Some people believe that alcoholics are morally, mentally and physically weak. Others believe that alcoholics have a legitimate, science-based disease. Divided opinion belies a basic fact: the majority of alcoholics -- your neighbors and mine -- do not receive the treatment they need.
A recent study funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) began with the premise that much of the information currently available on alcoholics is based on those who enter formal treatment, even though that group makes up a clear minority of alcoholics in society. Or, stated another way, an overwhelming majority of alcoholics in American society do not receive any kind of treatment for their problem. As demonstrated in the October issue of Alcoholism: Clinical & Experimental Research, this means that what is 'known' about alcoholics very likely does not reflect the 'typical' alcoholic in society.
"Prior research has shown that about a quarter of alcoholics have ever received treatment for their illness," said Dr. Eric B. Raimo, Research Fellow in Psychiatry at the University of California in San Diego and at the San Diego Veterans Administration Medical Center. "Conversely, that means about 75 percent have not received any kind of treatment, which includes intensive in-patient treatment, less intensive out-patient rehabilitation, counseling, Alcoholics Anonymous meetings, anything." The study conducted by Raimo and his colleagues, part of a larger six-center Collaborative Study on the Genetics of Alcoholism (COGA), found that about 30 percent of their sample had ever received treatment of any sort for their alcoholism..
"Denial is one of the main reasons why alcoholics do not enter treatment," said Raimo. "They just don't think they have a problem." Yet even for those who can admit to abuse of or dependence on alcohol, opinion is divided on what they should do next.
"People often equate having alcohol abuse or dependence [issues] with needing treatment and I don't think that's a one-to-one equation," said Professor Barbara S. McCrady of the Center of Alcohol Studies at Rutgers University in Piscataway, New Jersey. "A lot of people are able to change their drinking habits and deal with their problems on their own, using their own resources, community resources, family, friends, and so on. I don't think we actually know what proportion of people who have [these problems] would in fact need treatment."
What we do know, based on Raimo's study, is that alcohol-dependent individuals who seek out certain kinds of treatment often have similar characteristics. The researchers looked at three groups: those who had experienced at least one in-patient treatment, those who had received only out-patient treatment or attended AA meetings, and those who had experienced no treatment whatsoever. As noted earlier, a clear majority of alcoholics never receive any treatment. But the characteristics that identify each group are intriguing: the inpatient treatment group, for example, had the highest incidence of what Raimo calls 'general life problems,' which included marital instability, employment problems and health issues. Those who comprised the 'no treatment' group had the lowest incidence of general life problems and the 'outpatient treatment' group was between the two. The 'inpatient treatment' group also had the highest incidence of what Raimo called 'alcohol-related problems,' which included high alcohol consumption, blackouts and legal problems. The 'no treatment' group had the lowest incidence, and the 'outpatient treatment' group was between the two. This pattern continued across nearly all of the alcohol-related problems.
What these findings mean is that studies generated from alcoholics who receive in-patient treatment only may be presenting an overly bleak view of alcohol dependence. Which is not to say that alcoholism is a happy place to be. Alcohol affects virtually every organ system in the body and alters the activity of most major neurochemicals in the brain. People who abuse alcohol are, in essence, destroying their own bodies. According to some studies, 14 to 17 percent of the American population has problems with alcohol abuse, alcohol dependence, or both. Or, as Raimo noted, that means up to one out of every six Americans.
Among those, female alcoholics are of special concern. About one third of alcoholics are female, according to McCrady. Yet Raimo's study, as well as others, found a very low proportion of women ever enter treatment.
"People have suggested that treatment arenas are male oriented and some researchers have certainly found this to be true," said Raimo.
Are women receiving help elsewhere, from family or friends? Likely not, according to McCrady. "We need programs that are women-only, that take into consideration family issues like child-care responsibilities and emotional problems that may exist. There is also a pretty high incidence of sexual abuse and physical trauma among women alcoholics that isn't necessarily addressed by traditional confrontational or mixed-gender programs. We need programs that 'build up,' that enhance self-esteem," she said.
Raimo and his colleagues believe that their research, in conjunction with the continuing COGA study, is trying to "identify potential risk factors for the development of alcoholism." Their goal is to, one day, "actually stop the development of alcoholism."
Co-authors of the Alcoholism: Clinical & Experimental Research paper included: Jean-Bernard Daeppen, M.D. of Unite d'alcoologie in Lausanne, Switzerland; and Tom L. Smith, Ph.D., George P. Danko, Ph.D., and Marc A. Schuckit, M.D. of the Department of Psychiatry, University of California at San Diego and the San Diego Veterans Administration Medical Center. The study was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Veterans Affairs Research Service.