Alcohol Use Disorder
Dying for a Drink
Alcohol use disorder is a broad category that includes many types of problematic drinking. Alcohol addiction and dependence, both found in the category of alcohol use disorder, affect around 16 million American adults, according to the National Institute on Alcohol Abuse and Alcoholism.1 Half of Americans have a close family member with an alcohol use disorder, which takes a major toll on the health of the family. Alcohol use disorder reduces your sense of wellbeing and creates numerous problems in your life.
Recovery from alcohol use disorder is a process of restoring life and finding internal motivations for quitting drinking. Asking for help is often one of the hardest parts of recovery, but it’s the first step towards reclaiming life from alcohol.
Alcohol Use Disorder Defined
Alcohol abuse, addiction and dependence are diagnosed under the umbrella term “alcohol use disorder,” or AUD. The diagnosis is characterized as mild, moderate or severe, depending on how many of the diagnostic criteria are met. While all found under the umbrella of alcohol use disorder, alcohol abuse, addiction and dependence are not the same things, although these terms are often used interchangeably. Understanding the differences is important for understanding alcohol use disorder treatment and recovery.
Alcohol Use Disorder: Abuse
Alcohol abuse is defined as using alcohol in a way that causes negative consequences in life. Alcohol abuse can lead to relationship problems, legal troubles, financial issues or physical and mental health conditions. According to the Centers for Disease Control (CDC), binge drinking is a form of alcohol use disorder. Binge drinking is the most common, most costly and deadliest form of alcohol abuse in the U.S.2 Binge drinking occurs when enough alcohol is drank over the course of two hours to bring the blood alcohol concentration to .08 percent or higher. For men, this typically occurs with five drinks. For women, it typically occurs with four drinks.
According to the CDC, one in six U.S. adults binge drink, and therefore, have an alcohol use disorder. Although binge drinking is most common among people aged 18 to 34 years, more than half of the 17 billion binge drinkers are people aged 35 years and older.
Binge drinking leads to serious problems, including unintentional injuries, alcohol poisoning, violence, sexually transmitted diseases, unintended pregnancies, chronic diseases and cognitive problems. Most people who binge drink are not addicted to or dependent on alcohol.
Alcohol Use Disorder: Addiction
Around 15 percent of people who abuse alcohol will develop an addiction; classifying them as having an alcohol use disorder. People with an alcohol addiction drink compulsively, even though the drinking causes serious relationship, legal, financial and/or health problems. Once addiction develops, it’s difficult to stop drinking independently.
Addiction develops as the brain changes in response to heavy alcohol abuse. Alcohol acts on the dopamine system in the brain. Dopamine is a neurotransmitter that’s responsible for feelings of pleasure. It also plays an important role in the memory, learning, motivation and reward centers of the brain. Heavy alcohol abuse produces elevated dopamine levels. This leads to a rewiring of motivation, learning and memory centers of the brain. As a result of this rewiring, drinking becomes compulsive and driven by intense cravings.
Whether an alcohol addiction develops depends on a number of factors. A history of trauma, mental illness, chronic stress, and a family history of addiction are risk factors that may increase the chances of an alcohol addiction. Alcohol use disorder is widely considered to be a chronic and relapsing disease of the brain. As a chronic disease, alcohol use disorder can be sent into remission with treatment. If someone drinks again after a period of remission, the brain can quickly revert and lead to compulsive drinking.
Alcohol Use Disorder: Dependence
Dependence is a physical need for alcohol. It’s characterized by withdrawal symptoms that occur when drinking suddenly stops. Alcohol dependence, like addiction, results from changes in the structures and functions of the brain, caused by heavy alcohol abuse.
When alcohol is first consumed, it elevates the activity of the neurotransmitter GABA, which produces feelings of relaxation and calm. At the same time, it suppresses the activity of glutamate, which is responsible for feelings of excitability. With heavy alcohol abuse, the brain attempts to maintain normal neurotransmitter function. It does this by suppressing GABA and increasing glutamate activity in an attempt to compensate for the effects of the alcohol. This produces tolerance, which means that more is consumed in order to get the previous effects.
