Loss of Memory

The cumulative effects of chronic alcoholism result in brain cells that are destroyed, synapses broken, circuits that no longer fire or do so in wrong sequences. A person who drinks heavily over a long period of time may suffer brain deficits that persist long after he or she achieves sobriety. Heavy drinking may have extensive and far-reaching results, ranging from simple memory slips to permanently debilitating conditions that require long-term custodial care.

After heavy drinking – too much in too short a time – a person can experience blackouts, or periods where they can’t remember what they did, said, or thought while they were drinking. Studies of male and female alcoholics also showed significant brain shrinkage, which caused the memory loss as well as learning problems. Other more recent studies have shown that women’s brains may be even more vulnerable to alcohol-induced damage than men’s.

Other studies have shown that alcoholics have deficits in the frontal lobe deficits, which are responsible for many functions associated with memory and learning, and also the cerebellum, which controls coordination and movement.

Difficulty with Learning

Along with memory loss, other cognitive impairment common in alcoholics is difficulty learning. Serious and persistent changes to the brain may be the direct result of alcoholic intake or may indirectly result from poor overall health or severe liver disease. Thiamine deficiency, a nutrient essential to all tissues, including the brain, is common in alcoholics (up to 80 percent have thiamine deficiency). It is caused by poor nutrition.

Many alcoholics with thiamine deficiency develop serious brain disorders, consisting of two separate syndromes. Wernicke syndrome is a short-lived and severe encephalopathy. Its symptoms include mental confusion, eye nerve paralysis, and difficulty with muscle coordination. Up to 90 percent of those with Wernicke syndrome also develop Korsakoff’s psychosis, a chronic and debilitating condition characterized by persistent memory and learning problems.

Poor Judgment and Loss of Inhibition

Excessive alcohol in the brain’s cerebral cortex affects thought processes, leading to the individual having problems with poor judgment. The more alcohol a person consumes, the more they lose their inhibitions. This may result in them becoming overly talkative and/or more confident.

Emotional Effects of Alcoholism

When someone who is an alcoholic is intoxicated, they may resort to crying jags, bouts of hysteria, become angry, physically or verbally abusive. In short, their moods are wildly erratic and unpredictable.

Attempts at abstinence, even for short periods, result in depression and anxiety – often leading the alcoholic to quickly return to drinking. Alcohol blunts or blocks out emotional pain and allows the drinker to tolerate situations he or she may not want to or feels unable to deal with.

In personal relationships, especially in the home, alcoholism causes serious disruption, even irreparable damage. The alcoholic is often regarded by other family members as untrustworthy, unreliable, unworthy of respect. Normal, everyday activities and conversation are impossible around the alcoholic, since a word or a look may be perceived by the drinker as a provocation. Family members tiptoe around the house, afraid to speak, fearful of what may happen next. Violent arguments and physical abuse may occur, further fracturing the family dynamic.

Children of alcoholics often have low self-esteem, suffer from depression, anxiety, and stress, and tend to do worse academically than their peers. In addition to potentially inherited risks for later alcoholism, children of alcoholics, according to studies, may have lifelong coping abilities. As adults, they are at higher risk for divorce and psychiatric symptoms.

Improvement after Abstinence

The good news is that most alcoholics show at least some improvement in brain structure and cognitive functioning within a year of abstinence. Clinicians use a variety of treatment methods to help alcoholics stop drinking and recover from alcohol-induced brain damage. Of course, such treatment must be tailored to the individual. Brain-imaging techniques help clinicians monitor both the course of treatment and its success. Imaging reveals biochemical, structural, and functional changes in patients over time. There are also new medications in place and being developed to help prevent the harmful effects of alcohol and promote the growth of new brain cells to replace those that have been damaged by alcohol.

With effective treatment, follow-up, and a dedication to remaining sober, many alcoholics can go on to live productive and fulfilling lives. Some end-stage alcoholics, however, may not be so fortunate, having lost too much in terms of physical, mental, and emotional deterioration. Still, treatment may offer some amelioration, although it requires going through withdrawal, detoxification, psychological rehabilitation and conditioning to living a healthier lifestyle. This must be coupled with a firm commitment to living sober.

Addiction recovery experts say that the sooner an alcoholic gets treatment, the quicker he or she can be on the road to recovery. The bottom line is that it is never too late to get treatment. Making improvements in the alcoholic’s quality of life – and that of those around him or her – is a goal worth pursuing.
 

