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What Is Alcoholism?
Dr. Nancy Snyderman Chats With Alcohol-Abuse Experts

ABCNEWS.com
June 7 How is alcoholism defined? What can people suffering from it, and their loved ones, do? And how are alcoholics, family members, and children affected by the condition?
     Is there a difference between alcohol abuse and alcoholism? Are there new treatments available to help alcohol abusers? These and other questions are still debated among the medical community.
     Following her appearance on a special edition of 20/20 tonight, ABCNEWS medical correspondent Dr. Nancy Snyderman joined ABCNEWS.com readers for a live chat with psychologist Marc Kern, director of Addiction Alternatives in Los Angeles, and John Schwarzlose, president of the Betty Ford Center at Eisenhower.
     Below is a transcript of the chat.
Moderator
Welcome to our conversation on alcohol abuse and alcoholism. Now joining us are Dr. Nancy Snyderman, Marc Kern, and John Schwarzlose.
Dr. Nancy Snyderman
I would like to thank everyone for joining our chat tonight and joining myself and our two experts. What a wonderful follow-up.
Marc Kern
Thanks, everyone, for coming to our chat.
John Schwarzlose
I'm very happy to be part of the chat and to answer questions you may have.
Toby says:
What is meant by alcoholism?
Dr. Nancy Snyderman
I think that is a question I would love to hear defined by our two experts.
John Schwarzlose
Unfortunately, Dr. Snyderman made the comment that alcoholism is not a medical condition it is. It has been identified as a disease. Alcoholism is a chronic disease characterized by compulsive use of alcohol, and continued use.
Marc Kern
I do not know what alcoholism means. I'm not sure exactly what the term means, I consider that a lay term.
Lisa says:
Is alcoholism a disease?
Dr. Nancy Snyderman
I guess that if I were to answer for the two experts, one would say yes and one would say no. Is that correct?
Marc Kern
No, I would not say that is correct. I see it having biological and neurological components, but I don't think the term "disease" accurately (describes it).
Harry says:
Is alcoholism inherited?
Dr. Nancy Snyderman
The research done for this program certainly indicates there was a genetic component, but the science is not yet complete, which leaves the door open for environmental factors also.
John Schwarzlose
I agree with Dr. Snyderman, except that most experts in the field do not feel there is a genetic component. I would agree with Dr. Snyderman.
Marc Kern
I definitely would believe there are genetic propensities that are inherited and that neurological changes... there are medications to help detox someone from alcohol to withdraw, if necessary. One medication is Antibuse, which is a drug which can be prescribed and if a person drinks, (he) can have a very adverse reaction.
Dr. Nancy Snyderman
The future is promising for medications that may address brain chemistry.
Marc Kern
While I am very familiar with the medications that we spoke about in development, none of these drugs are for medication for alcoholism. They may prevent the alcoholic from drinking, they may reduce their craving, but it doesn't remedy the phenomenon that we are discussing, called alcoholism. They are not drugs for alcoholism.
Frank says:
Does a person have to be alcoholic to experience problems from alcohol?
Dr. Nancy Snyderman
My answer would be no. What do my experts think?
Marc Kern
No.
John Schwarzlose
My answer would also be no. It was addressed in the show, that more people fall into the criteria for problem drinkers than meet the criteria for alcoholism.
Krammy says:
If I have trouble with drinking, can't I simply reduce my alcohol use without stopping altogether?
Marc Kern
Well, yes, absolutely! That is the safest, surest way of never having alcohol again.
John Schwarzlose
I really agree that if someone is not addicted to alcohol, they would have a choice of cutting back, or cutting it out altogether but they still have that choice.
Ing says:
What is the "craving brain"?
Dr. Nancy Snyderman
I came away from doing this story with the understanding that not everyone buys into the theory of the craving brain. In fact, not every alcoholic falls into that. I would love to hear from the experts.
Marc Kern
I generally don't utilize that conceptualization. I do believe that all humans seek out altered states of consciousness, such as roller coasters. I believe people seeking (this) out of alcohol relies more in the relief, or satisfaction, or joy, rather than a biological pull to drink alcohol.
