What Is Alcoholism or Alcohol Use Disorder?
Alcoholism or people who can no longer control their use of alcohol, compulsively abuse it despite negative ramifications, and/or experience emotional distress when they are not drinking may be suffering from an alcohol use disorder (AUD) or alcoholism.1 AUD is a chronic, relapsing disease that is diagnosed based on an individual meeting certain criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To be diagnosed with AUD, individuals must meet any two of the below criteria within the same 12-month period:2
- Using alcohol in higher amounts or for a longer time than originally intended.
- Being unable to cut down on alcohol use despite a desire to do so.
- Spending a lot of time obtaining, using, and recovering from the effects of alcohol.
- Cravings, or a strong desire to use alcohol.
- Being unable to fulfill major obligations at home, work, or school because of alcohol use.
- Continuing to abuse alcohol despite negative interpersonal or social problems that are likely due to alcohol use.
- Giving up previously enjoyed social, occupational, or recreational activities because of alcohol use.
- Using alcohol in physically dangerous situations (such as driving or operating machinery).
- Continuing to abuse alcohol despite the presence of a psychological or physical problem that is probably due to alcohol use.
- Having a tolerance (i.e. needing to drink increasingly large or more frequent amounts of alcohol to achieve desired effect).
- Developing symptoms of withdrawal when efforts are made to stop using alcohol.
According to the National Institute on Alcohol Abuse & Alcoholism (NIAAA), women who have no more than 3 drinks on a given day and no more than 7 per week are at low-risk for developing AUD. For men, this low-risk range is defined as no more than 4 drinks on a given day and no more than 14 per week.
Statistics on Alcohol Use in the US
According to the 2017 National Survey on Drug Use and Health (NSDUH), 51% of the population aged 12 and older reported binge drinking in the past month. Binge drinking is defined as 5 or more drinks for males and 4 or more drinks for females on at least one day in the past month; heavy alcohol use means binge drinking for 5 or more days in the past month.3
Most binge drinking occurs among people aged 18–34 and is twice as common among men than women. One in 6 adults binge drinks around 4 times per month.5 Among 12- to 17-year-olds, 5.3% reported binge drinking in the past month, with 0.7% reporting heavy alcohol use in the past month.4 While not everyone who binge drinks has an AUD, binge drinking can be a very significant risk factor for the development of an AUD.
The NSDUH reports that more than 14 million people aged 12 and older had an AUD in 2017, with AUD occurring in 7% of males and 3.8% of females aged 12 and older.4
In 2015, out of more than 78,500 liver disease deaths that occurred in individuals ages 12 and older, 47.0% were attributed to alcohol use.6 In addition to these deaths from alcohol-related liver disease, there are several other sources of alcohol-related morbidity and mortality. Alarmingly, more than 2,200 people die due to alcohol poisoning each year, with 3 out of 4 deaths occurring to men and non-Hispanic white adults aged 35–64, according to 2015 statistics from the Centers for Disease Control and Prevention.7 An average of 6 people dies each day due to alcohol poisoning, or, drinking so much that the body becomes overwhelmed and the critical areas of the brain that control functions such as breathing and heart rate begin to shut down, leading to death.7
Is Alcoholism Inherited?
According to the DSM-5, alcoholism is believed to have a strong heritable component, with between 40–60% of the variance of risk being attributable to genetic factors.2 However, there is no cut-and-dry formula to explain alcoholism. It is a multifaceted and complex disease, so while someone may inherit a predisposition to the disorder, genes do not fully determine a person’s outcome.
The way genes are affected by environmental factors plays an important role in AUD.8 For example, being around parental figures who abuse alcohol, being exposed to peers who are heavy alcohol users, and using alcohol for the first time at an early age, can all influence the development of AUD.
Short- & Long-Term Physical Health Issues
Short- and long-term physical effects associated with AUD can include:10
- Heart problems like cardiomyopathy (enlarged, inefficient heart muscle), arrhythmias (irregular heartbeat), high blood pressure, and stroke.
