Alcoholism or Alcohol abuse is a condition wherein the individual becomes addicted to alcohol despite being aware of the negative consequences.
- Overview Of Alcoholism
- Understanding Alcoholism
- Alcoholism At A Glance
- Signs And Symptoms Of Alcoholism
- Alcohol Abuse
- Alcohol Use Disorder (AUD)
- Alcohol And Mental Health
- Causes Of Alcoholism
- Complications Associated With Alcoholism
- Diagnosis Of Alcoholism
- Tests For Screening Alcoholism
- Treatment For Alcoholism
- Recovery From Alcoholism
Overview Of Alcoholism
Alcoholism is a condition characterized by an uncontrollable urge to drink alcohol despite being negatively impacted either physically or emotionally. A person suffering from alcoholism is referred to as an “alcoholic”. Alcohol abuse is often linked to various social, economic, and health problems. However, it is not a recognized diagnosis. The individual suffering from this condition doesn’t understand when or how to stop their drinking. Hence, most of their time is spent either consuming or thinking about alcohol. This ultimately leads to significant impacts on their social and personal lives. Moderate consumption of alcohol usually doesn’t cause any psychological or physical damage. It is important to keep in mind that moderate drinking can lead to regular consumption and develop into an alcohol problem.
A study 1 as of 2019 found that almost 14.1 million American adults i.e 5.6 % of the population experienced an alcohol abuse problem. According to the World Health Organization (WHO), there are almost 3.3 million 2 deaths globally every year due to alcoholism. Alcoholism is more common among men than in women. A 2014 study pointed out that alcoholism reduces the life expectancy of a person by approximately ten years.
Alcoholism can have several physical effects such as loss of coordination, vision, balance, and speech that can be signals of acute alcohol intoxication. These effects tend to wear off in a matter of hours after a person stops drinking. Excess amounts of blood alcohol can significantly impair brain function and can eventually cause unconsciousness. One study 3 pointed out that excessive alcohol intake can damage organ systems especially the brain, heart, liver, pancreas, and immune system. Overdose of alcohol can cause alcohol poisoning which may also be fatal.
The causes of alcoholism usually depend on genetic and environmental influences. However, high stress and anxiety levels and easy accessibility may also increase the risk of developing this condition. Recovery is possible with treatment 4, medications, or rehabilitation centers. It is important to keep in mind that medical issues may occur due to withdrawal. Hence, alcohol detoxification should be carefully monitored by a professional.
Alcoholism At A Glance
- Alcoholism is an uncontrollable urge to drink alcohol despite being negatively impacted either physically or emotionally.
- Alcoholism can have several physical effects such as loss of coordination, vision, balance, and speech that can be signals of acute alcohol intoxication.
- The signs and symptoms of alcoholism depend on the degree of alcohol abuse.
- Alcohol use disorder is the inability to stop or control alcohol use and consume excessive amounts of alcohol despite adverse consequences.
- It is possible to prevent alcoholism through abstinence and self-control. However, if someone gets addicted, it is possible to recover with therapy, medications, support groups, or rehabilitation centers.
