Almost three-quarters of the entire adult population in the United States reported drinking alcohol in the prior year, according to the 2015 National Survey on Drug Use and Health (NSDUH) as published by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol is easy to get, socially acceptable, and can generally be enjoyed responsibly by people who are 21 or older.
Alcohol is a mind-altering substance, however, and it is the number one addictive substance used by Americans, the National Council on Alcoholism and Drug Dependence (NCADD) reports. Excessive alcohol abuse can lead to addiction and a host of additional emotional, physical, social, and behavioral issues as well.
Families that are in crisis after a period of addiction for one or more family members need answers and they need them now. They don’t have time to sift through unhelpful “frequently asked question” pages that do little more than provide obvious information with almost no help actually connecting with treatment services. Instead, families and individuals seeking treatment for alcohol use disorders require answers to the following questions:
- What type of alcohol rehab will be the most effective?
- How can loved ones find money to pay for alcohol rehab?
- What if someone is living with a co-occurring mental health disorder in addition to alcoholism?
- What measures are necessary to safely treat alcohol detox (e.g., withdrawal symptoms)?
- What can family members do to empower someone to enter treatment if they do not want to go?
- How can family members do to begin their own healing process?
- How can family members and friends support their loved one, both during alcohol rehab and after transitioning home?
- What can be done if past attempts at alcohol addiction treatment have failed?
- How can loved ones facilitate a smooth transition back home? What are the options if there is no safe and sober home to return to after treatment?
- What if issues of abuse or trauma are playing a role in the use of substances?
- How should underlying chronic ailments be handled if they contribute to cravings for alcohol?
- How should relapse be viewed? What are the best ways to avoid relapse? How can relapse be addressed proactively if it does happen?
What questions are you asking as you begin the process of figuring out how best to handle alcohol abuse or addiction? What is stopping you from connecting with the alcohol addiction treatment you need to heal? What information do you need to take the next step forward to connect with the right treatment program for you or your loved one?
Listed below are some common questions regarding alcohol use, abuse, and addiction involving alcohol.
What Is a Standard Drink?
A standard alcoholic drink is classified by the amount of pure alcohol it contains. The Centers for Disease Control and Prevention (CDC) publishes that a standard drink contains 0.6 ounces of pure alcohol. Each of the following is then considered to be a standard drink in the United States:
- One 12-ounce beer with 5 percent alcohol content
- One 5-ounce glass of wine with 12 percent alcohol content
- One 8-ounce malt beverage with 7 percent alcohol content
- One 1.5-ounce shot of 80 proof distilled spirits or liquor with 40 percent alcohol content
What Is Alcohol Abuse?
Any use of alcohol by someone who is under the legal age of 21 in the United States is considered abuse, as is alcohol consumption by a pregnant woman. Excessive alcohol use in a binge or heavy drinking pattern can also be considered alcohol abuse.
Binge drinking is when a man drinks four or more standard drinks in a sitting (typically considered a two-hour period) or a woman drinks five or more drinks, NIAAA reports. This pattern of drinking generally raises a person's blood alcohol concentration (BAC) to 0.08 g/dL. Heavy drinking is when a person binge drinks on five or more days in a single month, when a woman consumes eight or more drinks in a week, or when a man drinks 15 or more drinks per week.
Is There a Safe Level of Drinking?
The Dietary Guidelines for Americans 2015-2020 state that if alcohol is consumed, it should be done in moderation, which is classified as two drinks per day for a man and one drink per day for a woman, for those of legal age. They also recommend that if a person has not started drinking alcohol, they should not do so.
NIAAA publishes that if a man drinks four or fewer drinks per day, and 14 or fewer drinks per week (three per day and seven per week for a woman), this is considered low-risk drinking. Only about two out of every 100 people who consume alcohol within these limits suffer from alcohol addiction.
What Is Considered Intoxicated?
Alcohol is a central nervous system depressant that interacts with several of the brain's chemical messengers to have mind-altering effects. In the United States, when a person's BAC is 0.08 g/dL or higher, they are considered above the legal limit for driving. This is not to mean that a person can't be intoxicated at lower levels, however.
A general guideline of alcohol's effects based on BAC levels follows, per NIAAA:
- 0-0.05 g/dL: Mildly impaired
- Speech, memory, balance, coordination, and attention are mildly affected.
- Sleepiness may set in.
- The person may feel happy and relaxed.
- 06-0.15 g/dL: Intoxicated
- Further impairment of speech, memory, balance, coordination, and attention occurs.
- Driving is significantly impaired.
- Increased aggression is possible.
- Judgment is compromised.
