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Alcoholism

For many, beer, wine, and spirits conjure up thoughts of social gatherings and tipsy fun. But alcohol is a nervous system depressant and easily alters behavior, culminating in some cases in the emotional pain and physical disintegration of alcohol addiction, colloquially known as alcoholism. Experts continue to debate the benefits and risks of drinking and passionately argue over whether moderation or complete abstinence is the best option for those who struggle with alcoholism.

Alcohol Use Disorder is a pattern of disordered drinking that leads to significant distress. It can involve withdrawal symptoms, disruption of daily tasks, discord in relationships, and risky decisions that place oneself or others in danger. About 15 million American adults and 400,000 adolescents suffer from alcohol use disorder, according to the National Institute on Alcohol Abuse and Alcoholism. But treatment and support are available to help those suffering begin to heal.

For more information on symptoms, causes, and treatment of alcohol use disorder see our Diagnosis Dictionary.

Signs, Symptoms, and Diagnosis

Alcoholism most often refers to alcohol use disorder—a problematic pattern of drinking that leads to impairment or distress—which can be characterized as mild, moderate, or severe based on the number of symptoms a patient has, such as failing to fulfill obligations or developing a tolerance. Mild is classified as 2 to 3 symptoms, moderate is classified as 4 to 5 symptoms, and severe is classified as 6 or more symptoms, according to the DSM-5.

What are the symptoms of alcoholism?

Alcohol use disorder is a problematic pattern of alcohol use that leads to distress in one’s daily life, according to the DSM-5. The symptoms that can lead to a diagnosis include drinking more alcohol than intended, failing to cut back on alcohol use, devoting substantial time and effort to drinking and recovering from drinking, strong cravings for alcohol, failing to fulfill obligations at work, school, or home, disengaging from relationships and activities, and developing tolerance or withdrawal, among others. Experiencing at least two symptoms throughout the course of a year merits a diagnosis, from mild to moderate to severe.

What are early warning signs of addiction?

The later stages of addiction can yield physical changes, but behavioral signs can help detect it early on. People with an addiction often develop rigid routines that revolve around uninterrupted access to alcohol and other drugs; they may be irritated by schedule changes and blame their frustration on others. They may have powerful mood swings that seem to change their personality. Relationships may deteriorate, as their social circle narrows to other drug or alcohol users. Their work may decline as well, and they may lose a spiritual or religious practice they once valued.

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Causes and Risk Factors

Like all addictions, alcohol use disorder is linked to a complex combination of biological, social, and psychological factors. Research highlights a genetic component to the disorder, as about half of one's predisposition to alcoholism can be attributed to genetic makeup. People may turn to alcohol as a way to cope with trauma or other, often unrecognized psychological disorders. Socially, alcoholism may be tied to family dysfunction or a culture of drinking.

Why do people start drinking?

Before it becomes problematic, why do people turn to alcohol in the first place? A number of factors can motivate people to drink. One is simply its rewarding consequences, such as having fun or escaping social anxiety. Having an impulsive personality plays into the decision to seek rewards despite negative repercussions. Another factor is stress, because alcohol can alleviate distressing emotions. Social norms, such as drinking during a happy hour or on a college campus, and positive experiences with alcohol in the past (as opposed to getting nauseous or flushed) play a role as well.

Is alcoholism genetic?

The chance of developing any health problem is related to the genetic code we are born with. Just like some people have a greater risk of developing cardiovascular disease or cancer, others have a greater risk of developing an alcohol use disorder. Someone with a family history of alcohol problems, someone prone to anxiety or depression, someone who is highly impulsive and takes risks, and someone who needs more alcohol than average to experience its effects has a higher likelihood of developing the disorder.

The Effects of Alcohol

Alcohol is a powerful substance, with the capacity for positive experiences, such as bursts of creativity and fun, as well as harmful repercussions, such as addiction and health problems. Becoming dependent on alcohol can lead to challenges for both the mind and the body.

What does alcohol do to the brain?

