What is alcoholism?
- Alcoholism is a disease characterized by the habitual intake of alcohol.
- Definition of alcoholism is chronic alcohol use to the degree that it interferes with physical or mental health, or with normal social or work behavior.
- Alcoholism is a disease that produces both physical and psychological addiction.
- Alcohol is a central nervous system depressant that reduces anxiety, inhibition, and feelings of guilt.
- It lowers alertness and impairs perception, judgment, and motor coordination. In high doses, it can cause loss of consciousness and even death.
- Alcoholism is a disease that damages the brain, liver, heart, and other organs (short-term, long-term effects of alcohol).
Signs and Symptoms
Spotting the signs and symptoms of alcoholism is not always easy.
Alcoholism is a disease that can be seen through drinking-related arrests or job loss, but they tend to happen late in the disease.
Many signs occur earlier, yet are harder to detect. These signs include:
- An increasing tolerance to the effects of alcohol. You may have heard the expression that someone can “hold their liquor.” This is not a sign that this person will not have problems with alcohol; in fact, this may be an early sign of alcoholism as a disease.
- A growing preoccupation with or interest in drinking. Also drinking alone or drinking before an activity where there will be drinking. It may seem as though one simply enjoys drinking. We now know that these can be part of the definition of alcoholism.
- A person will dispute their drinking is a problem. This symptom, called denial, is almost always present in the disease of alcoholism. See alcoholic denial.
- Later, difficulties in relationships, on the job, or with the law often occur.
Other signs and symptoms closely matching the definition of alcoholism are:
- Hiding alcohol or sneaking drinks
- Gulping the first few drinks
- Wanting to drink more, or longer, than the rest of the crowd
- Losing control of drinking, leading to attempts to control it (“going on the wagon”)
(Sources: DSM IV – American Psychiatric Association, National Institute on Alcohol Abuse and Alcoholism)
Alcohol Use Disorder
The DSM-V lists alcoholism as an “alcohol use disorder”
Problem drinking that becomes severe is given the medical diagnosis of “alcohol use disorder” or AUD.
- Approximately 7.2 percent or 17 million adults in the United States ages 18 and older had an AUD in 2012.
- This includes 11.2 million men and 5.7 million women.
- Adolescents can be diagnosed with an AUD as well, and in 2012, an estimated 855,000 adolescents ages 12–17 had an AUD.
To be diagnosed with an AUD individuals must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Under DSM–5, the current version of the DSM, anyone meeting any two of the 11 criteria during the same 12-month period receives a diagnosis of AUD.
The severity of an AUD—mild, moderate, or severe—is based on the number of criteria met.
To assess whether you or loved one may have an AUD, here are some questions to ask. In the past year, have you:
- Had times when you ended up drinking more, or longer than you intended?
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
- Spent a lot of time drinking? Or being sick or getting over the aftereffects?
- Experienced craving — a strong need, or urge, to drink?
- Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
- Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?
If you have any of these symptoms, your drinking may already be a cause for concern. The more symptoms you have, the more urgent the need for change. A health professional can conduct a formal assessment of your symptoms to see if an alcohol use disorder is present.
However severe the problem may seem, most people with an alcohol use disorder can benefit from treatment. Unfortunately, only of a fraction of people who could benefit from treatment receive help. In 2012, for example, 1.4 million adults received treatment for an AUD at a specialized facility (8.4 percent of adults in need). This included 416,000 women (7.3 percent of women in need) and 1.0 million men (8.9 percent of men in need).
Ultimately, receiving treatment can improve an individual’s chances of success in overcoming an AUD. Talk with your doctor to determine the best course of action for you and see Rethinking Drinking and Treatment for Alcohol Problems: Finding and Getting Help for more information.
Alcohol use disorder (which includes a level that’s sometimes called alcoholism) is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, or having withdrawal symptoms when you rapidly decrease or stop drinking.
Unhealthy alcohol use includes any alcohol use that puts your health or safety at risk or causes other alcohol-related problems. It also includes binge drinking — a pattern of drinking where a male consumes five or more drinks within two hours or a female downs at least four drinks within two hours. Binge drinking causes significant health and safety risks.
