Less than ten percent of people with an alcohol use disorder seek help for their condition, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).1 Whether a high-functioning alcoholic or an individual who has an alcohol use disorder that is impacting every aspect of life, help is available.2 This includes seeking treatment at a drug rehabilitation facility or with a therapist or doctor that specializes in addiction medicine.
You may be familiar with the concept of alcohol dependence or alcohol abuse, but what is alcohol use disorder (AUD)? The term AUD is fairly recent and originates from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), published in 2013. While in previous editions alcohol abuse and alcohol dependence were classified as separate conditions, in DSM-5 the two conditions were combined and classified as alcohol use disorder.3 Therefore, the statistics mentioned below include both individuals who abuse alcohol and people who are dependent on alcohol. AUD usually requires treatment for recovery. Treatment is often completed in an addiction treatment center. AUD is treated differently than opiate use disorder, even though the recovery is done in the same treatment facility.
When a person consumes alcohol, the substance creates a chemical reaction in the brain that can be pleasant and relaxing. Some people develop a craving for this reaction and the more they seek it, the more alcohol it requires to be achieved. This is what leads to an AUD.
While there are several factors that contribute to AUD, research has found that one of the strongest risk factors is genetic predisposition. Through studies of families, twins, and adopted siblings, the genetic role in the development of AUD is estimated between 50 and 60 percent.4 This fact also plays into the role of upbringing and AUD, as children who grow up in households where alcohol is prevalent and/or abused are more likely to develop an AUD themselves.
Other factors that affect AUD include a person’s place of residence, culture, social activities, overall response to stress, and major life changes. For example, a person from a Northern European background living in the midwestern United States where alcohol consumption is widely accepted is at greater risk of developing an AUD than a person of Middle Eastern background living in the southeastern United States where alcohol consumption is discouraged. In both cases, the culture of the individual and the culture of the area where they live contribute to overall risk of AUD.
There’s no quick test that helps to determine the difference between an alcohol problem and a lapse in judgment related to alcohol. An alcohol use disorder can range from mild to severe.
The main difference between “ok” drinking and an alcohol use disorder is control. One who has an alcohol use disorder no longer has control over how much alcohol is used on a regular basis. For example, they will often drink more than they intended to drink or will make dangerous and potentially harmful choices due to what alcohol was consumed. Another sign of an alcohol use disorder is the tendency to skip or avoid social settings and activities in favor of drinking.
When there is a loss of control over one’s relationship with alcohol, it can feel like alcohol controls the individual instead of the other way around. If this seems evident, help may be needed.
Different people have different tolerance levels for alcohol. However, heavy drinking is when a woman drinks more than 3 days a week or more than 7 drinks per week.5 For men, drinking more than four days a week or more than 14 drinks per week is considered heavy drinking.
For some, there is no “safe” level of drinking. This is true when there has been a history of problems with alcohol and alcohol abuse. For those who have struggled with addiction, there may not be an instance to be able to drink at any level of safety.
The signs and symptoms of alcohol use disorder may start gradually and may not seem like a big deal at first. Over time, however, the prevalence of alcohol in a person’s life becomes more obvious. Here are some signs that might indicate that alcohol is becoming a problem:
Spending increasing amounts of time drinking or recovering from hangovers
Consuming alcohol at most social events, even if the setting or time of day does not seem appropriate for including alcohol
Drinking more without getting drunk
Getting into dangerous situations after drinking, such as driving drunk, having unprotected sex, and so forth
Continuing to drink even though family and friends express concern or encourage to stop drinking
Reducing the amount of time spent in important interests and activities in order to drink
Problems with work, school, or taking care family due to drinking
Legal problems resulting from drinking, such as conviction for Operating While Intoxicated (OWI), drunk and disorderly conduct, etc.
Withdrawal symptoms such as shakiness or nausea when the effects of alcohol wear off
Continuing to drink in spite of adverse health effects such as depression and anxiety and being unable to cut back or stop5
If these signs become more numerous or prevalent, chances are the person has developed an AUD and will have difficulty reversing the condition without treatment.
Heavy alcohol use is quite common in the United States. The Centers for Disease Control (CDC) estimated in 2018 that 25.1% of adults age 18 and over had one heavy drinking day (5 or more drinks for men and 4 or more drinks for women) over the previous year.6 For some, this heavy alcohol use leads to binging or dependence, both considered AUDs.