John Schwarzlose
I do not believe that all alcoholics, or even a majority of alcoholics, fall in love after their first drink. What research does tell us is once a person becomes addicted to alcohol or any other drug, there is a change in their brain chemistry.
jbar says:
I've heard of SMART Recovery. What are some other available programs? Do interventions work?
Marc Kern
There was a limitation I saw within the show. It lies in the idea that there are many other roads to recovery, including alternative nationally-based self-help groups such as SMART Recovery, which stands for Self Management And Recovery Training, or SOS, or Women for Sobriety, or Rational Recovery, or Moderation Management.
John Schwarzlose
I'd like to respond to the point about intervention. Our experience with both formal and informal interventions are that men and women who go to group intervention do just as well.
garth1 says:
How long has Addiction Alternatives existed, and (has it) been tested?
Marc Kern
My addiction clinic has been operating for 25 years now. The ideas behind alternative methods for recovery stem back to the beginning of time. There are clinics all over the world that do this type of stuff.
sober24299 says:
If alcoholics can modify their behavior and "control" their consumption, does it follow that heroin addicts or other drug-dependent individuals can also learn how to "use" in moderation?
Marc Kern
This is a loaded question! I believe that truly, someone who has lost control over alcohol should NOT drink to begin with. The truth is similar in the world of other drugs, that if you lost control over your relationship with these drugs, it is wiser to not use. The reality, however, is that many people, whether alcohol or illegal drug (users), have found ways of keeping these elixirs in their lives in a non-problematic way.
John Schwarzlose
The issue, whether talking about alcohol or any other drug, is whether it's addiction or abuse. If a person is not addicted, then we can control it.
Marilyn says:
How does one convince someone who is addicted to alcohol (and also in the most denial) that they cannot simply cut down, as perhaps an abuser can?
Marc Kern
If someone is in severe denial, as this individual seems to be implying, my recommendation would be to allow them to test out some of the thoughts brought up in tonight's program. The best way to help someone stop drinking is to help them come to that conclusion themselves.
John Schwarzlose
I think the most important answer to this question is that the person asking the question who loves someone who is an alcoholic, get help for yourself. If you love someone who is alcoholic, you have to figure out what's going on. So get help for the family first, and they can help out the alcoholic.
Paqrat says:
How can Moderation Management work for someone who is truly addicted to alcohol?
Marc Kern
The only way Moderation Management can be helpful for someone who is truly dependent is to help them be convinced that moderation is not a viable goal. It can not teach an alcoholic to be a successful moderate drinker.
dee says:
What's the difference between addiction and abuse?
Dr. Nancy Snyderman
My personal bias is, it's part of the same continuum. I would like to ask the experts if we are talking apples and oranges, or elements (that are) very similar.
John Schwarzlose
I think we are talking apples and oranges. I think people can use alcohol their entire life, but never be addicted to it. There are criteria to define the difference between abuse or misuse of alcohol, and alcoholism. It is very important that accurate diagnosis define the difference between those.
Marc Kern
I find this a very difficult question to answer. I tend to see addictions on a continuum from very mild to severe. I believe anyone who practices drinking long enough and hard enough can become truly addicted.
Kari says:
What are the basic premises of moderation therapy? How does it differ from abstinence programs?
Marc Kern
First of all, moderation therapy is not a set of techniques, it is a goal. It is not a specific set of techniques. That's where the essential difference lies. Moderation Management uses the Health Organization guidelines for what is moderate drinking.
Jim says:
Has there been a split in the medical community as to whether alcoholism is a disease or a learned behavior?
Dr. Nancy Snyderman
In interviewing people for this special, I came away with the belief that both are significant beliefs (about) alcoholism. Certainly, a young man, Ricky Higgins, who grew up on Chicago's South Side, was exposed to bar behavior as the norm. It is very possible that in another environment, he may NOT have become an alcoholic, even though he has a father and an uncle who had been.
