Alcoholism: Understanding The Addiction To Alcohol

Alcoholism, or alcohol addiction, is a chronic relapsing disorder characterised by compulsive alcohol drinking, an impaired ability to stop or control alcohol use, and negative emotional states when alcohol is not available. Alcohol use disorder (AUD) is a spectrum disorder that can be mild, moderate, or severe, and encompasses conditions such as alcohol abuse, alcohol dependence, and alcoholism. While the stereotype of an alcoholic may not always hold true, individuals struggling with alcohol addiction come from diverse backgrounds and age groups. Treatment for AUD typically involves medication and behavioural therapy, and most individuals are able to reduce their alcohol consumption or stop drinking entirely.

Alcohol Use Disorder (AUD) diagnosis and criteria

Alcohol Use Disorder (AUD) is characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It is a spectrum disorder, ranging from mild to moderate to severe, and encompasses conditions that some refer to as alcohol abuse, alcohol dependence, or alcoholism. AUD is the fourth leading preventable cause of death in the US, and it often goes untreated. However, it is important to note that seeking treatment at any point can be beneficial, and individuals can work towards a range of goals, from reducing drinking to complete abstinence.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), provides criteria for diagnosing AUD. According to the DSM-5, AUD involves frequent or heavy alcohol drinking that becomes challenging to control and leads to problems in relationships, work, school, family, or other areas. Binge drinking, typically defined as women having four or more drinks and men having five or more drinks within a couple of hours, can also be problematic.

To diagnose AUD, healthcare providers will look for symptoms and perform a physical examination to identify any conditions that AUD may have caused. Some of the symptoms that may indicate AUD include:

• Craving beverages containing alcohol
• Experiencing alcohol withdrawal symptoms
• Drinking despite the negative impact on relationships
• Planning life around the next drink
• Continued alcohol use despite persistent social or interpersonal problems caused or exacerbated by alcohol
• Recurrent alcohol-related legal problems
• Repeated consumption of large amounts of alcohol, affecting organ systems such as the digestive system, cardiovascular system, and central and peripheral nervous systems

It is important to note that drinking small amounts daily or occasional intoxication does not alone constitute a diagnosis of AUD. However, having two or more of the above symptoms in the last year could signal AUD.

Treatment options: medication and behavioural therapy

Treatment for alcohol use disorder (AUD) can vary depending on the individual and the severity of their condition. Treatment options include medication, behavioural therapy, support groups, and a combination of treatments.

Medication

Medications used to treat AUD include:

• Acamprosate (Campral®): This medicine helps to rebalance chemicals in the brain that may have been altered due to excessive drinking.
• Disulfiram (Antabuse®): If alcohol is consumed while taking this medication, it causes unpleasant side effects such as nausea, vomiting, headaches, flushing, sweating, and chest pain.
• Naltrexone (Revia®, Vivitrol®): This medication works by reducing cravings for alcohol.
• Topiramate (Topamax®, Trokendi XR®, Qudexy XR®): While this medication is primarily used to treat seizures and prevent migraines, it has also been found to reduce cravings for alcohol in some individuals.
• Gabapentin: This medication can also help decrease cravings for alcohol.

Behavioural Therapy

Behavioural treatments involve working with a healthcare provider to identify and modify the thoughts and behaviours that contribute to alcohol misuse. This can include cognitive-behavioural therapy (CBT), which helps individuals develop coping strategies to manage triggers and stressful situations that may lead to drinking. CBT can be conducted in individual or group settings. Motivational enhancement therapy is another form of talk therapy that aims to build and strengthen the internal motivation to change drinking behaviour.

Support Groups

Support groups provide individuals with a sense of community and connection with others who are facing similar challenges. They offer a safe space to share experiences and provide mutual support during the recovery journey.

It is important to note that treatment for AUD should be tailored to the individual, and setbacks or relapses should be viewed as temporary setbacks rather than failures. Seeking professional help and regular check-ins with a treatment provider can help prevent a return to drinking.

Health risks: cancer, liver disease, and mental health

Alcoholism, or alcohol addiction, poses serious health risks, including cancer, liver disease, and mental health issues. These risks are heightened for those who engage in chronic heavy drinking or binge drinking. Understanding these health consequences is crucial for making informed decisions about alcohol consumption and seeking help if needed.

Starting with cancer, alcohol has been classified by the International Agency for Research on Cancer as a Group 1 carcinogen, indicating a causal link to several types of cancer. These include cancers of the oral cavity, pharynx, larynx, oesophagus, liver, colon, rectum, and breast. Even light drinking increases cancer risk, with evidence specifically linking alcohol consumption to higher chances of breast cancer in women. The link between alcohol and cancer is attributed to various mechanisms, such as oxidative stress, DNA damage, and interference with nutrient absorption.

