If someone in your family is living with an active alcohol use disorder, you and your family are not alone. The Substance Abuse and Mental Health Services Administration (SAMHSA) 2015 National Survey on Drug Use and Health (NSDUH) found that more than 15 million Americans over the age of 18 were living with an alcohol use disorder and about 623,000 young people between the ages of 12 and 18 were struggling as well.
As a result of this ongoing battle with binge drinking, heavy drinking, and alcoholism, Americans are dealing with a range of alcohol-related problems.
- The Centers for Disease Control (CDC) and the Alcohol-Related Disease Impact Application (ARDI) reports that about 88,000 deaths in the United States are attributed to alcohol use every year.
- The National Council on Alcoholism and Drug Dependence (NCADD) reports that 36 people die every day and about 700 are injured due to accidents caused by drivers who are under the influence of alcohol.
- The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that about 17 percent of men and 8 percent of women in the US will develop an alcohol use disorder at some point in their lives.
- Teen alcohol use, too, is a deadly problem happening across the country. According to Mothers Against Drunk Driving (MADD), more than 4,700 people die every year because of teen use of alcohol.
NCADD also reports that long-term use of alcohol can damage every single organ in the body as well as emotional and mental health, financial status, employment, and social interactions. Additionally, assault, abuse, and homicides very commonly occur when one or both parties are under the influence of alcohol, according to the CDC.
This means that it is not just alcohol-related car accidents that can cause death. A range of fatal diseases, including certain cancers, homicide, and addiction itself, make alcohol abuse the third leading cause of death in the United States.
Though it can feel as if you are hiding a unique or embarrassing problem, the fact is that families across the country are experiencing the exact same thing you are. You are not alone with the disease, and you will not be alone as you seek the treatment necessary to begin to heal and start a new life in recovery. Alcohol.org is available to provide education and support all along the way.
What Is Alcohol Use Disorder?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has modified some of the criteria involved in the medical definition of an alcohol use disorder. There are 11 criteria listed to help clinicians determine if their patient has AUD and how serious the problem is. A mild AUD involves experiencing two or three of the 11 symptoms for one year; a moderate AUD involves four or five of the symptoms; and a severe AUD involves six or more of the listed criteria.
The 11 criteria for defining an AUD are:
- Drinking more alcohol, or for longer, than intended
- Trying to cut down or stop drinking but being unsuccessful
- Spending a lot of time drinking or feeling sick from a hangover or other aftereffects
- Experiencing interference in daily life and relationships because of drinking or being sick from drinking too much
- Having cravings for alcohol
- Continuing to drink even though it hurt relationships with friends and family
- Cutting back on, or giving up, hobbies to consume more alcohol
- Repeatedly being in situations where alcohol put one at risk of harm
- Having to consume more alcohol to experience the desired effects
- Continuing to consume alcohol even though it worsens a health condition, including anxiety or depression
- Experiencing withdrawal symptoms when alcohol’s effects began to wear off
Alcohol dependence and AUD are not the same condition, but people who struggle with AUD typically are dependent on alcohol. This leads to compulsively drinking, which escalates rapidly.
Is Alcoholism Inherited?
There is a known hereditary component to alcoholism, but that doesn’t mean that someone with an alcoholic family member will definitely become an alcoholic; nor does it mean that all alcoholics have an alcoholic family member.
Studies suggest that certain individuals are more likely to become alcoholics. People with a history of alcoholism in their family have an increased chance of becoming alcoholics. People who start drinking at an early age are also at a greater risk of developing alcoholic tendencies than those who begin drinking later in life. Men are more prone to become alcoholics, but women are much more likely to develop harmful medical effects that are linked to drinking such as liver disease.
When Drinking Becomes Problematic
Although all forms of problem drinking are getting worse in the US, not everyone who drinks too much meets the criteria for AUD. The CDC found, in 2014, that 90 percent of those who drink too much alcohol, even frequently, are not physically dependent on the substance to feel normal. Although one in three adults drink to excess, meeting the criteria for heavy or binge drinking, nine out of 10 do not meet the criteria for AUD from the DSM-5.
Still, it is possible for excessive social drinking or consistent drinking to become an addiction. Signs that a person struggles with AUD include:
- Frequent drinking
- Gulping drinks or otherwise drinking quickly
- Lying about how much alcohol is consumed or failing to realize how much alcohol has been consumed
- Drinking until drunk or being unable to stop drinking before becoming drunk
- Skipping work, school, family responsibilities, or social functions more often in order to drink
- Getting drunk on the job
- Drinking and driving, or performing other dangerous tasks while intoxicated
- Experiencing social, financial, and legal problems due to alcohol consumption
- Using alcohol to self-medicate mental health issues
- Feeling irritable, resentful, angry, or depressed when not drinking
- Experiencing medical problems from consuming too much alcohol
Two drinks for men, and one drink for women, a few times per week is moderate drinking. While any alcohol consumption is not specifically safe, moderate drinking is less risky compared to problem drinking. Drinking more than this per day can involve binge drinking, and drinking every day may display a pattern of abuse and addiction.