John Schwarzlose
There have been some very interesting recent polls on this question. Those polls indicate that the overwhelming number of physicians believe that alcoholism, and addiction, is an illness. The diversity in opinion is about how treatable this illness is.
Marc Kern
I have no doubt that within the medical community there is little divisiveness their training encourages anomaly being seen as a disease. I teach at UCLA, and most of the medical students have been indoctrinated in a single-minded view that alcoholism is a disease. When speaking to these residents in private, though, there is great dissent as to the true origins or treatment for that.
Dr. Nancy Snyderman
I must say, that's why the disease model is held widely, and at this point (is) conventional wisdom. I find that when I speak with doctors privately and one-on-one, there is the same confusion and questioning that Dr Kern just alluded to with his students. I think it goes to a very basic point of human behavior: what control do we have over our actions?
Dr. Nancy Snyderman
Welcome to (the second hour of) our continuing dialogue on alcoholism. We certainly hope you enjoyed the special. Our reason for our being here tonight is to continue talking about this very pressing problem and some of the controversies which surround it.
Marc Kern
I'd like to thank ABC for having the courage to air such a controversial topic and realistically open up a potential, fruitful discussion for many people who are "out in the cold."
Lioness429 says:
Are there any long-term figures for recidivism rates of moderation therapy "graduates" back to problem drinkers?
Marc Kern
There are statistics as to moderate drinkers returning to problematic drinking. Similarly, there is substantial evidence to suggest that long-term abstainers return to moderation.
Henry says:
If alcohol has not effected your personal life or professional life, can one still fit the criteria of an addict?
John Schwarzlose
The primary criteria for the alcoholism diagnosis is continued use of alcohol, despite major interference in a person's life. My understanding of that question would be the person is probably not an alcoholic, if there has not been any interference in those major areas.
Tully says:
Can alcoholism be cured?
Dr. Nancy Snyderman
I always hesitate to use the word "cure" in any kind of problem that is somewhat difficult to define. But the science, at this point, is incomplete. Certainly, a person's environment cannot be excluded. I believe people can be helped, and people can learn to stop drinking. But the word "cure" makes me nervous.
John Schwarzlose
We believe (as does most medical literature on this) that alcoholism is a chronic disease similar to diabetes, asthma, arthritis and like those chronic diseases, does not have a cure.
Harry says:
Is alcoholism inherited?
Dr. Nancy Snyderman
Yes and no. There may be genetic factors for some people.
Jackie says:
Does alcoholism treatment work?
Marc Kern
Absolutely it works! There's a variety of ways we can define being successful it need not be defined as lifelong abstinence, however.
John Schwarzlose
I would agree with Dr. Kern that treatment definitely works. One of the most interesting studies is the one done by business and industry, where they follow their own employees who have been referred to treatment. Two of the most recent studies have been done by Delta Airlines, but these studies have indicated when these corporations refer employees to treatment, and they follow these employees when they come back to work, that these results are extremely positive.
Kristan says:
Are certain groups of people more likely to develop alcohol problems than others?
Dr. Nancy Snyderman
There are some stereotypes that exist. Certainly, most of us have in our minds that American Indians and the Irish have problems with alcohol. But that's part of the conventional wisdom that is wrong. The Irish, as a country, in fact, have no higher an incidence of alcoholism than Americans. But certainly, in some cultures, drinking is taboo. You would not find a drunk in the streets of Tel Aviv or Jerusalem.
     We define alcoholism as an "equal opportunity disease" it affects people of all walks of life, and affects women as equally as men. We do not believe there is a typical alcoholic. While psychological research has not been able to define an alcoholic personality, there do seem to be some diagnostic psychological groups that have a higher incidence of alcoholism.
Lilliana says:
Who would you consider prime candidates for moderation therapy?
Marc Kern
Traditionally, it's thought that people that are characterized by having early-stage problems with drinking have greater success with moderation. That usually includes less than ten years of problematic drinking, no history of loss of control, no history of blackouts, (etc.)
Amy says:
How much education does a medical doctor usually get on substance abuse?