If your pattern of drinking results in repeated significant distress and problems functioning in your daily life, you likely have alcohol use disorder. It can range from mild to severe. However, even a mild disorder can escalate and lead to serious problems, so early treatment is important.
Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms you experience. Signs and symptoms may include:
- Being unable to limit the amount of alcohol you drink
- Wanting to cut down on how much you drink or making unsuccessful attempts to do so
- Spending a lot of time drinking, getting alcohol or recovering from alcohol use
- Feeling a strong craving or urge to drink alcohol
- Failing to fulfill major obligations at work, school or home due to repeated alcohol use
- Continuing to drink alcohol even though you know it’s causing physical, social or interpersonal problems
- Giving up or reducing social and work activities and hobbies
- Using alcohol in situations where it’s not safe, such as when driving or swimming
- Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount
- Experiencing withdrawal symptoms — such as nausea, sweating and shaking — when you don’t drink, or drinking to avoid these symptoms
Alcohol use disorder can include periods of alcohol intoxication and symptoms of withdrawal.
- Alcohol intoxication results as the amount of alcohol in your blood stream increases. The higher the blood alcohol concentration is, the more impaired you become. Alcohol intoxication causes behavior problems and mental changes. These may include inappropriate behavior, unstable moods, impaired judgment, slurred speech, impaired attention or memory, and poor coordination. You can also have periods called “blackouts,” where you don’t remember events. Very high blood alcohol levels can lead to coma or even death.
- Alcohol withdrawal can occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to four or five days later. Symptoms include sweating, rapid heartbeat, hand tremors, problems sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms can be severe enough to impair your ability to function at work or in social situations.
What is considered one drink?
The National Institute on Alcohol Abuse and Alcoholism defines one standard drink as any one of these:
- 12 ounces (355 milliliters) of regular beer (about 5 percent alcohol)
- 8 to 9 ounces (237 to 266 milliliters) of malt liquor (about 7 percent alcohol)
- 5 ounces (148 milliliters) of unfortified wine (about 12 percent alcohol)
- 1.5 ounces (44 milliliters) of 80-proof hard liquor (about 40 percent alcohol)
When to see a doctor
- If you feel that you sometimes drink too much alcohol, or it’s causing problems, or your family is concerned about your drinking, talk with your doctor.
- Other ways to get help include talking with a mental health provider or seeking help from a support group such as Alcoholics Anonymous or a similar type of self-help group.
- Because denial is common, you may not feel like you have a problem with drinking.
- You might not recognize how much you drink or how many problems in your life are related to alcohol use.
- Listen to relatives, friends or co-workers when they ask you to examine your drinking habits or to seek help.
- Consider talking with someone who has had a problem drinking, but has stopped.
If your loved one needs help
- Many people with alcohol use disorder hesitate to get treatment because they don’t recognize they have a problem.
- An intervention from loved ones can help some people recognize and accept that they need professional help.
- If you’re concerned about someone who drinks too much, ask a professional experienced in alcohol treatment for advice on how to approach that person.
- Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior.
- Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder.
- Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior.
- This may result in craving alcohol to try to restore good feelings or reduce negative ones.
Risk factors for alcohol use disorder include:
- Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-related problems or alcohol use disorder.
- Age. People who begin drinking at an early age, and especially in a binge fashion, are at a higher risk of alcohol use disorder. Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s. However, it can begin at any age.
- Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems with alcohol. This may be influenced by genetic factors.
- Depression and other mental health problems. It’s common for people with a mental health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances.
- Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it’s OK to drink too much. For young people, the influence of parents, peers and other role models can impact risk.
- Alcohol depresses your central nervous system. In some people, the initial reaction may be stimulation. But as you continue to drink, you become sedated.
- Too much alcohol affects your speech, muscle coordination and vital centers of your brain.
Impact on your safety
Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including:
- A heavy drinking binge may even cause a life-threatening coma or death.
- This is of particular concern when you’re taking certain medications that also depress the brain’s function.
