Alcoholism: Illness Or Personality Trait?

Alcoholism, or alcohol use disorder (AUD), is a common and complex condition that has been debated over the years, with some considering it an illness and others attributing it to one's personality or social choices. AUD is characterised by an impaired ability to stop or control alcohol consumption despite the negative impact on health, relationships, and occupational duties. It is considered both a physical and mental illness, with symptoms including cravings, increased tolerance, and withdrawal symptoms such as trouble sleeping and anxiety when not drinking. Treatment options vary, from medical intervention to support groups like Alcoholics Anonymous, and most people with AUD can reduce their alcohol consumption or stop drinking entirely.

Alcohol use disorder symptoms

Alcohol use disorder (AUD), sometimes called alcoholism, is a common medical condition. People with AUD experience changes in their mood and behaviour, which can include:

• Craving drinks containing alcohol
• Continuing to drink even when it negatively affects relationships with family, friends and colleagues
• Drinking more than intended, or for longer than intended
• Spending a lot of time obtaining and consuming alcohol or recovering from hangovers
• Failing to meet work, family or social obligations
• Giving up important activities because of alcohol
• Drinking in hazardous situations
• Continuing to drink when it worsens an existing medical or mental health condition
• Experiencing alcohol withdrawal symptoms, or drinking to avoid these
• Having a high tolerance for alcohol

AUD can be a severe condition that takes over a person's life. However, studies show that most people with AUD can reduce their alcohol consumption or stop drinking altogether. Treatment options include behavioural therapy, medication, and support groups.

Treatment for alcoholism

Alcohol use disorder (AUD), or alcoholism, is a common medical condition. People with AUD experience an impaired ability to stop or control their alcohol consumption despite adverse social, occupational, or health consequences. Treatment for alcoholism typically involves medication and behavioural therapy, with studies showing that most people can reduce their alcohol consumption or stop drinking entirely.

Medication

The US Food & Drug Administration has approved naltrexone and acamprosate as alcohol use disorder treatments. Topiramate and gabapentin can also decrease cravings in some people. These medications can be prescribed by a primary care provider or other healthcare professional and may be used alone or in combination with counselling.

Behavioural Therapy

Behavioural treatments aim to change drinking behaviour through counselling. This may involve working with addiction counsellors or psychologists. Counselling can help individuals identify triggers and develop strategies to avoid or cope with them.

Support Groups

Support groups, such as Alcoholics Anonymous (AA) and other 12-step programs, provide peer support for individuals quitting or cutting back on their drinking. These groups offer a valuable layer of support and can help individuals make and sustain beneficial changes, promoting recovery.

Exercise

Exercise is recommended as a way to manage stress and cope with the challenges of reducing alcohol consumption or quitting.

Inpatient Treatment

For individuals with severe alcohol use disorder, healthcare providers may recommend inpatient medical treatment or residential rehabilitation. This is particularly important for those at risk of delirium tremens (DT), a severe form of alcohol withdrawal that can be life-threatening.

Alcoholism as a physical and mental illness

Alcoholism, or alcohol use disorder (AUD), is a common medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It is considered both a physical and mental illness. The development of alcoholism is attributed to a combination of environmental and genetic factors. Genetics play a significant role, with hereditability accounting for approximately 60%. Additionally, a family history of alcohol problems increases the likelihood of developing AUD. Environmental factors, such as social, cultural, and behavioural influences, also contribute to the development of alcoholism. High stress levels, anxiety, and the accessibility and affordability of alcohol can further increase the risk of developing AUD.

The symptoms of AUD focus on changes in mood and behaviour. Individuals with AUD may experience cravings for alcohol and continue to consume it despite the negative impact on their relationships, work, and health. They may spend a significant amount of time obtaining and consuming alcohol, recovering from hangovers, or experiencing withdrawal symptoms when attempting to reduce their alcohol intake. AUD can lead to risky behaviours, such as drinking in hazardous situations or continuing to drink despite medical conditions that are exacerbated by alcohol consumption.

The severity of AUD can range from mild to moderate to severe, based on the number of criteria an individual meets regarding their symptoms. Treatment for AUD typically involves a combination of medication and behavioural therapy. Several medications, such as naltrexone, acamprosate, and disulfiram, are approved to help reduce alcohol consumption and prevent relapse. Behavioural therapies, mutual-support groups, and life training are also crucial components of treatment, helping individuals develop coping mechanisms and resist the urge to return to alcohol use.

Withdrawal from alcohol dependence should be carefully managed as it can be fatal if not properly supervised. Medical complications may arise during withdrawal, and symptoms such as trouble sleeping, shakiness, restlessness, nausea, and increased heart rate may occur. Treatment approaches vary, and some individuals may opt for detoxification followed by supportive therapy, self-help groups, and ongoing development of coping strategies. Abstinence-based programmes like Alcoholics Anonymous have shown higher abstinence rates and lower health care costs in some studies.

