How to Help an Alcoholic
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines alcohol use disorder (AUD) as problem drinking, like heavy or binge drinking, that becomes worse when the individual loses control over how much they consume. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists specific criteria for specialists to diagnose and treat people struggling with alcohol abuse.
The DSM-5 separates alcohol addiction and alcohol dependence, both of which can be physically harmful. There are 11 criteria listed as AUD in the DSM-5, and a person who experiences any two of those in a one-year (12-month) period receives a diagnosis of alcohol use disorder.
The 11 Criteria to Diagnose Alcohol Addiction
In the United States, 15.1 million adults ages 18 and older had a diagnosable AUD in 2015 – about 9.8 million men and 5.3 million women. Adolescents ages 12-17 may develop AUD; in fact, about 623,000 struggled with alcohol in 2015.
The 11 criteria for AUD include:
- Drinking more or for longer than intended
- Trying to cut down or stop drinking, but being unable to
- Spending a lot of time drinking or feeling sick after drinking too much
- Craving alcohol or feeling a strong urge to drink
- Discovering that drinking or being sick from drinking interferes with daily activities like work, school, or family obligations
- Continuing to consume alcohol even though it causes problems with friends or family
- Giving up or cutting back on important or enjoyable activities, specifically to drink more
- Entering situations where being intoxicated could lead to danger
- Continuing drinking despite the substance causing depression, anxiety, or leading to other health problems, or experiencing blackouts
- Having to drink more alcohol more often to obtain the desired level of intoxication or other effects
- Experiencing withdrawal symptoms, including shakiness, irritability, restlessness, sweating, nausea, or others, when going without alcohol
A person with mild AUD experiences two or three symptoms; an individual struggling with moderate AUD reports four or five symptoms; and a person struggling with severe AUD reports six or more of these symptoms in one year. Most people who struggle with AUD benefit from receiving treatment through rehabilitation, but fewer than 10 percent of people who need help receive it. This means that millions of people in the United States suffer acute and chronic health consequences from drinking too much.
The Risks Leading to AUD
When a person develops problem drinking patterns, they may do so because they have several risk factors. A combination of genetics, family history, environment, and mental health all contribute to whether or not a person may develop alcohol use disorder, but how these conditions, in combination, influence an individual’s risk is not fully understood. Some people have all of these risk factors but never develop AUD or alcohol dependence. Others may not have apparent risk factors, but they still develop struggles with problem drinking.
- Drinking consistently or steadily over time
- Beginning drinking at a young age
- Family history of drinking or mental illness
- Depression, anxiety, bipolar disorder, schizophrenia, or other mental illness
- Social and cultural factors, such as friends who drink regularly
- A high-stress home or work environment
- Experiencing higher levels of emotional or mental stress
- Boredom or loneliness
People who have these risk factors, or develop them later in life, are at risk of becoming dependent on alcohol to feel normal, relaxed, or happy. Consuming too much alcohol is likely to harm one’s health, both in the short-term and long-term.
Health Problems Associated with Alcohol Abuse
People who drink heavily put themselves at risk of serious, chronic health problems. Men who have more than 15 drinks per week (or more than two drinks per day) and women who have more than eight drinks per week (or more than one per day) put themselves at risk of damaging their livers, stomachs, brains, and other organs. There are also short-term risks, including falling due to lost balance, contracting a sexually transmitted infection (STI) due to lowered inhibitions, or even alcohol poisoning.
- Vomiting and nausea
- Low body temperature
- Irregular or slow breathing
- Stopped breathing
- Cyanosis, or blue-tinged skin due to oxygen deprivation
- Passing out
If a person displays symptoms of alcohol poisoning, it is necessary to call 911 immediately. The person needs emergency medical attention.
- Increased risk of larynx, esophageal, liver, breast, and colon cancer
- Alcoholic hepatitis, which is an acute form of liver failure that occurs if a person consumes 100 grams of alcohol daily for one year
- Acute or chronic pancreatitis
- Alcoholic neuropathy, a change in the nervous system affecting sensation and movement
- Alcoholic cardiomyopathy, or the sagging of the heart muscle
- High blood pressure
- Nutritional deficiencies, especially low thiamine or vitamin B12, which can cause dementia-like symptoms
- Wernicke-Korsakoff syndrome, a combination of two brain disorders triggered by thiamine deficiency, leading to memory loss, confusion, loss of balance, physical changes, and more
Consuming too much alcohol can also trigger mental illnesses, especially mood disorders like depression or anxiety. Struggling with an alcohol use disorder can harm friends and family as well.
5 Stages Leading to Alcohol Addiction
When a person begins to struggle with AUD, there are five different stages that may indicate the increasing severity of the problem.
- Occasional abuse or binge drinking: The first stage involves general experimentation with alcohol. This may begin in adolescence, or it could start later in life. The individual may not drink consistently, but when they do drink, they drink more than intended, consume alcohol for longer than intended, binge drink, or otherwise struggle with control over their alcohol consumption.