- Liver disease, including steatosis (fatty liver), alcoholic hepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma.
- Pancreatic problems like pancreatitis, an acutely painful inflammatory condition that can progress to a chronic disease. Pancreatitis can affect a range of pancreatic functions, including the normal release of digestive enzymes.
- Certain types of cancer, including head and neck cancer, esophageal cancer, liver cancer, breast cancer, and colorectal cancer.
- A weakened immune system, which can increase your risk of infection and contraction of diseases like pneumonia and tuberculosis.
Potential short- and long-term psychological and cognitive effects associated with AUD include:10, 11
- Cognitive problems, such as memory loss or problems thinking clearly.
- Blackouts (periods of time in which you cannot recall events).
- Serious brain damage and disorders like Wernicke–Korsakoff Syndrome, which leads to confusion, impaired optic nerve function, profound movement deficits, and problems with memory recall and consolidation.
- Mood disorders, like major depressive disorder or bipolar disorder.
- Anxiety disorders, especially panic disorder and social phobia.
The short- and long-term social impact of AUD can include:2, 13
- Failing to meet work, school, or home obligations.
- Giving up activities you used to enjoy in order to drink or recover from alcohol.
- Experiencing significant interpersonal problems (such as divorce) because of alcohol use.
- Domestic abuse.
- Financial problems.
Alcohol poisoning can occur when you ingest too much alcohol too quickly (as with rapid binge drinking), resulting in very high blood alcohol levels that impair brain control of vital functions such as breathing, heart rate, and body temperature, resulting in death.14 Individuals who ingest lethal amounts of alcohol often cease breathing. Even those who survive can suffer irreversible brain damage from a sustained lack of oxygen delivery.14 People who have an AUD are at an increased risk of alcohol poisoning.7
The signs and symptoms of alcohol poisoning can include:14
- Mental confusion.
- Being unable to wake the person.
- Slow (fewer than 8 breaths per minute) or irregular (10 seconds or more between each breath) breathing.
- Bluish skin color.
Just because someone may appear to be “sleeping it off,” they can still be in danger of serious harm from alcohol poisoning. Call 911 immediately if you suspect someone may be in danger of an alcohol overdose.
If you suspect that you or someone you care about has an AUD, it may be time to seek professional help. No matter how serious the problem seems, people can recover from alcoholism and live happier, more productive lives. NIAAA reports that treatment can be very effective, with research showing “that about 1/3 of people who are treated for alcohol problems have no further symptoms 1 year later.” Many people are able to significantly reduce their drinking and suffer from fewer alcohol-related problems after treatment.15
You can take several steps to help rehabilitate yourself or someone you care about from AUD, including:
- Having an intervention.
- Entering a medical detox facility to help manage a potentially-severe acute alcohol withdrawal syndrome when quitting use.
- Beginning an alcohol treatment/rehabilitation program.
- Engaging in aftercare once the treatment process is complete.