As more alcohol is consumed, the brain continues to compensate. At some point, brain function may shift so that it now operates more comfortably when alcohol is in the blood. Then, when drinking stops suddenly, normal brain function quickly rebounds. GABA, which was suppressed, now floods the brain. Glutamate, which was increased, is now suppressed. This sudden change in the function of these and other neurotransmitters causes physical withdrawal symptoms.
How Alcohol Use Disorder is Diagnosed
Alcohol use disorder is diagnosed using eleven criteria identified by the Diagnostic and Statistical Manual of Mental Disorders. If two or three of the criteria are met, the disorder is characterized as mild. Four to five indicates a moderate disorder. An alcohol use disorder is characterized as severe when six or more criteria are met.
To determine the presence of an alcohol use disorder, determine which of the following are applicable to the past year:
Drinking more alcohol or drinking for a longer period of time than you intended.
Wanting to quit or cut down but finding that you can’t.
Spending an inordinate amount of time drinking or recovering from drinking.
Neglecting responsibilities at work, home, or school.
Continuing to drink even though it causes problems with your relationships.
Experiencing intense cravings for alcohol.
Losing interest in activities you used to enjoy, usually to drink instead.
Finding yourself in high-risk or dangerous situations when under the influence.
Continuing to drink even though it’s causing new or worsening physical or mental health problems.
Developing a tolerance for alcohol so that you need more to produce the desired effects.
Experiencing withdrawal symptoms when you suddenly stop drinking.
Other Signs and Symptoms to Look For
People who have an alcohol use disorder may also show signs or symptoms such as:
Withdrawing from family and friends
Hiding alcohol around the house, in the car or at work
Lying about the extent of the alcohol abuse
Engaging in erratic or violent behavior
Worsening symptoms of a mental illness like anxiety or depression
The onset of new symptoms of mental illness
Denial about the alcohol abuse being a problem
Becoming angry or defensive when someone tries to talk about the alcohol abuse
Short-Term and Long-Term Effects of Alcohol Use Disorder
Alcohol use disorder has serious long-term health consequences. According to the CDC, around 88,000 Americans die as a result of alcohol abuse, with 10,000 of those deaths related to driving while under the influence.3
Short-term risks of alcohol use disorder include:
Injury or death related to drowning, burns, and falls
Increased risk of violence, including sexual assault
Risky sexual encounters
Legal problems related to intoxication
Long-term risks of alcohol use disorder include:
High blood pressure
Increased risk of some cancers
Mental illnesses like anxiety and depression
Social problems like homelessness, unemployment or relationship troubles
Addiction and dependence
Getting Help for an Alcohol Use Disorder
Whether an alcohol use disorder is mild, moderate or severe, treatment can help end alcohol abuse for good and restore daily life. According to the National Institute on Drug Abuse, once an addiction develops, professional help is almost always needed for long-term recovery.4 Currently, approximately less than eight percent of people who need help overcoming an alcohol use disorder get the help needed for successful recovery. Some of the reasons why people avoid treatment include:
Fear that treatment won’t work for them
Fear of what others will think
Fear of losing friends
Fear of what life will be like without alcohol
An inability to afford treatment
Feeling ambivalent about recovery
Denial that the drinking is a problem
Choosing to seek help for an alcohol use disorder vastly increases the chances of long-term recovery. Treatment does more than simply help stop drinking. It helps to repair damaged relationships, redefine happiness, purpose and meaning in a life without alcohol. Alcohol use disorder treatment occurs in three phases: detox, treatment, and aftercare.
Detox for Alcohol Use Disorder: Ending the Dependence
Detox is the first step in treating alcohol use disorder. Medical detox is recommended for people with alcohol dependence, since withdrawal symptoms may turn dangerous. Medical detox involves supervision by medical personnel who can administer medication as needed to alleviate uncomfortable withdrawal symptoms. Professionals are on hand to address serious medical complications in the event of severe withdrawal, also known as delirium tremens, or DTs.