Signs And Symptoms Of Alcoholism
The signs and symptoms of alcoholism depend on the degree of alcohol abuse. Some of the signs and symptoms are mentioned below:
1. Behavioral Symptoms
The behavioral symptoms of this condition are as follows:
- Drinking in solitary
- Consuming higher quantities of alcohol to understand the effects of alcohol and developing a high tolerance
- Engaging in violent or angry behaviors when asked about their drinking habits
- Poor eating habits
- Ignoring personal hygiene
- Missing work or school due to their drinking habits
- Inability to control the alcohol intake
- Coming up with excuses to drink
- Continuing to engage in drinking despite having legal, social, or economic problems
- Ignoring important social, occupational, or recreational activities due to alcohol usage
2. Physical Symptoms
Some of the physical symptoms of alcoholism may include:
- Alcohol cravings
- Withdrawal symptoms that include shaking, nausea, and vomiting
- Having tremors the morning after drinking
- Lapses in memory after a night of drinking
- Illnesses such as alcoholic ketoacidosis, or cirrhosis of the liver
Alcohol abuse can be defined by unhealthy alcohol drinking behaviors that involve binge drinking and consuming copious amounts of alcohol that ultimately lead to alcohol dependence. This condition was categorized as a psychiatric diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV) but was later merged with alcohol dependence in DSM 5. An alcoholic drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5 ounces of 80. The Center for Disease Control and Prevention 5 (CDC) found that nearly 1.4 million people under the age of 20 took part in heavy drinking practices in 2013, consuming five drinks or more at least five times a month. Some of the signs that you are abusing alcohol are:
- Drinking 7 drinks per week for men and 3 or more drinks per occasion for women
- Being unable to stop drinking once you start
- Feeling guilty after drinking
- Drinking in the morning to recharge yourself
- Having blackouts and memory lapses
Alcohol abuse may occur due to various reasons. Some of them can include:
- Peer pressure
- A coping mechanism for anxiety, depression, loneliness or unhappiness
- A means to relax
- A family history
If you find yourself abusing alcohol, there are several ways to prevent alcohol dependence or reduce the amount of alcohol intake. They are as follows:
- Seek professional assistance for underlying mental health conditions
- Reduce your drink number to one when you are with yourself or out with friends
- Avoid people who engage in alcohol abuse
- Join a support group
Alcohol Use Disorder (AUD)
The severe form of alcoholism is known as alcohol use disorder. Alcohol use disorder is a chronic medical condition characterized by the inability to stop or control alcohol use and consume excessive amounts of alcohol despite adverse consequences. The symptoms of this condition are as follows:
- Consuming more alcohol for a longer period than intended
- Being incapable of cutting back on the alcohol consumption
- Being unable to concentrate due to excess alcohol cravings
- Consuming alcohol despite having adverse social, occupational or health consequences
- Unwilling to participate in activities they once enjoyed
- Being in dangerous or harmful situations due to drinking
- Consuming alcohol despite having mental health issues
- Having an increased tolerance level due to excessive consumption of alcohol
- Experiencing withdrawal symptoms
The number of symptoms you are experiencing determines whether you have a mild, moderate, or severe AUD.
- Mild: 2-3 symptoms
- Moderate: 4-5 symptoms
- Severe: 6 or more symptoms
The individual experiencing AUD feels like they no longer have a choice when it comes to alcohol. They are incapable of stopping despite knowing the consequences. In such severe cases, some of the treatment options include:
- Support groups
- Rehabilitation centers
Alcohol And Mental Health
A common way of celebrating an occasion or success is drinking alcohol. Alcohol gives a momentary feeling of ecstasy and relieves stress. For most people, it usually works as an escape mechanism from painful emotions. Drinking reduces the serotonin levels of the brain and may trigger negative emotional responses such as anger, aggression, anxiety, or depression. It can also have an accumulative effect if an individual consumes alcohol regularly. Instead of improving your mood, it can actually make you feel worse. Studies 6 have found that drinking alcohol to cope with problems is more likely to lead to abusive drinking than social drinking.
Alcohol can even make people behave impulsively. Due to this, people are often found to engage in actions they wouldn’t normally opt for. This can include self-harm and suicidal tendencies. A 2009 study 7 found that people with AUD are at an increased risk of committing suicide.
Causes Of Alcoholism
The exact causes of this condition are still unknown. For people who are vulnerable to getting addicted, it can happen within months. However, some of the possible causes are laid down as follows:
1. Neurological Factors
Regular consumption of alcohol can cause imbalances of gamma-aminobutyric (GABA 8 ) acid and glutamate in the brain. GABA is responsible for governing the impulses and glutamate stimulates the nervous system. The dopamine levels in the brain rise after consuming alcohol. Thus, it makes the drinking experience more delightful. Over a long duration, the chemical in the brain alters significantly. The underlying cause is the body’s incessant need to crave alcohol as a means to feel good and avoid feeling upset. A 2002 study 9 found that GABA in the ventral pallidum regulates alcohol-seeking behaviors.
