Alcoholism

What is alcoholism, or alcohol use disorder?

Alcoholism has been known by a variety of terms, including alcohol abuse and alcohol dependence. Today, it’s referred to as alcohol use disorder.

It occurs when you drink so much that your body eventually becomes dependent on or addicted to alcohol. When this happens, alcohol becomes the most important thing in your life.

People with alcohol use disorder will continue to drink even when drinking causes negative consequences, like losing a job or destroying relationships with people they love. They may know that their alcohol use negatively affects their lives, but it’s often not enough to make them stop drinking.

Some people may drink alcohol to the point that it causes problems, but they’re not physically dependent on alcohol. This used to be referred to as alcohol abuse.

What causes it?

The cause of alcohol use disorder is still unknown. Alcohol use disorder develops when you drink so much that chemical changes in the brain occur. These changes increase the pleasurable feelings you get when you drink alcohol. This makes you want to drink more often, even if it causes harm.

Eventually, the pleasurable feelings associated with alcohol use go away and the person with alcohol use disorder will engage in drinking to prevent withdrawal symptoms. These withdrawal symptoms can be quite unpleasant and even dangerous.

Alcohol use disorder typically develops gradually over time. It’s also known to run in families.

What are the risk factors?

Although the exact cause of alcohol use disorder is unknown, there are certain factors that may increase your risk for developing this disease.

Known risk factors include having:

  • more than 15 drinks per week if you’re male
  • more than 12 drinks per week if you’re female
  • more than 5 drinks per day at least once a week (binge drinking)
  • a parent with alcohol use disorder
  • a mental health problem, such as depression, anxiety, or schizophrenia

You may also be at a greater risk for alcohol use disorder if you:

  • are a young adult experiencing peer pressure
  • have low self-esteem
  • experience a high level of stress
  • live in a family or culture where alcohol use is common and accepted
  • have a close relative with alcohol use disorder

What are the symptoms?

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

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
  • glutamate

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 likelyTrusted Source 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 riskTrusted Source of eventually developing health problems related to alcohol.

Diagnosis

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. Aging 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 suspects 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

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 ratesTrusted Source 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.

Treatment

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 websitesTrusted Source, 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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