Sometimes, we realize that someone we know and care about has a problem with alcohol when they reach out to us for help. Sometimes that realization doesn’t come until we learn they have been arrested for DUI or another alcohol-related offense. And sometimes that realization might not come until we bump into them in court, where they’re dealing with issues of divorce or other family issues caused by addiction.

About 18 million Americans — or about five percent of the U.S. population — deal with something that health experts label “alcohol use disorder.” It’s a fancy way of saying “alcoholic” or “alcoholism.” And it means that their drinking habits cause distress and harm — both to themselves and to others.

It is sometimes hard to think of alcoholism as a disease, and of those who suffer from addiction as victims. Indeed, there is a major social debate surrounding the issue of alcoholism as a disease. The Baldwin Research Institute, which studies addictions and other human behaviors, rejects the idea of alcoholism as a disease, calling it a “disease of speculation.”

But the American Medical Association has labeled alcoholism as a disease since 1966. And the general consensus of the health care community is that while alcoholism may start as a choice, it can become a dependence.

One thing that is not debated is the addictive nature of alcohol. While many millions of Americans consume alcohol occasionally or even as part of their daily lives without issue (the 2015 National Survey on Drug Use & Health found that 86 percent of people ages 18 or older reported drinking alcohol at some point in their lives, and 70 percent reported that they drank in the past year), it becomes addictive for those select few — the five percent or so of Americans who eventually become labeled as alcoholics.

No one is exactly sure what triggers addiction in some but not others. Researchers have studied genetics, socioeconomic links and other factors without finding a definitive cause. But once addiction develops, it quickly becomes a burden — both medically and socially.

According to the National Institute on Alcohol Abuse & Alcoholism, an estimated 88,000 people in the United States die from alcohol-related causes each year, making it the third leading preventable cause of death, behind tobacco and poor diet and physical inactivity. In 2014 alone, alcohol-impaired driving fatalities account for nearly 10,000 deaths. A little more than three in 10 driving fatalities are caused by alcohol.

DUI-related deaths are just one of the short-term health risks of alcohol abuse. Alcoholism can also result in alcohol poisoning, risky sexual behaviors that can lead to diseases that include HIV, miscarriage or stillbirth in pregnant women, and injuries to spouses and children who fall victim to domestic violence in which alcohol is a factor.

There are also long-term health risks to consider. Excessive use of alcohol over time can cause high blood pressure, heart disease, stroke, liver disease and digestive problems. According to the U.S. Centers for Disease Control & Prevention, it also increases the risk of breast cancer, cancers of the mouth and throat, esophageal cancer, liver cancer and colon cancer. Alcoholism can cause learning and memory problems, and increase the risk of dementia. And it can cause mental health problems, such as depression and anxiety.

The social impact may not be directly related to health, but there are indirect factors to consider. Sadly, alcoholism is prevalent among America’s youth, with 33 percent of 15-year-olds reporting that they have tried alcohol in one 2015 survey. That same survey found that 5.1 million people — or a whopping 13.4 percent — between the ages of 12 and 20 reported binge drinking within the past month. Researchers have found that alcohol use during the teenage years interferes with normal adolescent brain development and increases the risk of addiction.

So what’s the solution? It’s as simple as not drinking too much. The NIAAA defines moderate drinking as one drink per day for women and two drinks per day for men. Anything more than that can be harmful. Binge drinking is defined as a pattern of drinking that causes drunkenness — usually around four or five drinks in a two-hour period.

The NIAAA also has conducted research to determine how many drinks can be consumed without a serious risk of developing an addiction. For women, low-risk drinking is defined by the NIAAA as being no more than three drinks in a day and no more than seven in a week. For men, that number increases to four in a day or 14 in a week. According to NIAAA research, only about two in 100 people who drink within those limits will develop alcohol use disorder.

Of course, there are always people who should not drink at all — those who plan to drive or operate machinery, those who take medications that interact with alcohol, those who have a medical condition that can be aggravated by alcohol, and women who are pregnant or trying to become pregnant.

Unfortunately, the simple solution isn’t always that simple. The political debates aside, the U.S. National Institute of Health continues to maintain that too much alcohol can indeed cause disease by leading to mental changes that in turn cause alcohol dependency, a loss of control to stop drinking and a dangerous tolerance level.

The NIH warns that if you want to cut down or stop drinking but can’t, feel a strong urge to drink, find that drinking interferes with your family life, your job or with school, it’s time to seek help.

There are also additional warning signs of alcoholism. Friends and family might recognize the problem before you do. If someone you care about is giving up or cutting back on activities just so they can drink, keep drinking even though it makes them feel depressed or anxious, are drinking more than they used to, or are suffering from withdrawal symptoms such as shakiness, irritability, sweating or nausea as alcohol effects are wearing off, there could be cause for concern.

There are several treatment options available to help curb addiction. Disulfiram causes unpleasant symptoms — such as nausea and skin flushing — when you drink, Naltrexone blocks the receptors in your brain that make you feel good when you drink, and Acamprosate helps reduce cravings after you’ve decided to quit drinking.

The NIH also recommends joining a support program, such as Alcoholics Anonymous. The East Tennessee Intergroup, located in Knoxville, can be reached through a 24-hour answering service, (865) 522-9667, or online at In Oneida, Alcoholics Anonymous meets at the First Methodist Church on Main Street at 7 p.m. on Wednesdays and Fridays.

This story is the April 2018 installment of Focus On: Health, presented on the third week of each month by Brennan's Foot & Ankle Care, Big South Fork Medical Center, Roark's Pharmacy and Danny's Drugs as part of the Independent Herald's Focus On series. A print version can be found on Page A3 of the April 19, 2018 edition.