Alcoholism: Defining The Line Of Addiction

Alcoholism, also known as alcohol addiction, alcohol misuse, or alcohol dependence, is a common medical condition. While there is no definitive limit to classifying someone as an alcoholic, there are recommended drinking limits and various factors that can indicate harmful drinking or alcohol dependence. For example, the American Medical Association recommends a daily limit of two drinks for men and one drink for women. Heavy drinking is defined as consuming five or more drinks per day or 15 or more drinks per week for men, and four or more drinks per day or eight or more drinks per week for women. Alcoholism is characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. Treatment options for alcohol dependence include medication and behavioral therapy, such as Cognitive Behavioral Therapy (CBT).

Alcohol use disorder (AUD)

There is no definitive answer to the question of a set limit for being called an alcoholic. However, several organisations provide guidelines on alcohol consumption to help individuals evaluate their drinking patterns and identify potential misuse or AUD. For example, the American Medical Association recommends a daily limit of two drinks for men and one drink for women. Heavy drinking is defined as five or more drinks per day or 15 or more drinks per week for men and four or more drinks per day or eight or more drinks per week for women. Similarly, the UK Chief Medical Officers' guidelines advise a limit of 14 units of alcohol per week for those trying to conceive and recommend having several drink-free days and avoiding binge drinking. Binge drinking, as defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), corresponds to consuming five or more drinks by males or four or more drinks by females in about two hours.

The World Health Organization (WHO) states that any amount of alcohol consumption can be harmful. Excessive drinking can lead to short- and long-term health issues, including accidental injuries, worsened mental and physical health conditions, and increased risk of falls, car accidents, and fractures. It is important to note that the amount of harm caused by alcohol increases with the amount consumed.

If an individual believes their alcohol consumption has become an issue or is causing distress or harm in their life, they can seek help from healthcare or mental health professionals. Treatment options for AUD include medication and behavioural therapy, such as Cognitive Behavioural Therapy (CBT), to address negative thought patterns and change drinking behaviour. Support groups, such as Alcoholics Anonymous, can also provide assistance and help individuals adjust their thinking and attitudes. With treatment, most people with AUD can reduce their alcohol consumption or stop drinking entirely.

Binge drinking

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) define binge drinking as consuming five or more drinks (male) or four or more drinks (female) on the same occasion, i.e., at the same time or within a couple of hours of each other, on at least one day in the past month. The Dietary Guidelines for Americans 2020-2025 recommend that adults limit their intake to two drinks or less in a day for men and one drink or less in a day for women. Drinking less is better for health than drinking more, and having several alcohol-free days each week is advisable.

While there is no specific limit to define alcoholism, binge drinking is a significant contributor to the development of alcohol use disorder. Binge drinking increases the risk of adverse outcomes and can lead to alcohol dependence, characterised by an impaired ability to stop or control alcohol intake. Treatment options are available to help individuals reduce their alcohol consumption or stop drinking entirely.

Alcohol withdrawal

While there is no clear definition of the limit at which someone is an alcoholic, alcohol misuse, heavy alcohol use, and binge drinking increase the risk of developing alcohol use disorder (AUD). AUD is characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. Treatment for AUD includes medication and behavioural therapy, and studies show that most people can reduce their alcohol intake or stop drinking entirely.

Mild symptoms of alcohol withdrawal often start 6-12 hours after the last drink, with more serious symptoms developing within 12-48 hours. These can include hallucinations, which often start about 12-24 hours after stopping drinking, and seizures, which may occur within the first 48 hours. Symptoms are typically at their worst between 24 and 72 hours after stopping drinking, but they can sometimes linger for weeks or even months.

Treatment for alcohol withdrawal involves medical support and specific prescription medication to manage symptoms and avoid complications such as seizures. In mild cases, a supportive environment may be sufficient, while moderate cases may require short-term medications to alleviate symptoms. It is important to seek medical advice when experiencing alcohol withdrawal to ensure a safe and effective plan for reducing and stopping alcohol consumption.

Treatment options

Alcohol use disorder (AUD), or alcoholism, is a common medical condition in which people are unable to stop drinking, even when drinking negatively affects their health, safety, and personal relationships. While there is no definitive limit to being considered an alcoholic, the American Medical Association recommends a daily limit of two drinks for men and one drink for women. Heavy drinking is defined as exceeding these limits, with five or more drinks in one day or 15 or more drinks per week for men, and four or more drinks per day or eight or more drinks per week for women.

