Noah Vinter
Alcoholism, clinically referred to as Alcohol Use Disorder (AUD), is a complex condition that encompasses a range of adverse social, occupational, and health consequences. It is characterised by an impaired ability to control alcohol consumption, despite the negative impact on one's life. The topic of alcoholism is multifaceted and encompasses various aspects, including the physiological, psychological, and social effects of alcohol misuse. It is important to understand the misconceptions and facts about alcoholism to foster effective prevention, treatment, and support for those affected by this disorder.
| Characteristics | Values |
|---|---|
| Definition | Alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. |
| Synonyms | Alcohol abuse, alcohol dependence, alcohol addiction, alcoholism |
| Cause | Multiple factors, including self-medication for conditions like anxiety |
| Risk factors | Amount, frequency, and speed of alcohol consumption; temperament; genetics; high levels of impulsivity/sensation-seeking/disinhibition |
| Treatment | Behavioral therapies, mutual-support groups, medications, detoxification, supportive therapy, self-help groups, coping mechanisms |
| Prevention | Evidence-based educational campaigns, guidelines for parents, addressing underlying stressors |
| Withdrawal symptoms | Delirium tremens, seizures, anxiety, depression, fatigue, sleep disturbance |
| Relapse | Common; influenced by neuroadaptations that occur during periods of abstinence followed by re-exposure to alcohol |
| Cancer risk | Alcohol consumption caused about 5% of cancer cases and 4% of cancer deaths in the US in 2019; increased risk for oral cavity, pharynx, larynx, esophagus, and liver cancers |
| DUI | A person can be charged with DUI if their blood alcohol concentration is above 0.08%, or if their driving ability is deemed impaired by the arresting officer |
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What You'll Learn
Alcohol withdrawal symptoms can be life-threatening
The central nervous system adjusts to the presence of alcohol over time. The body works hard to keep the brain in a more awake state, and the nerves communicating with one another. When alcohol levels suddenly drop, the brain remains in this overactive state. This can result in a range of serious symptoms, including delirium tremens (DTs), which can be fatal.
Mild symptoms often start six to twelve hours after the last drink, with symptoms worsening between 24 and 72 hours after stopping drinking. However, some symptoms may persist for weeks or even months. The severity of the withdrawal symptoms depends on the amount and frequency of alcohol consumption.
Moderate alcohol withdrawal is typically treated with benzodiazepines or barbiturates to reduce the risk of seizures and delirium tremens. For severe and complicated alcohol withdrawal, hospitalisation may be required, sometimes in the intensive care unit (ICU). Treatment may include IV fluids for dehydration, anti-nausea medications, and beta-blockers or clonidine for high blood pressure and a fast heart rate.
It is important to seek medical advice before attempting to stop drinking, as alcohol withdrawal can be life-threatening. Doctors can prescribe medications to address these symptoms and make the process safer and less distressing.
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Alcohol use disorder (AUD) is a medical condition
The risk of developing AUD depends on how much, how often, and how quickly one consumes alcohol. Binge drinking is a type of alcohol misuse that increases the risk of AUD. For men, binge drinking means consuming 5 or more drinks within a few hours, and for women, it is after 4 or more drinks within a few hours. This results in a blood alcohol concentration (BAC) level of 0.08% or more, which is above the legal limit for driving in many places. It is important to note that not everyone who binge drinks has AUD, but they are at a higher risk of developing the disorder.
AUD can cause lasting changes in the brain, making individuals vulnerable to relapse. Genetics and family history also play a significant role in the development of AUD, with hereditability accounting for approximately 60%. Mental health conditions, such as depression, post-traumatic stress disorder, and attention deficit hyperactivity disorder, are associated with an increased risk of AUD. Additionally, people with a history of childhood trauma are also more vulnerable to developing the disorder.
Withdrawal from alcohol can be life-threatening and should be carefully managed. Doctors can prescribe medications to address withdrawal symptoms, such as benzodiazepines, which help reduce anxiety, restlessness, insomnia, and seizures. Behavioural therapies and mutual-support groups are also effective in helping individuals with AUD achieve and maintain recovery.
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Alcohol is a carcinogen
Alcohol is a Group 1 carcinogen, a classification given by the International Agency for Research on Cancer (IARC) in 1987. This classification is due to the sufficient evidence that alcohol causes cancers of the oral cavity, pharynx, larynx, oesophagus, and liver. Alcohol is converted into a toxic chemical called acetaldehyde in the body, which can cause cancer by damaging DNA and stopping cells from repairing the damage. This toxic chemical is produced mainly in the liver through the activity of the enzyme alcohol dehydrogenase (ADH).
