Alcohol Abuse & Addiction
Alcohol consumption has a long tradition in the U.S. with alcohol being consumed on numerous social occasions, business transactions, and personal activities. As alcoholic beverages are marketed aggressively in many different forms and are legal for individuals over the age of 21, the use and availability of alcohol remain quite extensive despite numerous dangers associated with its use and abuse.
The term alcohol use disorder(AUD), as coined by the American Psychiatric Association (APA), is used to describe the entire spectrum of alcohol abuse.1 An individual with an alcohol use disorder is experiencing problems associated with their use of alcohol which can range from mild issues (previously referred to as alcohol abuse) to significant problems with alcohol addiction (often referred to as alcoholism or alcohol dependence).
Only a trained mental health clinician can formally diagnose an SUD, and only such a clinician is able to reliably ascertain the potential seriousness of one’s issues regarding their use of alcohol. In many cases, people suffering from AUD need professional help, i.e. alcohol treatment programs that can help them overcome addiction.
The Statistics of Alcohol Use and Abuse in the U.S.
Alcohol use and AUD are relatively common in the U.S. The National Survey on Drug Use and Health conducted by Substance Abuse and Mental Health Service Administration (SAMHSA) established the following:2
- Well over 85% of individuals over the age of 18 report using alcohol at least once in their lifetime. In 2017, 140.6 million individuals aged 12 or older admitted to using alcohol within the month prior to the survey.
- Approximately 66.6 million individuals reported engaging in binge drinking (five or more alcoholic drinks on a single occasion for men and four or more for women) within the past month, whereas 16.7 million reported being heavy alcohol users (binge drinking five or more times within a period of a month).
- Approximately 14.5 million individuals qualify for a diagnosis of AUD, according to SAMHSA’s diagnostic criteria.
- Adolescents are not immune to alcohol abuse issues either. In 2017, approximately 2.5 million people aged 12 to 17 admitted to drinking in the prior month, about 1.3 million admitted to binge drinking, approximately 174,000 adolescents admitted to heavy alcohol use, and about 434,000 met the criteria for AUD.
According to the official data published by the Centers of DIsease Control and Prevention, around 95,000 people in the U.S. die every year as a result of alcohol abuse.3 Therefore, it is essential that individuals learn more about alcohol abuse treatment and seek professional help for themselves or their loved ones.
What is Alcohol?
Alcohol is a psychoactive drug that is present in many drinks, including beer, wine, and liquor. It is also known as ethanol or ethyl alcohol. When consumed, alcohol produces a number of effects on the body, including relaxation, slurred speech, and impaired coordination. Alcohol is a central nervous system depressant, meaning that it slows down the activity of the brain and nervous system.24
Heavy drinking can lead to many health issues, including liver disease, heart disease, and cancer. It can also cause mental health problems, such as depression and anxiety. Alcoholism is a major problem in many countries, including the US, and is one of the leading causes of death worldwide.21
What is Alcohol Abuse?
Alcohol abuse is a serious problem that can lead to a wide range of negative consequences. It can cause problems with family and friends, at work or school, and in other areas of an individual’s life. Alcohol use disorder can also lead to physical and mental health problems. There is no single cause of alcohol addiction. Instead, it is the result of a combination of factors. These can include genes, family history, peer pressure, and personal problems.21
There are many factors that can influence someone’s risk of developing alcohol abuse or dependence. Some of these include:21
- Family history: If you have a blood relative who has struggled with alcohol abuse, you’re more likely to as well. This may be due to genetics or simply because of learning behaviors from observing relatives.
- Mental health disorders: People with certain mental health conditions are more prone to abusing alcohol as a way to self-medicate. Examples of mental health disorders that may increase the risk for alcohol abuse include depression, anxiety, and post-traumatic stress disorder (PTSD).
- Peer pressure: Teens and young adults are especially susceptible to peer pressure when it comes to alcohol. The peer pressure to drink can be especially strong if all of your friends are doing it and you feel like you’re missing out.
- Stress: Stressful life events, such as the loss of a loved one, divorce, or job loss, can trigger a need to self-medicate with alcohol.
- Easy access: If alcohol is easily accessible — for example, if you keep a stash at home or your parents frequently drink — you’re more likely to abuse it.