Dr. Nancy Snyderman
Minimal, if any.
Marc Kern
Surprisingly minimal education of the treatment and diagnosis of alcoholism.
John Schwarzlose
We have a unique program at Betty Ford Center where we bring a little over 200 first- and second-year medical students a year, where we admit them as if they were a patient, so they go not through the classroom, but the entire treatment center for six days. It's truly hands-on experiential training. They experience addiction treatment. Unfortunately, 200 per year just isn't that many.
WookieNumbers says:
Is there a combination alternative to combatting alcohol dependency? Such as AA in addition to a 12-step program? What are the options available to those seeking help?
Marc Kern
There's literally unlimited recovery options within anyone's traditional community. There are the national self-help groups I mentioned earlier, there are professional psychologists, marriage and family counselors that have substantial training in alcohol and drug problems. To my dismay, most of the research that has been done on effective treatments for alcoholism is not generally available to the lay public, though.
Jill says:
Are there people out there who drink too much who are not getting the help they need because there are too few options?
John Schwarzlose
Absolutely. Even with the many alternatives to treatment and various kinds of treatment that have been mentioned here, there is clearly not enough treatment available, and access to treatment, for middle-class men and women across the country. It's very limited.
Marc Kern
I would fully agree. There are too few options. It's not exclusively the function of the availability of treatment, but it's the philosophical approaches of the various programs that there are too few of. Like people purchase different cars by different brands, different religions, ice cream flavors, we don't offer people a variety of methodologies that they can take and fit with themselves, and how they might make behavioral changes.
Mike3335 says:
Do you believe that craving develops in an alcoholic once that person takes the first drink?
John Schwarzlose
We kind of answered this in the first hour, but I do not believe that most alcoholics become alcoholic when they take their first drink, and there's certainly no research that indicates that that is so.
Marc Kern
I, too, like Mr. Schwarzlose, do not believe alcoholics generally start craving from the first drink. I think the question, though, is once you're an alcoholic, are you endangering yourself if you take that first drink? Often cases, the answer is "yes."
Mar asks:
What help can the family get to understand the alcoholic?
John Schwarzlose
The first choice for most families is the Alanon group, which is a self-help program that is free and available in almost any community in the US. There are many family therapists specialized in family programs for the loved ones of the addict. We certainly recommend these highly to family members.
Marc Kern
I would very much agree. I think the family can be profoundly instrumental in getting a loved one into treatment and help by their act of involvement in the therapeutic process.
IceeMocha says:
I am the granddaughter and daughter of alcoholics. I do not drink to excess, just occasionally. Doesn't this show that the "chain" of addiction can be broken?
Dr. Nancy Snyderman
Certainly, Ricky Higgins, the young man in our special tonight, is the example of a young man at risk because of his genetics. But yet it was an environment in the bars of South Chicago that also played an important role. Genes are certainly part of the answer, but not the entire answer.
Daniel asks:
Mr. Kern, you say that AA has no medical basis, but do you think faith can help at all with alcoholism?
Marc Kern
This is another loaded question! I'm firmly a believer that spirituality and faith and hope are essential ingredients or can be essential ingredients in evolving out of a problem with alcohol. On the other hand, it is not (necessarily) an essential ingredient.
John Schwarzlose
We take the stance that spiritual recovery from alcoholism is just as important as medical or psychological recovery.
Barney asks:
What does it mean if you binge drink in social situations, but not at home, where you only drink once or twice a month, and only one or two drinks even then?
Dr. Nancy Snyderman
People who abuse alcohol, even if just a few times, still put themselves and others at risk. I believe this is a problem that should be addressed. If the person is a problem drinker, even if we're just talking about the weekends, and waits until every aspect of the life falls apart, it's too late.
John Schwarzlose
I agree totally with Dr. Snyderman's thoughts. One thought to add is, it's not how much or how often one drinks that determines if you have a problem or if you're an alcoholic.
Growler2000 says:
I've been sober four and a half years and would like to have an occasional beer. How do I know if it's safe for me to drink again?