- There is elevated risk of injury to oneself and others.
- Increased drowsiness may occur.
- 16-0.30 g/dL: Severely impaired
- Significant impairment of speech, memory, balance, attention, and coordination takes place.
- Blackouts or amnesia are possible.
- Dangerous impairment of decision-making abilities can occur.
- Loss of consciousness is possible.
- Nausea and vomiting are possible.
- 31-0.45 g/dL: Potentially deadly
- Loss of consciousness is likely.
- Life-threatening suppression of vital life functions, such as breathing, heart rate, and blood pressure, is possible.
- There is a high risk of alcohol poisoning.
Does Alcohol Impact Everyone the Same Way?
There are several factors that can influence how much, or how little, alcohol will affect people. Two people can drink the same amount in the same period of time, and one person may become more intoxicated than the other. Things like gender, metabolism, race, age, and how much food or water a person had before drinking are all factors in the rate of intoxication. As such, genetics, biology, and environmental aspects all play a role in how alcohol is metabolized, NIAAA publishes, and how quickly alcohol is metabolized influences intoxication levels. The more alcohol that remains in a person's system, the more impaired they will be, for instance.
In general, men are thought to process alcohol differently than women, leaving women more vulnerable to lower amounts of alcohol. Certain races may metabolize alcohol differently as well. For example, people of Asian descent may suffer from what is often termed the "Asian flush" when they drink, which is due to issues metabolizing alcohol related to a genetic variant, the journal Berkley Wellness publishes. This means that alcohol impacts them more significantly.
Taking other drugs while drinking alcohol can also increase alcohol's impact as can the presence of co-occurring mental health or medical disorders.
Can a Person Overdose on Alcohol?
An overdose on alcohol is usually called alcohol poisoning. It occurs when alcohol reaches toxic levels in the bloodstream and cannot be metabolized or broken down safely. This can be life-threatening. The CDC warns that around six people per day die from alcohol poisoning in the United States.
Signs of alcohol poisoning that require immediate medical attention include:
- Nausea and vomiting
- Severe mental confusion
- Difficulties breathing, such as slow or irregular breathing
- Bluish tinge to the skin and low body temperature
- Loss of consciousness and inability to wake up
- Weak pulse and irregular heart rate and blood pressure
What Is Alcoholism?
Alcohol addiction, or alcoholism, occurs when a person is no longer able to stop drinking despite trying to, and when they can't control how much and how often they drink. The current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) uses the term substance use disorder in place of addiction. The National Institute on Drug Abuse (NIDA) reports that if a person has any two of the following signs during a year-long period, their condition may be classified as addiction, a substance use disorder, or alcoholism:
- Multiple attempts to stop drinking without success
- Drinking more at a time and for longer than intended
- Cravings for alcohol
- Spending a lot of time getting alcohol, drinking it, and recovering from its effects
- Giving up social or recreational activities to drink alcohol instead
- Drinking interfering with fulfilling school, home, and/or work obligations
- Continuing to drink despite negative interpersonal and social consequences of doing so
- Knowledge that drinking is causing physical and/or psychological issues and drinking anyway
- Drinking in situations that are potentially physically dangerous
- Developing a tolerance for alcohol that requires more to be consumed in order to feel its effects
- Withdrawal symptoms when alcohol wears off
Can a Person Be Dependent on Alcohol without Being Addicted to it?
Alcohol dependence is often a sign of addiction, but in and of itself, it does not constitute addiction. Dependence is a physical manifestation of chronic drinking that occurs when the brain becomes accustomed to certain levels of alcohol being present and adjusts its brain chemistry accordingly.
When alcohol wears off, a person can then feel withdrawal symptoms as the brain attempts to balance itself chemically. This may encourage a person to want to drink more in order to self-medicate these symptoms, which can lead to significant cravings and compulsive drinking. A person battling addiction will not only suffer from physical alcohol dependence and withdrawal, but will also struggle with additional emotional, behavioral, and social consequences.
Is Alcoholism a Disease?
The American Society of Addiction Medicine (ASAM) defines addiction as a brain disease. As alcoholism is addiction involving alcohol, it is therefore classified as a disease. Brain chemistry and circuitry are actually changed through repetitive and regular episodes of problematic drinking, which can then lead to an inability to control drinking regardless of a person's desire to do so.
Are There Different Levels of Alcoholism?
Alcohol addiction can vary from mild to severe based on how many of the DSM-5 criteria a person meets. NIAAA publishes that if a person suffers from 2-3 symptoms, they are diagnosed with a mild alcohol use disorder (AUD), while 4-5 constitutes a moderate AUD, and the presence of 6 or more is classified as a severe AUD.