- Drinking more often: The occasional bout of “too many drinks” becomes drinking more frequently or using social gatherings as an excuse to drink. Drinking every weekend, drinking with meals, using the substance as an excuse to go out or as a relaxant, or combating loneliness or sadness with alcohol are all signs that a person may be drinking more and losing control over their consumption habits.
- Problem drinking: Abusing alcohol begins before this stage, but the term problem drinking applies when an individual begins to experience the impact of drinking too much. They may struggle with worsening relationships with friends and family, changes to their behavior that impact them negatively, hanging out with others who drink more often, and health impacts like more frequent hangovers or feeling sick when not drinking.
- Alcohol dependence: The individual’s body begins to require the presence of alcohol to moderate brain chemistry to feel normal. When the individual does not consume alcohol regularly, they may experience withdrawal symptoms and intense cravings.
- Addiction: Alcohol use disorder, alcohol addiction, and alcoholism translate to compulsive behaviors around alcohol. Both physical dependence and psychological craving are intense at this stage.
A person who begins to display struggles with alcohol should not wait to get help. Sadly, too many people believe that a person needs to hit “rock bottom” to get the help they need, and even then, few people seek treatment.
Signs a Loved One Needs Help
When a person needs help dealing with their alcohol consumption problems or struggles to moderate their alcohol intake, they may:
- Express concern for how much they drink
- Feel they should cut down on their drinking
- Feel bad or guilty about drinking
- Drink earlier in the day or to cover withdrawal symptoms, signs of a mental illness, “nerves,” etc.
- Drink to get rid of a hangover
Unfortunately, people who struggle with alcohol dependence or AUD may hide how much they drink, lie to themselves or others about their alcohol consumption, or otherwise deny they have a problem. This means they are less likely to get help before they struggle with physical, emotional, psychological, relationship, financial, or other problems.
The Myth of the Functional Alcoholic
The term functional alcoholic, or high-functioning alcoholic, is deceptive. This implies that there are people who can drink a lot of alcohol on a regular basis and not experience a negative impact. This is false.
People who appear to function while drinking in excess may appear normal or successful; they may have a long-lasting marriage, take care of their children, have a good job or career, or show other signs of success. Just because a person does not appear to struggle does not mean that they do not experience frustration with their lack of control, emotional pain due to relationship problems brought about by alcohol abuse, or physical or financial problems because of how much alcohol they consume.
If an individual who drinks too much does not get help managing this condition, they may lose important relationships, their job, and their health. Hitting rock bottom does not have to occur to get help, but many people assume that, because they have not lost everything, they are not “struggling.”
Getting Treatment and Staying Sober
Although millions of Americans struggle with alcohol use disorder or alcohol dependence, few know that there is evidence-based help available. In fact, many people may assume that the main way people with AUD get treatment is through Alcoholics Anonymous or another type of support group. While these groups are very beneficial, there are medically based treatments that work well for a wide variety of people. In general, treatment for drug or alcohol addiction should involve medications to ease withdrawal symptoms; therapy through a rehabilitation program to understand the addiction and change behaviors; and long-term social support through peer support groups, therapists, and friends and family to maintain sobriety and avoid relapse.
For people specifically struggling with AUD and problem drinking, the first step is to find a physician to diagnose the condition. Addiction is a medical disorder, and medical professionals are trained to help.
A physician or therapist can use the DSM-5 criteria to determine if the individual struggles with AUD, and then refer the individual to a treatment program that is appropriate for them. A program should include medically supervised detox. Withdrawing from alcohol dependence can be dangerous without help, so working with a professional who can prescribe medications and oversee potential health risks is the best process.
Once detox is complete, entering a rehabilitation program – either inpatient or outpatient, depending on the severity of the AUD and the individual’s personal needs – will help the person learn about the root causes of their alcohol addiction, understand compulsive behaviors and what emotions trigger these, and change their behavior in response to intoxicating substances. The National Institute on Drug Abuse (NIDA) recommends remaining in treatment for 90 days, or three months, to change behaviors effectively.
Types of treatment programs are outlined below.
- Residential or long-term inpatient: For people who may have struggled with alcohol abuse for many years, particularly those who have chronic health problems associated with drinking that require medical supervision.
- Intensive outpatient or outpatient: People who prefer to live at home, need to maintain a job, or have other specific responsibilities that they cannot leave may benefit from forms of outpatient treatment. Generally, these are less intense than inpatient treatment, but intensive outpatient treatment is closer to the same number of hours per week as inpatient care, so it requires more focus and commitment, and leaves less time for other responsibilities.
- Individual or group therapy: Outside of a rehabilitation program, a person may see a therapist who leads groups or works with individuals struggling with drug or alcohol addiction.
- Sober living: For those who have completed a rehabilitation program but still need a change of surroundings and a supportive environment to maintain sobriety, sober living homes are a good option. These homes enforce a drug-free environment to help residents focus on getting a job, attending school or retraining programs, and work on new sober behaviors.
After a rehabilitation program has been successfully completed, ongoing support for sobriety is very important. Friends and family can support their loved one while they go through treatment and early recovery. Continued sessions with a therapist and ongoing participation in peer support groups, such as 12-Step meetings, also support sustained recovery.