Alcoholism, also known as alcohol use disorder, is an addiction to alcohol that is characterized by an inability to control drinking, drinking in spite of problems that it causes, developing a tolerance to alcohol, and experiencing cravings and withdrawal when not drinking. Some people are more susceptible to alcoholism than others, and while there is no cure, good, consistent treatment after medically supervised detox can help manage this chronic illness.
What Is Alcoholism?
Alcoholism is an addiction to alcohol or a pattern of misuse of alcohol that is problematic. Another term more often used by professionals today is alcohol use disorder. To be diagnosed with an alcohol use disorder, according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must meet two of 11 criteria during one 12-month period.
This broad definition of alcohol use disorder includes many people with behaviors ranging from minor problem drinking patterns to full-blown addiction. However, the diagnosis is also broken down into mild, moderate, and severe categories. Someone diagnosed with a severe alcohol use disorder can be considered to be an alcoholic or to be dependent on alcohol. This means being unable to control drinking, experiencing negative consequences from drinking but continuing to do so, developing a tolerance, and experiencing withdrawal when not drinking.
Facts and Statistics
Alcohol is the most commonly abused of all substances, including legal and illegal substances. While many people drink responsibly, underage drinking, drinking and driving, binge drinking, and long-term drinking and alcohol dependence are all serious issues that affect many people.
- In 2015, nearly 27 percent of adults aged 18 and older reported binge drinking in the past month. Binge drinking is defined as four or more drinks for women and five or more for men in a two-hour period or less.
- More than 15 million adults, 18 and older, had alcohol use disorder in 2015. The total includes 9.8 million men and 5.3 million women.
- Approximately 88,000 people die each year from conditions or accidents related to alcohol. This makes alcohol the third leading cause of preventable deaths.
- About one-third of vehicle accidents are related to alcohol.
- Any underage drinking is considered alcohol abuse, but the number of people under 21 drinking is declining. In 2016, 33 percent of 12th graders reported drinking, down from more than 50 percent in 1996.
- Drinking is also down for 10th and 8th graders, with drops by 60 percent and 75 percent respectively from peaks in the 1990s to 2016.
- Binge drinking is most prevalent among college students, with 37 percent reporting engaging in this behavior.
- About 25 percent of college students report some degree of academic consequences from drinking.
- Long-term drinking contributes to high blood pressure, heart disease, liver disease, and mental health conditions, and increases the risk of developing certain types of cancer.
Symptoms and Diagnosis of Alcoholism
Signs of alcoholism are numerous and common among most people who struggle with drinking, although there may be some individual differences. Experiencing just two of these can indicate a mild alcohol use disorder. The more symptoms present and the more severe they are, the more likely someone is to have a severe disorder. The stages of alcoholism can quickly lead someone from a mild problem to a real addictive disorder. Symptoms of alcoholism include:
- Trying to drink less but failing
- Being unable to control the amount of alcohol consumed
- Consistently drinking more than planned
- Spending a lot of time, energy, and money on getting more alcohol
- Experiencing cravings when not drinking
- Developing a tolerance, a need to drink more to get drunk
- Drinking in spite of problems that it causes, like fights with family or legal problems
- Experiencing withdrawal symptoms
- Drinking in situations when it is clearly not safe to do so, such as before driving
- Drinking even though it makes physical or mental health conditions worse
- Limiting engagement in activities, hobbies, and social engagements to drink
- Missing work or school or not completing responsibilities because of drinking or hangovers
Signs that someone is intoxicated with alcohol include physical impairment, inappropriate behaviors, loss of inhibitions, unstable mood, slurred speech, impaired memory, difficulty paying attention, and impaired judgment. Alcohol poisoning, or an overdose, may occur when blood alcohol levels rise to dangerous levels. Signs of alcohol poisoning include:
- Extreme confusion
- Slowed or irregular breathing
- Low body temperature
- A blue tint to skin
- Loss of consciousness and unresponsiveness
Alcohol poisoning is very serious and should be treated as a medical emergency. It can quickly lead to death if not treated as soon as possible. If in doubt that someone is suffering from alcohol poisoning, always call 911 or get the person to the emergency room immediately.