For others, however, what started as harmless fun becomes a struggle with addiction. Many college students, who go into their freshman year experimenting with alcohol, but leave their college years with alcohol use disorder, are caught in a difficult addiction to alcohol.

There are many factors that can create a higher risk of developing alcohol use disorder, and one of the main ones is family history. Most research on family history, however, has looked only at the parental alcohol use. A study done in 2008 explored further family impact on drinking behaviors by looking at the density of family history of alcoholism.

The study used information from first-, second-, and third-degree relatives to determine whether family history of alcoholism was a risk for alcohol use disorder when the density of drinking behaviors was examined.

The researchers led by Christy Capone, a postdoctoral research fellow at Brown University’s Center for Alcohol and Addiction studies, recruited 408 undergraduate students from a northeastern university in the United States. The students were asked to take part in an anonymous survey for course credit during the 2005-2006 school year.

The study’s results, published in Alcoholism: Clinical and Experimental Research, showed that the greater number of relatives that an individual had with an alcohol addiction, the greater the potential of risk for developing an alcohol use disorder. This is the first study to examine how density of relatives with an alcohol use disorder can predict risk of developing an alcohol use disorder.

The research is important because identifying those with a dense family history of alcohol use disorder may be very helpful in targeting those with a potentially high risk for developing the disorder. However, Capone believes that intervention must start early: many students begin drinking long before entering the university.

In addition, when a student finds that they have a densely alcohol disordered family; they should be encouraged that it is only their risk of alcohol use disorder that is increased. There is not any guarantee that someone whose family struggles with alcohol use disorder will also develop the disorder. There should be focused attention on the personal choices an individual can make to avoid developing a problem.
 

Lead researcher Lisa Chiodo, Ph.D, and her team performed a long-term cohort study by examining the varying levels of attention in 462 children (231 male and 231 female) born to inner-city women who were known to have specific levels of alcohol consumption per day. The mothers were recruited during their pregnancies at an antenatal university clinic and were assessed on their age and levels of alcohol, nicotine, cocaine, marijuana, and opiate consumption throughout their pregnancies. The researchers specifically analyzed the mothers’ participation in binge drinking by assessing their absolute alcohol ounce intake per day of consumption. Later, when the children of these mothers reached the age of 7, researchers tested the children using the Continuous Performance Test and had their teachers complete the Achenbach Teacher Report Form as well.

When controlling other influential factors in their study, the researchers’ results showed that children of older alcoholic mothers (women age 30 and older) had more alcohol-related attention deficits than the children of younger alcoholic mothers (women age 29 and younger). Children born to older mothers who had a pattern of binge drinking during pregnancy were slower in their response time on their exams, yet still made more errors—an indication of neurobehavioral deficits. The heightened presence of attention problems in these children was the result of brain damage caused by prenatal alcohol exposure combined with the older age of their mothers. Children of older alcoholic mothers had more cognitive-behavioral deficits and physical anomalies than the children born to younger alcoholic mothers.

The researchers concluded that the greater presence of FASD in children born to older drinking mothers is consistent with other related studies. Although further investigation is needed to verify why older alcoholic mothers have more FASD births, the researchers cite that older mothers may have more experience with drinking, may have built up greater tolerances to alcohol’s effects, and/or may have accrued more health problems related to alcohol consumption than younger mothers. All of these potential reasons have the ability to cause higher levels of alcohol in the fetuses of these mothers. Furthermore, researchers mention that other contributing factors such as the mother’s metabolism/composition, body size, and number of pregnancies (all of which relate to maternal age) may also influence the likelihood of prenatal alcohol exposure in the fetus. Additionally, prior studies have found that women tend to consume alcohol with more frequency as they age—perhaps as an effect of greater tolerance or experience. Accordingly in Wayne State University’s latest study, researchers also discovered that the older mothers were more likely to consume alcohol more frequently during their pregnancies than the younger mothers. Whatever the cause of their greater tendency to drink, older alcoholic mothers were putting their fetuses at greater risk of FASD.