What Defines an Alcoholic?
While the image of an "alcoholic" probably brings a certain picture to mind, there are actually five different types of alcoholics, NIAAA publishes. The chronic severe subtype actually only makes up about 9 percent of all alcoholics in the United States; however, this is likely what comes to mind when one thinks of an "alcoholic." They typically are middle-aged and began drinking young, often struggle with co-occurring psychiatric disorders, come from families of alcoholics, and often do other drugs as well. This subtype regularly seeks help for alcoholism, and they make up the greatest number of alcoholics in treatment.
Other subtypes of alcoholism include:
- Young adult subtype: The largest group, making up 31.5 percent of all American alcoholics, this group consists of young adults who have a low rate of family history of addiction, rarely suffer from co-occurring disorders, and do not regularly seek treatment for the disease.
- Young antisocial subtype: More than half of this group (which makes up 21 percent of all American alcoholics) have a family history of alcoholism and suffer from co-occurring mental health disorders. The majority of this group are in their mid-20s and started struggling with alcohol issues early in life. Most smoke cigarettes and/or marijuana, and they are often addicted to other drugs as well. About one-third of this subtype seek professional care.
- Functional subtype: Making up 19.5 percent of all US alcoholics, this group consists of well-educated, middle-aged people with stable family and work lives. About half of those in this group also smoke, a quarter have also suffered from depression at some point, and one-third have a family history of alcoholism.
- Intermediate familial subtype: About 19 percent of all American alcoholics fall into this group. They are generally middle-aged, and about half have a family history of alcoholism. Most smoke, and many struggle with other drug abuse. Only one-quarter of this group seeks treatment for alcoholism.
Can an Alcoholic Be Functional?
The functional alcoholic is often overlooked because they may seem to "have it all together." They generally have stable home lives, hold down a steady job, and are well educated. Families often act as enablers, making excuses for the drinking since everything seems to be attended to as needed on the surface.
A functional alcoholic often denies that a problem exists and is less likely to seek help for alcohol abuse. A high-functioning alcoholic commonly leads a double life, however, and will often segregate their "normal" life from their drinking life. Cravings for alcohol, changes in personality when drinking, and an inability to stop drinking once they start are signs of problematic drinking that can be managed with professional treatment.
Can Alcoholism Be Inherited?
Alcoholism is considered to be heritable about half of the time, the journal Psychological Medicine reports. This means that genetics can play a role in the onset of alcoholism. If a family member struggles with alcohol addiction, it puts their direct relatives at risk for also battling the disease.
Alcoholism is thought to be equally tied to a person's environment, however, and not to genetics alone. High levels of stress, childhood trauma, and a lack of a supportive and stable home environment can all contribute to the onset of alcohol abuse and alcohol-related problems.
Is Someone Destined to Be an Alcoholic?
Just because someone battles alcoholism does not mean that their family members will as well. Alcoholism is a complex disease that has many social, emotional, physical, and behavioral facets, and it can be triggered not only by genetics but also by environmental and other aspects. People who have a family history of alcoholism can limit their risk by drinking responsibly and not engaging in potentially harmful patterns of drinking on a regular basis.
Can Alcoholism Be Prevented?
Obviously, alcoholism can be prevented by not drinking at all, but a person can also minimize their risk for struggling with the disease by drinking safely and responsibly, sticking to moderate drinking patterns, and avoiding heavy or excessive drinking.
People under the age of 21 should refrain from drinking, as drinking young can increase the odds that a person will then struggle with addiction later in life. The American Psychological Association (APA) warns that people who start drinking alcohol by the time they turn 13 are 38 percent more likely to become dependent on alcohol when they get older. This risk increases if there is also a family history of alcoholism.
Individuals who use drugs or suffer from co-occurring disorders should also minimize alcohol use in order to prevent alcohol-related issues, including addiction.
Is There a Cure for Alcoholism?
Alcoholism is a chronic disease that can be managed with medications, therapies, and support; however, there is no cure. Specialized and professional treatment can help to manage symptoms and minimize relapse, and support groups and aftercare programs promote long-term recovery.
Can Alcohol Be Stopped Cold Turkey?
Around half of all people who struggle with alcohol dependence will experience withdrawal symptoms when they stop drinking, the New England Journal of Medicine (NEJM) publishes. About 3-5 percent of the time, these withdrawal side effects are severe enough to be potentially life-threatening. Severe alcohol withdrawal is called delirium tremens (DTs), which can include seizures, extreme confusion, psychotic symptoms, high fever, coma, and even death.
