Alcohol Use Disorder

Alcohol is commonly used as a form of celebration, to relax, or when socializing with others. Our age, family history, how often we drink and how much we drink are important variables to keep in mind when considering our relationship with alcohol. Drinking in moderation is a reasonable way to use alcohol. However, when we drink in excess, as a way to cope with or avoid other problems and stressors, it can lead to physical and emotional problems.

According to the "Dietary Guidelines for Americans 2015-2020,” U.S. Department of Health and Human Services and U.S. Department of Agriculture, moderate drinking is up to 1 drink per day for women and up to 2 drinks per day for men. 

In the U.S., one "standard" drink contains roughly 14 grams of pure alcohol, which is found in:

  • 12 ounces of regular beer, which is usually about 5 percent alcohol
  • 5 ounces of wine, which is typically about 12 percent alcohol
  • 1.5 ounces of distilled spirits, which is about 40 percent alcohol

Definition

Because alcohol use varies greatly between people and over time, it can be helpful to think about signs that can signal the start of a problem, such as when drinking interferes with home life, school, or work. There may be a problem if you continue to drink even though it causes problems with family and friends. Or there may be a problem if you had to cut back activities because of drinking.

Alcohol abuse cuts across gender, race, and ethnicity. Nearly 14 million people in the U.S. are dependent on alcohol. More men than women are alcohol dependent or have alcohol problems. Issues surrounding alcohol are highest among young adults ages 18-29 and lowest among adults ages 65 and older. Defining and diagnosing Alcohol Use Disorder can be complicated when working with young adults; the lifestyle of college students often includes excessive use of alcohol, making it difficult to ascertain when it is a problem and when it isn't.  

Short-term effects include memory loss, hangovers, and blackouts. Long-term problems associated with heavy drinking include stomach ailments, heart problems, cancer, brain damage, memory loss, and liver cirrhosis. Heavy drinkers also markedly increase their chances of dying from automobile accidents, homicide, and suicide. 

Alcohol use and abuse is also linked to a higher incidence of unemployment, domestic violence and legal issues.

Symptoms

Alcohol Use Disorder is defined as a problematic pattern of drinking that results in two or more of the following situations within a 12-month period:

  • Situations where you end up drinking more or for a longer period than intended
  • On more than one occasion there is an attempt or feeling the need to cut down or stop drinking
  • Spending a lot of time during your day or week drinking, or recovering from the aftereffects of alcohol
  • Craving or thinking about wanting a drink or urge to use alcohol
  • Failure to fulfill major work, school, or home responsibilities due to drinking
  • Continuing to drink even though it was causing relationship troubles with your family or friends
  • Prioritizing drinking by giving up or cutting back activities that were important to you, or gave you pleasure
  • Drinking before or during situations that are physically dangerous—while driving a car, operating machinery, swimming, having unsafe sex
  • Continuing to drink even though: drinking is making you feel depressed or anxious; is linked to another health problem; or results in having memory blackouts
  • Tolerance for drinking, which is: needing much more than you once did to get the desired effect from alcohol, or not experiencing the same effect when drinking the same amount of alcohol
  • Withdrawal, as characterized by having withdrawal symptoms (trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, a seizure, or sensed things that were not there)

Alcoholism, or alcohol dependence, used to be considered the most severe form of alcohol abuse. The DSMV integrates alcohol abuse and alcohol dependence, into a single disorder called alcohol use disorder (AUD) with mild, moderate, and severe sub-classifications. 

Mild: The presence of two to three symptoms

Moderate: The presence of four to five symptoms

Severe: The presence of six or more symptoms. 

Answering the following four questions can help you find out if you or a loved one has a drinking problem:

  • Have you ever felt you should cut down on your drinking?
  • Have people been annoyed by or criticized your drinking?
  • Have you ever felt bad or guilty about your drinking?
  • Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

One yes answer suggests a possible problem. A yes answer to more than one question indicates that a problem likely exists. Answering no to the above questions may still imply the need for help. It is important to consult a doctor or other health care provider immediately and be honest and forthcoming with them to determine if you have a drinking problem and, if so, collaborate on the best course of action.