The treatment options for alcoholism include medication and behavioural therapy, with studies showing that most individuals are able to reduce their alcohol consumption or stop drinking entirely with the right treatment.

Medication

There are currently three medications approved for AUD in the United States:

• Naltrexone (available as a pill or injection) helps reduce the urge to drink.
• Acamprosate (a pill) decreases the negative symptoms associated with alcohol abstinence, making it easier to maintain abstinence.
• Disulfiram (a pill) discourages drinking by causing unpleasant symptoms when alcohol is consumed.

Behavioural Therapy

Behavioural treatments aim to change drinking behaviour through counselling. Licensed therapists can help individuals build coping strategies and skills to stop or reduce their drinking through one-on-one, family, or group sessions.

Combination Therapy

Medications and behavioural therapy can be used in combination and tailored to individual needs. The four basic levels of care or intensity for alcohol treatment, as defined by the American Society of Addiction Medicine, include:

• Outpatient: Regular office visits for counselling, medication support, or both.
• Intensive outpatient or partial hospitalization: Coordinated outpatient care for complex needs.
• Residential: Low or high-intensity programs in 24-hour treatment settings.
• Intensive inpatient: Medically-directed 24-hour services that may manage withdrawal.

Support Groups

In addition to professional treatment, many people benefit from mutual support groups such as Alcoholics Anonymous (AA). These groups can provide a sense of community and shared experience, offering additional support and accountability during the recovery process.

Helplines

For those facing mental and/or substance use disorders, there are confidential helplines such as SAMHSA's National Helpline, which offers free, 24/7 referral and information services in multiple languages. These helplines can provide referrals to local treatment facilities, support groups, and community-based organizations.

Seeking help

Alcohol use disorder (AUD), commonly referred to as alcoholism, is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. While there is no universally agreed-upon limit to being "an alcoholic", medical guidelines do provide some parameters for what constitutes healthy drinking. According to the Dietary Guidelines for Americans 2020-2025, adults of legal drinking age should limit their intake to two drinks or fewer per day for men and one drink or fewer per day for women. Binge drinking is defined as consuming five or more drinks (for men) or four or more drinks (for women) in about two hours, leading to a blood alcohol concentration of 0.08% or higher.

If you or someone you know is struggling with alcohol use, seeking help is crucial. Here are some steps and resources to consider:

Recognise the Problem: The first step towards recovery is acknowledging that a problem exists. Be honest with yourself about your drinking habits and the negative impact they may be having on your life.

Seek Professional Help: Consult a healthcare professional, such as your general practitioner (GP). They can provide an assessment, offer support options, and refer you to local community alcohol services, support groups, or counselling services. Be open and honest about your drinking habits to receive the most appropriate care.

Treatment Options: Treatment for alcohol use disorder typically involves a combination of medication and behavioural therapy. Medication can help manage withdrawal symptoms and make the process safer and less distressing. Behavioural therapies, such as cognitive-behavioural therapy (CBT), can help individuals identify triggers, change thought processes, and develop coping strategies to avoid and overcome drinking triggers.

Support Groups: Joining support groups such as Alcoholics Anonymous (AA) or SMART Recovery groups can provide a sense of community and ongoing support during recovery. These groups often follow a "12-step" programme to help individuals get sober and maintain their sobriety.

Family and Youth Support: Alcohol misuse not only affects the individual but also their families and youth in their lives. Organisations like Al-Anon Family Groups, Alateen, and the National Association for Children of Alcoholics (NACoA) offer support and understanding to those impacted by a loved one's drinking.

Hotlines and Helplines: If you need immediate support or someone to talk to confidentially, hotlines and helplines are available. The National Helpline by SAMHSA offers a free, confidential, 24/7 referral and information service for individuals and families facing substance use disorders. Additionally, the Drinkline is a national alcohol helpline that can be reached during weekdays and weekends.

Remember, seeking help is a sign of strength. Recovery from alcohol use disorder is an ongoing process, and setbacks are common. With persistence and the right support, most people can reduce their alcohol consumption or achieve long-term sobriety.

Frequently asked questions