BEYOND THE BOTTLE:

Recovering from Alcohol Use Disorders

WHAT IS ALCOHOL USE DISORDER?

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.1 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.

What Causes AUD?

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.2  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.

Signs of Alcohol Use Disorder

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 drug, 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 of 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 stop3

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.

Statistics on Heavy Alcohol Use

Heavy alcohol use is quite common in the United States. The Centers for Disease Control (CDC) estimated in 2018 that 25.1 percent of adults age 18 and over had one heavy drinking day (five or more drinks for men and four or more drinks for women) over the previous year.4 For some, this heavy alcohol use leads to bingeing 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 percent 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 percent of the adolescent population.  Out of those who were identified as having an AUD, only 6.7 percent of adults and 5.2 percent of adolescents received treatment for their conditions.5

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.6

HOW DOES AUD AFFECT THE BODY?

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 tract, as well as breast cancer in women

Difficulty managing existing health conditions like diabetes, high blood pressure, pain conditions, and sleep disorders

All of these health problems can be fatal if not treated, and the continued use of alcohol during treatment usually renders treatment less effective or not effective at all.

Heavy alcohol use can also lead to problems resulting from the impaired judgement 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.

Withdrawal and Detox

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:

SWEATING

SHAKINESS

NAUSEA AND VOMITING

HEADACHE

DIFFICULTY SLEEPING

ANXIETY

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.

Delirium Tremens

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:

HALLUCINATIONS

DELUSIONS

HIGH BLOOD PRESSURE

PROFUSE SWEATING

CONFUSION

RACING HEARTBEAT

FEVER

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.

TREATMENT FOR ALCOHOL USE DISORDER

Although many treatment options exist for AUD, the number of people who actually receive treatment in the United States remains quite low. According to the National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), the percentage of survey participants age 12 and older who reported receiving alcohol related treatment did not change significantly from 2013 to 2017.7

One of the reasons people may not seek treatment for AUD could be a lack of awareness of the many treatment options that now exist. Here is a short list of commonly used treatment options for AUD, along with brief descriptions of each:

Medications

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:

NALTREXONE

An anti-opioid drug that reduces cravings for alcohol

ACAMPROSATE

A drug that stabilizes the chemical signals in the brain that are normally disrupted by symptoms of withdrawal

DISULFIRAM

Commonly known as Antabuse, this drug produces increased sensitivity to alcohol in the body, resulting in adverse symptoms such as headaches and nausea when alcohol is consumed

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.

Behavior Treatment

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

Identities 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

BRIEF INTERVENTIONS

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

12-Step Programs

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.

Inpatient Rehabilitation Programs

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.

CONCLUSION

Recovery from an AUD is difficult, but it doesn’t have to be impossible. With the growing number of treatment options available, customized treatment is there for anyone who chooses to look beyond the bottle and seek help.

Resources


    1. Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5. (2019, June 26). Retrieved July 17, 2019, from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm
    2. FastStats – Alcohol Use. (n.d.). Retrieved July 17, 2019, from https://www.cdc.gov/nchs/fastats/alcohol.htm
    3. Alcohol Facts and Statistics. (2018, August 12). Retrieved July 17, 2019, from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics
    4. Kochanek, K. D., M.A., Murphy, S. L., B.S., Xu, J., M.D., & Arias, E., Ph. D. (2019, June 24). Deaths: Final Data for 2017. Washington, D.C.: National Center for Health Statistics. https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf
    5. What are symptoms of alcohol use disorder? – Rethinking Drinking – NIAAA. (n.d.). Retrieved July 17, 2019, from https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/Whats-the-harm/What-Are-Symptoms-Of-Alcohol-Use-Disorder.aspx
    6. Dick, D.M. & Bierut, L.J. Curr Psychiatry Rep (2006) 8: 151. https://doi.org/10.1007/s11920-006-0015-1
    7. NSDUH National Survey on Drug Use and Health. (2019, June 12). Retrieved July 17, 2019, from https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health