406 CHAPTER 9
- loss of control, which consists of not being able to stop drinking once drinking
has begun; - physical dependence, which brings withdrawal symptoms, such as nausea, sweat-
ing, shakiness, and anxiety after stopping drinking; and - tolerance, which causes a person to need to drink greater amounts of alcohol to
get “high.”
CASE 9.5 • FROM THE INSIDE: Alcohol Dependence
Caroline Knapp describes her alcohol dependence in her memoir Drinking: A Love
Story (1997):
By that point I don’t even think the alcohol worked anymore. Certainly drinking was no longer
fun. It had long ago ceased to be fun. A few glasses of wine with a friend after work could
still feel reassuring and familiar, but drinking was so need driven by the end, so visceral and
compulsive, that the pleasure was almost accidental. Pleasure just wasn’t the point. At the end
I didn’t even feel like myself until I had a drink or two, and I remember that scared me a little:
alcohol had become something I felt I needed in order to return to a sense of normalcy, in or-
der to think straight. After one or two drinks I’d feel like I’d come back into my own skin—more
clearheaded, more relaxed—but the feeling would last for only half an hour or so. Another few
drinks and I’d be gone again, headed toward oblivion.
(p. 231)In Case 9.5, above, Knapp describes the four elements of alcohol dependence:
craving (“need driven”), loss of control (she would continue to drink until she was
“headed toward oblivion”), physical dependence (“something I felt I needed in
order to return to normalcy”), and tolerance (the alcohol didn’t have as strong an
effect as it had initially).
Alcohol abuse and dependence are also associated with memory problems, in
particular, blackouts, periods of time during which the drinker cannot later remem-
ber what transpired while he or she was intoxicated. Knapp (1997) described her
blackouts: “Sometimes I’d be so drunk at the end of the night I’d have to drive
home with one eye shut, to avoid double vision. Sometimes I’d wake up at Sam’s
[a friend’s] house, in his bed, wearing one of his T-shirts. I don’t think we ever had
sex but I can’t say for sure” (p. 154).Sedative-Hypnotic Drugs
Sedative-hypnotic drugs reduce pain and anxiety, relax muscles, lower blood pres-
sure, slow breathing and heart rate, and induce sedation and sleep. In general, drugs
in this class cause disinhibiting and depressant effects similar to those of alcohol
(impaired physical coordination and mental judgment and increased aggressive or
sexual behavior). Although these psychoactive substances can lower inhibitions and
bring a sense of well-being, they also can cause memory problems, confusion, poor
concentration, fatigue, and even respiratory arrest (NIDA, 2008e). When sedative-
hypnotic drugs are mixed with another depressant, such as alcohol, the combined
effect can be lethal: The person’s breathing and heart rate can slow to dangerously
low levels. Chronic use of these drugs can lead to tolerance. Two general types of
drugs are in this class: barbiturates and benzodiazepines.Barbiturates
Barbiturates, which include amobarbital (Amytal), pentobarbital (Nembutal), and
secobarbital (Seconal), are usually prescribed to treat sleep problems. Although use
of a barbiturate is legal with a prescription, this type of medication is commonly
abused by both those with a prescription and those who obtain the drug illegally.
As with other depressants, repeated barbiturate use leads to tolerance, so the person
takes ever larger doses to get to sleep or reduce anxiety. Barbiturate abuse can also
lead to withdrawal symptoms, including agitation and restlessness, hallucinations,