- Motor vehicle accidents and other types of accidental injury, such as drowning
- Relationship problems
- Poor performance at work or school
- Increased likelihood of committing violent crimes or being the victim of a crime
- Legal problems or problems with employment or finances
- Problems with other substance use
- Engaging in risky, unprotected sex, or becoming the victim of sexual abuse or date rape
- Increased risk of attempted or completed suicide
Impact on your health
Drinking too much alcohol on a single occasion or over time can cause health problems, including:
- Liver disease. (pancreatitis).Heavy drinking can cause increased fat in the liver (hepatic steatosis), inflammation of the liver (alcoholic hepatitis), and over time, irreversible destruction and scarring of liver tissue (cirrhosis).
- Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers.
- It also can interfere with absorption of B vitamins and other nutrients.
- Heavy drinking can damage your pancreas or lead to inflammation of the pancreas or lead to inflammation of the pancreas (pancreatitis).
- Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause a serious heart arrhythmia called atrial fibrillation.
- Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level.
- Sexual function and menstruation issues. Excessive drinking can cause erectile dysfunction in men. In women, it can interrupt menstruation.
- Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamine). A thiamine deficiency also can be associated with other brain changes, such as irreversible dementia, if not promptly treated.
- Birth defects. Alcohol use during pregnancy may cause miscarriage. It also may cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems that last a lifetime.
- Bone damage. Alcohol may interfere with the production of new bone. This bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding.
- Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss.
- Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia.
- Increased risk of cancer. Long-term excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, colon and breast cancer. Even moderate drinking can increase the risk of breast cancer.
- Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.
Treatments and Drugs
Treatment for alcohol use disorder can vary, depending on your needs. Treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay.
Working to stop the use of alcohol to improve quality of life is the main treatment goal.
Treatment for alcohol use disorder may include:
- Detox and withdrawal. Treatment may begin with a program of detoxification or detox — withdrawal that’s medically managed — which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital.
- Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center.
- Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcohol use. You may benefit from couples or family therapy — family support can be an important part of the recovery process.
- Oral medications. A drug called disulfiram (Antabuse) may help to prevent you from drinking, although it won’t cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help you combat alcohol cravings once you stop drinking. Unlike disulfiram, naltrexone and acamprosate don’t make you feel sick after taking a drink.
- Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol use disorder to use consistently.
- Continuing support. Aftercare programs and support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group.
- Treatment for psychological problems. Alcohol use disorder commonly occurs along with other mental health disorders. If you have depression, anxiety or another mental health condition, you may need talk therapy (psychotherapy), medications or other treatment.
- Medical treatment for health conditions. Many alcohol-related health problems improve significantly once you stop drinking. But some health conditions may warrant continued treatment and follow-up.
- Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcohol use disorder or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery.
Residential treatment programs
For a serious alcohol problem, you may need a stay at a residential treatment facility. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement and activity therapy.
Residential treatment programs typically include licensed alcohol and drug counselors, social workers, nurses, doctors and others with expertise and experience in treating alcohol use disorder.
Lifestyle and Home Remedies
You’ll need to focus on changing your habits and making different lifestyle choices.
- Consider your social situation. Make it clear to your friends and family that you’re not drinking alcohol. Develop a support system of friends and family who can support your recovery. You may need to distance yourself from friends and social situations that impair your recovery.
- Develop healthy habits. For example, good sleep, regular physical activity, managing stress more effectively and eating well all can make it easier for you to recover from alcohol use disorder.
- Do things that don’t involve alcohol. You may find that many of your activities involve drinking. Replace them with hobbies or activities that are not centered around alcohol.
I will be posting something important about mental illness every day throughout the month of May on my blog in honor of Mental Health Awareness Month.
Please keep visiting my blog My Loud Bipolar Whispers and look for statistics or other beneficial information related to mental illness to increase awareness, educate, reduce mental illness stigma and reduce suicides. It is crucial and imperative for all of us to get involved and save lives.
So, please visit my blog every day, but especially every day throughout the month of May.
Thank you. Hugs and blessings to all of you always and forever.