The researchers refer to their findings as evidence for specialized intervention and educational programs that target vulnerable women who may become pregnant. Also, more effective therapy and educational programs should be developed for children with FASD that involves repetition of information in a slower, steady format than those designed for children without FASD. FASD can affect any child born to women who engage in prenatal alcohol consumption. However, some women who drink have given birth to children unaffected by alcohol consumption, but this occurrence does not prevent FASD from affecting future pregnancies as the women age or the pregnancies of other drinking women. Clinically, younger children born to alcoholic mothers have higher levels of neurobehavioral and morphologic consequences than their older siblings. This result coincides with the researchers’ findings that children of older drinking mothers are at a heightened risk of FASD.

For more information on FASD, visit the Center for Disease Control and Prevention’s FASD Homepage at www.cdc.gov/ncbddd/fasd/index.html.

In a study published in the latest issue of Archives of General Psychiatry, lead researcher Dr. Kate M. Scott and her team explain that most documented research on the relationship between childhood maltreatment and later psychological disorders in adulthood has been based on retrospective reports on individuals’ familial histories. Usually, this information is considered unreliable for scientific purposes since most cases of child abuse and neglect go unreported and that memories of past events can become distorted overtime. Instead, the researchers at the Department of Psychological Medicine, University of Otago–Wellington in New Zealand performed a cohort study that involved young adults from the general public and any information that had been reported on these participants within the national child protection agency database.

Researchers surveyed 2,144 participants ages 16 to 27 from the New Zealand population to ascertain the prevalence of mood, anxiety, substance abuse, and other behavioral disorders. Of the group, 221 participants (about 10%) had histories of childhood maltreatment reported in the national child protection agency database. Participants were asked to describe psychopathological symptoms experienced within the last 12 months as well as throughout their lifetime.

After considering socioeconomic and demographic factors, researchers found that participants with histories of being involved with child protection agencies were associated with multiple types of mental illnesses–including post-traumatic stress disorder, anxiety disorders, mood disorders, or substance abuse disorders–as well as comorbid disorders or all disorders. These individuals demonstrated a correlation to these disorders for both the 12-month period measure and lifetime measure.

Regarding prevalence of these disorders, an average of 5.12% of participants had post-traumatic stress disorder within the past year, 1.86% had a type of mood disorder within the past year, 2.41% had any type of anxiety disorder, and 1.71% had any type of substance abuse disorder. Those with a recorded history of childhood abuse or neglect were most closely associated with post-traumatic stress disorder and obsessive-compulsive disorder.

When surveyed, 15% of the young adult participants without a history of childhood maltreatment reported in the child protection agency database reported that they had experienced abuse or neglect as a child. After removing these participants from the comparison, the associations to the adulthood psychopathological disorders for individuals with child protection agency histories increased almost tenfold. According to this data, the researchers found that the occurrence of maltreatment–and not just the memory of maltreatment–significantly increases the risk of psychological disorders in adulthood.

Researchers conclude that further mental health interventionist strategies are needed that target both past and present clients of child welfare agencies, in conjunction with the interventions performed to reduce or stop the maltreatment. Also, researchers point out that more prevention and intervention strategies are still needed to help those children who experience maltreatment that go unreported.

Sources: Archives of General Psychiatry, Prospectively Ascertained Child Maltreatment and Its Association with DSM-IV Mental Disorders in Young Adults, July 2010

Science Daily, Abused Children Appear Likely to Have Mental Disorders as Young Adults, July 6, 2010

Basing their research on data from 3,308 older patients accessing primary care clinics around Santa Barbara, California, the authors report that just as many individuals were at risk from alcohol consumption in combination with comorbidities or medication as from alcohol consumption alone.

The study, published in the current online edition of the Journal of General Internal Medicine, also found that at-risk drinking was associated with being younger, white and less educated.

"Compared to the U.S. Census population over age 60, the sample studied was more likely to be white, married, well-educated and high-income," said lead study author Andrew Barnes, a researcher in the UCLA School of Public Health’s department of health services. "However, the adjusted associations of patient demographics with at-risk drinking found in our research should be more generalizable than the descriptive data published previously."

At-risk drinking was assessed using the Comorbidity Alcohol Risk Evaluation Tool (CARET), which categorizes older adults as at risk if they display at least one of the following drinking behaviors: they consume more than two drinks on most days; they consume one to two drinks on most days and have certain comorbidities, such as gout, hepatitis or nausea; they consume one to two drinks on most days and take select medications, such as antidepressants or sedatives.

The specific findings include:

• 34.7 percent (1,147) of older adults were at risk due to drinking alone or to drinking in combination with comorbidities or medications, and 19.5 percent fell into multiple risk categories.

