For most adults, moderate or social alcohol use is not problematic, however, approximately 18 million American adults have an alcohol addiction, or what is medically termed as an Alcohol Use Disorder. Far more experience binge drinking or other forms of excessive, irresponsible, or problematic alcohol use. While severe alcohol abuse is often blatant, mild abuse or problem drinking is often difficult for individuals to recognize or acknowledge within themselves or a loved one. Many are unaware of the symptoms of alcohol abuse, the dangers of alcohol withdrawal, and what to do if an alcohol problem arises. Below is some basic information to help individuals navigate alcohol addiction.
Key Terms
Alcohol Use Disorder (AUD) is the clinical term used by addiction specialists and mental health professionals to diagnose an individual as having a problem with alcohol of varying degrees. To be diagnosed as such, an individual is assessed and needs to meet specific diagnostic criteria by a professional. Such criteria may include but is not limited to drinking more or longer than initially intended, having difficulty moderating or stopping alcohol use, alcohol use interfering with life obligations such as work or school, and continuing to drink alcohol despite negative consequences, as well as several others. Depending on the severity of symptoms an individual with AUD can be assessed as having a mild, moderate or severe diagnosis.
Alcohol abuse is the habitual misuse of alcohol. Alcohol abuse used to be a clinical term used by medical professionals to diagnose an individual as having a mild/moderate problem with alcohol. Now the term used is Alcohol Use Disorder (mild or moderate).
Alcohol dependence is the excessive and uncontrollable use of alcohol. Alcohol dependence was a clinical term used by medical professionals to diagnose an individual as having a severe problem with alcohol. Now the term used is Alcohol Use Disorder (Severe). Individuals with alcohol dependence are generally daily and frequent drinkers who experience withdrawal symptoms when they abruptly stop drinking.
Binge drinking is defined as consuming large amounts of alcohol in a short period of time, bringing your blood alcohol concentration (BAC) to .08 g/dl or greater. This is generally defined as 5 or more drinks for men within 2 hours or 4 or more drinks for women within 2 hours, but can vary from person to person depending on physiological factors such as body mass index. Binge drinking is done in such a pattern that the individual can go days, weeks, or perhaps even months without drinking to excess, but will eventually have a binge episode.
The terms alcoholism or alcohol addiction are often used interchangeably by the general public as describing an individual who has an Alcohol Use Disorder. Although these terms may be used by addiction specialists during conversation, they are not used in a clinical or professional sense. The term alcoholism or describing oneself as an alcoholic are commonly used in mutual help groups such as Alcoholics Anonymous.
A problem drinker is an individual who may not meet the clinical criteria for Alcohol Use Disorder, but their alcohol consumption may still be problematic. These are generally individuals who have extremely mild symptoms or experienced consequences from drinking such as DUI/DWI. Such individuals may still benefit from receiving some type of alcohol addiction counseling, alcohol education, or mutual support group for alcohol.
A craving is when an individual has a strong desire to drink alcohol. Although cravings are primarily psychological, they can be physiological in nature as well.
A relapse is when an individual with an alcohol problem has maintained abstinence for some period of time and then returns to drinking alcohol. When relapses are isolated events and/or involve a very small quantity of alcohol some people refer to these relapses as “slips.”
Tolerance to alcohol occurs in frequent alcohol drinkers over time as the individual’s body becomes acclimated to the effects of alcohol. This results in alcohol producing a reduced effect on the individual and/or the individual requiring more alcohol over time in order to produce the same effects at earlier stages in their alcohol use.
Alcohol withdrawal refers to mental and physical symptoms that occur when an individual stops drinking alcohol and can range from mild to moderate to severe. Alcohol withdrawal can have an onset within just a few hours of the last drink, generally peak within 1 to 4 days, and begin to subside after 7 days. Mild withdrawal symptoms can last for weeks or months, known as post-acute withdrawal. Alcohol withdrawal symptoms can include headaches, nausea, vomiting, hallucinations, insomnia, heart palpitations, abnormal breathing, seizures, tremors, anxiety and depression among others, and can be fatal.
Medical detoxification for alcohol, or often referred to as alcohol detox, is the process of an individual safely stopping their alcohol use under supervision and guidance from medical professionals who specialize in the treatment of alcohol dependence. Although alcohol detox can be done on an outpatient basis, it is more commonly done in an inpatient setting. Alcohol detox typically lasts for approximately 5 to 7 days and utilizes medication such as Librium (Chlordiazepoxide) to mitigate alcohol withdrawal symptoms while closely monitoring the patient’s vitals to ensure safety.
Alcohol rehabilitation is the process of helping an individual with an alcohol problem to achieve the highest degree of health, functioning and quality of life possible. Although alcohol rehabilitation nearly always involves complete abstinence from alcohol, there are alcohol moderation and harm-reduction programs that exist for patients that are appropriate based on their history and relationship with alcohol. However, even such programs usually entail 4-6 weeks of abstinence at the onset of treatment.
