, I.L., Gonzalez, G., Rosenheck, R., & Krystal, J.H.
(2002, November). Comorbidity of Alcoholism and Psychiatric Disorders: An
Overview. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism (NIAAA).
http://www.niaaa.nih.gov/publications/arh26-2/81-89.html
8. L. K. Trent (1995) Predictors of outcome one year after a Navy
residential alcohol treatment program. (Report No. 95-42) San Diego, CA: Naval Health
Research Center. Also C. Wright, D. M. Grodin & P. T. Harig (1990). Occupational
outcome after military treatment for alcoholism. Journal of Occupational Medicine, 32(1),
24-32.
9. C. Wright, D. M. Grodin & P. T. Harig (1990). Occupational outcome
after military treatment for alcoholism. Journal of Occupational Medicine, 32(1),
24-32.
10. J. A. Hermos, J. S. LoCastro, R. J. Glynn, G. R. Bouchard & L. O.
DeLabry (1988). Predictors of reduction and cessation of drinking in community-dwelling
men: Results from the normative aging study. Journal of Studies on Alcohol, 49,
363-368. K. Fillmore & L. Midanik (1984). Chronicity of drinking problems among men: A
longitudinal study. Journal of Studies on Alcohol, 45(3). K. Fillmore (1987).
Women's drinking across the adult life course as compared to men's. British Journal of
Addiction, 82, 801-811.
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