Review of Related Literature

Alcoholism is also known as alcohol dependence and is considered a disease with

symptoms such as craving or feeling a strong urge to drink; loss of control or not being able to

stop once drinking has begun; physical dependence such as nausea, sweating, shakiness, and

anxiety; and tolerance or drinking greater amounts of alcohol to "get high" ('National Institute on

Alcohol Abuse and Alcoholism' 2006). Many people believe that drinking alcohol will and may

ease their problems regarding their family, work and the society, but in fact, it would not.
Acquiring alcoholism may lead to more serious complications and fatal illnesses that would

cause the person's life.

Several think that alcoholism is a disease, and in fact, the National Institute on Alcohol

Abuse and Alcoholism (2006) is supporting this statement. The Institute explains that the craving

that an alcoholic feels for alcohol can be as strong as the need for food or water, and an alcoholic

will continue to drink despite serious family, health, or legal problems. Moreover, like many

other diseases, alcoholism is chronic, which means that it lasts a person's lifetime, usually

follows a predictable course, and has symptoms ('National Institute on Alcohol Abuse and

Alcoholism 2006). The risk for developing alcoholism is influenced by both the person's genes

and by his or her lifestyle ('National Institute on Alcohol Abuse and Alcoholism' 2006).

It has been reported that alcoholism was first recognized as a disease in the 1930s by a

group called "Alcoholics Anonymous", and since then, the American Medical Association has

recognized alcoholism as a serious and chronic disease ('What is Chemical Dependency?' 2005).

Alcoholism takes time to develop, but once it develops, it does not go away ('What is Chemical

Dependency?' 2005). Cure is not available for alcoholism, but is treatable, and with proper

treatment, an alcoholic will be able to reclaim his or her normal, satisfying lifestyle ('What is

Chemical Dependency?' 2005).

It has been reported that the World Health Organization (WHO) estimates that there are

about 2 billion people worldwide who consume alcoholic beverages and 76.3 million with
diagnosable alcohol use disorders ('Global Status Report on Alcohol' 2004, p. 7). From a public

health perspective, the global burden related to alcoholism and alcohol consumption, both in

terms of morbidity and mortality, is considerable in most parts of the world ('Global Status

Report on Alcohol' 2004, p. 7). Moreover, given alcohol's significance in world health, the

World Health Organization has been developing a database since 1996, named the Global

Alcohol Database, in its aim in providing a standardized reference source of information for

global epidemiological surveillance of alcohol use and its related problems ('Global Status

Report on Alcohol' 2004, p. 7). This database will be helpful for the organization to record the
incidence of alcoholism worldwide. This is essential so the government can take action and

responsibility in proposing or implementing programs to help lessen the incidence of

alcoholism.

Similarly, in the United States, alcohol is still the number one drug problem, and affects

adolescents, middle-aged people and senior citizens, and people of all races, religions,

intelligence levels and professions ('What is Chemical Dependency?' 2005). In fact, there are

approximately 18 million alcoholics in America ('What is Chemical Dependency?' 2005), and

this high incidence affects many aspects in the society. In 1995, the estimated annual cost of

alcohol abuse in the United States was $166.5 billion, where alcohol use disorders cost $56.7

billion more than the estimated annual economic cost of illegal drug use and $36.5 billion more

than the estimated annual economic cost of smoking ('Impact on Society' 2006).

Effects of Alcoholism
Alcoholism presents a variety of effects, not only on the physical or biological aspect of

an individual, but on the society as well. It has been reported that short-term physical effects of

alcohol use include distorted vision, hearing and coordination, altered perceptions and emotions,

impaired judgment and hangovers ('What is Alcoholism?' 1999). On the other hand, long-term
physical effects of heavy alcohol use include loss of appetite, vitamin deficiencies, stomach

ailments, skin problems, sexual impotence, liver damage, heart and central nervous system
damage, and memory loss ('What is Alcoholism?' 1999). Long-term physical effects also include

diseases and organ malfunctions. These diseases include brain damage, which varies from

psychosis to permanent memory loss; cancer, such as in the mouth, esophagus, and stomach due

to the irritating effects of alcohol; heart disease, such as an enlarged heart and congestive heart

failure; liver damage leading to cirrhosis or scarring of the liver and liver cancer; ulcers that

produces stomach and intestinal irritation; glandular problems in the adrenal and pituitary glands;

and birth defects on women who drink alcohol during pregnancy ('What is Chemical

Dependency?' 2005). This condition is known as Fetal Alcohol Syndrome or FAS ('What is
Chemical Dependency?' 2005).

