Alcohol Use Disorder

What is alcohol use disorder?

According to the National Institute on Alcohol Abuse and Alcoholism, AUD is a "medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It encompasses the conditions that some people call alcohol abuse, alcohol dependence, alcohol addiction, and the colloquial term, alcoholism." ^[1]

AUD is the medical term for this disorder that is considered a brain disorder and may be classified as mild, moderate, or severe.

People with alcohol use disorder may engage in certain behaviors as a result of their health condition. For example, they might start drinking at different times of the day or start drinking alone. They may even begin to skip meals or eat less due to their excessive drinking. Eventually, the alcohol intake starts to affect their responsibilities, so they may take more sick days due to hangovers or because they want to be free to drink.

Their internal experiences include cravings, withdrawal symptoms, and memory lapses.

AUD can lead to liver damage, heart disease, gastrointestinal problems, and neurological damage. It can also increase the risk of accidents and injuries. Treatment for AUD often includes counseling, support groups, and medication.^[2]

Is alcohol use disorder the same as alcoholism?

Alcohol use disorder is a broad term that describes a range of drinking patterns, from problematic but not physically dependent drinking to severe dependence.

Alcohol use disorder has been known as alcoholism, alcohol abuse, or alcohol addiction in the past. However, the terms' alcoholism', 'alcoholic', and ‘addiction’ are somewhat outdated, as they stigmatize the individual and they make it more difficult for people to overcome certain treatment barriers when these labels are placed on them.

The terms alcoholism/alcoholic are falling out of use and have not been considered diagnostic terms by medical professionals for some years. Doctors use diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) to determine whether alcohol use disorder is present.

Some recovery groups, such as alcoholics anonymous (AA) and others still use these descriptions in their meetings. However, other support groups are starting to use the clinical and correct term AUD.

Symptoms of alcohol use disorder

People with AUD may have difficulty controlling their drinking and continue to drink even when it causes financial, social, or physical problems. Many different symptoms can be associated with AUD, varying in severity. Occasional or moderate drinking should not lead to such symptoms.

Some of the most common symptoms include:

Behavioral Symptoms

• Start drinking when alone
• The need to drink more before the effects of alcohol start showing (signs that tolerance to alcohol is developing)
• Reacting aggressively or angrily when asked about their drinking
• Neglecting their nutritional needs, eat poorly, or stop eating
• Turning up late or miss work or school
• Becoming unable to control their alcohol intake
• Continuing to drink even when problems develop
• Making activities that were previously deemed important secondary to drinking
• Inventing excuses to drink

Physical Symptoms

• Strong cravings for alcohol
• Experiencing blackouts, hangovers, and withdrawal symptoms
• Blacking out and short-term memory loss after heavy drinking
• Withdrawal symptoms such as nausea, vomiting and shaking
• Dehydration
• Involuntary shaking the morning after drinking, also known as delirium tremens, although this only occurs in some individuals with AUD

Other illnesses

Other illnesses can also occur in the long term and also depend on the individual's general health:

• Alcoholic acidosis.This leads to malnourishment, especially if there has been vomiting and decreased food consumption. It can cause the body to reduce its insulin production.
• Inflammation of the pancreas
• Liver disease, including cirrhosis
• Ulcers: While alcohol does not directly cause ulcers, it irritates and inflames the stomach lining, which can worsen existing stomach or peptic ulcers, or cause irritation and inflammation of the stomach lining that develops into ulcers over long periods of time. Alcohol consumption also interferes with any healing of an ulcer, thus worsening the symptoms.
• Ethylene glycol poisoning: This starts with intoxication, abdominal pain, and vomiting in the early stages of illness. It can lead to headaches, decreased levels of consciousness, and seizures. If left untreated, this can progress to kidney failure and brain damage, resulting in toxicity and death. ^[3]

Diagnosing alcohol use disorder

Doctors and mental health professionals use the diagnostic criteria set out in the DSM 5 to determine whether AUD is present and to understand the severity of each case. For someone to be diagnosed with AUD, they must experience the following symptoms over 12 months:

1. Drinking more than they meant to
2. Wanting to stop drinking but cannot
3. Obtaining alcohol, drinking, and recovering from drinking occupies a great deal of time
4. Experiencing cravings for alcohol
5. Drinking gets in the way of daily activities, e.g., work, school
6. Drinking disrupts social or interpersonal relationships
7. Drinking takes over life activities that were previously priorities
8. Doing risky things while drinking, e.g. unprotected sex, driving
9. Knowing that drinking is harmful but doing it anyway
10. Developing a tolerance so that more alcohol is consumed to achieve the desired effect
11. Experiencing symptoms of withdrawal

Two or three symptoms indicate a mild case of AUD, four or five symptoms indicate a moderate case, and severe cases will present with six or more symptoms.^[4]

Alcohol withdrawal symptoms

Alcohol withdrawal symptoms can range from mild to severe and typically begin within 8 hours after the last drink. These symptoms occur in someone who has been drinking heavily for some time and suddenly stops or drastically decreases the amount of alcohol they are drinking. In some cases, symptoms may appear as early as 4-6 hours, as the alcohol in the bloodstream returns to zero. The most common symptoms include:

• Anxiety
• Sweating
• Increased heartbeat and blood pressure
• Nausea and/or vomiting
• Insomnia and vivid dreams
• Shaking
• Headache
• Fatigue

More severe symptoms include hallucinations, agitations, extreme tremors, confusion, disorientation, delusions, and seizures. Symptoms tend to peak on the second day after the last drink. The acute phase is usually over by day four or five.

Delirium tremens, or DT, is a specific condition caused by alcohol withdrawal, which can cause a rapid onset of confusion, hallucinations, fever, high blood pressure, and a fast heart rate.

If you experience any of these symptoms, it's essential to seek medical help immediately. Withdrawal can be dangerous, and detoxing under medical supervision is important.

The time needed to detox from alcohol depends on various factors, including how much you drink, how often you drink, and your overall health. In general, the detox process takes about a week. However, some people may experience lingering symptoms (known as post-acute alcohol withdrawal syndrome) for months or even years after stopping drinking.

If you're struggling with alcohol use disorder, there is help available. Alcohol rehab centers offer a safe and supervised environment for detoxing from alcohol. They also provide counseling and support to help you stay sober after you leave treatment.^[5]

Causes of alcohol use disorder

Alcohol use disorder typically develops over time. Alcohol use causes brain changes that make some people associate alcohol intake with pleasurable feelings. This makes them want to drink more often, even if they know it causes harm. With repeated use, the pleasant feelings go away. Still, the individual gets withdrawal symptoms and continues to drink to prevent these symptoms.

Some risk factors may increase the chances of developing this condition:

• Consuming more than 14 drinks per week for males, or 7 drinks per week for females
• Binge drinking (more than 4 drinks per day for males, 3 for females)
• A parent or close relative with AUD
• Living in a family where alcohol use is routine and accepted
• Co-occurring mental health conditions, such as depression or anxiety
• Experiencing peer pressure as a young adult
• High levels of stress
• Low self-esteem
• Living in a culture where alcohol use is prevalent^[6][9]

Prevention of alcohol use disorder

Even though the only sure way to prevent alcohol use disorder is to abstain, individuals can significantly reduce their risk by taking these steps.

It is essential to be aware of the signs and symptoms of alcohol use disorder and to seek help early if you or someone you know is exhibiting these signs. If you suspect (or know) that alcohol use is problematic, avoid situations that trigger drinking, such as social gatherings where alcohol is present, to prevent alcohol misuse and relapse.

A strong support system can provide individuals with the resources they need to stay sober. This includes attending therapy and support group meetings and undergoing rehabilitation when necessary.

Since going cold turkey can be dangerous in those with alcohol use disorder, a patient who has relapsed should seek professional support to get back on track.