How One Becomes an Alcoholic
Alcohol addiction is a gradual process that occurs within the human brain. When alcohol is consumed, it alters the levels of certain chemicals in the brain, mainly gamma-aminobutyric acid, or GABA, and dopamine. GABA monitors and controls a person's impulsivity, and frequently drinking copious amounts of alcohol alters this chemical's production, often making people more impulsive and less aware of what they are doing. Dopamine is one of the chemicals in the brain that, when released, causes pleasurable feelings like happiness, joy, or even euphoria. As more and more alcohol is consumed on a frequent basis, the brain begins to grow accustomed to this chemical imbalance. If an alcoholic tries to stop drinking, then the brain is deprived of the alcohol's effect, which results in unpleasant withdrawal symptoms such as sweating, shaking, tremors, or even hallucination.
Statistics on Alcohol Use Disorder in the US
The National Survey on Drug Use and Health (NSDUH) for 2015 found that 86.4 percent of the population ages 18 and older consumed alcohol at some point in their lives; about 56 percent reported that they drank in the past month, indicating a pattern of regular alcohol consumption. Alcohol is legal in the US for people ages 21 and older to consume, but as an intoxicating substance, it is dangerous and can lead to addiction. The NSDUH also found that 26.9 percent of the population engaged in binge drinking in the past month (more than four drinks within two hours), and 7 percent reported that they drank heavily in the past month (more than two drinks per day). These behaviors indicate higher risk for AUD.
Of the over 16 million people in the country who have a potential AUD, 9.8 million men and 5.3 million women respectively have a diagnosable AUD. About 10 percent of children in the US have at least one parent who struggles with problem drinking, and about 31 percent of driving fatalities in the US involve a drunk driver. Unfortunately, very few people every year seek treatment for AUD despite physical, mental, social, financial, and legal ramifications.
The 5 Types of Alcoholics
A NIAAA study from 2007 found that there are five basic types of people struggling with AUD. Most of these individuals are young adults, between the ages of 18 and 34. These include:
- Young adult subtype: These individuals account for, per the study, about 32 percent of people struggling with AUD. This group generally begins to experience compulsive behaviors around alcohol associated with addiction when they are around 20 years old. While they have fewer occasions during an average week in which they drink, they tend to binge drink on those occasions.
- Young antisocial subtype: This group represents about 21 percent of people struggling with AUD, according to the NIAAA study. On average, this group is about 26 years old – so still young, but not as young as the young adult group. They are defined by having antisocial personality disorder; this mental health condition leads them to begin drinking in adolescence, around age 15 on average, and they display symptoms of AUD by age 18. They are also more likely to struggle with polydrug abuse, especially abuse of tobacco and marijuana. There is no overlap between the young adult and young antisocial subtypes.
- Functional subtype: Representing about 19 percent of those struggling with AUD in the study, this group is typically middle aged and, on the surface, appears to have their lives together. They have higher income, more education, and stable relationships compared to other adults struggling with AUD. They drink, on average, every other day, and tend to binge drink on those days.
- Intermediate familial subtype: Making up close to 19 percent of the study’s adults with AUD, these individuals are in families struggling with AUD. About half have close family members who abused alcohol. In response to family stress, these individuals typically began drinking around age 17 and display addiction symptoms by their early 30s.
- Chronic severe subtype: The final group is the rarest, with about 9 percent of the survey’s adults struggling with AUD. Most of the individuals in this group are male, with a high divorce rate and a high likelihood of polydrug abuse.
When most people think about “alcoholism,” they assume the chronic severe group is the only group. However, adolescents and young adults, both with and without mental illnesses, can struggle with compulsive behaviors around alcohol, and many adults in the US are dependent on alcohol to stabilize their emotions. These conditions, too, indicate a potential AUD. If alcohol abuse remains unaddressed, it can lead to severe health consequences, both acute and chronic.
Short-Term Side Effects of Drinking Too Much
The first few sips of an alcoholic beverage can lead to pleasant feelings. When alcohol is metabolized into the bloodstream and enters the brain, it binds to the gamma-aminobutyric acid (GABA) receptors, which are involved in the stress response. If a person has active production of GABA, which is absorbed by receptors rapidly, they may experience several conditions, from anxiety to seizure disorders. Alcohol slows this neuron firing down, so even people without anxiety or stress feel relaxed. The substance also inhibits glutamate absorption, which further reduces stress or anxiety.
However, as the individual continues to drink, they are likely to experience negative effects associated with alcohol, including:
- Sleepiness or fatigue
- Slowed reaction times
- Loss of balance
- Slowed brain activity
- Slurred speech
- Perceptions and physical sensations becoming unclear
- Changes to vision, including blurry vision
- Changes in emotional state
- Lowered inhibitions
- Disruption of sleeping patterns
- Increased urine production
- Lowered body temperature
- Flushing in the face
- Nausea and gastrointestinal changes
A person who continues to drink past being intoxicated is at risk of experiencing alcohol poisoning, which can be deadly if not treated by emergency medical professionals.