Aside from the diseases caused by alcoholism, it also presents psychological and

psychiatric problems, which in turn determines social issues happening in the society, such as

suicide, accidents, and crimes. Some of these problems include depression, which can be

triggered by alcoholism and vice versa; anxiety, which occurs during attempted withdrawal;

change in personality with loss of normal behavior and appearance; and hallucinations, which is

an affect of alcohol withdrawal ('Alcohol Abuse, Alcoholism and Alcohol-Related Problems'

1997). These psychiatric problems often lead to social issues such as suicide, which is result of

depression; accidents, being a result of drunk-driving; and physical abuse, which are the cause of

a large portion of homicides, child abuse cases and other domestic violence cases ('What is

Chemical Dependency?' 2005).

Adolescent Alcoholism
Alcohol abuse and alcohol dependence are not only adult problems, but they also affect a

significant number of adolescents and young adults between the ages of 12 and 20, even though

drinking under the age of 21 is illegal (Califano 2000). According to a research done by the

National Institute on Alcohol Abuse and Alcoholism, adolescents who begin drinking before age
15 are four times more likely to develop alcohol dependence than those who begin drinking at

age 21 (Califano 2000). In addition, drinking at an early age can also be associated with alcohol-
related violence, not only among persons under the age of 21 but among adults as well (Califano

2000).

It has been estimated that over three million teenagers are alcoholics, and several million

more have a serious drinking problem that they cannot manage on their own (Califano 2000).

This is why early treatment of alcoholism in adolescents must be done to prevent further damage

on their lives. It has been mentioned earlier that alcoholism presents grave threats on the lives of

many individuals, especially on the lives of many teenagers. These threats include accidents

associated with drunk driving, and crimes. It has been reported that the three leading causes of
death for 15 to 24 year olds are automobile crashes, homicides and suicides, and alcohol is a

leading factor in all three (Califano 2000). While drinking may be a singular problem behavior

for some, research suggests that for others if may be an expression of general adolescent turmoil

that includes other problem behaviors and that these behaviors are linked to unconventionality,

impulsiveness, and sensation seeking (Califano 2000).

It has been reported that binge drinking, often begins around the age of 13, tends to

increase during adolescence, peak in young adulthood in the ages between 18 to 22, then

gradually decreases (Califano 2000). Individuals who increase their binge drinking from the age

of 18 to 24 and those who consistently binge drink at lease once a week during this period may

have problems attaining the goals typical of the transition from adolescence to young adulthood

(Califano 2000). These goals include marriage, education, employment, and financial

independence (Califano 2000).

Moreover, alcohol use among adolescents has also been associated with considering,

planning, attempting, and completing suicide (Califano 2000). Research does not indicate

whether drinking causes suicidal behavior, only that the two behaviors are correlated (Califano

2000). Suicide is also related to depression and anxiety, for these behaviors somehow trigger

alcoholics to result to suicide. In addition, these behaviors can also become severe with the
influence of alcohol. This is why during the event of suicide, the alcoholic has already
experienced severe depression and anxiety prior to the activity, including the fact that with the

influence of alcohol, a person cannot make sound judgments.

Furthermore, the influence of peers can also be attributed to adolescent drinking. More

often than not, adolescents become exposed to alcohol drinking through their peers. With this,

the role of the parents becomes crucial in the discipline of their children. Proper guidance must

be given to adolescents regarding drinking alcohol. Education also is important, for information

regarding alcoholism and drug abuse must be give to adolescents for early prevention.