Alcoholism has wide-ranging physical and mental health consequences. Excessive alcohol consumption can lead to liver disease, high blood pressure, heart disease, digestive problems, and a weakened immune system. It is also associated with mental health conditions such as depression and anxiety and can contribute to relationship problems and issues at school or work. Additionally, alcohol misuse during pregnancy can result in fetal alcohol spectrum disorder (FASD). It is important to recognise that alcoholism is a treatable condition, and most people can reduce their alcohol intake or achieve abstinence with appropriate interventions.

Genetic and environmental factors

While there is a growing body of scientific evidence that alcoholism has a genetic component, it is not the sole factor. According to the National Institute on Drug Abuse, up to 50% of the reason an individual develops an addiction is influenced by genetics. However, it is important to note that possessing the gene does not guarantee the development of an alcohol use disorder (AUD).

Genetic factors influence not only the risk of alcohol dependence but also the level of alcohol consumption and the likelihood of alcohol-associated diseases, including cirrhosis and upper GI cancers. Studies have identified several genes that play a role in risky behaviours associated with alcohol abuse or dependence. For example, the DRD2 gene was the first candidate gene that showed a potential association with alcoholism. Other genes such as alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2) are also closely tied to the risk for problem drinking.

Environmental factors also play a significant role in the development of AUD. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) highlights the interplay of genetic and environmental factors in influencing drinking patterns and AUD risk. External stress is one of the most potent environmental risk factors for AUD. Individuals who have experienced trauma, especially during childhood, or accumulated significant stressors throughout life, may be more prone to heavy drinking patterns. Additionally, social and cultural norms surrounding drinking and alcohol availability can impact an individual's drinking habits. For instance, living with parents who drink and encourage alcohol consumption can increase the likelihood of alcohol-related issues.

Adoption studies further strengthen the understanding of the genetic influence on alcoholism. These studies reveal that adoptees' alcoholism correlates more strongly with their biological parents than their adoptive parents. Twin studies also suggest that approximately 45-65% of the liability for alcoholism is due to genetic factors. Animal studies, particularly with mice, rats, and fruit flies, provide additional evidence for the genetic basis of alcohol dependence.

While genetics and heredity are mostly interchangeable when discussing alcohol addiction, it is important to distinguish between the two. "Genetics" refers to a person's DNA, while "heredity" refers to the transmission of mutated genes from one generation to the next. In the context of alcoholism, genes, environment, and social interactions collectively influence an individual's risk level for alcohol addiction.

Withdrawal and relapse

Alcohol use disorder (AUD), commonly known as alcoholism, is a medical condition characterised by a person's inability to stop drinking despite the negative impact on their health, safety, and personal relationships. The development of alcohol dependence is a complex process influenced by various neurobiological and environmental factors. This dependence can lead to a withdrawal syndrome when alcohol consumption is ceased or significantly reduced, and both withdrawal and relapse are critical aspects of the disorder that require careful management.

When an individual with alcohol dependence abruptly stops or reduces their alcohol consumption, they may experience a range of physical and psychological withdrawal symptoms. While the physical symptoms often subside within a few days, psychological symptoms such as anxiety, negative affect, and dysphoria can persist for much longer. The presence of these symptoms increases the risk of relapse, as individuals may turn to alcohol to cope with the distress and psychological discomfort associated with withdrawal.

Relapse refers to a return to previous levels of alcohol consumption after a period of abstinence or reduction. It is a common occurrence during the recovery process and can be triggered by various factors, including stressful life events, emotional challenges, and social or economic problems. Relapse is not a sign of weakness or failure but rather a reflection of old coping mechanisms that need to be replaced with new, healthier strategies.

To manage withdrawal and prevent relapse, individuals should consider the following strategies:

• Support networks: Building a strong support system, including clinical professionals, family, and friends, is crucial. A supportive network can help individuals avoid negative behaviours and situations that may trigger a relapse.
• Avoiding triggers: Identifying and avoiding people, places, and situations that previously led to alcohol use is essential. This proactive approach can reduce the risk of relapse by minimising exposure to potential triggers.
• Meaningful activities: Engaging in positive and meaningful activities can help distract individuals from cravings and build a sense of self-worth. Joining community groups or pursuing special interests can provide a healthy outlet during recovery.
• Exercise: Physical activity is an effective stress management strategy. By incorporating exercise into their routine, individuals can better manage daily challenges and reduce the urge to drink.
• Medical support: Seeking professional help is vital, especially when experiencing unusual or significant symptoms. Medical professionals can provide medication and behavioural therapy to support individuals through withdrawal and relapse prevention.

In summary, withdrawal and relapse are interconnected aspects of alcohol use disorder. The fear of withdrawal symptoms can perpetuate alcohol abuse, and the presence of these symptoms can lead to relapse. However, with the right strategies and support, individuals can effectively manage withdrawal and reduce the risk of relapse during their recovery journey.

Frequently asked questions