2. Genetic Factors
Experts 10 believe that genetic predisposition may also play a role in developing this condition. A 1997 twin study 11 in the US and Europe suggests that approximately 45% to 65% of the liability is due to genetic factors. People having a family history of alcoholism are more likely to develop an addiction to alcohol and other substances. There have been several studies indicating the presence of genetic influences prevalent among alcoholics. A 1981 adoption study 12 reported that alcoholism in adoptees was clearly influenced by genetics from biological parents rather than adoptive parents.
3. Initiation & Experimentation
The first drinking age may also be a contributing factor towards developing alcoholism. A 2007 study 13 pointed out individuals who start drinking before the age of 15 are more likely to develop alcohol problems later in life.
4. Ease of Access to Alcohol
One of the most contributing factors to developing this disorder is the ease of access to alcohol. A 2008 study found a significant fall in alcohol-related deaths after one state raised the alcohol taxes.
Sometimes stress factors may also be linked to alcohol abuse. In case the anxiety and stress levels of the individual are high, they may consume alcohol as a coping mechanism. A 2012 study 14 showed that stress was seen to increase anxiety, and in response, alcohol was consumed to reduce anxiety
6. Peer pressure drinking
Individuals who have friends that are addicted to drinking are more likely to develop this condition. Thus it can ultimately lead to alcohol-related problems. Even though there may be a variety of influences, a 2003 study 15 reported that peer influence is one of the most powerful influences of alcoholism.
7. Low self-esteem
People with low self-esteem and with easy access to alcohol, are more likely to consume alcohol.
People with depression may also develop substance abuse or alcohol-related problems as a means of self-treatment. However, consuming excess alcohol may also increase the risk of depression, rather than reducing it. A 2017 study 16 found evidence of dependence on alcohol while suffering from depression. It was also found that adolescence heightens the risk of developing alcohol abuse and depression.
9. Media and Advertising
The media 17 often portrays drinking as a cool and fun activity. Hence, alcohol advertising and media may increase the risk of developing this condition by portraying the message that alcohol consumption or excessive drinking is an acceptable act. In a 1983 study 18 , children were shown videotaped segments of popular television shows containing drinking series. It was found that they portrayed more favorable attitudes and beliefs about drinking than children exposed to similar segments without drinking.
10. Metabolizing Alcohol
The low-level response to alcohol is an endophenotype that is associated with heavier drinking and alcohol issues. A 2009 study 19 found that some people who take a longer time to metabolize alcohol to experience the effects can have an increased risk of developing health conditions associated with alcohol.
11. Mental Disorders
Mental disorders may also be a contributing factor for developing this condition. People with mental health conditions often use alcohol as an escape agent to numb their painful emotions. A 2016 study 20 suggests that individuals with mental health conditions such as depression or anxiety are more likely to use alcohol as a form of treatment.
Complications Associated With Alcoholism
Excess alcohol consumption can cause several complications. They include:
- Feeling fatigued almost all the time
- Short term memory loss
- Eye muscles get weaker
- Irreversible liver damage such as cirrhosis and hepatitis
- Gastrointestinal complications or pancreatic damage due to the inability to digest food, absorb certain vitamins, and produce hormones
- Hypertension and high blood pressure
- Heart problems such as cardiomyopathy, heart failure, and stroke
- Increased risk of type 2 diabetes
- Disruptive menstruation
- Erectile Dysfunction
- Fetal alcohol syndrome that increases the risk of birth defects
- Thinning bones leading to an increased risk of fractures
- Nervous system issues such as dementia, confused or disordered thinking
- Several types of cancer in the mouth, esophagus, liver, colon, rectum, breast, prostate, and pharynx.