• Of those at risk, 56.1 percent fell into at least two risk categories, and 31 percent fell into all three.

• Participants who had not graduated from high school had 2.5 times the odds of at-risk drinking as those who had completed graduate school.

• Respondents with annual household incomes between $80,000 and $100,000 had 1.5 times the odds of being at-risk as those with incomes under $30,000.

• Respondents who were 80 or older had half the odds of at-risk drinking as those between the ages of 60 and 64.

• Asians had less than half the odds of at-risk drinking as Caucasians.

Risk varied considerably, depending on patient characteristics. For example, a 62-year-old white male respondent who was married and had an annual household income of $90,000 was estimated to have a 57.1 percent adjusted probability of being an at-risk drinker, compared with an 8.1 percent adjusted probability for an 85-year-old Asian female patient who was widowed and had an annual income of $35,000.

The study does have some limitations, the researchers noted. For instance, it relied on patients’ self-reported drinking frequency and quantity, so some participants may have been misclassified. Also, the sample was more likely to be white, married, well-educated and higher income than the over-60 U.S. population as a whole.

"In summary, even among our relatively advantaged study patients, as many as one in three who continued to consume alcohol into older adulthood were at risk of harm from drinking," the researchers wrote. "Physicians may be less aware of other alcohol-related risk factors common among the elderly (e.g., interactions with select medications and comorbidities) than the risks associated with heavy drinking. Information suggesting which patients have the highest likelihood of at-risk drinking may assist physicians to better target patients for further screening and intervention."

The study was conducted through the Geffen School of Medicine’s division of general internal medicine and health services research. Study co-authors are Alison A. Moore, Haiyong Xu, Alfonso Ang, Michelle Mirkin and Susan L. Ettner, all of UCLA, and Louise Tallen of the University of Southern California.

The study was funded by the National Institute on Alcohol Abuse and Alcoholism.

The effects of violence extend into adulthood, even for those victims experiencing abuse by a non-family member. A study by Smith, Elwyn, Ireland, and Thornberry explores how an intimate partner in adolescence can affect drinking behaviors in early adulthood.

Smith et al. examined the impact of adolescent exposure to intimate partner violence on substance abuse in early adulthood. Though it had been theorized that adolescent exposure to intimate partner violence increased the risk of substance abuse problems, the earlier research on the subject had been inconclusive.

The researchers wanted to explore the risk for problem substance abuse in early adulthood and how it is affected by violence with an intimate partner, and whether gender played a role in the results.

The data was gathered using a subsample of the Rochester Youth Development Study, with a total of 508 participants. The study was longitudinal, and was comprised of participants from urban, mostly minority adolescents that were at high risk for antisocial behavior and drug use.

The researchers used logistic regression analyses to determine whether the odds of four indicators of problem substance abuse in early adulthood were predicted by intimate partner violence. The researchers controlled for parental substance abuse, adolescent maltreatment and sociodemographic risk factors.

The results of the study indicate that exposure to severe violence from an intimate partner when the individual is an adolescent greatly increase the risk of alcohol-use problems in early adulthood for females. However, the same results were not found for males.

Neither gender was affected when measures were examined for other substance-use indicators related to the exposure to intimate partner violence.

The findings of the study indicate that females exposed to intimate partner violence may have an increased risk of alcohol use problems in early adulthood. The study’s results show that targeting young women with a history of intimate partner violence may be effective in reducing the number of young women struggling with alcohol abuse.

However, the results of the study show a less significant association between adolescent violence with an intimate partner and early adulthood drinking behavior than was anticipated with the high risk sample that was used.
 

"I had become a functioning alcoholic," said Heather Fanning, a recovering alcoholic.
Fanning says she’s lucky her drinking didn’t kill her or anyone else. "Around my house there would be alcohol stashed every where, and I’d drink when people weren’t watching," said Fanning.

At her worst, Fanning was drinking three shots of vodka, 10 beers, and two glasses of wine every day, all while holding down a job and raising a son.

According to a federal study, the number of women between 30 and 44 who reported abusing alcohol doubled over the past decade. The number of women arrested for DUI is up almost 30 percent.

Psychologist Barbara Kelly says families need to look past the stereotype of the old man on the barstool and look more closely for signs of a functioning alcoholic. Some of the warning signs include always thinking about the next drink, behaving in ways that are uncharacteristic, and having trouble controlling alcohol intake.