According to the National Institute on Alcohol Abuse and Alcoholism, 15.1 million adults age 18 and over in the United States had an AUD in 2015. The group included 9.8 million men and 5.4 million women. Overall, this accounts for about 6.2% of the U.S adult population. In addition, about 623,000 teenagers ages 12-17 developed AUD, including 298,000 males and 325,000 females, accounting for 2.5% of the adolescent population. Out of those who were identified as having an AUD, only 6.7% of adults and 5.2% of adolescents received treatment for their conditions.7
Without treatment, AUD can lead to devastating results. The CDC reported 35,823 alcohol-induced deaths in 2017. This number included deaths related to dependent and nondependent alcohol use, as well as accidental alcohol poisoning. It did not include accidents or homicides that involved alcohol or deaths related to fetal alcohol syndrome. Furthermore, the number of deaths caused by liver disease related to alcohol use in 2017 was 22,246, which was about 53% of deaths caused by this diagnosis.8
Heavy alcohol use can lead to a number of health conditions, including the following:
Increased risk of liver disease
Increased risk of heart disease
Increased risk of stroke
Stomach and esophageal bleeding and ulcers
Increased risk of developing several different types of cancer, including cancers of the mouth, esophagus, larynx, liver, and digestive tracts, as well as breast cancer in women
Difficulty managing existing health conditions like diabetes, high blood pressure, pain conditions, and sleep disorders
Heavy alcohol use can also lead to problems resulting from the impaired judgment that alcohol causes, such as physical injuries and sexually transmitted diseases. Using alcohol while pregnant increases the infant’s risk of developing fetal alcohol syndrome, which causes brain damage.
Drinking alcohol in any fashion more than moderation can increase the risks for several different cancer types.4 This is because when the liver breaks down alcohol into a chemical called acetaldehyde that can cause changes to the body’s cells that lead to cancer. Examples of these cancers include:
As a general rule, the more alcohol that is consumed, the greater the cancer risk. That’s why the Dietary Guidelines for Americans recommend drinking in moderation.9 Moderation is drinking no more than one drink a day for women or more than two drinks a day for men.
The truth is, not all individuals with an alcohol use disorder meet the traditional picture of alcoholism. There are many individuals who are “high functioning” alcoholics that maintain most of their working, family, and friend lives, even with an alcohol use disorder.
High-functioning alcoholics will often drink every day, promising themselves that they won’t drink the next day, but finding themselves going back to alcohol. They also may feel their alcohol helps them escape the stresses of their daily life and may start to drink regularly and blackout at night, but no one else in their lives may know about it. These are all examples of how a high-functioning alcoholic may live their life on a daily basis.
Unfortunately, it’s an inevitability for many heavy alcohol drinkers that their abuse will catch up to them. High-functioning alcoholics may still put themselves at risk by getting into potentially dangerous situations, such as drinking and driving, blacking out when drinking, or even engaging in risky sexual behaviors.
High-functioning alcoholics are CEOs, successful business people, moms, and dads who seem to navigate their everyday lives with ease. There are many examples of famous individuals who are admittedly high-functioning alcoholics. Examples of these people include:
Betty Ford, the former First Lady, who admitted her struggles with alcohol abuse and painkilling medications and opened rehabilitation centers.
Stephen King, author of thriller novels.
Leonard Nimoy, the actor who played Dr. Spock on Star Trek.
Samuel L. Jackson, the actor, who has detailed his life as a high-functioning alcoholic.
An alcohol use disorder can affect every aspect of an individual’s life. Sometimes, these effects can sneak up on some people as they get further and further into their drinking problem. The following are some examples of different ways an alcohol use disorder can impact a person.
An alcohol use disorder can cause an individual to withdraw from their family. They start to focus on alcohol and recovering from their hangover before starting to drink again. This can take them away from their family members and friends. Also, one may start to avoid friends and family because they are afraid they will notice they have problems with drinking.
Alcohol can affect one’s judgment and can make them do things that they otherwise would not, including the decision to get behind the wheel and drive. Sometimes, those with an alcohol use disorder may drink and drive because they don’t want people to think they have a problem, or they simply don’t recognize how much they have had to drink.
When they drive, their reaction time, decision-making, and attention are all impaired, which can increase the likelihood of an accident. Drunk driving not only increases a person’s risks for injury to themselves but can also injure others.
According to MADD (Mothers Against Driving Drunk), an estimated 9% of all drivers in fatal car accidents during the day were drunk, while 32% of all drivers in fatal car accidents at night were drunk.10 They also report people drive drunk an estimated 300,000 times a day.
An alcohol use disorder can affect a person’s health in a variety of ways. These include complications to a person’s liver, which is where the body filters alcohol.2 Other medical conditions that alcohol abuse impacts include:
High blood pressure
Alcohol abuse also increases the likelihood an individual will experience an accident, such as a car accident or fall.
Alcohol abuse can impact one’s finances and overall success in several ways. First, they spend a significant amount of money on a regular basis purchasing alcohol. Even the most inexpensive alcohol can start to add up financially when used every day.
Second, one may not be able to work as effectively or efficiently while struggling with alcohol abuse, causing problems holding down a job, which can severely impact their finances.