Parental Guidance and Influence

Califano (2000) reports that parents' drinking behavior and favorable attitudes about

drinking have been positively associated with adolescents' initiating and continuing drinking.

Children who were warned about alcohol by their parents and children who reported being closer

to their parents were less likely to start drinking (Califano 2000). Lack of parental support,

monitoring and communication has been significantly related to frequency of drinking, heavy

drinking, and drunkenness among adolescents (Califano 2000). Harsh, inconsistent discipline

and hostility or rejection toward children has also been found to significantly predict adolescent

drinking and alcohol-related problems (Califano 2000).

Adolescent Drinking Study

In relation to this is the study done by Hill and Yuan (1999) regarding the familial

density of alcoholism and onset of adolescent drinking. According to the authors, the purpose of

the study was to assess the age of onset to begin drinking in relation to family history of

alcoholism using survival analysis, and to examine the importance of selected risk factors in

predicting outcome, using a Cox proportional hazards model analysis (Hill and Yuan 1999). The

study examined 52 children and adolescents at low risk for developing alcoholism and 73
children and adolescents from high-risk families, with the ages of 7 to 18 years old and evaluated

annually to provide 2.1 waves of longitudinal data concerning age of onset along with a number
of predictors (Hill and Yuan 1999). These predictors include positive familial loading of

alcoholism, extraversion, and manifest anxiety scores (Hill and Yuan 1999). It has been reported

that a number of normal population studies have shown that initiation of drug use in adolescence

follows a predictable pattern in which adolescents first use licit drugs like alcohol and cigarettes,

before they try marijuana and illicit drugs (Hill and Yuan 1999). Furthermore, the identification

of this sequence in adolescence, along with adult follow-up, has allowed for the determination

that the earlier an adolescent begins to experiment with alcohol and cigarettes the greater the

severity and persistence of problems with illicit drugs (cited in Hill and Yuan 1999). Excessive
drinking during adolescence has also been found to be predictive of later problems with alcohol

(Hill and Yuan 1999). In relation, a study done by Andersson and Magnusson in the year 1988

found that self-reported frequency of intoxication between the ages of 14 and 16 was predictive

of being in Swedish registries for alcohol abuse in young adulthood. Similarly, the report of

Grant and Dawson in 1997 shows that age of onset to begin regular drinking predicts the

likelihood of adult alcohol dependence in a large population-based sample, further suggests the

importance of determining the factors that predict initiation of drinking in youth.

With these findings involving the general population, the initiation of alcohol use in

normal populations of adolescents may differ from that seen among adolescents who come from

families with histories of alcohol and drug dependence (Hill and Yuan 1999). Moreover, the

factors predicting onset in high-risk families may differ from that seen in the general population

surveys of adolescents (Hill and Yuan 1999). This is why a study tracing the family histories of

adolescents is important. It has long been known that a positive family history is one of the most

powerful predictors of risk for becoming alcoholic (cited in Hill and Yuan 1999). Alcoholics

with a family history of alcoholism in fact appear to have an earlier onset of problem-related

drinking and an earlier onset of regular drinking, both of which appear to be highly correlated

(cited in Hill and Yuan 1999). Therefore, it would just appear reasonable to predict that the
children of alcoholic parents might become more susceptible for development of early-onset

regular drinking and/or alcohol abuse compared to children of non-alcoholics (Hill and Yuan
1999). With these reasons, it is considerable to target to those children and adolescents in

particular who have begun to drink earlier than their low familiar risk counterparts for

specialized intervention and treatment (Hill and Yuan 1999). In addition, according to Hill and

Yuan (1999), children of alcoholics are typically considered to be at greater risk for developing

alcohol problems due to the presence of alcoholism in one or more members of their nuclear or

extended family. However, these high risks children frequently come from multi-problem

backgrounds (Hill and Yuan 1999).