Acetaldehyde production also occurs in the oral cavity and may be influenced by factors such as the oral microbiome. Certain individuals of East Asian descent have a "superactive" form of ADH that increases the conversion of alcohol to toxic acetaldehyde. This form of ADH is also associated with a higher risk of pancreatic cancer. Another enzyme, aldehyde dehydrogenase 2 (ALDH2), metabolizes acetaldehyde into non-toxic substances. However, some people, particularly those of East Asian descent, have a form of this enzyme that causes acetaldehyde to build up when they consume alcohol.
Alcohol consumption increases the risk of at least seven types of cancer, including bowel and breast cancer. It is one of the most preventable causes of cancer after smoking. The risk of developing alcohol-related cancer is directly proportional to the amount of alcohol consumed. Even light drinkers have an increased risk of certain cancers, such as breast cancer. Women who have just one drink per day have a higher risk of breast cancer than those who consume less than one drink per week. This risk is further elevated in heavy drinkers and binge drinkers.
In addition to increasing the risk of breast cancer through elevated estrogen levels, alcohol consumption can also make it easier for harmful chemicals in tobacco smoke to enter the cells lining the mouth and throat, increasing the risk of mouth and throat cancer. Young women who drink alcohol during their teens and early twenties are more likely to develop breast cancer than those who abstain during this period. Similarly, young men and women who drink alcohol throughout their lifetime have an increased risk of mouth, throat, and colorectal cancer.
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Alcohol detoxification
Medications are often provided to help reduce a patient's withdrawal symptoms. Benzodiazepines (e.g. diazepam and chlorazepoxide) are the most commonly used drugs for this purpose and are well-established in their efficacy. They not only reduce alcohol withdrawal symptoms but also prevent alcohol withdrawal seizures, which occur in an estimated 1 to 4% of withdrawal patients. Anticonvulsant medications are also necessary for patients with a history of seizures unrelated to alcohol withdrawal.
Additional components of alcohol detoxification may include education and counselling to help the patient prepare for long-term treatment, attendance at Alcoholics Anonymous meetings, recreational and social activities, and medical or surgical consultations.
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Alcoholism treatment
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 is considered a brain disorder that can cause lasting changes in the brain, making individuals vulnerable to relapse. However, AUD is not a choice or character flaw, and change is possible through treatment.
Treatment Options for Alcoholism
There are various treatment options available for alcoholism, and understanding the different options can be an important first step. Seeking professional help early can prevent a return to drinking. Here are some treatment options:
- Behavioural Therapies: These therapies help individuals develop skills to avoid and overcome triggers such as stress that might lead to drinking. Counselling is a form of behavioural treatment led by healthcare providers, which has been shown to be beneficial.
- Mutual-Support Groups: Alcoholics Anonymous (AA) and other 12-step programs provide peer support for people quitting or cutting back on their drinking. These free and flexible assistance programs can help promote recovery by offering an added layer of support to professional treatment.
- Medications: Doctors can prescribe medications to address alcohol withdrawal symptoms and make the process safer. Three medications are currently approved in the United States to help reduce drinking and prevent relapse. Benzodiazepines are commonly used to reduce anxiety, restlessness, insomnia, tremors, and withdrawal seizures associated with alcohol withdrawal. However, they should be carefully administered due to their potential for abuse and side effects.
Finding Treatment
If you or someone you know is struggling with alcoholism, there are resources available to help. The NIAAA Alcohol Treatment Navigator® is an online tool that helps individuals find qualified treatment providers near them. SAMHSA also offers a free, confidential National Helpline (1-800-662-HELP (4357)) that provides 24/7 treatment referral and information services for individuals and families facing substance use disorders. This service can refer you to local treatment facilities, support groups, and community-based organisations.
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Frequently asked questions
Yes, alcoholism is a recognised medical condition, often referred to as Alcohol Use Disorder (AUD). It is characterised by an impaired ability to stop or control alcohol use despite adverse consequences.
Alcohol withdrawal can be life-threatening and symptoms include delirium tremens, seizures, anxiety, depression, fatigue and sleep disturbances. Doctors can prescribe medications to address these symptoms.
Prenatal alcohol exposure is toxic to the developing foetus and can cause intellectual disabilities and decreased birth weight. It is also associated with an increased risk of spontaneous abortions.
Alcoholism can lead to harmful physical, mental, emotional and social consequences. It is also associated with an increased risk of cancer, particularly of the oral cavity, pharynx, larynx, oesophagus and liver.
While some people with Alcohol Use Disorder are able to return to moderate drinking, most are unable to limit their intake in this way. Treatments for alcoholism typically focus on discontinuing alcohol intake, followed by life training and social support to prevent relapse.