- Binge drinking in the past: People who have engaged in binge drinking (drinking heavily over a short period of time) are more likely to continue doing so and develop an alcohol addiction.
What Are the Signs and Symptoms of Alcohol Addiction?
There are several behavioral and physical indicators that may suggest someone has developed alcohol abuse problems. Most of these issues relate to an individual’s inability to stop drinking or moderate their alcohol consumption, as well as the negative consequences that happen once the person sobers up.21
The symptoms of alcohol abuse can vary depending on the person. But there are some common signs, such as:21
- Drinking more than you intended to or for longer than you planned
- Inability to control your alcohol consumption
- Repeatedly getting into situations while drinking that put you in danger, such as driving drunk or having unprotected sex
- Facing legal problems because of your drinking, such as being arrested for DUI
- Having relationship problems because of your drinking
- Missing work or school because of hangovers
- Drinking even though you know it’s causing physical or mental health problems
- Experiencing symptoms of withdrawal when not drinking
How Does Alcohol Addiction Affect the Body?
The human body is designed to process and eliminate alcohol relatively quickly. However, when a person consumes alcohol at a rate faster than the body can eliminate it, this can lead to a build-up of toxins in the system. Over time, this can have serious consequences on a person’s health, including damage to the liver, pancreas, and brain. Additionally, chronic alcohol intoxication can increase a person’s risk of developing cancer.24
In the short-term, alcohol addiction can cause a number of problems, including:25
- Slurred speech
- Impaired coordination
- Slow reaction time
- Difficulty thinking clearly
- Memory problems
Long-term alcohol abuse can lead to even more serious health problems, including:25
- Liver disease
- High blood pressure
- Heart disease
- Cancer of the mouth, throat, esophagus, liver, or breast
Depending on your gender, weight, and age, the effects of drinking alcohol can vary from person to person. Generally, those who drink more frequently or in larger quantities will be affected more by it. However, people can also react to alcohol differently based on their individual biological traits.24,25
Risk Factors for Developing AUD
Alcohol use disorder is a medical condition that describes someone who excessively uses alcohol. This can include heavy drinking, binging, or addiction. People with AUD often have difficulty controlling their intake and may continue to drink alcohol even when it causes serious problems in their professional and personal lives.21
AUD refers to a problematic drinking pattern resulting in negative consequences that can lead to health, relationship, and financial problems. There are several stages of alcohol abuse, which include mild, moderate, and severe. Alcohol dependence is the most severe stage and is defined by the presence of withdrawal symptoms when alcohol is not consumed.21
In 2020, around 28 million people in the United States aged 12 or older were diagnosed with AUD.2,3 Alcoholism is a progressive disease, which means that it typically gets worse over time. If left untreated, it can lead to serious health complications, including liver disease, cancer, and heart problems. Luckily, there are many different types of alcohol addiction treatment programs available that can be effective for people suffering from alcohol abuse.21
The path that individuals transverse from social alcohol use to the development of AUD is not uniform. Typically, individuals begin drinking alcohol socially and may increase their use in order to deal with stress, socialize, or even resort to alcohol as a substitution for companionship. Some may even drink alcoholic energy drinks for a caffeine boost. Since repeated use of alcohol is reinforcing for some individuals, a significant number of people may be at risk of developing alcohol use disorders.
APA and the National Institute on Drug Abuse (NIDA) have listed the risk factors that can increase the potential that an individual will develop an AUD. Although the presence of any of these risk factors does not guarantee that an individual will develop any specific condition, some risk factors are associated with a more salient probability of developing a specific type of disorder. Having more than one of the following risk factors can substantially increase the risk of developing a specific disorder:6
- Having a family history of alcohol abuse or some other substance abuse issue. Having a first-degree relative with an SUD history substantially increases the risk that one will develop an SUD. Having any family member with an SUD also increases this risk as this is associated with learning these types of behaviors. It is also well accepted that there are genetic factors that significantly increase the risk for developing any form of substance abuse issue, but specific genetic factors that could aid in the diagnosis of an SUD have not been identified.
- Gender. Males are at greater risk to develop alcohol abuse issues than females, although the gap between the prevalence of AUDs in males and females has narrowed in recent years.