- Accidental injuries from falls, or road traffic accidents
- Domestic or child abuse
- Issues at employment or educational institution
- Increased suicidal tendencies and rates
- Mental illnesses
- Having legal consequences
Diagnosis Of Alcoholism
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has laid out the diagnostic criteria for Alcoholism. The criteria include having a consistent pattern of alcohol consumption that can lead to a considerable amount of distress or impairment. The diagnostic criteria suggests that at least three of the following criteria must be present during the past 12 months:
- Developing a high amount of tolerance wherein the individual consumes a large quantity of alcohol to feel intoxicated
- Experiencing withdrawal symptoms such as tremors, insomnia, nausea, or anxiety. Thus drinking more to avoid such symptoms.
- Drinking for a long duration than they intended
- Persistent desire to cut back on alcohol consumption
- Spending a lot of time obtaining, using, or recovering from alcohol consumption.
- Withdrawal from recreational, social, or occupational activities that they previously engaged in
- Engaging in alcoholic behaviors despite being aware of the negative consequences either physically or physiologically.
The doctor can ask several questions related to family history and current behaviors in order to make a diagnosis.
Tests For Screening Alcoholism
The doctor may also run tests to rule out any underlying medical issues related to alcohol abuse such as digestive problems, or heart diseases. It is important to mention all the symptoms to the doctor to ensure a correct diagnosis. Blood tests may be conducted to check the alcohol level in the blood. In case the red blood cells have increased in size, it can be an indication of long-term alcohol abuse. The doctor may also ask the patient to take a screening questionnaire to reach an accurate diagnosis. Most people often deny their alcohol habits which may pose a problem for diagnosis.
Treatment For Alcoholism
The primary step towards recovery from alcoholism is acknowledging the problem. It is important to seek professional help to ensure recovery. Some of the treatment methods that are adopted are as follows:
Seeking professional assistance can also help to ease the symptoms of the condition. Cognitive behavioral therapy helps to identify the negative thoughts and patterns that govern alcohol-dependent behavior. Once identified, these are then replaced with positive thoughts to attain the desired outcome. The doctor also helps to develop coping mechanisms to deal with the incessant need to drink. A scientific report 21suggested that cognitive behavioral therapy was found to be more effective in treating patients with alcoholism than any other form of therapy since its primary focus is on the individual’s ability to cope in everyday life.
Sometimes there may be underlying mental health conditions associated with alcoholism that may require medical attention. These can include depression, anxiety, stress, or hypertension. People often resort to alcohol as a means to cope with these underlying mental health conditions. Hence it is essential to address the underlying conditions to ensure a full recovery.
2. Rehabilitation Centers
There are several programs that offer therapy in a residential institute. Therapy sessions that occur in these centers can include individual therapy, group therapy, support groups, family therapy, activity therapy, and various coping mechanisms for treating alcoholism. When a person has a drug or alcohol addiction they are sent to rehabilitation centers to recover and heal in an alcohol or drug-free environment. The goal is to remove the temptation and keep an eye on the patient. Rehabilitation centers provide dorm accommodations and are designed to make them feel safe and comfortable. This helps the patient to learn healthy coping skills in a contained environment.
The doctor may prescribe certain medications that can help the individual deal with their addiction. For instance, Antabuse (disulfiram) 22 can cause an extreme reaction when someone drinks that include nausea, flushing, vomiting, and headaches. It acts as a deterrent for people with alcoholism. After ethyl alcohol is absorbed by the body, it becomes converted to acetaldehyde, which is oxidized in the liver by the mitochondrial enzyme aldehyde dehydrogenase (ALDH). Disulfiram produces an irreversible inhibition of ALDH activity. However, it doesn’t treat the compulsion towards alcohol consumption. Naltrexone 23 (ReVia) can help to reduce the urgency to drink. The clinical efficacy of this medication can be found due to its interactions between dopamine and the endogenous opioid neuropeptide systems. Acamprosate 24 (Campral) is a widely used abstinence-promoting drug used for people with this disorder.