If someone is struggling with an AUD but isn’t yet ready to seek treatment, it may be time to consider an intervention. An intervention is a process that can involve family and friends, in conjunction with advice from a physician, drug and alcohol counselor, or an intervention specialist.16 During this time, you’ll confront your loved one about the effects of addiction and ask them to seek professional help. You’ll be asked to provide specific examples of the damaging effects of the person’s alcoholism, offer a pre-arranged treatment plan, and provide consequences for what will happen if the person refuses to seek help.16
Medical detox is often the starting place on the road to recovery from an AUD. It is a process that provides medical supervision and medication to help you stay as safe and comfortable as possible while dealing with the symptoms of alcohol withdrawal.17 It can be unpleasant and potentially dangerous to detox from alcohol on your own, but proper medical management can help ease any discomfort and/or address serious conditions that may occur, such as anxiety, headaches, insomnia, rapid heartbeats or seizures.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), hospitalization or some form of 24-hour care is advised for people withdrawing from alcohol due to humanitarian and safety concerns. Although alcohol withdrawal can be very painful and unpleasant, it is often not fatal.18
At a medical detox facility, you can expect to receive 24-hour care, monitoring, supervision, and medical interventions to manage withdrawal symptoms, minimize the risk of complications, as well as to address any medical or psychiatric conditions that may develop. You may receive medication to help ease withdrawal symptoms, such as benzodiazepines or barbiturates to prevent agitation, delirium tremens and seizures; anticonvulsants to treat or prevent seizures; or antipsychotics for hallucinations.18
A wide range of treatment options exist for the treatment of alcohol use disorder, including:
- Inpatient: Those choosing an inpatient treatment center stay within a residential facility for the duration of treatment and receive round-the-clock care and monitoring. Different types of facilities offer various amenities and services and incorporate a variety of recovery programming such as individual and group counseling, coping skills education, and relapse prevention classes. Some require long-term residential stays while others may attend short-term treatment for 3–6 weeks.19
- Outpatient: If your current level of physical dependence does necessitate the need for inpatient treatment (such as for those with less severe addictions), outpatient treatment may be an option. Outpatient treatment often provides the same types of programming as inpatient facilities but is relatively less time-intensive, as people are able to return home or other living situation outside of treatment hours.
Recovery doesn’t end once treatment is complete though; rather, it is a lifelong process that requires commitment, patience, self-compassion, and ongoing support. Aftercare is one important way of obtaining support that can help individuals remain sober and avoid relapse. According to SAMHSA, 84% of treatment facilities offer aftercare services.20 Those that don’t operate their own will help you devise a plan using other outlets of aftercare prior to program completion. Some of the more commonly utilized aftercare services include:
- 12-step meetings, like Alcoholics Anonymous.
- Non-12-step groups, like SMART Recovery.
- Individual counseling.
- Group therapy.
- Sober living homes (group homes that provide structure, offer support, and require a promise to remain sober).
Find Out If Your Insurance Plan Covers Rehab
American Addiction Centers can improve treatment outcomes for those in recovery for alcohol use disorder. Find out if you or your loved one's insurance covers treatment at an American Addiction Centers facility by filling out the form below:
. National Institute on Alcohol Abuse and Alcoholism. (2018). Alcohol Use Disorder.
. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing; 490-491.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.) Drinking Levels Defined.
. Substance Abuse and Mental Health Services Administration. (2018). Results from the 2017 National Survey on Drug Use and Health: Detailed Tables.
. Centers for Disease Control and Prevention. (2018). Fact Sheets: Binge Drinking.
. National Institute on Alcohol Abuse and Alcoholism. (2018). Alcohol Facts and Statistics.
. Centers for Disease Control and Prevention. (2015). Alcohol poisoning kills six people in the US each day.
. Anstee, Q., Knapp, S., Maguire, E., Hosie, A., Thomas, P., et. al. (2013). Mutations in the Gabrb1 gene promote alcohol consumption through increased tonic inhibition. Nature Communications, 4 (2816).
. Edenberg, Howard J. Indiana University School of Medicine. (2013). Genetics of Alcoholism.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol's Effects on the Body.
. National Institute on Alcohol Abuse and Alcoholism. (2004). Alcohol's Damaging Effects on the Brain.
. Shivani, R., Goldsmith, J., & Anthenelli, R. (2002). Alcoholism and Psychiatric Disorders: Diagnostic Challenges. Alcohol Research & Health, 26(2), 90-98.
. National Health Service. (2018). Alcohol Misuse.
. National Institute on Alcohol Abuse and Alcoholism. (2018). Understanding the Dangers of Alcohol Overdose.
. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for Alcohol Problems: Finding and Getting Help.
. Substance Abuse & Mental Health Services Administration. (2012). Alcohol and Drug Addiction Happens in the Best of Families.
. National Institute on Drug Abuse. (2016). 8: Medical Detoxification.
. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45.
. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
. Substance Abuse and Mental Health Services Administration. (2014). The N-SSATS Report: Recovery Services Provided by Substance Abuse Treatment Facilities in the United States