What is alcohol abuse disorder, and what is the treatment?
In the past, a person with this condition was referred to as an "alcoholic." However, this is increasingly seen as an unhelpful and negative label. Health professionals now say that a person has an alcohol use disorder (AUD).
According to the National Institute of Health (NIH), in 2015, 15.1 million American adults (6.2 percent of the population) had an alcohol use problem.
According to the World Health Organization (WHO), globally, 3.3 million deaths every year result from the harmful use of alcohol.
Alcohol abuse disorder refers to a long-term addiction to alcohol.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes alcohol use disorder as "problem drinking that becomes severe."
A person with this condition does not know when or how to stop drinking. They spend a lot of time thinking about alcohol, and they cannot control how much they consume, even if it is causing serious problems at home, work, and financially.
Alcohol abuse can be used to talk about excessive or inappropriate consumption of alcohol, but not necessarily dependence.
Moderate alcohol consumption does not generally cause any psychological or physical harm. However, if who enjoy social drinking increase their consumption or regularly consume more than is recommended, AUD may eventually develop.
A person who drinks excessive amounts of alcohol will often not be the first person to realize that this is so.
Some signs and symptoms of AUD include:
- drinking alone or in secret
- not being able to limit how much alcohol is consumed
- blacking out and not being able to remember chunks of time
- having rituals and being irritated if someone else comments on these rituals, for example, drinks before, during, or after meals, or after work
- losing interest in hobbies that were previously enjoyed
- feeling an urge to drink
- feeling irritable when drinking times approach, especially if alcohol is not, or may not be, available
- storing alcohol in unlikely places
- gulping drinks down in order to feel good
- having problems with relationships, the law, finances, or work that stem from drinking
- needing more alcohol to feel its effect
- experiencing nausea, sweating, or shaking when not drinking
Some people experience some of these signs and symptoms but are not dependent on alcohol.
Alcohol consumption becomes a problem when it takes precedence over all other activities. Dependence can take several years to develop.
The problems linked to alcohol dependence are extensive. The effects can be physical, psychological, and social.
Causes and risk factors include peer pressure, drinking from a young age, and depression.
Alcohol dependence can take from a few years to several decades to develop. For some people who are particularly vulnerable, it can happen within months.
Over time, regular alcohol consumption can disrupt the balance of:
- gamma-aminobutyric acid (GABA) in the brain
GABA controls impulsiveness and glutamate stimulates the nervous system.
Dopamine levels in the brain rise after consuming alcohol. Dopamine levels may make the drinking experience more gratifying.
Over the long- or medium-term, excessive drinking can significantly alter the levels of these brain chemicals. This causes the body to crave alcohol in order to feel good and avoid feeling bad.
Possible risk factors
Some risk factors may also be linked to excessive drinking.
- Genes: Some specific genetic factors may make some people more likely to develop an addiction to alcohol and other substances. There may be a family history.
- The age of the first alcoholic drink: A study has suggested that people who start drinking alcohol before the age of 15 years may be more likely to have problems with alcohol later in life.
- Easy access: There appears to be a correlation between easy access to alcohol — such as cheap prices — and alcohol abuse and alcohol-related deaths. One study registered a significant drop in alcohol-related deaths after one state raised alcohol taxes. The effect was found to be nearly two to four times that of other prevention strategies, such as school programs or media campaigns.
- Stress: Some stress hormones are linked to alcohol abuse. If stress and anxiety levels are high, a person may consume alcohol in an attempt to blank out the upheaval.
- Peer drinking: People whose friends drink regularly or excessively are more likely to drink too much. This can eventually lead to alcohol-related problems.
- Low self-esteem: Those with low self-esteem who have alcohol readily available are more likely to consume too much.
- Depression: People with depression may deliberately or unwittingly use alcohol as a means of self-treatment. On the other hand, consuming too much alcohol may increase the risk of depression, rather than reducing it.
- Media and advertising: In some countries, alcohol is portrayed as a glamorous, worldly, and cool activity. Alcohol advertising and media coverage of it may increase the risk by conveying the message that excessive drinking is acceptable.
- How the body processes (metabolizes) alcohol: People who need comparatively more alcohol to achieve an effect have a higher risk of eventually developing health problems related to alcohol.
For AUD to be diagnosed in the U.S., the individual must meet the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APS).
The criteria include having a pattern of consumption that leads to considerable impairment or distress.
At least three of the following criteria should have been present during the past 12 months:
- Alcohol tolerance: The person needs a large quantity of alcohol to feel intoxicated. However, when the liver is damaged and cannot metabolize the alcohol so well, this tolerance may drop. Damage to the central nervous system may also reduce tolerance levels.
- Withdrawal symptoms: When the individual abstains from alcohol or cuts down, they experience tremors, insomnia, nausea, or anxiety. They may drink more to avoid these symptoms.
- Beyond intentions: The person drinks more alcohol, or over a longer period, than they intended.
- Unsuccessful attempts to cut down: The person is continuously trying to cut down alcohol consumption but does not succeed. They may have a persistent desire to cut down.
- Time consumed: The person spends a lot of time obtaining, using, or recovering from alcohol consumption.
- Withdrawal: The individual withdraws from recreational, social, or occupational activities that they previously participated in.
- Persistence: The person continues consuming alcohol, even though they know it is harming them physically and psychologically.
Some signs and symptoms of alcohol abuse may be due to another condition. Ageing can lead to memory problems and falls, for example.
A person may go to the doctor about a medical condition, such as a digestive problem, and not mention how much alcohol they consume. This can make it difficult for a doctor to identify who might benefit from alcohol dependency screening.
If a health worker suspect alcohol may be a problem, they may ask a series of questions. If the patient answers in a certain way, the doctor may then use a standardized questionnaire to find out more.