Some medications such as delirium tremens or DTs can help treat withdrawal symptoms experienced when avoiding alcohol. Treatment usually lasts between 4 to 7 days. One of the most popular detoxification medications that are usually prescribed is Chlordiazepoxide.
4. Self-help Methods
It is possible to recover from alcoholism with self-determination. Alcoholism may be managed with abstinence without seeking professional help if the symptoms are not too severe. There are several resources published online such as self-help books or articles, which may help to develop healthy habits and learn self-control. Such methods can be adopted as an effective measure to avoid alcohol. Some of the self-help methods that you can adopt are:
- Socialize with people
- Engage in regular physical activity
- Follow a regular sleep schedule
- Prioritize important activities and commitments
- Spend time with your pet
- Avoid triggers
Recovery From Alcoholism
It is possible to prevent alcoholism through abstinence and self-control. However, in case the individual gets addicted it is possible to recover from this condition with therapy, medications, support groups, or rehabilitation centers. Alcoholics Anonymous (AA) is a well renowned international fellowship for men and women designed to help alcoholics. This support group welcomes anyone who wants to quit drinking. Access to support groups like such can go a long way to avoid alcohol and lead a healthy life.References:
- Alcohol facts and statistics. (2020). National Institute on Alcohol Abuse and Alcoholism (NIAAA). https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
- Alcohol. (2018). WHO | World Health Organization. https://www.who.int/en/news-room/fact-sheets/detail/alcohol
- Alcohol’s effects on the body. (2020). National Institute on Alcohol Abuse and Alcoholism (NIAAA). https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body
- Mckay, J. R., & Sturmhofel, S. H. (2011). Treating alcoholism as a chronic disease: Approaches to long-term continuing care. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625994/
- Binge drinking. (2020). Centers for Disease Control and Prevention. https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm
- Cooper ML, Russell M, George WH. Coping, expectancies, and alcohol abuse: a test of social learning formulations. J Abnorm Psychol. 1988 May;97(2):218-30. doi: 10.1037//0021-843x.97.2.218. PMID: 3385075.
- Flensborg-Madsen T, Knop J, Mortensen EL, Becker U, Sher L, Grønbaek M. Alcohol use disorders increase the risk of completed suicide–irrespective of other psychiatric disorders. A longitudinal cohort study. Psychiatry Res. 2009 May 15;167(1-2):123-30. doi: 10.1016/j.psychres.2008.01.008. Epub 2009 Apr 9. PMID: 19359047.
- Hyytiä P, Koob GF. GABAA receptor antagonism in the extended amygdala decreases ethanol self-administration in rats. Eur J Pharmacol. 1995 Sep 5;283(1-3):151-9. doi: 10.1016/0014-2999(95)00314-b. PMID: 7498304.
- Harvey SC, Foster KL, McKay PF, Carroll MR, Seyoum R, Woods JE 2nd, Grey C, Jones CM, McCane S, Cummings R, Mason D, Ma C, Cook JM, June HL. The GABA(A) receptor alpha1 subtype in the ventral pallidum regulates alcohol-seeking behaviors. J Neurosci. 2002 May 1;22(9):3765-75. doi: 10.1523/JNEUROSCI.22-09-03765.2002. PMID: 11978852; PMCID: PMC6758355.
- Edenberg, H. J., & Foroud, T. (2013). Genetics and alcoholism. Nature reviews. Gastroenterology & hepatology, 10(8), 487–494. https://doi.org/10.1038/nrgastro.2013.86
- Heath AC, Bucholz KK, Madden PA, Dinwiddie SH, Slutske WS, Bierut LJ, Statham DJ, Dunne MP, Whitfield JB, Martin NG. Genetic and environmental contributions to alcohol dependence risk in a national twin sample: consistency of findings in women and men. Psychol Med. 1997 Nov;27(6):1381-96. doi: 10.1017/s0033291797005643. PMID: 9403910.