Withdrawal During Detox
Withdrawal may produce a range of symptoms. Not everyone experiences all of the symptoms associated with alcohol withdrawal. The severity of symptoms can range from mild to severe, depending on a number of factors.
Common withdrawal symptoms associated with alcohol include:
- Intense cravings
- Anxiety or depression
- Mood swings
- Mild hallucinations
- Difficulty concentrating
- Nausea and vomiting
- Severe hallucinations
Severe alcohol withdrawal symptoms include:
- Chest or stomach pain
- Sudden delirium
- Rapid or irregular heartbeat
- High fever
Support During Detox
Detox provides a high level of emotional and medical support. High quality detox programs offer complementary therapies like yoga, acupuncture, massage therapy and meditation to help improve feelings of calm, good health and wellbeing.
Assessments During Detox
Detox only addresses alcohol dependence. It’s not addiction treatment and does very little to address the issues that lead to the alcohol use disorder. During detox, a variety of medical and mental health assessments give care providers information about your medical history, mental health history, nutrition, the underlying causes of your addiction, and whether you need additional services, such as housing or employment assistance. Care providers use this information to develop a comprehensive, individualized treatment plan and determine the best setting for treatment, whether an inpatient or outpatient program.
Treatment: Addressing the Addiction in Alcohol Use Disorder
A high quality, holistic treatment program offers the best possible outcomes of treatment, according to the Substance Abuse and Mental Health Services Administration. A holistic approach to treatment addresses a wide range of issues of body, mind and spirit. It recognizes that there are many pathways to recovery, and what works for one person may not work for another. A holistic treatment program promotes whole-person healing through traditional and complementary therapies and a number of other services and interventions. It addresses multiple issues to help clients create a new, sober lifestyle that will promote long-term recovery.
Traditional therapies used in treatment are evidence-based therapies that are shown to successfully treat an alcohol use disorder. The most effective and commonly used traditional treatment therapy is cognitive-behavioral therapy, which helps individuals change harmful thought and behavior patterns and develop coping skills for managing negative emotions, cravings and stress, which are major relapse triggers.
Complementary treatment therapies include art therapy, mindfulness meditation, sound bath healing and yoga. These and other therapies are shown to be effective for treating addiction when they’re used alongside traditional “talk” therapies. Complementary therapies help reduce stress and negative emotions while also promoting greater self-awareness and a healthier lifestyle.
How Treatment Helps
Through traditional and complementary therapies, individuals in treatment:
Change unhelpful thought and behavior patterns
Address underlying issues, such as a history of trauma, chronic stress, or mental illness
Develop essential skills central to recovery
Find purpose and meaning in a life of sobriety
Learn to relax and have a good time without alcohol
Repair damaged relationships
Restore function to all domains of life
Improve self-esteem, self-awareness, and self-confidence
Learn to cope with negative emotions and experiences in healthy ways
Aftercare: Support for Early Solo Recovery
Once treatment ends, recovery support continues through aftercare. Aftercare plans are highly individualized and help the transition from treatment to independent recovery. A typical aftercare plan will include ongoing therapy through an outpatient program, participation in a peer support group in the community and ongoing monitoring of physical or mental health issues. Additional components of the plan will be added as needed and may include a variety of services and interventions. A case manager periodically reviews the aftercare plan and makes adjustments based upon a client’s changing needs.
Overcoming an alcohol use disorder isn’t easy, but treatment helps develop the mindset, skills, strategies and techniques needed for long-term success. Treatment helps to transform life on all fronts, including helping to repair damaged relationships, find purpose and meaning in life without needing alcohol to relax and have fun.
The first step to recovery is seeking help when you feel helpless against alcohol. Treatment works for most people who fully participate in their treatment plan, and it can help you overcome an alcohol use disorder, too.