"They hide the alcohol in places that they know people wouldn’t typically look for it," said Kelly." Sometimes they hide it in the nursery where their baby sleeps."

Stay-at-home mom Michelle McClennen kept an immaculate home, took care of her two kids, and still managed to juggle daily drinking.

"It was one of these huge goblets that became so in style a few years ago. It was more than half a bottle of wine, but to me I felt like I was having one glass of wine," said McClennen. "So I’d put the roast in the oven and I’d go out into the driveway with my daughter with the glass of wine in my hand."

Her nights out with other moms became her excuse. "We’d go to jewelry making parties to Tupperware parties," said McClennen. "There was also Bunko, a dice rolling game, that’s actually called Drunko, because you definitely drink a lot."

Fanning found help through an inpatient addiction treatment center. Both McClennen and Fanning say that admitting they needed help was the toughest part. "It’s the socially acceptable sleeping giant that nobody’s going to say anything," said McClennen.

Men are twice as likely to die from alcohol as women, and the male death rate has soared from 9.1 per 100,000 people in 1991 to 18.7 per 100,000 in 2008. Separate statistics showed that alcohol was a factor in almost 42,000 cases of children under 18 being admitted to English hospitals in the last three years.

The charity Drinkaware said the figures were "shocking", while the Conservatives said they demonstrated the Labour party’s "complete failure" to tackle binge-drinking.

Rates of alcohol-related deaths in the UK have doubled from 6.7 per 100,000 people in 1992 to 13.6 per 100,000 in 2008, according to an Office for National Statistics (ONS) report.

Between 2007 and 2008 alone, the number of people who died from alcohol abuse increased by 3.5 percent.

Chris Sorek, chief executive of Drinkaware, which is funded by the alcohol industry, said: "It’s shocking to discover that alcohol-related deaths are again on the increase, and it’s vital now, more than ever, that we act to reduce the harms caused by drinking too much. With more and more people dying from alcohol misuse it’s essential we change people’s relationship with drinking, and education has a key role to play."

Shadow health secretary Andrew Lansley said: "These worrying figures are a sad indictment of our broken society and demonstrate Labour’s complete failure to tackle binge-drinking. Labour’s irresponsible decision to roll out 24-hour drinking on our towns and communities while at the same time failing to deal with the problems caused by over-drinking has caused great harm, particularly amongst younger people."

A Department of Health spokesman said: "We are going to be looking closely at the increase in the number of alcohol-related deaths at a time when the amount people are drinking is reducing. No one thing will solve the complex challenge of alcohol abuse, which is why the Government is taking action on all fronts including better information, banning irresponsible promotions (such as women drinking for free) and treatment, advice and support."

What is a High-Functioning Alcoholic?

To function is to be capable of carrying out a specific action or activity, to operate or to work. High-functioning alcoholics, then, are those people who are able to convincingly go through their prescribed roles and carry out their duties – yet who continues to drink alcohol. They are able to maintain relationships with family, friends and colleagues, keep up with their job and home. In essence, they lead a double life: they are outwardly the successful, capable husband, wife, sibling, child or other relative, friend, or coworker, while inside they are alcoholics.

High-functioning alcoholics would never put themselves in the same consideration set as a skid-row drunk. In fact, while both have the same disease, with high-functioning alcoholics (HFAs) the progression is quite a bit different. With their extraordinarily high level of denial, they often find it extremely difficult to admit that they even have a problem with alcohol. Through years of success and achievement – despite drinking – the HFA isn’t looked upon by others as an alcoholic.

In addition, due to the stigma and shame still associated with alcoholism, the HFA would be loathe to admit to others, let alone himself, that he has a problem with alcohol. Such personal denial is also accompanied by denial of others. “He can sure handle his liquor,” some might say. Or, “I’ve never seen her drunk,” might be another comment.

Since they won’t or can’t admit that they are alcoholics, HFAs often remain undiagnosed and slip through the cracks of America’s health care system. They also are likely to be the last to seek treatment for the disease.

Warning Signs and Symptoms of HFAs

Although some of the warning signs and symptoms of HFAs are similar to those of other alcoholics, they often appear at different stages of the progression of alcoholism. Some signs may not be present in all HFAs, or may occur in clusters. One thing is certain: the longer the HFA goes without treatment, the more likely he or she will display some of these warning signs and symptoms.

