Alcohol Use Disorder 101
People tend to think of alcohol in terms of beverages, namely: beer, wine, and liquor. The intoxicating ingredient in alcohol is called “ethanol.” Alcohol itself is made by fermenting different ingredients such as sugar or yeast.
Alcohol is legal to drink in the United States for those aged 21 and over. Alcoholic beverages are sold in stores and at restaurants and bars for consumption, and drinking alcohol is widely advertised to consumers.
The Effects of Alcohol
Consuming alcohol generally results in intoxication or “getting drunk.”
This may cause the following effects:
- Warm sensation in face or limbs
- General relaxation/sedation
- Slurred speech
- Lowered inhibitions
- Delayed reaction time
- Loss of balance
- Memory loss (aka “blackouts”)
There are several short-term health issues associated with drinking alcohol that would have an immediate impact on the user. These risks include:
- Alcohol poisoning (medical emergency)
- Risk-taking behaviors such as driving drunk or having unprotected sex
- Injuries and death due to drownings, falls, car accidents, etc.
Additionally, even short-term alcohol consumption when pregnant can cause issues for the developing fetus and can result in fetal alcohol syndrome.
There are many long-term risk factors of alcohol consumption that can affect the user’s physical and mental health, which include:
- Development of depression and anxiety
- High blood pressure
- Liver disease (also known as cirrhosis)
- Increased risk for heart disease, stroke, and several types of cancer
- Weakened immune system
- Digestive problems
- Developing alcohol dependence
According to the Centers for Disease Control and Prevention (CDC), moderate consumption of alcohol is considered appropriate for most adults over the age of 21. Moderate drinking is defined as one alcoholic beverage per day for women and two per day for men. The CDC recommends only moderate drinking to avoid most short- and long-term effects of alcohol use.
If you or a loved one become concerned about your drinking habits or the amount of alcohol you regularly consume, speak with your healthcare provider about solutions to help you change your habits.
Alcohol Abuse and Addiction
Understanding the signs of alcohol abuse and its consequences can help you identify whether your relationship with alcohol may indicate a drinking problem.
Abuse of alcohol is defined as consumption of alcohol beyond the recommendations for moderation. Also known as excessive drinking, alcohol abuse includes heavy drinking, binge drinking, or drinking underage.
Heavy drinking is categorized as having 15+ drinks weekly (men) or 8+ drinks weekly (women).
Binge drinking can be defined as a pattern of alcohol consumption where the drinker’s blood alcohol concentration (BAC) reaches 0.08% or greater, which is often the result of consuming 5+ drinks within a short period of time (roughly 2-4 hours).
While an estimated 25.6% of Americans abused alcohol in 2019, not everyone develops substance abuse problems due to excess drinking. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that roughly 90% of excessive drinkers do NOT develop alcohol use disorder (AUD), also known as alcoholism. However, a person’s risk of developing AUD does increase over time.
Alcohol Use Disorder
Alcohol addiction, alcohol dependence, and alcoholism are all terms used to describe the substance use problems that can arise from excessive alcohol consumption. And while these three conditions have some slight differences, the medical community now combines these alcohol problems into a singular condition called alcohol use disorder, or AUD.
According to the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), AUD will typically be clinically diagnosed when at least two of their 11 behavioral conditions are present within a 12-month period of time. To paraphrase, these conditions include:
- Excessive drinking (either in amount or over a long period)
- Inability to cut down alcohol use
- Excess time spent acquiring alcohol, drinking alcohol, or recovering from drinking
- Strong cravings
- Missed obligations (family, work, social)
- Continued drinking despite negative effects
- Losing interest in important activities due to alcohol use
- Drinking when it is physically dangerous
- Continued drinking despite physical or psychological harm from alcohol use
- Developing a tolerance to alcohol
- Alcohol withdrawal symptoms occur when alcohol use is stopped
AUD is a hereditary disorder, which means a person with a family history of alcoholism is more likely to develop AUD due to excessive drinking. AUD can also range in severity from very mild to severe.
However, like many substance use disorders, AUD is a treatable condition. Treating AUD is usually addressed with a solid support system, behavioral therapy, and additional treatment to encourage successful recovery.
An alcohol overdose happens when enough alcohol enters the bloodstream and begins to cause life-threatening health conditions. Too high of a blood alcohol content can cause critical bodily functions to stop—including breathing, temperature regulation, and heart rate. Overdosing on alcohol can cause permanent brain damage and even death.