Treatment for alcohol use disorder

Several treatments for AUD are available, but what works for one person might not work for another.

Detox

Detoxification helps to treat withdrawal symptoms. It is performed in an inpatient setting (hospital or a specialized center) and typically lasts one week. During this time, medications may be given to counteract severe withdrawal symptoms.

Therapy and support groups

During behavioral therapy, those with alcohol addiction learn how to modify their behavior and learn skills to cope with life without reverting to alcohol. They also learn to avoid alcohol and situations that might tempt them to drink. Support groups (such as Alcoholics Anonymous) can be beneficial as individuals with alcohol use disorder are introduced to peers who understand their fears and motivate them to stay sober. Support groups also hold the person with AUD accountable.

Medicine

Medications used to treat AUD are

• Naltrexone removes the feel-good effects of alcohol
• Acamprosate decreases alcohol cravings
• Disulfiram causes flushing, nausea, and headaches when alcohol is consumed

Rehabilitation

Residential treatment is often called 'rehab', which refers to inpatient treatment at a specialized facility for alcohol use disorder. Detox, therapy, and medication all make part of rehab, and the patient stays in this residence between 30-90 days.^[7]

Self-care for alcohol use disorder

One of the most important aspects of recovering from use disorder is taking care of yourself. This means:

• Getting enough sleep, eating a balanced diet, and exercising regularly.
• Avoiding triggers that can cause you to relapse, including stressful situations, social situations where alcohol is present, and places where you used to drink.
• Getting professional help if you need to cope with withdrawal symptoms and cravings.
• Joining a support group where you can share your struggles and feel less alone.
• Managing your stress levels and emotions through relaxation techniques, talk therapy, and group support.

Taking care of yourself can increase your chances of staying sober and healthy.

Helping someone with alcohol use disorder

If you have a loved one struggling with alcohol misuse, you may be wondering what you can do to help. Here are five steps that can make a difference:

1. Educate yourself about alcohol use disorder.
2. Talk to your loved one about their drinking openly and honestly without placing blame. Let them know that you're concerned and offer your support.
3. Encourage them to get help. If your loved one is willing to seek treatment, offer to go with them to appointments or help them find a program that's right for them.
4. Be supportive during treatment. Recovery from alcohol use disorder is a long and challenging process, but you can make a difference by being supportive throughout treatment. Offer encouragement and understanding, and let your loved one know that you're there for them.
5. Help them maintain sobriety after treatment. Relapse is common among people who struggle with alcohol use disorder, but it doesn't have to be the end of the road. There are things you can do to help your loved one stay sober, such as attending support groups or continuing to provide emotional support.

If your loved one relapses, don't give up on them – remind them that recovery is possible and offer your support again.

FAQs about alcohol use disorder

How common is alcohol use disorder?

According to the National Survey on Drug Use and Health (NSDUH), in 2019, there were 14.5 million people over 12 years with AUD in the US. That amounts to 5.3% of this population group, of which 6.8% were men and 3.9% were women.

When focusing on youths aged between 12 and 17 in the same year, AUD prevalence was 1.7% of the entire population within this age group.

How do I know if my teenager is drinking too much?

If you have a teenager and suspect alcohol misuse, watch out for the following signs that may indicate AUD:

• Loss of interest in personal appearance
• Loss of interest in hobbies
• Slurred speech, red eyes, and memory lapses
• Declining grades or other problems in school
• Changes in mood and behavior

Does alcohol cause depression?

Alcohol affects chemicals in the brain that regulate mood and is a depressant. Binge drinking and alcohol use disorder have been connected to symptoms of depression because the balance of chemicals is disrupted.

Even though the short-term effects of alcohol can feel relaxing in those who drink moderately/occasionally, when someone is misusing alcohol, these effects wear off quickly. In addition, individuals with depression use alcohol to mask their symptoms and start to rely on it. This creates a vicious cycle of dependence and depression.^[8]