• In the company of others who drink – The HFA surrounds himself with others who like to drink. This assimilation makes it difficult to pick out the HFA as being different from the rest. Besides, the HFA truly enjoys drinking and being around others with similar likes.

• Obsessing over alcohol – The thought of alcohol is never far from the mind of the HFA. Counting hours until the next drink, mentally savoring the mellowness and pleasure of the impending drink, calculating how much alcohol can be consumed without any outward signs of drunkenness – the HFA obsesses over alcohol.

• Consuming craving – One drink is never enough for the HFA. The lure is too strong, and the craving consumes the HFA until he or she can have the next drink – and the next, and the next. Before long, the HFA has lost control over total alcohol intake – even though he or she still may appear outwardly normal and in control. After all, they are masters of discipline and concealment.

• Alcohol is part of their lives – The HFA would no more give up alcohol than they’d give up their identity. Alcohol is so much a part of their lives that they cannot imagine a life without alcohol.

• Finishing drinks of others – If someone the HFA is with leaves a drink on the bar or the table, the HFA may pick it up and finish it. “Don’t want to let this go to waste,” he may say in a joking manner. Related to this is the example of the HFA downing his own drink when it’s time to leave – to go to the table at the restaurant after waiting at the bar, for example – and then quickly ordering another. If a family member or friend doesn’t touch his or her drink, the HFA often drinks it along with his own.

• Experiencing shame over drunken behavior – Being such masters of concealment, the HFA does often experience remorse and/or shame over instances where their behavior has become sloppy after drinking. Such behavior isn’t part of their carefully crafted images and they consequently work even harder to avoid such mistakes in the future. But they won’t quit drinking.
They’ll just watch their behavior more.

• Self-deluding – Some HFAs drink only expensive wine or liquor in the mistaken belief that this means they’re not an alcoholic. It’s a self-delusion that allows them to continue to drink with impunity.

• Fit life into compartments – Another familiar sign of HFAs is that they are able to conveniently separate their drinking lives from the rest of their existence. Who they are at home, on the job, or to casual acquaintances is totally different from their drinking routine and environment.

• Tried to quit but failed – At some point the HFA may have tried to quit drinking but failed in the attempt. This pattern may often be repeated, but still the HFA refuses to seek treatment. It is part of their personality makeup, their self-constructed identity that they feel they can handle their drinking on their own. Such refusal to get help is difficult to overcome.

• Excuses and rewards – HFAs feel they work hard and deserve a drink as a reward. Drinking, to the HFA, is both an excuse and a reward. The HFA may even use those words in defense of his actions – to himself and to others.

• Hiding and sneaking – When others are going to be around – and watching – the HFA may sneak a drink early, drink before going out, or drink alone. Such secrecy is part of the concealment of the HFA’s true problem. He or she has to get in the drinking, but can’t take the risk of others finding out or suspecting the real problem.

• Emotional and physical consequences don’t matter – Whether minor or severe, emotional and physical consequences of drinking don’t make a difference to the HFA – who will continue to drink, regardless. It’s only when things really spiral out of control that the HFA, or those closest to him, may seek help for the problem.

• Blackouts, memory losses, or worse – At the end of the HFA’s downward spiral – just as with any other alcoholic – blackouts, memory losses, increasing physical, emotional, psychological, social and/or legal problems intensify. It’s at this point that the HFA either gets treatment or continues to deteriorate.

Who are HFAs?

Look around you. High-functioning alcoholics are in every profession and walk of life. They’re not all men, either. Alcoholism strikes men and women equally. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), there are more than 2.5 million female alcoholics, and one-third of women report regular consumption of alcohol.

Another pretty frightening statistic (which is borne out in recent stories of fatal automobile crashes) is that there has been a 28.8 percent increase in the number of women arrested for driving under the influence (DUI) in the past decade. Surprisingly, however, there was a 7.5 percent decrease in the number of males arrested for DUI over the same period.

When you consider that many of these millions of female alcoholics are also mothers, you begin to understand the magnitude of the problem – for the female HFAs as well as their families and others. Stigma and shame for HFA mothers keeps many from getting the treatment they so desperately need.

