When Bill Wilson, co-founder of Alcoholics Anonymous (A.A.), declared his powerlessness over alcohol about seventy years ago, he claimed that alcoholics needed to “hit bottom” before he was able to make life-changing decisions, and only through totally abstaining from alcohol consumption could sobriety be achieved. Americans and others have taken these ideas as gospel truth for decades, but some addiction experts say they’re no longer sure. They say that based upon years of research, using new information about the behavioral and genetic risks of addiction, that it’s possible for many who drink a lot to evaluate their habits and change them. And even some of those who suffer from alcohol-use disorders can cut their consumption before it has a destructive impact of their lives and health. Many of the country’s leading addiction experts say – and not without controversy – that there’s strong evidence suggesting it’s a long road from alcohol use to powerlessness against the substance, and that most people never reach it. In fact, many who give up alcohol altogether may not have to. The idea of “controlled drinking,” in which people with alcohol-use disorders limit, or control, their drinking has been around for years. But recent evidence shows that such limiting is possible for some people. This reassessment was brought about by the comprehensive National Epidemiologic Survey on Alcohol and Related Conditions, the largest and most wide-ranging examination of alcohol use in the U.S. The Survey looked at 43,000 people, 18 years and older, in the years 2001 and 2002, then again in 2004 and 2005; the results were released incrementally starting in 2006. This project has convinced a number of the nation’s top substance abuse experts that their approach to alcohol disorders has been too narrow. And the Survey findings have been supported by research into psychology and genetics. One of the most extraordinary findings of the Epidemiologic Survey was the large number of Americans who had experienced an alcohol-use disorder – either abuse or more severe dependence – and had recovered on their own. The Survey showed that approximately 30% of Americans had experienced a disorder, but that around 70% of them either quit drinking entirely or cut their consumption back to safe patterns without the need for treatment after four years or less. Just 1% of respondents had experienced severe, recurring alcohol addiction. The research identifies two forms of alcohol disorders, the first fitting traditional views on alcoholism (during which the need to drink consumes a person’s life), and a limited form (during which people drink heavily for a time, then cut back and recover). Alcohol abuse is defined as consumption that contributes, over a 12-month period, repeatedly to risks of bodily harm, relationship problems, difficulties meeting obligations, and troubles with the law. The more serious alcohol dependence includes these symptoms, accompanied by an inability to cut back or stop drinking; the need for higher amounts of alcohol in order to achieve the same effect; consumption levels that take increasing amounts of time; and presence of withdrawal symptoms. Another key finding is that, at least once during the previous year, 28% of U.S. adults had exceeded either the daily or weekly limits considered low-risk for alcohol use. In men, low-risk drinking is considered no more than four drinks per day or no more than 14 drinks in a given week. For women, it’s defined as three drinks per day or seven drinks per week. (A drink is considered to be five ounces of wine, eight-to-nine ounces of malt liquor, 12 ounces of beer, or 1.5 ounces of 80-proof spirits.) Most Americans who drink beyond these limits are considered to have mild-to-moderate drinking disorders, meaning they have occasional trouble controlling their consumption. This is where overall risk assessment comes in. Scientists say the assessment is tantamount to treating high cholesterol or blood pressure before it develops into heart disease. In the epidemiologic survey, roughly half those people who’d experienced an alcohol-use disorder recovered, allowing them to consume at low-risk levels without showing signs of dependence. Some have taken exception to the new data, arguing that a better and safer route is advising people to abstain. But research suggests that a large percentage of users cut back on their consumption and don’t lose control. Other signposts can also predict future alcohol problems, and ought to be considered when people assess their alcohol intake. They include: A young age when drinking begins – Possibly as a result of changes in their still-developing brains, people who start drinking when 15 years old or younger are at especially high risk of alcohol problems developing. The Survey found that almost 50% of people who become alcohol-dependent do so by the age of 21; 75% by 25. Turning red when drinking – Some people carry a genetic mutation (ALDH2) that affects how they metabolize alcohol, causing their faces to get “flushed” when they drink. Most often seen in those of Asian descent, the mutation is linked to higher risk of alcohol-use disorders; as a consequence of the “flushing” effect, these individuals often are dissuaded from drinking. Higher tolerance for alcohol – There are those who need to drink more in order to feel the same effect as the average person (sometimes called an ability to “drink everyone else under the table”). At least five genes are believed to be linked to this trait. About 40% of children of alcoholics are predisposed this way. Genetic mutations – These include mutation of the 5HTT gene, linked to low brain serotonin levels and found in 60% of people who were alcoholics at age 40, and a mutation of the GABA (A) gene, linked to a high tolerance for alcohol. Smoking dependence or the presence of emotional, behavioral or psychiatric disorders. Experts say that, combined with a pattern of surpassing drinking limits, any of these factors should help people gauge someone’s personal risk. Research by the Alcohol and Drug Treatment Program at the Veterans Affairs San Diego Healthcare System says that genes account for around 60% of the risk of alcohol-use disorders, while environmental factors account for 40%. Scientists, including those from the National Institute on Alcoholism and Alcohol Abuse and other health organizations, say that drinking habits should be screened when Americans visit their primary-care physician and during visits to the emergency room. – Boomer