What is alcohol use disorder? How to treat alcoholism (original) (raw)

Alcoholism, now known as alcohol use disorder, is a condition in which a person has a desire or physical need to consume alcohol. Treatment can include counseling, medications, residential programs, and support groups.

The National Institutes of Health (NIH) states that in 2022, 29.5 million Americans ages 12 years and older had alcohol use disorder (AUD).

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes AUD as “an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.”

This article explains what to know about AUD.

A person with AUD does not know when or how to stop drinking. They spend a lot of time thinking about alcohol and cannot control how much they consume, even if it is causing serious problems financially and at home or work.

Excessive or inappropriate consumption of alcohol is not necessarily the same as alcohol dependence.

Moderate alcohol consumption does not generally cause any psychological or physical harm. However, if someone who enjoys moderate drinking increases their consumption or regularly consumes more than the recommended quantity, AUD may eventually develop.

A person who drinks excessive alcohol may not be the first to realize it is a problem.

Someone with AUD may do the following:

• drink alone or in secret
• be unable to limit how much alcohol they consume
• black out and be unable to remember chunks of time
• have rituals and show irritation if someone else comments on these rituals, such as drinking before, during, or after meals or after work
• lose interest in hobbies they previously enjoyed
• feel the urge to drink
• feel irritable when drinking times approach, especially if alcohol may not be available
• store alcohol in unusual places
• gulp down drinks
• have problems with relationships, the law, finances, or work that stem from drinking
• need more alcohol to feel its effect
• experience nausea, sweating, or shaking when not drinking

Alcohol consumption becomes a problem when it takes precedence over all other activities.

The problems relating to alcohol dependence are extensive, and its effects can be physical, psychological, and social.

Alcohol dependence develops over time and can disrupt the balance of gamma-aminobutyric acid (GABA) in the brain and glutamate. GABA controls impulsiveness, while glutamate stimulates the nervous system.

In the brain, levels of the neurotransmitter dopamine rise after consuming alcohol. These heightened 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 to feel good and avoid feeling bad.

Possible risk factors

Some risk factors may also contribute to AUD, including:

• Genes: According to the NIH, genetic factors account for around half the risk of AUD. Environmental factors and interaction between genes and the environment account for the remaining risk.
• The age of the first alcoholic drink: People who start drinking alcohol before the age of 15 years may be 3 times as likely to develop AUD as people who begin drinking at the age of 21 years or older.
• Stress: Some stress hormones may have links to alcohol misuse. 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: People with low self-esteem are more likely to consume too much.
• Depression: People with depression may use alcohol as self-treatment. On the other hand, consuming excess alcohol may increase the risk of depression rather than reducing it.
• How the body processes or metabolizes alcohol: People who need comparatively more alcohol to achieve an effect have a higher risk of eventually developing health problems related to alcohol.

To diagnose AUD, people must meet at least 2 of 11 criteria described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) in the past 12 months.

According to the number of criteria a person meets, doctors diagnose AUD as mild, moderate, or severe.

The criteria include having a pattern of consumption that leads to considerable impairment or distress.

Generally, drinking alcohol elevates a person’s mood at first. However, as they consume more drinks, an individual is likely to become sedated. 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.

Regular heavy drinking can seriously affect a person’s ability to coordinate their muscles and speak properly.

Eventually, regular heavy drinking may cause at least one of the following issues:

• Fatigue: The person feels tired most of the time.
• Memory loss: Alcohol affects short-term memory in particular.
• Eye muscles: The eye muscles can become significantly weaker.
• Liver diseases: There is a higher risk 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 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, heart failure, and stroke.
• Diabetes: There is an increased risk of developing type 2 diabetes. People with this condition have a high risk of complications if they regularly consume more alcohol than health experts recommend.
• Menstruation: Excessive consumption of alcohol can stop or disrupt menstruation.
• Erectile dysfunction: Males may experience issues getting or sustaining an erection.
• Fetal alcohol syndrome: Consuming alcohol during pregnancy increases the risk of birth abnormalities. An infant may have a small head, heart problems, shortened eyelids, developmental problems, and issues with thinking.
• 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 mouth, esophagus (food pipe), liver, colon, rectum, breast, prostate, and pharynx cancers.
• Accidents: There is a higher risk of injuries from falls, road traffic collisions, and other events.
• Domestic abuse: Alcohol is a major factor in domestic abuse, child abuse, and conflicts with neighbors.
• Work or school problems: Employment or educational problems and unemployment often relate to alcohol consumption.
• Suicide: Suicide rates among people with AUD are higher than among those without it.
• Mental illness: Alcohol misuse increases the risk of mental illness and can worsen existing mental illnesses.

The first step toward a person’s recovery is to acknowledge they have an alcohol dependency problem.

The next step is to get help. This is available from a range of support groups and professional services.

Some recognized treatment options for alcoholism include:

• Doing it yourself: Some people with AUD manage to reduce their drinking or abstain without seeking professional help. Help to do this is available online.
• Counseling: Qualified counselors can help people share their problems and devise a plan to tackle the drinking. They may use cognitive behavioral therapy (CBT) or other strategies.
• Treating underlying problems: Alongside treating alcohol dependency, it is important to treat mental health problems, such as depression, and alcohol-related issues, such as hypertension, liver, and heart diseases.
• 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 misuse.
• Drugs that provoke a severe reaction to alcohol: Doctors may recommend taking a drug such as disulfiram (Antabuse), which causes a severe reaction when somebody drinks alcohol, including nausea, flushing, vomiting, and headaches. It is a deterrent but will not treat the compulsion to drink or solve the problem in the long term.
• Drugs for cravings: Naltrexone (Vivitrol) 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. Doctors may prescribe chlordiazepoxide, a benzodiazepine medication for detoxification (detox).
• Abstinence: Some people complete detox, but they start drinking again either soon after or sometime later. Access to counseling, medical help, support groups, and family support can all help the individual avoid alcohol in the long term.
• Alcoholics Anonymous: Alcoholics Anonymous is an international fellowship of people who have faced problems with alcohol. It is nonprofessional, self-supporting, multiracial, apolitical, and available almost everywhere. Membership is open to anyone who wants to stop drinking.

Below are answers to common questions about alcohol use disorder.

Does drinking three beers a day make me an alcoholic?

If someone feels compelled to drink 3 drinks or more every day and is uncomfortable when alcohol is unavailable, they may have an alcohol dependency problem. The Dietary Guidelines for Americans 2020-2025 states that moderate drinking equates to 2 drinks or less per day for males and 1 drink per day or less for females.

According to the NIH, “heavy drinking” equates to:

• For females: 4 or more drinks on any day or 8 or more per week
• For males: 5 or more drinks on any day or 15 or more per week

Are alcohol abuse and alcoholism the same thing?

Alcohol abuse and alcoholism both describe drinking that causes negative consequences for the drinker. Alcoholism often describes a person’s chemical dependency on alcohol and their inclination to prioritize drinking in their lives.

Alcohol abuse could encompass both occasional problematic drinking and alcohol dependency. Professionals now use the term alcohol use disorder to describe the spectrum of alcohol use problems.

People with alcohol use disorder (AUD) cannot control how much they need and desire alcohol and, as a result, consume it in amounts that can lead to severe health issues. Genetics may make some individuals more susceptible, but a person’s environment plays an important part.

AUD can impair daily functioning and lead to various complications. Long-term health effects include liver and heart disease.

Treatment for AUD may be lifelong and include counseling, support groups, residential programs, and medications.