Marc Kern
My recommendation to him would be, if your sobriety and abstinence is going along smoothly, there's no need to find out whether it's safe or not. It's not worth the risk!
Charlenean says:
Why do you suppose the court system, which systematically insists that offenders attend AA meetings, or only 12-step programs?
Marc Kern
First of all, it is mostly because of the naivete of the legal system that 12-step programs are recommended in most states. In California, they are not mandated to 12-steps. In fact, it's unconstitutional there. In the state of California, you're given at least 35 different options of self-help/support groups, all the way to just doing a scrapbook, if you get a DUI. The prominence of the 12-step program over the past 50 years has caused a monopoly, and many judges aren't aware of the alternatives!
DavidO says:
If a person doesn't have loss of control or blackouts, why would they want to moderate their drinking?
Marc Kern
If a person is not having blackouts or loss of control, he's probably moderating!
Bea says:
What is the best way to intervene with a family member who defends a drinking problem with anger?
John Schwarzlose
We believe the first step is for the loved ones, the family, to educate themselves, so they are equipped to deal with it. Many families will then turn to an intervention counselor to get help in a formal intervention with a family member. These interventions work more than half the time. They seem to have a very good track record.
Mefsj says:
What can be done to help keep your environment from affecting your children, and keep them from falling into the same destructive behavior as the alcoholic?
Dr. Nancy Snyderman
I think a lot of it begins by teaching children the role of alcohol. In our house, our daughters, ages 11 and 13, are allowed to have a small glass of wine on special occasions, and at the dinner table. Our goal as parents is to teach them that wine is part of the meal, and in so doing, we hope that they learn to respect the special tradition. We are also very careful not to drink after work and every evening. Nor have any of our children ever seen us out of control. I guess, for us, it comes down to teaching by example.
John Schwarzlose
I think, for me, what makes what Dr. Snyderman does with her daughters okay is that they talk about it. Why that's positive is because most families don't talk about it. I'd add that I believe what children learn is, are adults able to have fun without drinking, or is alcohol always part of the equation?
Dr. Nancy Snyderman
I would like to second that. It's very important for children to see adults enjoying each other's company without the presence of drugs and alcohol. And when alcohol is consumed, it should be in a child's presence, but always with conversation and dialogue.
Molly says:
Do we really know the effects on children of a parent who drinks? Emotionally? Socially?
Dr. Nancy Snyderman
The emotional toll is devastating.
Marc Kern
I would fully agree with Dr. Snyderman. There is no doubt (a child is affected) emotionally, psychologically, educationally literally on every front. (A child) is dramatically affected by alcohol abuse in the family.
John Schwarzlose
I agree with both my fellow panelists. The children are the silent victims of this disease. We have a unique children's program for children ages 7-12 who are living every day of their lives around alcoholism and addiction. It affects them emotionally, and in every other way.
Molly asks:
My husband is an alcoholic. Should I get my seven-year-old and four-year-old into counseling with us?
John Schwarzlose
My experience would say that the seven-year-old should have some education and counseling, and I would say the four-year-old is probably too young.
Dr. Nancy Snyderman
I'd like to thank everyone for joining us tonight. We put this program on ABC News because we recognize the tremendous problem that alcohol abuse is in this country. It is our hope that this program and this Internet chat will be the spark for continued dialogue. And certainly, for those of you who are wrestling with alcohol, we urge you to get help.
John Schwarzlose
I really want to focus on the fact that for people who have problems with alcohol, people who are alcoholic, and those people who love them, that there is help available for all of these categories, different types of help, and we just have to keep giving the message that you must reach out for help when faced with these problems.
Marc Kern
I encourage people to think about what they've seen, and do reach out for help. It IS available.
Moderator
And from all of us at ABC News, goodnight. Dr. Snyderman, Mr. Kern and Mr. Schwarzlose, thank you for chatting on ABCNEWS.com. And thanks to all those who submitted questions. If you'd like to check out recent 20/20 chat transcripts, please visit this Web address.
     Thanks again for joining this ABCNEWS.com live event. Good night!


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