- Having a co-occurring mental health issue. The co-occurrence of SUDs and other psychological disorders (e.g., depression, personality disorders, trauma- or stressor-related disorders, anxiety disorder, etc.) is so prevalent that when individuals are assessed for a substance abuse issue, they should automatically also be assessed for the presence of any other formal psychiatric diagnosis.
While the exact reason for this relationship has not been determined, it is most often believed that the biological and environmental factors that make a person susceptible to any type of mental health disorder also result in being more susceptible to developing a substance abuse issue.
- Peer influence. Individuals with friends who drink heavily are more likely to drink heavily themselves, which increases the risk for the development of AUD. This risk factor is influential over all ages, but particularly salient in younger individuals.
- Lack of perceived social support. People who do not believe they have strong family ties or productive peer relations often become isolated, which makes them more vulnerable to the development of SUDs.
- Experiencing stress or trauma. Individuals who perceive they are under extreme stress or have experienced traumatic events are more vulnerable to the development of SUDs. While this risk factor is salient across all age groups, it is particularly influential in younger individuals and children.
- Other personal variables. There are numerous personal factors that can increase the risk that an individual might develop issues with alcohol abuse. These can include having a history of delinquent behavior, beginning to use alcohol at an early age, having a natural higher tolerance to the effects of alcohol, living in areas where there are high rates of drug abuse or high rates of crime, etc.
Negative Consequences of AUD
The negative effects of chronic alcohol abuse have been well documented in literature. These include:7
- Significant and often irreparable damage to professional and/or personal relationships.
- Significant losses of productivity or failure to meet goals.
- Increased financial burdens to the individual, the individual’s family, and society as a result of lost productivity and increased need for medical and psychological services.
- Increased risk of having accidents, while driving under the influence of alcohol, for example, that can lead to serious and even permanent physical injuries.
- Increased risk of developing serious diseases or disorders of numerous organ systems that can include increased risk of cardiovascular disease, cancer, fetal alcohol syndrome in the children of pregnant mothers suffering from AUD, liver damage, etc.
- Increased potential to be a victim of crime, to be a perpetrator of the crime, or to engage in acts of self-harm.
- Increased potential to develop serious neurological issues, such as dementia.
- Increased potential to develop other mental health disorders, including depression, anxiety disorders, trauma- and stressor-related disorders, bipolar disorder, etc.
- The development of physical dependence on alcohol.
Considering both short-term and long-term consequences of alcohol use disorder, individuals who are struggling with alcohol abuse should consider undergoing alcohol rehab at a dedicated treatment facility.
Chronic use of alcohol is associated with the development of physical alcohol dependence. Physical dependence is characterized by the syndromes of tolerance and withdrawal. As individuals continue to drink alcohol on a regular basis, they will often find that they need to drink more alcohol to achieve the effects that they once achieved with lower amounts (tolerance).8
After the development of tolerance, some individuals will begin to experience negative effects that can consist of physical and psychological/emotional issues once they have not consumed alcohol. This is the beginning of the withdrawal syndrome.9 When an individual expresses both tolerance and withdrawal symptoms, they have developed physical dependence on alcohol.8
Research suggests that the actual withdrawal syndrome an individual experiences is dependent on numerous factors, including:9
- Individual’s genetic makeup.
- The amount of alcohol typically consumed.
- Metabolic differences in individuals.
- Using alcohol in conjunction with other drugs.
Symptoms of Alcohol Withdrawal
- A minor alcohol withdrawal syndrome occurs when individuals experience discomfort and stress but do not experience potentially severe consequences. This syndrome is far more common than the more severe presentation.
- A severe alcohol withdrawal syndrome is associated with a far more chronic and severe level of an alcohol use disorder. This syndrome has potentially serious complications associated with it.
Minor Alcohol Withdrawal Syndrome
The symptoms of the minor withdrawal alcohol syndrome are typically the following:11
- Symptoms begin appearing within roughly six hours after the person has stopped using alcohol.
- The withdrawal syndrome will typically last 24–72 hours, with most individuals experiencing withdrawal symptoms for 24–48 hours.
- Withdrawal symptoms mostly peak 12–24 hours after discontinuation of alcohol.