Health Hazards that may indicate problematic drinking habits or alcohol abuse:

  • Increased incidence of cancer, particularly cancer of the larynx, esophagus, liver, and colon
  • Alcoholic hepatitis, an acute syndrome reported by patients who have ingested about 100 grams of alcohol (about eight ounces of 100-proof whiskey, 30 ounces of wine, or eight 12-ounce cans of beer) daily for over one year. Symptoms can include fever, jaundice, and enlarged liver
  • Acute and/or chronic pancreatitis—inflammatory disease of the pancreas
  • Cirrhosis of the liver— fibrotic changes in the liver
  • Alcoholic neuropathy—or degenerative changes in the nervous system affecting nerves responsible for sensation and movement
  • Alcoholic cardiomyopathy
  • High blood pressure
  • Nutritional deficiencies—vitamin B12, folate, and thiamine
  • Erectile dysfunction
  • Cessation of menses
  • Fetal alcohol syndrome in the children of women who drink during pregnancy
  • Alcohol related dementia
  • Wernicke-Korsakoff syndrome or Wernicke's encephalopathy: a syndrome of central nervous system changes resulting from thiamine deficiency that leave permanent brain damage that causes symptoms where an individual becomes confused, loses balance while walking, and shows loss of vision. ​

Causes

The risk for developing alcoholism is influenced by both genetic and environmental factors.

Alcohol use tends to run in families, and the rate of the condition is three to four times higher in close relatives. When there is a family history of alcohol or substance use behaviors, the risk increases with closer genetic relationship to the affected person. 

Environmental factors include cultural attitudes about drinking, availability of alcohol, stress levels, substance abuse by peers, positive expectations of the use of alcohol and maladaptive ways of coping. Impulsivity as a personality variable is also linked to high alcohol use and abuse.

Risk for abusing alcohol also increases if an individual uses alcohol to avoid thinking about things or numbing themselves to their problems, to cope with anxiety, fears or mood issues, or enhance their creativity. 

Treatments

Many people with alcohol problems don't recognize when their drinking becomes problematic, and others are not ready to get help with their drinking. It is important for each individual person to consider the pros and cons related to their drinking and to decide whether they need to cut down (harm reduction) or quit altogether (abstinence).

Abstinence from alcohol is strongly recommended for those who have 

  • Tried cutting down but cannot stay within the limits set
  • Have had an alcohol use disorder or now have symptoms
  • Have a physical or mental condition that is caused or worsened by drinking
  • Are taking a medication that interacts with alcohol
  • Are or may become pregnant

Others may benefit from the harm reduction approach, aimed to help individuals reduce the impact of the consequences associated with drinking.

When drinking is associated with significant intoxication (problematic behavior or changes caused by recent ingestion of alcohol) and/or withdrawal symptoms (nausea, vomiting, agitation, insomnia, seizures, hand tremors), detoxification may be required to start the process of treatment. 

Detoxification, entailing withdrawal from alcohol, is done in a controlled, supervised setting in which medications relieve symptoms. Detoxification usually takes four to seven days. Examination for other medical problems is necessary. For example, liver and blood-clotting problems are common. A balanced diet with vitamin supplements is important. Complications associated with the acute withdrawal from alcohol may occur, such as delirium tremens (DT's), which could be fatal. Depression or other underlying mood disorders should be evaluated and treated, as alcohol abuse often develops from efforts to self-treat an illness.

Following detoxification, alcohol recovery or rehabilitation programs support the affected person to maintain abstinence from alcohol. Counseling, psychological support, nursing, and medical care are usually available within these programs. Education about the disease of alcoholism and its effects is part of the therapy. Many of the professional staff involved in rehabilitation centers are recovering alcoholics who serve as role models. Programs can be either inpatient, with the patient residing in the facility during the treatment, or outpatient, with the patient attending the program while living at home.