Alcohol overdose symptoms include:
- Excess drowsiness or loss of consciousness
- Mental confusion
- Slowed or irregular breathing
- Slower heart rate
- Very low body temperature
Due to the dangers of alcohol overdose, the CDC recommends drinking only moderately—which equals roughly one beverage per day for women and two daily for men (aged 21+).
When someone develops a tolerance to alcohol, quitting alcohol use can cause various side effects and withdrawal symptoms. Depending on the severity of use (including duration and amount of alcohol consumed) withdrawal symptoms may vary in intensity.
Alcohol withdrawals can lead to seizure and death, so health professionals recommend a medical detox under professional supervision rather than quitting “cold turkey.”
Alcohol Use Statistics
More than half of Americans over 18 reported alcohol use in the last 30 days, according to a 2019 report by The Substance Abuse and Mental Health Services Administration (SAMHSA).
The 2019 National Survey on Drug Use and Health (NSDUH) indicates that nearly 86% of adults (aged 18+) reported drinking alcohol at some point.
Of those who chose to drink in 2019, roughly 25% reported binge drinking within the past 30 days, and about 6% said they engaged in heavy drinking within that same month. A reported 14.1 million adults met the diagnostic criteria for having AUD, and 414,000 adolescents (ages 12-17) had AUD in 2019.
Excessive alcohol use from 2011 to 2015 resulted in an average of 95,000 deaths per year, and more people die each year from excessive drinking than from drug overdoses.
Excessive alcohol use is the third leading cause of death in the United States, following tobacco use (first) and poor diet/inactivity (second).
Alcohol Addiction Treatment
Alcohol is a legal substance for adults 21 and over in the US, making it harder to determine whether you have a drinking problem. If any of the following are true for you, it may be time to talk to your doctor or similar healthcare provider for some support.
- Drinking without concern for the consequences
- Obsession or not being able to stop thinking about drinking
- Alcohol cravings
- Being regularly drunk or hungover
- Failed attempts to cut back on or quit drinking
Many treatment options are available for people who want to change their drinking habits, and recovery is within your reach.
Alcohol withdrawal can be dangerous without appropriate support and supervision. In moderate to severe cases of AUD, medical detox is necessary to help you safely get all alcohol out of your system. Your vitals will be monitored during this phase. You may also be given medication to assist you with avoiding drinking.
The most common medication used to treat alcohol use disorder is naltrexone. This drug reduces alcohol cravings and blocks any pleasurable effects from drinking. Disulfiram may also be prescribed, but does not have as high success rates as naltrexone.
Medical detox can occur at a residential facility or a separate treatment facility, depending on the severity of your alcohol addiction.
Alcohol Treatment Programs
Treatment programs for alcohol addiction are similar to other kinds of substance abuse treatment. There are both inpatient and outpatient programs available; the choice will likely depend on your level of substance abuse as well as your lifestyle. For instance, inpatient rehab may be ideal for someone struggling with severe AUD. In contrast, an outpatient program such as a PHP (partial-hospitalization program) may work better for an individual with work or family commitments.
In addition to receiving physical healthcare through your chosen treatment program, behavioral therapy will also play a large role in your recovery. Behavioral therapy is designed to help you maintain your sobriety and avoid relapse during your initial rehabilitation and afterward.
Recovery from alcohol abuse is a lifelong journey, and many people have celebrated continued years of success. With the right support and a commitment to your well-being, you can absolutely join them.
Post-Treatment Support Programs
After completing your initial treatment program, you will likely want to join a peer support group or recurring meetings to help you maintain your abstinence from alcohol. Programs such as Alcoholics Anonymous (AA) and SMART Recovery have regular, local meetings throughout the US to provide this kind of support. Psychiatry and other therapy can also help rebuild healthy behaviors and habits after your initial treatment phase.
Whatever option you choose, you must have some support after rehabilitation to help you maintain success.
Friends and Family Members of Alcoholics
Many resources are available to the loved ones of those who struggle with excessive drinking. The impact that AUD can have on friends and family members is significant, and while the drinker may eventually seek treatment, many times their loved ones also require healing and support.
Groups such as AlAnon are designed specifically for friends and family members of alcoholics. These support groups bring together people with similar experiences and provide a space to heal from these negative experiences.
It is important to remember that no matter what your relationship is with alcohol, recovery is possible and happens every day.