Arielle Cruz
Alcoholism, also known as alcohol addiction, alcohol misuse, or alcohol dependence, is a serious form of high-risk drinking characterized by a strong, often uncontrollable, desire to consume alcohol. It is a type of alcohol use disorder (AUD) that can lead to negative consequences in various aspects of one's life, including physical and mental health, relationships, career, parental abilities, finances, and legal status. Alcoholism is typically coupled with habitual intoxication, daily drinking, and drinking larger quantities than most. It is important to recognize the signs of alcoholism and seek help through healthcare providers, self-help groups, cognitive-behavioral therapy (CBT), and pharmacological treatments to prevent severe health complications and begin the journey to recovery.
| Characteristics | Values |
|---|---|
| Alcohol use disorder diagnosis criteria | Two of the 11 criteria over a 12-month period |
| Severity | Mild (2-3 criteria), Moderate (4-5 criteria), Severe (6+ criteria) |
| Physical symptoms | N/A |
| Behavioral symptoms | Drinking despite negative impact on work, school, or relationships; impaired control over alcohol use; giving up other activities to drink; drinking in inappropriate places or occasions |
| Treatment | Behavioral therapy, mutual-support groups, medications, detoxification, exercise, 12-step programs, therapy, inpatient medical treatment, residential rehabilitation |
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What You'll Learn
Alcohol use disorder (AUD)
The risk of developing AUD is influenced by various factors, including genetics, family history, mental health, and trauma. Genetics accounts for approximately 60% of AUD risk, with the remaining influenced by environmental factors and personal drinking patterns. Additionally, mental health conditions such as depression, post-traumatic stress disorder, and attention deficit hyperactivity disorder are associated with an increased risk of AUD. Individuals with a history of childhood trauma are also more susceptible to developing AUD.
The severity of AUD is assessed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It is classified as mild (2-3 criteria), moderate (4-5 criteria), or severe (6 or more criteria). Some behavioural signs of AUD include drinking despite negative impacts on work, school, or relationships, and giving up important activities to prioritise drinking. Physical signs may also be present, such as withdrawal symptoms when the effects of alcohol wear off.
Treatment for AUD typically involves a combination of behavioural therapies, mutual-support groups, and medications. Behavioural treatments aim to change drinking behaviour through brief interventions, reinforcement approaches, motivation-building, and coping skills training. Mutual-support groups provide peer support for reducing or stopping drinking, while medications such as naltrexone, acamprosate, and disulfiram can help individuals manage their alcohol consumption. It is important to note that individuals with severe AUD should seek medical assistance when attempting to stop drinking to avoid potentially life-threatening alcohol withdrawal symptoms.
If you or someone you know is struggling with AUD, there are resources available to help. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides information on drinking and its impacts, treatment options, and support through their Rethinking Drinking website and Alcohol Treatment Navigator. Additionally, SAMHSA offers a free and confidential National Helpline, operating 24/7, for individuals and families facing mental health and substance use disorders. These services can provide referrals to local treatment facilities, support groups, and community-based organisations.
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Physical and behavioural signs
Alcoholism, or alcohol use disorder (AUD), is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD can be mild, moderate, or severe, and is diagnosed when a person meets at least two of eleven diagnostic criteria within a 12-month period.
Physical signs:
- Developing a tolerance for alcohol, requiring more alcohol to feel the same effects.
- Experiencing alcohol withdrawal symptoms such as delirium tremens (DT) when stopping or reducing alcohol consumption. This can include serious medical issues like seizures and hallucinations that require immediate medical attention.
- Changes in physical appearance, such as bloodshot eyes, an unkempt appearance, or weight changes.
- Tremors or shaking, which can be a sign of alcohol withdrawal.
- Frequent illnesses or infections due to a weakened immune system.
Behavioural signs:
- Drinking in inappropriate places or at inappropriate times, such as in the morning or during work/school hours.
- Neglecting personal, professional, or financial obligations in favour of drinking.
- Giving up or reducing activities that were once important, interesting, or pleasurable to prioritise drinking.
- Attending events or social gatherings only if alcohol is available, or spending time primarily with others who drink.
- Continuing to drink despite negative consequences, such as relationship issues, legal troubles, or problems at work or school.
- Drinking to cope with emotions or using alcohol as a chief tool to deal with everyday life.
- Hiding alcohol or drinking in secret, or becoming upset or defensive when confronted about their drinking habits.
- Inability to control alcohol consumption, including the frequency, duration, and quantity of drinking.
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Alcohol dependence
AUD is considered a brain disorder, with lasting changes in the brain caused by alcohol misuse perpetuating the disorder and making individuals vulnerable to relapse. Certain circumstances or situations may trigger the urge to drink, and the fear of withdrawal symptoms may also contribute to alcohol dependence. Indeed, alcohol withdrawal can be life-threatening and cause serious medical issues like seizures and hallucinations, requiring immediate medical care.
