In 2015, the National Survey on Drug Use and Health (NSDUH) found that 87 percent of American adults drank alcohol at least once in their lifetime, and about 70 percent reported that they drank at least once in the past year. Over half of adults in the US drink at least once per month. None of these patterns of alcohol consumption are necessarily troublesome, as they are well within the guidelines for moderate drinking. However, the NSDUH also found that close to 27 percent of Americans binge drank at least once in the past month, 7 percent drank heavily, and around 16 million people in the United States struggle with alcohol use disorder (AUD).
Part of the reason so many people in the US struggle with drinking is that few understand what a standard drink is and how much alcohol is considered moderate. Basic serving sizes include:
- 12 ounces of beer, or about one bottle
- 5 ounces of wine, or about one small glass
- 1.5 ounces of hard liquor, or about one shot
For example, a pint of beer is more than one serving because it is 15 ounces. Many servings of wine in restaurants or bars, especially white wine, are more than five ounces. Often, bars put more than a shot of liquor in cocktails. This can lead to drinking too much by accident. However, even when a person understands basic serving sizes, they may not understand how many servings are too many. Drinking more than moderately increases the risk of alcohol dependence and addiction.
Binge Drinking, Heavy Drinking, Alcohol Abuse, and the Consequences
The Centers for Disease Control and Prevention (CDC) defines binge drinking as:
- For men: five or more servings of alcohol in a two-hour period
- For women: four or more servings in a two-hour period
The CDC lists heavy drinking as:
- For men: 15 servings of alcohol per week, or more than two per day
- For women: 7 servings per week, or more than one per day
The definitions change based on gender because of differences in body mass, body composition, and hormones. These can all affect how the body metabolizes alcohol.
People who drink heavily tend to drink consistently, rarely bingeing, but still struggling with alcohol dependence because they feel like they need to drink a lot to feel normal. People who binge drink2, however, put themselves at risk of alcohol poisoning, and they may develop an addiction if they drink to reduce the effects of a hangover the next day.
Alcohol use disorder, a form of alcohol addiction, begins with compulsive behaviors around alcohol, leading to a loss of control. People who struggle with AUD are more likely to binge drink regularly and drink consistently, combining risks from both binge drinking and heavy drinking.
Defining Alcohol Use Disorder
The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the criteria a physician will use to determine if you struggle with AUD. The manual requires at least two of the listed symptoms that cause distress or harm for at least one year.
- There have been several times when you drank more than you intended or for longer than you intended.
- You spend a lot of time drinking, and/or feeling sick the next day because of drinking.
- You tried to stop drinking more than once, but you were unable to do so.
- You experienced cravings for alcohol.
- Drinking or being sick from drinking interfered with work, family responsibilities, school, or social engagements.
- You continued to drink despite consequences at work, at school, with family, etc.
- You cut back on hobbies or activities that were important to you, so you could drink instead.
- You continued to drink despite changes to mood, especially depression or anxiety, or drinking too much began to affect your physical health. You suffered more than one memory blackout.
- You drank even though being drunk increased your changes of getting hurt, such as drinking before driving.
- You continue to drink even though you feel like you need to drink more to achieve the original effects.
- You experienced withdrawal, including physical symptoms, when you did not drink.
According to the DSM-5, the number of symptoms can indicate how severe the addiction is.
- Mild AUD is 2-3 symptoms from the list.
- Moderate AUD is diagnosed with the presence of 4-5 symptoms.
- Severe AUD is diagnosed if the person displays six or more symptoms.
If your physician gives you a questionnaire with this list, or you read the list and worry about your own drinking habits, you may struggle with AUD or another form of problem drinking. Fortunately, there are many ways to treat this condition. The foundation of any addiction treatment starts with medically supervised detox, which is very important for alcohol abuse since alcohol withdrawal can be life-threatening. Then, an evidence-based rehabilitation program can help you change compulsive behaviors.
How Detox and Rehabilitation Can Help
The National Institute on Drug Abuse (NIDA) maintains a list of Principles of Effective Treatment, which states basic information about overcoming addiction with help from professionals. While the list states that no single form of treatment is appropriate for everyone, there are basic steps that anyone struggling with addiction, including to alcohol, can benefit from.
Detox: This is the first step in overcoming addiction. Detox is designed to end the body’s physical dependence on an intoxicating substance like alcohol, which can reduce physical distress and cravings on a long-term basis. If you see that you can feel normal and healthy without abusing drugs or alcohol, then you are more likely to stay sober.
Again, alcohol requires medical oversight during detox because some withdrawal symptoms are life-threatening. These include seizures and hallucinations. During detox, your physician will evaluate you to determine if these symptoms are a risk and may prescribe medications like Valium to help taper your body off alcohol. Benzodiazepines like Valium work on a similar area of the brain as alcohol.
Rehabilitation: The purpose of rehabilitation, whether inpatient or outpatient, is to help you change your behaviors when you feel stressed, run into triggers, or experience cravings. Most of this behavioral retraining involves therapy, mostly in the form of group therapy. Inpatient treatment and intensive outpatient treatment will also involve individual therapy. Types of therapy applied to addiction treatment include Cognitive Behavioral Therapy, Motivational Enhancement Therapy, family counseling, 12-Step programs, and brief interventions. NIDA recommends remaining in a rehabilitation program for at last 90 days, or three months, to make sure that behavioral changes stick; this reduces the risk of relapse.
Support groups: In the 1930s, Alcoholics Anonymous pioneered the idea of a support group for people working to end their addiction to alcohol. Since then, these support groups have been the foundation of many alcohol and drug addiction treatment programs. During and after rehabilitation, support groups can help you receive emotional support and learn how others deal with stress while avoiding alcohol.
Maintenance medication: It is rare for a doctor to prescribe maintenance medication for alcohol use disorder, but sometimes, a person relapses so often that reducing cravings for alcohol will help them stay sober for longer. Naltrexone and acamprosate are the primary drugs prescribed to maintain sobriety after overcoming AUD because these two substances have been shown to reduce cravings for many people.
Disulfiram was one of the first maintenance medications. If a person relapsed and drank alcohol while on disulfiram, they would feel very sick. The point of the drug was to create a mental association between alcohol and illness, but the substance is rarely used anymore since it causes more distress than it relieves.
Aftercare: Once you complete detox and rehabilitation, you should find ways to get emotional support to remain sober. In addition to support from family and friends, attending mutual support groups, going to an individual therapist, and/or finding complementary medical practices like meditation, yoga, and nutritional supplements can help you stay on track.
Alcohol use disorder can feel overwhelming, but there are many approaches to treatment that have been proven to work. If you worry about your drinking or a loved one’s drinking, ask for help from a physician, therapist, or addiction specialist.