Liver disease is another significant health risk associated with alcoholism. Alcohol is primarily metabolized by the liver, making this organ particularly vulnerable to damage from excessive drinking. Alcoholic liver disease can manifest as inflammation (hepatitis) and heavy scarring (cirrhosis), which can lead to liver failure. Cirrhosis is also the biggest risk factor for hepatocellular carcinoma, the most common form of liver cancer. Thus, alcohol abuse can indirectly increase the risk of liver cancer through cirrhosis.

The mental health consequences of alcoholism are also profound. Excessive alcohol use can lead to mental health issues such as depression and anxiety. Additionally, while alcohol does not cause schizophrenia, alcohol psychosis can result in similar symptoms, including hallucinations and delusions. These symptoms typically resolve within days to weeks if the individual refrains from drinking.

It is important to recognize that the health risks associated with alcoholism extend beyond cancer, liver disease, and mental health issues. Alcohol misuse contributes to a range of other conditions, including heart disease, pancreatitis, and memory problems. Furthermore, excessive alcohol consumption can lead to social and relationship issues, negatively impacting an individual's life and the lives of those around them.

To mitigate these health risks, drinking in moderation or abstaining from alcohol is recommended. Public health guidelines suggest limiting alcohol consumption to no more than two drinks per day for men and one drink per day for women. However, it is important to note that even light drinking can increase cancer risk, and there is currently no established safe threshold for alcohol consumption regarding cancer prevention.

Alcohol poisoning and overdose

Alcohol poisoning, also commonly referred to as alcohol overdose, occurs when a person consumes so much alcohol that their body cannot process it quickly enough. This results in a high blood alcohol concentration (BAC) that can overwhelm the body's ability to break down and clear alcohol from the bloodstream. Binge drinking, which involves consuming excessive amounts of alcohol in a short period, is a common cause of alcohol poisoning.

Alcohol poisoning can have severe and life-threatening consequences. It can lead to impairments in motor coordination, decision-making, impulse control, and other vital functions. As BAC levels increase, the risk of harm also increases. Even small increases in BAC can cause nausea, clouded judgment, and decreased motor coordination. Higher BAC levels can result in blackouts, loss of consciousness, and even death.

The signs and symptoms of alcohol poisoning can vary from person to person but are typically observable and obvious. These may include mental confusion, stupor, difficulty remaining conscious, slowed or irregular breathing, clammy skin or paleness, slow heart rate, loss of gag reflex, and low body temperature. It is important to recognize these signs and act quickly, as alcohol poisoning can be life-threatening.

If you suspect someone is experiencing alcohol poisoning, it is crucial to call for emergency medical help immediately. Do not wait for all the symptoms to appear or for the person to pass out. While waiting for emergency services, collect information such as the amount and type of alcohol consumed, any medications or substances taken, and any existing health conditions. Stay with the person and position them on the ground in a sitting or upright position to prevent choking and falls. Monitor their vomiting and encourage them to lean forward to prevent choking. Do not give them coffee or caffeinated drinks, as this can worsen dehydration.

Alcohol poisoning is a serious condition that requires immediate medical attention. It can lead to permanent brain damage or even death if left untreated. It is important to seek help and support for alcohol-related issues and to consume alcohol responsibly to reduce the risk of alcohol poisoning and its potentially devastating consequences.

Alcohol's impact on personal relationships

Alcohol addiction, or alcohol use disorder (AUD), is a chronic relapsing disorder characterised by an impaired ability to stop or control alcohol consumption despite adverse social, occupational, or health consequences. AUD can have a detrimental impact on personal relationships, affecting partners, children, and other family members.

One of the key ways in which AUD affects relationships is through changes in personality and behaviour. Alcohol is a psychoactive substance that can alter mood, inhibitions, and decision-making. This can lead to increased aggression, verbal or physical confrontations, and impulsive behaviour. People with AUD may become secretive and dishonest about their drinking, leading to trust issues and resentment in relationships.

AUD can also result in intimacy problems and a lack of emotional availability. It can negatively impact sex life, causing erectile dysfunction, limiting ejaculation, and causing vaginal dryness due to the dehydrating effects of alcohol. The quality of communication may also be impacted, further straining intimate relationships.

Alcohol addiction can lead to financial burdens and create tension and conflict within relationships. It can result in lost friendships, estranged marriages, and family conflict. Children of parents with AUD may experience negative consequences such as loneliness, depression, guilt, anxiety, and anger issues.

Additionally, AUD can intersect with codependency, where a partner enables the addiction, creating an unhealthy dynamic. Alcohol is also associated with domestic violence and violent crimes worldwide, further exacerbating the negative impact on personal relationships.

The impact of AUD on relationships is widespread and can affect every single relationship an individual has. It can be challenging for partners and loved ones to cope with these changes and the resulting consequences. Seeking professional help, such as rehabilitation services and behavioural health therapies, is crucial for managing AUD and its impact on personal relationships.

Frequently asked questions