Alcoholism, also known as alcohol use disorder, is a condition in which a person has a compulsion or physical need for alcohol consumption, even though it has a detrimental effect on their lives.
An individual with this disorder has been referred to as a “alcoholic” in the past, but this is increasingly seen as an unhelpful and derogatory term. Health practitioners now say a person is suffering from an alcohol use disorder ( AUD).
In 2015, 15.1 million American adults (6.2 per cent of the population) had an alcohol use epidemic, according to the National Institute of Health ( NIH).
According to the World Health Organization (WHO), 3.3 million deaths worldwide result every year from unsafe alcohol use.
Definition
The National Institute on Alcohol Abuse and Alcoholism ( NIAAA) explains alcohol use disorder as “problem drinking that becomes extreme.”
An individual with this condition is unsure about when or how to avoid drinking. They spend a lot of time worrying about alcohol and they are unable to control how much they drink, even though it creates significant issues at home , at work and financially.
Alcohol addiction can be used to speak about alcohol intake being excessive or improper, but not inherently dependency.
Moderate alcohol intake usually does not cause any physical or psychological harm. However, AUD can gradually grow if those who enjoy social drinking increase their consumption or consume more frequently than is recommended.
Symptoms
An individual who drinks large quantities of alcohol frequently won’t be the first one to know this is so.
Some signs of AUD and some symptoms 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 any of those signs and symptoms but are not alcohol-dependent.
Drinking alcohol becomes a concern as it takes priority over all other activities. Dependency can take several years to grow.
The alcohol abuse related issues are severe. The results can be physical, social and psychological.
Causes
It may take from a few years to several decades to establish alcohol dependency. It can happen within months for some individuals, who are especially vulnerable.
Over time, daily alcohol use can interfere with the balance of:
- gamma-aminobutyric acid (GABA) in the brain
- glutamate
GABA regulates impulsiveness, and activates the nervous system with glutamate.
Dopamine levels increase in the brain after alcohol intake. Dopamine levels can make the experiences of drinking more gratifying.
Excess drinking can dramatically alter the levels of these brain chemicals over the long- or medium-term. This causes the body to yearn for alcohol to feel good and to stop 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 likely 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 risk of eventually developing health problems related to alcohol.
Diagnosis
For AUD to be diagnosed in the US, the person must meet the requirements set out in the American Psychiatric Association’s (APS) Diagnostic and Statistical Manual of Mental Disorders (DSM).
The requirements include having a consumption pattern which results in considerable impairment or distress.
During the last 12 months there should have been at least three of the following criteria:
- 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.
Any of the substance dependency signs and symptoms may be due to another disorder. For example, ageing may cause memory problems and falls.
An individual can go to the doctor for a medical condition, such as a digestive problem, and neglect to mention how much alcohol they are consuming. This can make it difficult for a doctor to determine who may benefit from screening for alcohol addictions.
If a suspected health worker may have a problem with alcohol, they might ask a series of questions. If the patient reacts in a certain manner, then the doctor can use a standardized questionnaire to find out more.
Tests for alcoholism
Only very recent alcohol use can be detected by blood tests. They can not say whether a person has long been drinking heavily.
If a blood test shows that the number of red blood cells has risen, this may be an indicator of alcohol consumption over the long term.
Carbohydrate-deficient transferrin (CDT) is a blood test that helps diagnose a high intake of alcohol.
Other tests may suggest damage to the liver, or — in males — reduced levels of testosterone. Both may be representative of chronic alcohol use.
Screening with a suitable questionnaire is, however, seen as an important way of achieving correct diagnosis.
Many people who drink excessive levels of alcohol deny that they have a problem with the alcohol. They may tend to minimize the extent of their drinking.
Talking to members of the family may help the doctor understand the situation, but they need permission to do so.
Complications
Drinking alcohol typically in the first place raises a person’s mood.
A person who has long consumed excessive levels of alcohol, however, is likely to become sedated when they drink.
This is because the nervous system is affected by Alcohol.
Alcohol can weaken a judgment on an individual. It may suppress inhibitions, and change the feelings , emotions, and general actions of the drinker.
Heavy daily drinking can seriously impair a person’s ability to communicate and talk well with their muscles.
Extreme binge drinking can result in a coma.
Eventually heavy drinking regularly can 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 rates 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 in rehabilitation is understanding that there is an issue of alcohol dependence.
The next move is to reach out for support. A variety of community groups and specialist services offer this.
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 websites.
- 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.