Once a person becomes dependent on alcohol and starts to struggle with withdrawal symptoms when alcohol leaves the body, suddenly stopping drinking can be dangerous and should not be attempted without professional help. Instead of stopping alcohol cold turkey, it may be slowly weaned off during a controlled taper during detox. Alcohol may also be replaced by a different central nervous system depressant medication, like a benzodiazepine, during detox in order to slowly and safely help a person reach a stable physical level.
Is Home Detox from Alcohol Safe?
Alcohol withdrawal can be extremely uncomfortable and downright hazardous for some people; therefore, detox should be performed in a medical detox facility that can provide around-the-clock medical and vital sign monitoring as well as medication management for withdrawal symptoms and 24/7 emotional support. Alcohol withdrawal can include the following symptoms:
- Decreased appetite and possible anorexia
- Muscle aches
- Difficulties thinking straight, concentrating, and making decisions
- Memory issues
- Irregular heart rate and blood pressure
- Jitteriness and feeling "on edge"
- Depression and trouble feeling pleasure
- Potential suicidal thoughts and actions
Alcohol withdrawal can have significant physical and emotional side effects that are best managed through a specialized medical detox program.
Is Detox All That is Needed to Treat Alcoholism?
Detox helps a person regain safe physical balance; however, it should be immediately followed with a comprehensive treatment program that includes counseling and therapy sessions to address the psychological, behavioral, and social ramifications of addiction. Treatment programs can aid in minimizing relapse and help to provide coping mechanisms and tools for recovery as well as ongoing support.
Are There Medications to Treat Alcohol Addiction?
There are three FDA-approved medications to treat alcohol addiction, NIDA reports. These include naltrexone (ReVia), acamprosate (Campral), and disulfiram (Antabuse). Naltrexone is an antagonist medication that can block the pleasure-inducing feeling of alcohol and may therefore help to reduce cravings and minimize relapse. Acamprosate aids in reducing long-term withdrawal symptoms, whereas disulfiram is used as a deterrent medication, as it can make drinking alcohol unpleasant by interfering with its breakdown.
A fourth medication, topiramate (Topamax), is used off label to help with alcohol cravings and withdrawal symptoms during alcohol addiction treatment. Other medications may address specific side effects of alcohol withdrawal during detox and treatment, such as antidepressants, sleep aids, or anti-nausea medications.
How Common Is Relapse?
Addiction is a chronic disease that NIDA reports has a relapse rate of between 40 percent and 60 percent, similar to other chronic disease like hypertension, type I diabetes, and asthma. Relapse is a common aspect of alcoholism and does not mean that treatment didn't work. It is merely part of recovery, and with professional help and support, instances of relapse can be minimized.
Can Relapse Be Avoided?
A big part of helping to reduce relapse is to remain in a treatment program long enough for the brain to have time to reset itself and for new healthier habits to become more fixed. NIDA recommends spending at least 90 days in a treatment program for addiction.
Therapy and counseling sessions during addiction treatment teach healthy coping mechanisms for potential stressors that can be used long into recovery to reduce relapse. Support groups, such as 12-Step programs like Alcoholics Anonymous (AA), can help to minimize relapse as well. AA is a peer-support program that provides fellowship and a safe environment for individuals who wish to achieve and sustain abstinence from alcohol. The Journal of Addictive Disorders publishes that people who actively participate in AA are twice as likely to remain abstinent over those who don't. Making healthy peer connections while avoiding people, places, and things that might be triggers for relapse is highly beneficial during recovery.
Family therapy can help ensure that all members of the household are on the same page and understand how to reduce possible stressors and communicate better. Peer and family support can go a long way in minimizing relapse and fostering ongoing recovery.
Does a Person Need to Hit Rock Bottom to Get Help for Alcoholism?
Alcoholism is a treatable disease, with a variety of available treatment options, ranging from outpatient services to residential treatment programs. Anyone who struggles with alcohol abuse can benefit from some level of substance abuse treatment program. Mild alcoholism may be circumvented at an earlier stage with the right form of treatment, and severe alcoholism can be managed to improve overall quality of life of all involved parties.
Contrary to the long-held belief that a person needs to get arrested; lose their job, family, or home; or otherwise hit rock bottom in order to benefit from, or perceive the need for, alcohol treatment, anyone at any stage of the disease can get help. Alcoholism is recognized as a disease, which helps to dispel the stigma that surrounds it and may encourage more people to get help sooner.
The CDC reports that 88,000 people per year died from excessive alcohol use between 2006 and 2010. This equated to 2.5 million years of potential life lost (YPLL). In addition to vastly improving lives, alcohol addiction treatment can literally save lives.