Tests for alcoholism
Blood tests can only reveal very recent alcohol consumption. They cannot tell whether a person has been drinking heavily for a long time.
If a blood test reveals that the red blood cells have increased in size, it could be an indication of long-term alcohol abuse.
Carbohydrate-deficient transferrin (CDT) is a blood test that helps detect heavy alcohol consumption.
Other tests can indicate whether there is damage to the liver, or — in males — reduced testosterone levels. Both of these might indicate chronic alcohol consumption.
However, screening with an appropriate questionnaire is seen as an effective means of reaching an accurate diagnosis.
Many people who consume unhealthy amounts of alcohol deny that alcohol poses a problem for them. They may tend to minimize the extent of their drinking.
Talking to family members may help the doctor understand the situation, but they will need permission to do this.
Complications of this condition may include memory loss, confusion, mental health issues, and problems with work or home life.
Drinking alcohol usually elevates a person's mood at first.
However, a person who has been consuming unhealthy amounts of alcohol for a long time is likely to become sedated when they drink.
This is because alcohol depresses the nervous system.
Alcohol may undermine a person's judgment. It can lower inhibitions and alter the drinker's thoughts, emotions, and general behavior.
Heavy regular drinking can seriously affect a person's ability to coordinate their muscles and speak properly.
Heavy binge drinking could lead to a coma.
Eventually, regular heavy drinking may cause at least one of the following problems:
- Fatigue: The person feels tired most of the time.
- Memory loss: Alcohol affects the short-term memory in particular.
- Eye muscles: The eye muscles can become significantly weaker.
- Liver diseases: There is a higher chance of developing hepatitis and cirrhosis, an irreversible and progressive condition.
- Gastrointestinal complications: Gastritis or pancreas damage can occur. These will undermine the body's ability to digest food, absorb certain vitamins, and produce hormones that regulate metabolism.
- Hypertension: Regular heavy drinking is likely to raise blood pressure.
- Heart problems: There is a higher risk of cardiomyopathy (damaged heart muscle), heart failure, and stroke.
- Diabetes: There is a high risk of developing diabetes type 2, and people with diabetes have a high chance of complications if they regularly consume more alcohol than is recommended. Alcohol prevents the release of glucose from the liver, resulting in hypoglycemia. If a person with diabetes is already using insulin to lower their blood sugar levels, hypoglycemia could have serious consequences.
- Menstruation: Excessive consumption of alcohol can stop or disrupt menstruation.
- Erectile dysfunction: There may be problems getting or sustaining an erection.
- Fetal alcohol syndrome: Consuming alcohol during pregnancy increases the risk of birth defects. The newborn may have a small head, heart problems, shortened eyelids, and developmental and cognitive problems.
- Thinning bones: Alcohol interferes with the production of new bone, leading to a thinning of the bones and an increased risk of fractures.
- Nervous system problems: There may be numbness in the extremities, dementia, and confused or disordered thinking.
- Cancer: There is a higher risk of developing several cancers, including cancer of the mouth, esophagus, liver, colon, rectum, breast, prostate, and pharynx.
- Accidents: There is a higher chance of injuries from falls, road traffic accidents, and so on.
- Domestic abuse: Alcohol is a major factor in spouse-beating, child abuse, and conflicts with neighbors.
- Work or school problems: Employment or educational problems and unemployment are often alcohol-related.
- Suicide: Suicide rates among people with alcohol dependence or who consume alcohol inappropriately are higher than among those who do not.
- Mental illness: Alcohol abuse increases the risk of mental illness, and it can make existing mental illnesses worse.
- Problems with the law: People who consume alcohol are significantly more likely to spend time in court or in prison, compared with the rest of the population.
The first step toward recovery is to acknowledge that there is an alcohol dependency problem.
The next step is to get help. This is available from a range of support groups and professional services.
The following are recognized treatment options for alcoholism:
- Do-it-yourself: Some people with an alcohol problem manage to reduce their drinking or abstain without seeking professional help. Free information is available on websites, and self-help books can be purchased online.
- Counseling: A qualified counselor can help the person share their problems and then devise a plan to tackle the drinking. Cognitive behavioral therapy (CBT) is commonly used to treat alcohol dependency.
- Treating underlying problems: There may be problems with self-esteem, stress, anxiety, depression, or other aspects of mental health. It is important to treat these problems, too, as they can increase the risks posed by alcohol. Common alcohol-related issues, such as hypertension, liver diseases, and possibly heart diseases, will need to be treated too.
- Residential programs: These can offer expert professional help, individual or group therapy, support groups, training, family involvement, activity therapy, and a host of strategies for treating alcohol abuse. Being physically away from access to temptation is helpful for some people.
- Drug that provokes a severe reaction to alcohol: Antabuse (disulfiram) causes a severe reaction when somebody drinks alcohol, including nausea, flushing, vomiting, and headaches. It is a deterrent, but it will not treat the compulsion to drink or solve the problem in the long term.
- Drugs for cravings: Naltrexone (ReVia) may help reduce the urge to have a drink. Acamprosate (Campral) may help with cravings.
- Detoxification: Medications can help prevent withdrawal symptoms (delirium tremens, or DTs) that can occur after quitting. Treatment usually lasts 4 to 7 days. Chlordiazepoxide, a benzodiazepine medication, is frequently used for detoxification (detox).
- Abstinence: Some people complete detox successfully, but they start drinking again either soon after or some time later. Access to counseling, medical help, support groups, and family support can all help the individual avoid alcohol as time goes on.
- Alcoholics Anonymous: Alcoholics Anonymous is an international fellowship of men and women who have faced problems with alcohol. It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. There are no age or education requirements. Membership is open to anyone who wants to stop drinking.
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