Risk Factors for Becoming an HFA – or Alcoholic

Research studies show several risk factors contribute to a person becoming an alcoholic, HFA or otherwise. These include, but are not limited to, the following:

• Drinking at an early age, such as before the age of 15

• Family history of alcoholism

• Presence of an underlying mental health disorder or condition (such as anxiety, depression, post-partum depression, etc.)

• History of trauma

• Impulsive personality

• Peer influence

• Other substance abuse (including cigarettes, street or prescription drugs)

How to Approach an HFA about Treatment

Family members or concerned others may try to convince the HFA that treatment is necessary, but they first have to overcome the obstinate denial and resistance from the HFA. Remember, the HFA has been able to go through life hiding their alcoholism. It won’t be easy for them to admit that they have a problem, let alone a problem they can’t resolve themselves.

Recognize the signs and symptoms of an HFA in your loved one? If you do, you’ve gotten past your own denial. It’s often very difficult for those closest to the HFA to see the signs of alcoholism – even when they’ve been present for years. Once you do recognize your loved one is an HFA, what should you do?

Addiction experts say it is important – crucial, even – to let the HFA know how much their drinking behavior hurts you, how it negatively affects you and the family. Never approach them when they have been drinking or are suffering from the aftereffects of a bout of drinking. Wait until they are completely sober and, hopefully, have eaten a nourishing meal. It is also important that the conversation is not defensive. Start by stating how you would like things to be in the family, and emphasize your feelings and concerns. Expect the HFA to deny the problem. You could then talk about how people can function at home and at work and still be alcoholics, that they’re called high-functioning alcoholics. Denial may still – and probably will – occur. Be prepared to show tangible evidence of alcohol-related problems. Such documentation is perhaps the only proof that will convince the HFA that there could be an issue with their drinking that needs addressing. Never put yourself or your children or other family members at risk, however. Avoid confrontation and conflict, as this will not solve the problem.

Intervention may be appropriate, as skilled professionals are often able to chip away at the HFA’s denials and resistance and succeed in getting them into treatment.

You will need resources to do this. Check out the assessment tools, tips on cutting back, treatment referrals and services at the NIAAA site. For example, at-risk or heavy drinking involves consumption of more than 4 drinks per day or 14 per week for men and 3 drinks per day or 7 per week for women. Look through the FAQs for answers to common questions about alcoholism. Professional help to quit drinking may involve medications (naltrexone, acamprosate, and topiramate), alcohol counseling (12-step groups, cognitive-behavioral, motivational enhancement, or a combination), or specialized, intensive treatment programs. On the NIAAA site you can also download the 16-page NIAAA booklet Rethinking Drinking: Alcohol and Your Health.

For an interventionist, review referral information from the Association of Intervention Specialists.

Another helpful resource is the National Institute on Drug Abuse (NIDA).

Also check out the highly-recommended book, Understanding the High-Functioning Alcoholic: Professional Views and Personal Insights, by Sarah Allen Benton, a licensed mental health counselor. Also check out her blogs on Psychology Today and her interview and excerpt from the book on Oprah.com.

Bottom line: don’t give up – on the high-functioning alcoholic. But do encourage them to get the necessary help to overcome their problems with alcohol. Set boundaries and insist on open and honest discussion of the HFA’s situation. Be safe, supportive, and persistent.
 

Researchers, led by scientists at Washington University School of Medicine in St. Louis, studied 6,257 adult twins from Australia. The summary of this study was captured in a recent Science Daily release.

In studying the twins, researchers hoped to determine if early age alcohol consumption would lead to a more heritable form of alcohol dependence as compared to individuals who began drinking later in life. The study findings suggest the younger the individual was at first drink, the greater the risk for alcohol dependence. It also increased the impact the role of genetic factors played.

"There seemed to be a greater genetic influence in those who took their first full drink at a younger age," said first author Arpana Agrawal, Ph.D., in Science Daily. "That’s very consistent with what has been predicted in the literature and in the classification of types of alcohol dependence, but we present a unique test of the hypothesis."

In the process of this study, Agrawal’s team determined that when twins started drinking early, genetic factors had a major impact on their risk for alcohol dependence. The rates soured as high as 90 percent in the youngest drinkers. Those who started drinking later in life were impacted more by environmental factors than genetic factors.

"Something about starting to drink at an early age puts young people at risk for later problems associated with drinking," Agrawal says. "We continue to investigate the mechanisms, but encouraging youth to delay their drinking debut may help."