- Major symptoms associated with minor alcohol withdrawal include: nausea, stomach cramps, vomiting, sweating, increased heart rate, loss of appetite, shakiness, mild tremors, sleep difficulties, headache, dehydration, anxiety, and mild depression.
Most individuals who experience withdrawal at this level are moderate users of alcohol and may or may not need to seek alcohol rehab treatment.
Severe Alcohol Withdrawal Syndrome
For some individuals who have chronic and more severe alcohol abuse histories, withdrawal symptoms will be as follows:11
- Though symptoms may appear only a few hours after discontinuation of alcohol, it may take up to 48 hours for them to appear for some people. Some individuals may experience withdrawal symptoms while they are still intoxicated as they have extremely high tolerance and normally have high levels of alcohol in their blood. When the individual’s blood alcohol level begins to fall, the withdrawal syndrome is elicited.
- Withdrawal symptoms can last for a week or longer.
- Individuals with severe alcohol withdrawal are at a risk of experiencing seizures. Seizures can develop rapidly after discontinuation (within six hours), and the potential to develop seizures typically peaks within 12–18 hours after the individual has discontinued alcohol use. Nonetheless, individuals with severe AUD may be at risk to develop seizures for several days or weeks following discontinuation. Seizures occurring as a result of alcohol withdrawal can be potentially fatal, and individuals who experience them require medical alcohol treatment immediately.
- Some individuals may develop hallucinations (most often, visual hallucinations or auditory hallucinations) within 18 hours after discontinuation. Hallucinations may continue to occur for a week or more.
- Individuals may have severe issues with depression, hopelessness, and anxiety, and may be at risk of self-harm.
- There is a risk to develop delirium tremens (DTs). This occurs when there is a sudden drop in an individual’s blood alcohol level. The syndrome consists of severe disorientation, confusion, psychosis (hallucinations, delusions, and a loss of reality), potential seizures, and other typical alcohol withdrawal symptoms, such as chills, sweating, nausea, vomiting, etc.
Individuals with severe alcohol use disorders are at risk of DTs within 48–72 hours after discontinuation. The risk may last for days or even weeks, depending on the individual and the serious nature of their alcohol abuse. As individuals can become extremely dehydrated, develop seizures, and become psychotic, DTs can be potentially fatal.
How is Alcoholism Diagnosed?
A person must possess two or more of the 11 characteristics diagnosing alcohol use disorder to be classified as an alcoholic:26
- Drinking large amounts of alcohol over a long period of time, or drinking more than the recommended amount on a regular basis
- Having difficulty cutting down or stopping drinking alcohol
- Spending a great deal of time getting, using, or recovering from the effects of alcohol
- Experiencing intense cravings for alcohol
- Failing to fulfill major work, school, or home responsibilities because of drinking
- Continuing to drink despite relationship problems that are caused or worsened by drinking
- Cutting back on important social, work, or recreational activities because of drinking
- Drinking alcohol in situations that are physically dangerous, such as while driving a car or operating machinery
- Developing tolerance to alcohol so that you need to drink greater amounts in order to feel its effects
- Needing larger amounts of alcohol to experience the same effects
- Experiencing withdrawal symptoms, such as anxiety, tremors, sweating, nausea, or visual hallucinations
Psychological exams can be used to detect alcohol abuse. These exams can show if a person is struggling with alcohol addiction and how serious their drinking habits are. Furthermore, through physical examinations, doctors can not only detect, but also diagnose alcohol use disorders. By looking for signs such as a swollen liver or jaundice, they can identify other health concerns that may be brought on by alcohol abuse.27
In addition, laboratory tests can be useful in detecting alcohol abuse. For example, these types of tests may identify high levels of certain chemicals in blood or urine as potential markers for heavy drinking.27
Alcohol Addiction Treatment
Alcohol abuse is a serious problem that can have devastating consequences on a person’s health, relationships, and career. If you or someone you love is struggling with alcoholism, it’s essential to get help from a treatment center that specializes in alcohol addiction.28
There are many different types of centers for alcohol treatment, so it’s important to find one that will meet your specific needs. These include outpatient programs, which allow patients to participate and receive treatment while living in their home. There are also inpatient programs, which require the person to stay at the facility while receiving treatment, and alcohol detox programs under professional supervision. 12-step programs are available to those in need of support on their journey to recovery.28
Although alcoholism treatment may prove difficult, there are many evidence-based methods that support their efficacy. Some of the most commonly used treatments are motivational enhancement therapy, cognitive-behavioral treatment, and medication-assisted therapy. These techniques have demonstrated effectiveness in aiding those recovering from alcohol addiction.28
If you or your loved one is suffering from alcohol use disorder, American Addiction Centers are here to assist you. AAC’s admissions navigators help individuals in need of professional assistance get a better understanding of how treatment works. In addition, their alcohol addiction hotlines can assist you with verifying your insurance coverage, finding the nearest AAC-affiliated alcohol abuse treatment facility, and explaining various payment options.