With the information and problem in mind, the study conducted examined two major
groups, namely, the high-risk group and the low-risk group. The high-risk group consisted of

children and adolescents from high-density multi-generational alcoholism families, while the

low-risk group consisted of children and adolescents with one of their parents coming from a

"low-risk" target pedigree ascertained as part of a larger family study designed to assess the role

of familial or genetic factors in the development of alcoholism (Hill and Yuan 1999).

Furthermore, the socioeconomic status and family stability of the participants were also

determined.

Results of the study indicate that there appears to be converging evidence that high-risk

children not only drink earlier but also drink more during adolescence than do low-risk children

(Hill and Yuan 1999). These findings are further proven by the examination of the quantity per

occasion consumed by individuals who had begun drinking revealed risk group differences as

well (Hill and Yuan 1999). Moreover, although the primary focus of the study is on

intergenerational transmission of alcohol dependence, clarifying the patterns of use of other

drugs such as marijuana, amphetamines, cocaine, opioids, hallucinogens and tobacco was also of

interest (Hill and Yuan 1999). The tests revealed that among the 26 drinkers identified, seven

came from low-risk families and did not report any drug use other than cigarette smoking (Hill

and Yuan 1999). In contrast, 42% of the high-risk subjects who drank regularly also reported
some form of drug use along with cigarettes (Hill and Yuan 1999).
 In discussion, the study implies that high-risk children begin drinking earlier than low-

risk children do, and its significance is that population-based samples have demonstrated that the

risk for developing alcohol dependence can be predicted by the age of onset to begin drinking

(cited in Hill and Yuan 1999). In addition, the strongest predictor for alcoholism is extraversion

(Hill and Yuan 1999). Moreover, the results also suggest that the high-risk children will be likely

to develop problems at a higher rate than other groups (Hill and Yuan 1999). With this

information, it will be helpful to propose effective ways for treatment of adolescent alcoholics at

an early age. This is to prevent more grave consequences on the lives of the adolescent
alcoholics, such as discontinuing education, substance misuse, and committing crimes.

Ways of Motivating Treatment

At some point, many alcoholics will choose to become treated of their disease. This is

why motivation of alcoholics, especially of alcoholic adolescents must be effective to propose

treatment. Treatment at an early age will be beneficial so as not to result to worse consequences

or events.

It has been reported that once a diagnosis of alcoholism is made, the next major step is

getting the patient to seek treatment, and one study suggests that the main reasons alcoholics do

not seek treatment are due to lack of confidence in successful therapies; denial of their own

alcoholism; and the social stigma attached to the condition and its treatment ('Alcoholism' 2006).

Recognizing the Problem – It has been reported that the first and most important step in getting

appropriate treatment for alcoholism is recognizing that you have a problem, and often, family

members and close friends initiate treatment for the person with the addiction ('Alcoholism'

2004).

In addition, the alcoholic patient and everyone involved should fully understand that
alcoholism is a disease, and responses to this disease are not character flaws but symptoms, just

as pain or discomfort are symptoms of other illnesses ('Alcoholism' 2006). They should also
realize that treatment is difficult and sometimes painful, just as are treatments for other life-

threatening diseases, such as cancer, but that treatment is the only hope for a cure ('Alcoholism'

2006).

Role of Family and Friends – Another effective way for motivation are the intervention of

family members, employers, and therapists, which can be very effective in motivating a person

to quit ('Alcoholism' 2006). This can also help in reducing drinking over the short term

('Alcoholism' 2006). Moreover, even brief interventions from a primary care doctor and self-help
information can be helpful in reducing harmful drinking, for studies report, that only regular

follow-up and reinforcement will sustain quit rates and possibly even improve survival rates

('Alcoholism' 2006).

Personal Intervention Meetings – It has been reported that the best approaches for motivating a

patient to seek treatment are interventional group meetings between people with alcoholism and

their friends and family members who have been affected by the alcoholic behavior

('Alcoholism' 2006). Using this approach, each person affected offers a compassionate but direct

and honest report describing specifically how the person has been hurt by their loved one's

alcoholism ('Alcoholism' 2006).