- Bohman M, Sigvardsson S, Cloninger CR. Maternal inheritance of alcohol abuse. Cross-fostering analysis of adopted women. Arch Gen Psychiatry. 1981 Sep;38(9):965-9. doi: 10.1001/archpsyc.1981.01780340017001. PMID: 7283667.
- Dawson DA, Grant BF, Li TK. Impact of age at first drink on stress-reactive drinking. Alcohol Clin Exp Res. 2007 Jan;31(1):69-77. doi: 10.1111/j.1530-0277.2006.00265.x. PMID: 17207104.
- Anthenelli, R., & Grandison, L. (2012). Effects of stress on alcohol consumption. Alcohol research : current reviews, 34(4), 381–382.
- Reifman A, Watson WK. Binge drinking during the first semester of college: continuation and desistance from high school patterns. J Am Coll Health. 2003 Sep-Oct;52(2):73-81. doi: 10.1080/07448480309595727. PMID: 14765761.
- Danzo, S., Connell, A. M., & Stormshak, E. A. (2017). Associations between alcohol-use and depression symptoms in adolescence: Examining gender differences and pathways over time. Journal of adolescence, 56, 64–74. https://doi.org/10.1016/j.adolescence.2017.01.007
- National Research Council (US) and Institute of Medicine (US) Committee on Developing a Strategy to Reduce and Prevent Underage Drinking; Bonnie RJ, O’Connell ME, editors. Reducing Underage Drinking: A Collective Responsibility. Washington (DC): National Academies Press (US); 2004. 11, Alcohol in the Media: Drinking Portrayals, Alcohol Advertising, and Alcohol Consumption Among Youth. Available from: https://www.ncbi.nlm.nih.gov/books/NBK37586/
- Rychtarik RG, Fairbank JA, Allen CM, Foy DW, Drabman RS. Alcohol use in television programming: effects on children’s behavior. Addict Behav. 1983;8(1):19-22. doi: 10.1016/0306-4603(83)90050-3. PMID: 6880922.
- Schuckit, M. A., Smith, T. L., Danko, G. P., Trim, R., Bucholz, K. K., Edenberg, H. J., Hesselbrock, V., Kramer, J. J., & Dick, D. M. (2009). An evaluation of the full level of response to alcohol model of heavy drinking and problems in COGA offspring. Journal of studies on alcohol and drugs, 70(3), 436–445. https://doi.org/10.15288/jsad.2009.70.436
- Brooks Holliday S, Pedersen ER, Leventhal AM. Depression, posttraumatic stress, and alcohol misuse in young adult veterans: The transdiagnostic role of distress tolerance. Drug Alcohol Depend. 2016 Apr 1;161:348-55. doi: 10.1016/j.drugalcdep.2016.02.030. Epub 2016 Feb 27. PMID: 26948757; PMCID: PMC4792662.
- HIDES, L., SAMET, S., & LUBMAN, D. I. (2010). Cognitive behaviour therapy (CBT) for the treatment of co-occurring depression and substance use: Current evidence and directions for future research. Drug and Alcohol Review, 29(5), 508-517. https://doi.org/10.1111/j.1465-3362.2010.00207.x
- Johansson B. A review of the pharmacokinetics and pharmacodynamics of disulfiram and its metabolites. Acta Psychiatr Scand Suppl. 1992;369:15-26. doi: 10.1111/j.1600-0447.1992.tb03310.x. PMID: 1471547.
- Clapp P, Bhave SV, Hoffman PL. How adaptation of the brain to alcohol leads to dependence: a pharmacological perspective. Alcohol Res Health. 2008;31(4):310-39. PMID: 20729980; PMCID: PMC2923844.
- De Witte P, Littleton J, Parot P, Koob G. Neuroprotective and abstinence-promoting effects of acamprosate: elucidating the mechanism of action. CNS Drugs. 2005;19(6):517-37. doi: 10.2165/00023210-200519060-00004. PMID: 15963001.