AUD affects a person's physical and mental health, and treatment often includes medication and behavioural therapy. Mutual-support groups can also offer a valuable layer of support, and evidence-based treatments are available to help people with AUD achieve and maintain recovery.
To be diagnosed with AUD, a person must exhibit two of the defined criteria over a 12-month period. There are five alcoholic subtypes, with the young adult subtype making up the largest group. This group tends to consist of college-aged males who binge drink, with their drinking habits developing around the age of 19 and progressing into alcoholism by around 24.
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Treatment and recovery
Alcoholism, or alcohol addiction, is a disease that affects the brain and can range from mild to severe. Treatment and recovery from alcoholism can be challenging due to the brain changes that occur as a result of repeated, excessive alcohol use. However, with the right support and interventions, recovery is possible.
The first step towards recovery is often detoxification, or detox, which involves stopping alcohol consumption completely under medical supervision. This allows the body to adjust to the absence of alcohol and can be a crucial step in breaking the physical dependence on alcohol. It is important to have professional support during this process as withdrawal symptoms can be dangerous and medically supervised detox can help manage these symptoms.
There are two main types of evidence-based treatments for alcohol use disorder (AUD): medications and behavioural healthcare. Medications can help facilitate healthy brain changes and reduce the urge to drink. Three non-addictive medications, acamprosate, naltrexone, and disulfiram, are FDA-approved to treat AUD and can be prescribed by a primary care physician. These medications work by reducing the emotional discomfort associated with withdrawal, interfering with the pleasurable effects of alcohol, and reducing the urge to drink.
Behavioural health interventions, on the other hand, aim to normalise activity in the reward and stress circuitry of the brain and strengthen cognitive networks that help inhibit the drive to drink. Therapeutic approaches such as cognitive behavioural therapy, mindfulness, and coping skills training can be effective in altering neural circuits associated with craving and improving a person's ability to tolerate and resist urges to drink. Additionally, support groups such as Alcoholics Anonymous (AA) and SMART Recovery can provide valuable social support and help individuals adjust their thinking and attitudes towards themselves and others.
It is important to note that there is no one-size-fits-all approach to treatment and recovery. Understanding the different subtypes of alcoholics and the unique circumstances of each individual can help determine the most effective treatment plan. For example, the young adult subtype, which is the largest group and consists mostly of college-aged males, may require different interventions than older adults struggling with alcoholism.
Seeking professional help is crucial in the treatment and recovery process. Support services such as the SAMHSA National Helpline offer free and confidential referrals to treatment facilities, support groups, and community-based organisations. With the right combination of medical and behavioural interventions, social support, and self-help groups, recovery from alcoholism is achievable.
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Alcoholism subtypes
- Young Adult Alcoholic Subtype: This is the most common subtype, comprising 31.5% of alcoholics. These individuals are typically in their late teens or early 20s and have an average age of dependence of around 20-25 years old. They tend to binge drink, consuming five or more drinks on the majority of their drinking days. This group has a moderate probability of alcohol dependence in their families and lower rates of co-occurring mental health disorders.
- Functional Alcoholic Subtype: This subtype makes up 19.5% of alcoholics and consists of middle-aged individuals (around 41 years old) who started drinking later (around 18 years old) and developed dependence later (around 37 years old). They tend to have moderate rates of depression but lower rates of other co-occurring disorders. About 60% of this group is male, and they have the highest education and income levels among all subtypes.
- Intermediate Familial Subtype: This group accounts for 18.8% of alcoholics and tends to start drinking at a younger age (around 17 years old) and develop dependence earlier (around 32 years old). They have a high probability of having family members with alcoholism and are more likely to suffer from mental health disorders such as antisocial personality disorder, depression, anxiety, and bipolar disorder. This subtype has high rates of cigarette, marijuana, and cocaine addiction.
- Young Antisocial Alcoholic Subtype: This subtype typically consists of middle-aged individuals who appear to have their lives together. They may have a steady job and a stable family life, not fitting the typical stereotype of an alcoholic. They suffer from high rates of co-occurring mental health disorders and substance use, including marijuana, cigarettes, opioids, and cocaine.
- Chronic Severe Alcoholic Subtype: This is the rarest and most severe subtype, accounting for about 9% of alcoholics. They experience heavy drinking almost daily and have the highest rates of alcohol-related emergency room visits and social problems. They are typically unable to stop drinking on their own and have the highest probability of alcohol dependence in their families.
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Frequently asked questions
Alcoholism, or alcohol use disorder (AUD), is a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It is considered a brain disorder and can be mild, moderate, or severe.
Signs of alcoholism include drinking despite negative impacts on work, school, or relationships, and giving up other activities in favour of drinking. People with AUD may also develop a tolerance, requiring more alcohol to feel the same effects.
Treatment for alcoholism typically involves behavioural therapy, mutual-support groups, and/or medications. Detoxification, or detox, is also a key stage of treatment, involving stopping drinking completely under medical supervision.