Medical Alcohol Treatment
The majority of individuals with alcohol use disorders will not experience severe complications, such as seizures or delirium tremens. Nevertheless, the American Society of Addiction Medicine (ASAM), the largest organization of physicians specializing in addiction medicine in the country, recommends that anyone with AUD should undergo a physician-assisted withdrawal management program (medical alcohol treatment) when they discontinue alcohol for several reasons:12
- There is no standard protocol that can predict what symptoms an individual undergoing withdrawal from alcohol will experience.
- Other issues besides seizures and delirium tremens can be potentially serious, such as dementia, dehydration, etc.
- Significant relief of withdrawal symptoms is associated with greater success and lower instances of relapse in the early days of recovery.
- The use of medications in a physician-assisted withdrawal management treatment program results in the easiest and safest approach to manage alcohol withdrawal.
There are various medications that can be used to assist individuals through alcohol withdrawal in alcohol abuse treatment programs:13
- Benzodiazepines, such as Librium, Valium, Xanax, etc., are often the primary treatment for alcohol withdrawal. They reduce the symptoms of withdrawal, protect against seizures, guard against delirium tremens, and alleviate other issues. Benzodiazepines should only be used under the supervision of a physician.
- Beta blockers are drugs that are typically used in the treatment of hypertension, and they can be used to address issues with high blood pressure, irregular heartbeat, etc., during withdrawal from alcohol.
- Certain anticonvulsant medications may reduce the withdrawal symptoms associated with alcohol.
- The muscle relaxant baclofen has been shown to reduce cravings in individuals undergoing withdrawal from alcohol.
- Antabuse is a medication that may be given to individuals who have had relapses. It does not address the symptoms of withdrawal, but if an individual drinks alcohol while taking the medication, they become violently ill. This increases the individual’s motivation to stay abstinent from alcohol.
Physicians have access to numerous other medications for specific symptoms that can also be useful during the early and middle stages of withdrawal.
Different Alcoholic Treatment Options
Simply going through medical alcohol treatment is not sufficient for an individual to recover from AUD. Individuals should consider becoming involved in some form of comprehensive care once they have gotten through the withdrawal period. Alcohol treatment programs may involve the following elements:13
Getting involved in alcohol use disorder behavioral therapy in either a group format or in individual sessions, or both, helps the individual get the insight and develop tools needed to ensure that recovery will be successful on a long-term basis.
Peer Support Groups
Peer support groups represent potential long-term aftercare programs that people can continue to participate in for years, even after they have completed their formal alcohol treatment programs.
Becoming involved in social support groups, either those based on 12-step principles (such as Alcoholics Anonymous) or other more secular groups, can have a very positive effect on recovery.14 These groups offer a formal program of recovery, peer support, the chance to meet individuals in recovery and develop new relationships, and long-term participation in treatment-related activities. Organizations for peer support in addiction treatment usually provide opportunities for both in-person and online alcohol treatment meetings.
To maintain the positive outcomes of alcohol rehab treatment, there should be continued medical management of issues that are relevant to the individual’s personal situation. This includes the treatment of co-occurring psychological/psychiatric conditions and physical problems.
Involvement in complementary activities, such as animal-assisted therapy, psychodrama, music therapy, and others, can be beneficial. These forms of alternative therapy are not mandatory in alcohol treatment programs and should only be used if the patient enjoys them. They can add variation to an individual’s recovery program but should not be considered as standalone treatment. They are rather used in conjunction with formal treatment within inpatient facilities for alcohol abuse or outpatient treatment options for individuals struggling with alcoholism.