Heavy drinking can fuel changes in the brain—about half of people who meet the criteria for alcoholism show problems with thinking or memory, research suggests. The ability to plan ahead, learn and hold information (like a phone number or shopping list), withhold responses as needed, and work with spatial information (such as using a map) can be affected. Brain structures can shift as well, particularly in the frontal lobes, which are key for planning, making decisions, and regulating emotions. But many people in recovery show improvements in memory and concentration, even within the first month of sobriety.

Does alcohol affect creativity?

The idea that altered forms of consciousness such as mania or alcohol can enhance creativity is a popular belief. And it turns out there’s some evidence for that idea. Researchers found that participants who had a few drinks were better and faster at creative problem solving than their sober counterparts. The reason may be that alcohol tamps down working memory and therefore sparks people to think outside the box.

Treatment and Recovery

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In some cases, the first step in treating alcohol use disorder is detoxification—experiencing withdrawal in a safe setting with medical professionals. Following withdrawal, there are many paths to recovery.

Some people are able to stop drinking on their own. There are many organized programs that provide the support of peers, usually through frequent meetings. Alcoholics Anonymous is one example; it offers a structured 12-step path toward recovery with a community of support from those who have dealt with similar challenges.

Cognitive behavioral therapy is another path, available in person or online. Non-abstinence-based recovery models—such as Moderation Management—advocate for reducing one's alcohol consumption rather than abstaining completely.

The biggest barrier to therapy of any kind that patients may face is shame and stigma; most programs address such concerns directly.

What steps can I take to curb my drinking on my own?

Some people prefer to try cutting back or quitting on their own before committing time and money to rehab. And there are a few approaches that can identify and combat drinking at an early stage. People can focus on education and support, such as through Alcoholics Anonymous, or take on a sobriety challenge. People can learn mindfulness; rather than trying to soothe uncomfortable feelings with alcohol, mindfulness encourages techniques such as breathing, visualization, and meditation.

In a clinical setting, motivational interviewing, which cultivates the drive to change behaviors, and Screening, Brief Intervention, Referral, and Treatment (SBIRT), which funnels patients to treatment, are also helpful options.

What should I look for in an addiction treatment center?

A few empirically validated practices can help identify strong treatment programs. Treatment centers should ideally have rigorous and reliable screening for substance use disorders and related conditions. They should have an integrated treatment approach that addresses other mental and physical health conditions. They should emphasize linking different phases of care, such as connecting patients to mental health professionals, housing, and peer support groups when transitioning out of the acute phase of care. They should also have proactive strategies to avoid dropping out, involve the family in treatment, employ qualified and certified staff, and be accredited by an external regulatory organization.

Find a treatment center using the Psychology Today Therapy Directory.

Supporting Someone with a Drinking Problem

The pathway to healing and recovery is often a process that occurs over many years. Addiction not only involves the individual suffering, but their partner, their family, and their friends as well. Loved ones can provide immeasurable support, but they almost take care of themselves throughout an often difficult journey.

Why do people deny they have an alcohol problem?

Very few people easily and quickly accept the conclusion that they have a problem. Most struggle against it and craft a variety of arguments to demonstrate that they don’t have a problem. These arguments often rely on misdirection—moving the focus onto someone or something else.

A few common arguments to deny an alcohol problem include: “All my friends drink more than I do,” “I only drink when…,” “But I’m too functional,” “I haven’t hit rock bottom like so and so...,” and “I’ve stopped for long periods of time before.” Recognizing these misleading statements can be the first step in having an honest conversation and helping the person eventually explore treatment.

What do I do if I think someone has a drinking problem?

If you’re concerned that a friend or family member is misusing alcohol, you can begin by doing research. Learn about the nature of the disorder, terms that reduce stigma (avoid “alcoholic”), and different treatment options. Carefully consider when and how you’ll talk to them; for example, bringing it up while they’re intoxicated risks an overly emotional and negative response. Rehearse what you plan to say. Frame the conversation as worry and care for the person. Offer to help them deal with what might be driving their drinking, and volunteer to take concrete steps with them like calling a therapist for a consultation. (Of course, if someone is in immediate danger, call 911 or seek medical attention.)

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