In addition, legal trouble, such as a drunk driving arrest or disorderly public charge, legal fees, and fines, can be very expensive.
Often when an individual realizes they need help with alcohol, they have come to a place where they have tried to quit on their own. However, the strong pull and cravings for alcohol can quickly and easily reel them back in.
Sometimes, one has to go to a place that doesn’t remind them of their drinking. They may also need support and encouragement, as well as medical attention, to help them meet their goal of becoming alcohol-free.
Rehabilitation can help an individual get through the withdrawal process and learn how to stop using alcohol. It can help them identify their triggers as to why they used alcohol or what has kept them in their cycle of abuse. Once in rehab, the individual can work with a therapist to identify ways to resist the pull to return to substance abuse.
While the logical conclusion from all of this information is to stop drinking, quitting is not easy. Many people who have an AUD must go through a period of detoxification to allow the body to remove the alcohol and associated chemicals. This process varies in length depending on the amount of alcohol in a person’s system. For people who do not have AUD and just have a few too many drinks in an evening, the process is commonly known as a “hangover” and takes a few hours. People who use alcohol daily and/or heavily, however, must go through a longer detox period, which can last a number of days.
Because of the chemical reaction that occurs in the brain, the body begins to crave alcohol when it is not present. The longer an AUD exists, the larger and more severe the body’s reaction when alcohol consumption ceases. This is called withdrawal. Early symptoms of withdrawal include:
Nausea and vomiting
These symptoms vary in severity, but are not usually life-threatening. Treatment for mild withdrawal includes lots of fluids, healthy food, and a quiet environment with a limited number of people around. If withdrawal continues for more than a day, more severe symptoms may set in, including hallucinations and possibly seizures.
Alcohol treatment usually begins with the detoxification process. This is where one stops drinking altogether. If they have struggled with alcohol abuse, it will likely involve some type of alcohol withdrawals once they stop drinking. Withdrawals can range from mild to severe. Sometimes, it’s hard to predict who will have severe withdrawals. The more a person has gone through the withdrawal process, the more likely it is the next withdrawal period will be worse.
A severe form of withdrawal is called delirium tremens. Known as DTs, this type of withdrawal only occurs in about 5% of people who experience withdrawal. Symptoms of DTs include:
High blood pressure
These symptoms may become quite severe and may require medical care. Medications and inpatient hospitalization may be recommended for severe cases of DTs.
A person going through detox and experiencing withdrawal symptoms should not be left alone. While a quiet, comfortable environment is preferred, at least one person should be present at all times to monitor the person’s health symptoms, provide fluids and medication as needed, and contact medical professionals if more severe withdrawal symptoms or DTs surface.
Research on the effectiveness of medications for the treatment of AUD is ongoing and advancing. Currently, three medications are approved in the United States for the treatment of AUD. These include:
An anti-opioid drug that reduces cravings for alcohol
A drug that stabilizes the chemical signals in the brain that are normally disrupted by symptoms of withdrawal
An anti-opioid drug that reduces cravings for alcohol
Other medications are currently in the research and approval process. Medications may also be used to treat the symptoms and causes of AUD, such as anti-depressants or anti-seizure drugs. All medications approved for the treatment of AUD are non-addictive. Medications must be prescribed and monitored by a physician.
The detox process doesn’t last forever. In a few days, a person usually starts to feel better and more clear-minded. They realize their mind and body can survive without alcohol. Then, they can move forward in their recovery.
This type of treatment involves counseling to change the behaviors that a person exhibits related to alcohol. Several different types of treatment may be used, such as:
Cognitive Behavioral Therapy
Identifies and attempts to change the thought processes related to heavy alcohol use
Motivational Enhancement Therapy
Focuses on building motivation and confidence to change drinking habits
Marital and Family Counseling
Incorporates family members in the treatment process with a goal of repairing relationships and building a strong support system
Used primarily with people who are at risk of developing AUD – these are short counseling sessions that help the person gain awareness of their problems with alcohol and set goals to change drinking habits
These programs involve regular involvement with support groups and peer mentors to help change drinking behavior. The oldest and most well-known of these programs is Alcoholics Anonymous. Programs like this can be found in every community for people of every culture and background.
This type of program, usually reserved for people who do not respond to other types of treatment, involves a stay for a prolonged period of time in a specialty treatment facility. Medications, counseling, and support groups may all be included as a part of an inpatient program, as well as medical management of detoxification and other types of support to resume daily activities. These programs vary in length. Dismissal from an inpatient program may be gradual and may involve referral to a halfway house or structured outpatient program.
If you or a loved one struggle with a drinking problem, it is difficult to admit. If you have taken the self-test, and several of your answers were positive, you may need to seek treatment for your problem at a professional rehabilitation facility. There, you can get the treatment you need for medical detox as well as learning how to stop abusing alcohol.