There’s a lot of confusion about alcoholism and exactly how it affects those who are struggling with it. Some people propose that it is a lifestyle choice, and that stopping drinking is simply a matter of deciding to do so. However, those who understand alcoholism better, including the researchers and treatment professionals who deal with it every day, know that there is much more to it than that.
Alcoholism is a type of substance addiction. As defined by the American Society of Addiction Medicine, this means alcoholism, like other addictions, is a chronic disease affecting the reward, memory, and motivation systems of the brain. This, in turn, leads to dysfunction in physical, mental, emotional, social, and spiritual manifestations for individuals who are struggling with it. In addition, as with other chronic illnesses, there is no cure for alcoholism; however, there is treatment available that can help individuals manage the condition.
General Overview of Alcoholism
Alcoholism is a type of alcohol use disorder – a condition where an individual is unable to control use of alcohol, is preoccupied with it, or continues to use it even when it causes problems in their life. This results in unsafe levels of alcohol use, including heavy, frequent use or binge drinking large amounts of alcohol in a short period of time (usually generalized as two hours).
Alcoholism is not the only type of alcohol use disorder, but it is the most severe form. Still, any type of alcohol use disorder is cause for concern, as even a mild disorder can eventually develop into alcoholism if there is no intervention.
How a Person Develops Alcoholism
Alcoholism is not a switch that can be turned off and on. It and other alcohol use disorders develop over time, and usually involve certain preexisting risk factors that make the individual more susceptible to developing it if they drink alcohol. The risk factors for alcoholism include, among others:
- Prior history of behavioral or substance abuse or addiction
- Addiction or alcoholism in close family members
- Social awkwardness
- Neglect or abuse in childhood
When a person begins to abuse alcohol at more than the low-risk level defined by the National Institute for Alcohol Abuse and Alcoholism – that is, drinking more than five drinks a day or 14 drinks per week for a man, or more than three drinks per day or seven drinks per week for a woman – the abuse itself in combination with the risk factors can lead the individual to become more and more tolerant of large amounts of alcohol. Over time, they may become dependent on alcohol to function normally and develop alcoholism.
Alcoholism Signs and Symptoms
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the current symptoms that indicate alcoholism or another type of alcohol use disorder is present. These 11 symptoms include:
- Inability to control the amount of alcohol consumed or the amount of time spent drinking
- Inability to quit drinking, even when wanting to
- A large percentage of time focusing on, using, or recovering from use of alcohol
- Inability to focus on anything other than the next drink
- Lack of ability to keep up with personal or professional commitments due to drinking
- Relationship issues based on drinking habits
- Loss of interest in other, previously enjoyed activities in order to focus on drinking
- Participation in risky activities while, or as a result of, drinking
- Continued drinking even when it leads to mental or physical health issues
- Tolerance to alcohol – that is, needing more and more to feel the same effect
- Withdrawal symptoms when alcohol use is stopped
Other signs that someone has a problem with alcoholism can include secretiveness around drinking, running out of alcohol faster than expected, arguments around alcohol use, and various mental and physical symptoms, such as:
- Slurred speech
- Inability to focus
- Loss of coordination
- Bloodshot eyes
- Regular hangover symptoms
The Chronic Disease Model of Alcoholism
As mentioned above, alcoholism is considered to be a chronic brain disease. This means, it cannot be cured using medicine or prevented through vaccination. Instead, a chronic disease requires ongoing, often indefinite treatment to maintain control over symptoms.
Another common aspect of chronic illness is that it involves a risk of relapse; that is, it is possible for the person to succumb to symptoms even after treatment has gotten the condition under control. In the case of alcoholism and other forms of addiction, relapse rates are quite similar to those for other chronic physical and psychological disorders. For example, rates of relapse for asthma and diabetes are 50-70 percent and 30-50 percent, respectively while relapse rates for substance addictions like alcoholism are 40-60 percent, explained by the National Institute on Drug Abuse.
Managing Alcoholism Symptoms
Based on this chronic disease model, the way to approach treatment for alcoholism is to help the individual manage the symptoms and thereby gain control over drinking. Keeping in mind that there is no permanent cure for alcoholism, there are a variety of methods that can support individuals in the two main goals of alcoholism treatment: stopping alcohol use and preventing relapse.
The hurdles to be overcome in treating alcoholism include triggers and cravings to return to alcohol use. Triggers are situations that tend to create cravings in the individual, and can therefore lead to relapse. As described by Psychology Today, triggers can include:
- Volatile emotions
- Life challenges and stress
- A rigid belief that the person will never drink again
- Lack of motivation or commitment to recovery
- Being around former drinking buddies or favorite bars
- Symptoms of other mental or physical disorders that the person self-treats with alcohol
Therefore, the main methods of treating and managing alcoholism are focused on helping the person deal with these and other triggers in ways that don’t involve drinking.
Treatment for Alcoholism
Taking everything above, treatment for alcoholism includes various means and methods to provide individuals with the tools, skills, and confidence to avoid or overcome triggers and cravings and thereby avoid relapse. Research has shown that the methods that provide the greatest chance of stopping drinking and avoiding relapse, some of which are discussed by the Substance Abuse and Mental Health Services Administration, include:
- Medically supported detox from alcohol
- Behavioral therapy to identify triggers, find alternative responses, and practice avoidance
- Peer support through 12-Step programs for motivation, experience, and understanding
- Other motivational methods, such as rewards for maintaining sobriety
- Nutritional support for any deficiencies resulting from alcoholism
- Exercise and other activities that can distract from the symptoms of alcoholism
- Family, personal, and interpersonal therapy for relationship and other emotional and social issues that may contribute to the desire to use alcohol
- Treatment of co-occurring conditions that the person may be self-treating with alcohol
- Occupational therapy to help the person return to normal daily living after treatment
- Follow-up programs to keep motivation and commitment high after treatment ends
In reputable, research-based treatment programs, these program elements are customized to fit the individual’s needs, creating the program most likely to help that person achieve recovery and avoid relapse. It is important to note that alcohol withdrawal can be dangerous, particularly for those who have been drinking heavily for a long time. Because of this, medically supported detox in a professional treatment or detox facility is advised to avoid severe illness or even death.
The Need for Continual Maintenance
Again, based on the chronic disease model of addiction, stopping treatment just because the person has stopped drinking is not helpful due to the potential for relapse. Detox from alcohol is not enough treatment to help with the symptom management required to stay sober. For this reason, the individual should enter the appropriate treatment program for their level of alcohol abuse.
Over time, a committed person managing an alcohol use disorder will become more confident and capable at staying sober. As this occurs, it is possible for the person to taper off some treatments. With long-term sobriety, even though alcoholism is a lifelong condition, the individual can emerge out from under alcohol’s control and stay in recovery for the long run.