It is also important to remember that oftentimes other psychiatric conditions, such as depression or bipolar disorder, may coexist with alcoholism. Therefore, coexisting or underlying disorders may also need to be treated. Individuals suffering from other underlying psychiatric conditions may use alcohol as a form of self-medication. If this is the case, dual diagnosis of any coexisting condition is essential as it can guide treatment.

Medication

Three oral medications—disulfiram (Antabuse), naltrexone (Depade, ReVia), and acamprosate (Campral)—are currently approved to treat alcohol dependence. In addition, an injectable, long-acting form of naltrexone (Vivitrol) is available. These medications have been shown to help people with dependence reduce their drinking, avoid relapse to heavy drinking, and achieve and maintain abstinence. Naltrexone acts in the brain to reduce craving for alcohol after someone has stopped drinking. Acamprosate is thought to work by reducing symptoms that follow lengthy abstinence, such as anxiety and insomnia. Disulfiram discourages drinking by making the person taking it feel sick after drinking alcohol.

Other types of drugs are available to help manage symptoms of withdrawal (such as shakiness, nausea, and sweating) if they occur after someone with alcohol dependence stops drinking. Early recognition of these symptoms and immediate treatment can prevent some of the symptoms or drastically limit severity.

Alcoholics Anonymous

Virtually all alcoholism treatment programs also include support meetings such as Alcoholics Anonymous (AA). AA describes itself as a "worldwide fellowship of men and women who help each other to stay sober." Although AA is generally recognized as an effective mutual help program for recovering alcoholics, not everyone responds to AA's style or message. Even people who are helped by AA usually find that AA works best in combination with other forms of treatment, including counseling and medical care.

Seeking Help for an Unwilling Alcoholic

An alcoholic can't be forced to get help except under certain circumstances, such as a violent incident that results in court-ordered treatment or medical emergency. Many alcoholism treatment specialists suggest the following steps to help an alcoholic:

  • Stop all "coverups." Family members often make excuses or try to protect the alcoholic from the results of his or her drinking. It is important to stop covering for the alcoholic so that he or she experiences the full consequences of drinking.
  • The best time to talk to the drinker about his or her drinking is shortly after an alcohol-related problem has occurred—a serious family argument or an accident. Choose a time when he or she is sober, both of you are fairly calm, and you have a chance to talk in private.
  • Be specific. Tell the family member that you are worried about his or her drinking. Use examples of the ways in which the drinking has caused problems, including the most recent incident.
  • State the results. Explain to the drinker what you will do if he or she doesn't seek help. What you say may range from refusing to go with the person to any social activity where alcohol will be served to moving out of the house. Do not make any threats you are not prepared to carry out.
  • Get help. Gather information in advance about treatment options in your community. If the person is willing to get help, call immediately for an appointment with a treatment counselor. Offer to go with the family member on the first visit to a treatment program and/or an Alcoholics Anonymous meeting.
  • Call a friend. If the family member still refuses to get help, ask a friend to talk with him or her using the steps just described. A friend who is a recovering alcoholic may be particularly persuasive, but any person who is caring and nonjudgmental may help. 
  • Find strength in numbers. With the help of a health-care professional, some families join with other relatives and friends to help the alcoholic. This approach should only be tried under the guidance of a health-care professional experienced in group intervention.
  • Get support. It is important to remember that you are not alone. Support groups offered in most communities include Al-Anon, which holds regular meetings for spouses and other significant adults in an alcoholic's life, and Alateen, which is geared toward children of alcoholics. These groups help family members understand that they are not responsible for an alcoholic's drinking and that they need to take steps to take care of themselves, regardless of whether the alcoholic family member chooses to get help.

Alcoholism treatment works for many people. But just like any chronic disease, there are varying levels of success when it comes to treatment. Some people stop drinking and remain sober. Others have long periods of sobriety with bouts of relapse. And still others cannot stop drinking for any length of time. With treatment, one thing is clear, the longer a person abstains from alcohol the more likely he or she will stay sober.

Find a Treatment Program here.

References

  • National Institute of Mental Health
  • National Institute of Alcohol Abuse and Alcoholism
  • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised
  • Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • National Institutes of Health (NIH) - National Library of Medicine

Last reviewed 04/19/2017