Causes and Risk Factors
Exact causes of alcoholism are difficult and sometimes maybe impossible to identify, but anyone who misuses alcohol and drinks a lot is at risk of developing a dependence. Some people are also more genetically predisposed to any type of addictive disorder, which can cause a quicker deterioration from problem drinking to alcoholism. As with other addictions, drinking alcohol regularly and in large quantities can cause changes to the brain over time that make it difficult to stop drinking. Some of the known risk factors—those things that make someone more vulnerable to developing alcoholism—include:
- A family history of alcoholism or other addictions
- Beginning drinking at an early age
- Binge drinking or steady drinking over a long period of time
- Having a mental illness, especially untreated
- Having a partner or friends that drink heavily
- Childhood trauma
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Alcohol Withdrawal and Detox
One of the most characteristic signs of alcoholism is withdrawal. Anyone who experiences withdrawal when not drinking and drinks to avoid those unpleasant side effects is physically dependent on alcohol. Withdrawal from alcohol can be severe and dangerous. The possible symptoms include:
- Tremors and shaking
- Nausea and vomiting
- Excessive sweating
- Stomach cramps
- High blood pressure
- Elevated heart rate
A severe reaction to withdrawing from alcohol is called delirium tremens. It causes confusion, severe vomiting, agitation, hallucinations, a fever, and convulsions or seizures. It should be treated as a medical emergency, and although not common delirium tremens is possible for anyone who has a severe alcohol use disorder.
Because withdrawal from alcohol can be so uncomfortable and even dangerous, it is best to detox with medical supervision. Treatment for alcoholism is best done in a residential facility beginning with supervised, and sometimes medicated, detox.
Co-Occurring Disorders and Substance Use
It is not uncommon for alcoholism to occur with other disorders, especially mental illnesses. Any mental illness may co-occur with alcoholism, but depression and anxiety are the most common. The connection exists because some people with undiagnosed or untreated mental illnesses use alcohol to self-medicate. Drinking too much can also trigger symptoms of depression and anxiety or make them worse. Both addiction and mental illness also have common risk factors, another explanation for why they often co-occur.
There are also several physical health problems that can co-occur with alcoholism, mostly because of the damage alcohol abuse causes to the body over time. For example, fatty liver and alcoholic hepatitis are not uncommon in heavy drinkers because of how alcohol damages the liver. Also linked with alcoholism are chronic pancreatitis, malnutrition, cancer of the mouth, esophagus and larynx, and dental problems. Alcoholism may also co-occur with drug addictions.
Another common co-occurring issue with alcoholism is abuse of other substances. People who misuse alcohol also may misuse illicit or prescription drugs for similar reasons. This can be very dangerous, though, as certain combinations of alcohol and drugs can increase physical health problems and even increase the risk of overdose. For example, mixing alcohol with other depressants, like benzodiazepines or opioids, is dangerous because of the additive effects.
Alcoholism Treatment and Prognosis
There is no cure for any addiction, but when it is viewed as a chronic illness and treated accordingly, alcoholism can be managed. The most effective treatment is a combination of strategies that include long-term residential treatment, behavioral therapies, social support, and treatment of any co-occurring conditions, including diagnosis and treatment of any mental illnesses.
Treatment for alcoholism begins with a period of detox, which should be medically supervised. This is then followed by one-on-one therapy sessions that help the patient determine what underlies his or her drinking problems and that teaches the patient how to change behaviors and make more positive choices. Residential treatment also typically includes working in groups, family therapy sessions, alternative therapies, nutrition, exercise, and planning for ongoing care after the residential stay is over.
The question, is alcoholism a disease, is commonly asked and often still debated. However, most experts now agree that it is a disease, or a chronic illness, that should be treated as such. It is not a moral weakness on the part of the alcoholic, as some people still believe. This means that anyone can be treated. A commitment to long-term treatment and a residential stay in a facility equipped to help someone with alcohol abuse can lead to overcoming alcoholism and lifetime management of the disease.