If a person appears to suffer from alcohol poisoning, it is important to immediately call 911. They require emergency medical attention.
Signs of alcohol poisoning include:
- Extreme intoxication
- Memory loss
- Slowed or irregular breathing
- Cold or clammy hands, due to hypothermia
- Falling unconscious and not waking up
- Cyanosis, or blue-tinged skin due to oxygen deprivation
Long-Term, Chronic Health Issues from Alcohol Abuse
People who abuse alcohol may experience acute problems associated with problem drinking, but continuing to drink in spite of the negative effects puts them at risk of developing chronic health problems. Alcohol abuse damages most organs in the body, especially the liver, cardiovascular system, gastrointestinal system, and brain. Chemical changes to the brain that lead to addiction may also cause harm to memory and cognition.
People who drink too much are more likely to suffer vitamin deficiencies, especially thiamine or B12. A thiamine deficiency leads to a condition called Wernicke-Korsakoff syndrome, with symptoms including losing the ability to walk and dementia-like issues.
Drinking too much damages the circulation by causing consistent high blood pressure. It also causes cardiomyopathy, or drooping of the heart muscle, which reduces the ability of the heart to effectively pump blood throughout the body. Nutrient deficiency can lead to anemia. Other problems with blood can lead to clots, causing strokes or heart attacks.
Added fat and scar tissue on the liver due to excessive alcohol consumption can lead to all sorts of problems, but most often either cirrhosis or alcohol-induced hepatitis. Liver failure among those who drink heavily for many years is likely. Pancreatitis, or the consistent inflammation of the pancreas, can also cause damage to the body, including high blood sugar leading to diabetes.
People who drink too much are at an increased risk of ulcers, digestive problems, low hormone levels, and several cancers, including esophageal, stomach, colon, liver, mouth, and breast cancers. People who drink too much may induce a mood disorder, like anxiety or depression, or they may trigger a seizure disorder due to changes to the GABA system in the brain.
Social and Family Repercussions from Alcohol Use Disorder
People who struggle with AUD may begin drinking because of social situations or anxiety about being around people; however, signs of a potential AUD include changes in friend groups, especially geared toward friends who drink versus those who don’t, and avoiding social situations to drink instead. Those who have a family member who struggles with AUD are more likely to suffer from high stress, emotional and physical abuse, and mental health or substance abuse problems later in life.
The Need for Intervention
Although the concept of an intervention is pervasive in popular culture – even leading to the development of a reality television show – there are types of interventions that are more helpful than suddenly accusing a loved one of struggling with addiction. Family and friends may create an intervention – which requires a plan, including specific requirements and consequences – or a therapist, doctor, or other healthcare professional may conduct an intervention. Often, these are brief interventions, which occur after a person has been hospitalized due to side effects from drinking too much or after a person is diagnosed with a chronic illness due to problem drinking.
An intervention is a useful way for friends, family, and healthcare professionals to express concern for an individual’s wellbeing. This is a time to explain the harm that alcohol abuse has done to the individual’s body, mind, or social and family circles. A person struggling with AUD does not need to hit rock bottom for an intervention to be effective. If the intervention focuses on concern for the person’s health, expressing the desire that they get better, and offers help if they choose to change their behavior, it can be effective.
Detox and Rehabilitation for Alcohol Use Disorder
When a person struggling with problem drinking or alcohol dependence decides to get help, it is important for them to consult with a doctor regarding how serious their physical condition may be. Gauging the severity of withdrawal symptoms is important, as quitting alcohol suddenly can lead to seizures, which may be deadly. Racing heart rate, high blood pressure, insomnia, vomiting and related dehydration, and fever can also be dangerous alcohol withdrawal symptoms.
A medical professional can work with a person attempting to detox from alcohol to help them manage cravings and other withdrawal symptoms. A doctor can also refer their patient to addiction treatment programs and therapists, so the individual can get help overcoming their alcohol abuse issues. If there are no serious withdrawal symptoms, a doctor can recommend over-the-counter remedies to manage pain or nausea. The support of friends and family can help keep the individual focused on sobriety.
Once the person has safely detoxed from alcohol, a comprehensive rehabilitation program is the best step. These programs offer intensive therapy to help clients understand the root causes of their addiction and change their behaviors toward intoxicating substances. The National Institute on Drug Abuse (NIDA) recommends remaining in a rehabilitation program for 90 days, or three months.
Once a person has completed detox and rehabilitation, they are not cured of addiction. Since the condition is a chronic illness, like hypertension, asthma, or diabetes, there may be relapses in the future, but addiction can be managed for life, and the individual can stay sober and healthy.
Relapse can be avoided by getting sufficient aftercare. Oftentimes, aftercare involves a peer support group, ongoing therapy, and even a maintenance medication like naltrexone, which reduces or eliminates cravings. Support from family and friends is also a very important part of sustained recovery, so finding a supportive home environment – through a sober home, moving to a new house, or clearing drugs and alcohol out of one’s existing home – is very important. Working with an evidence-based treatment program can help one gather resources about nearby or online support groups and therapists.