Moreover, the family and friends should express their affection for the patient and their

intentions for supporting the patient through recovery, but they must strongly and consistently

demand that the patient seek treatment ('Alcoholism' 2006). Children may even be involved in

this process, depending on their level of maturity and ability to handle the situation ('Alcoholism'

2006). With this interventions, the alcoholic adolescents can be helped by their parents and loved

ones, and be guided regarding what they should do with their life.
Employer Intervention – For adolescents who are working, their employers can be also

particularly effective ('Alcoholism' 2006). Their approach should also be compassionate but

strong, threatening the employee with loss of employment if he or she does not seek help

('Alcoholism' 2006). Some large companies provide access to inexpensive or free treatment

programs for their workers ('Alcoholism' 2006). These rehabilitation programs can be helpful for

the alcoholics to realize their worth as individuals in the company. In this way, they can be

motivated to undergo treatment and in turn, become productive.

Long-Term Treatment – This is when the alcoholic decides to participate in the treatment from

the Alcoholics Anonymous. To achieve total abstinence as being done by the patients, the

alcoholic aims to avoid high-risk situations and replace the addictive patterns with satisfying,

time-filling behaviors ('Alcoholism' 2006).

Moreover, many alcohol treatment programs are based on the 12-step program, which is

used in Alcoholics Anonymous, where the alcoholics are encouraged to be open and share

experiences, but are not required to do so ('Treatment for Alcoholics' 2006). Those who are

serious about quitting must seek out a sponsor, which help them through their recovery process,

and this person is available to them in case they are having a weak moment or if they just need

words of encouragement ('Treatment for Alcoholics' 2006).

Inspiring Words – It has been reported that alcohol treatment programs are designed to get the

person back on track physically and emotionally, so that they can face their addiction and gain

control of their lives ('Treatment for Alcoholics' 2006). Self-esteem and self-worth is greatly

distorted by the addiction, so treatment interventions include group and individual therapy to get

at the root of the trauma which may have caused the cycle to begin in the first place ('Treatment

for Alcoholics' 2006). Inspiring words can be beneficial for the alcoholic adolescent to become
motivated to undergo treatment. With this, the family and friends can help by talking frequently

to the patient.
Drugs and Medication – The alcoholic must discover what causes them to drink, whey they

cannot stop, and what counter measures they can use when these triggers occur ('Treatment for

Alcoholics' 2006). Recovering alcoholics may also benefit from prescribed medications, such as

anti-depressants or anti-anxiety drugs to help them control their physical symptoms of

withdrawal, which can only be prescribed by a medical doctor or psychiatrist ('Treatment for

Alcoholics' 2006). However, the parents or guardian of the patient must supervise the patient in

administering treatment of drugs. In this way, the patient can be given the proper dose of the
medication and can be ensured of proper treatment.

Preventive Measures
The saying 'an ounce of prevention is worth a pound of cure' is applicable in this

situation. With earlier prevention and information, many adolescents will not be involved in

drinking at an early age. With this, parents and guardians of the adolescents must take

responsibility over them to inform them of the consequences of being an alcoholic.

It has been reported that one way to prevent adolescent drinking is to stay involved and

interested in the teenager's life ('Alcoholism' 2004). In this way, the parents know the activities

of their children, including their peers and their schedule in school. Another way is to talk openly

to your children, especially to pre-teens and teens, about the widespread presence and dangers of

alcohol and drugs ('Alcoholism' 2004). This will serve as a warning for them and information to

prevent the incidence of alcoholism. Act as a role model and do not drink excessively or use

other drugs or smoke ('Alcoholism' 2004). The adolescents will realize that their parents are good

example of moral values, and not indulge themselves to becoming alcoholics.

With these, the parents can interact properly with their children and somehow monitor

their behavior. The key concept in this issue is communication. With good and constant

communication, parents and children can have a good and lasting relationship. This can help
both parties to educate one another regarding life and become involved with the activities of one

another. Good communication can help each other create a good environment for one another.