Alcohol rehabilitation may start with inpatient alcohol treatment for individuals with moderate to several alcohol use disorder, often referred to as “rehab.” Inpatient alcohol treatment involves the admission to a clinic, treatment center or hospital specializing in alcohol treatment at which the individual will remain overnight for a period of time. The duration of inpatient alcohol treatment is often 30 days, 60 days, or 90 days, but there are also longer-term inpatient programs of 6 months to 12 months. Inpatient treatment for alcohol often involves individual therapy sessions, group therapy sessions, medication assisted treatment, as well as holistic methods of treatment such as meditation, yoga, nutritional therapy, exercise, or spiritual counseling among others.
If an individual has a mild to moderate alcohol use disorder, they may be appropriate to begin with outpatient alcohol treatment at an alcohol treatment center or with a mental health professional specializing in substance abuse such as a therapist or psychiatrist specializing in alcohol treatment. Outpatient alcohol treatment involves therapy such as Cognitive Behavioral Therapy for alcohol use disorder and may also include medication assisted treatment if deemed appropriate and beneficial to the patient. There is more information on alcohol treatment below in the section titled, “How is Alcohol Addiction Treated?”
How Does Somebody Become Addicted to Alcohol?
Most of us know that alcohol is addictive, but many do not understand why alcohol is addictive or why some become addicted to alcohol while others do not. At the root cause of alcohol addiction is the impact that alcohol has on the brain. During the early stages of alcohol use, the brain releases dopamine. This neurochemical is linked with feelings of pleasure. Over time, individuals associate alcohol with feeling good and revert to drinking alcohol to induce pleasure. Concurrently individuals build physical tolerance to alcohol, resulting in the individual requiring more of it in order to produce the same desired effect. Physical tolerance to alcohol also results in physical withdrawal when the individual stops drinking alcohol abruptly, meaning that the individual will need to drink alcohol to simply feel normal and not experience withdrawal symptoms.
Why some individuals become addicted to alcohol and others do not is still a phenomenon that is being studied by addiction researchers. However, we do know that there are underlying facets that can make some individuals more susceptible to develop an alcohol addiction than others. For example, genetics can play a role. That is, if you have a history of addiction in your family you are more likely to develop an addiction yourself. The environment also plays a role. Those who grow up in families with easy access to alcohol or who are surrounded by alcohol in their community or through their peers are also more likely to develop an addiction to alcohol. Environments of physical, mental, emotional, or sexual abuse can have a similar result. Also, those who begin to drink alcohol at an early age are more likely to develop an alcohol problem than those who begin to drink later in life. More than 90% of people who have an addiction to alcohol started to drink before they were 18 years old. Another contributing factor alcohol dependence is having a mental health issue.
What Are the Symptoms of Alcohol Addiction?
Symptoms of alcohol addiction include:
What Are the Symptoms of Alcohol Withdrawal?
Withdrawal symptoms can be physical or psychological. Some common alcohol withdrawal symptoms may include:
How is Alcohol Addiction Treated?
Alcohol addiction is treated in a number of ways and should be tailored to meet the unique needs of the individual. Areas to consider for alcohol treatment include but are not limited to the individual’s history with alcohol with regards to frequency of alcohol use, quantity of alcohol use, past attempts to stop drinking, multicultural considerations, and the individual’s level of willingness to receive help, motivation to stop drinking, and insight into their problem with alcohol.
The first step of alcohol addiction treatment may require a medically supervised detoxification if the individual is vulnerable to moderate/severe withdrawal symptoms when they stop drinking. Alcohol withdrawal can be fatal, so it is imperative that the individual seek out medical attention if they begin to experience moderate withdrawal symptoms or have experienced such symptoms during past attempts to stop drinking. Medical detox involves medical supervision to monitor withdrawal symptoms and monitoring of vitals to ensure safety, medication to mitigate withdrawal symptoms and side-effects of withdrawal, and brief therapy and support for alcohol dependence. For more information on detoxing from alcohol please read, “Do I Need a Medical Detox From Alcohol?”
Once the individual is detoxed from alcohol they can begin alcohol addiction treatment. There are a wide variety of options and methods of treatment. A good starting point is to determine if the individual requires inpatient treatment, which may involve a 30-day, 60-day, or 90-day stay at an alcohol rehab facility where they will undergo a variety of traditional therapies, holistic therapies, and medication assisted treatment if deemed appropriate and beneficial. These treatments are also available on an outpatient basis via an outpatient rehabilitation facility for alcohol or privately with therapists who work in conjunction with addiction psychiatrists.
Common forms of therapy used for alcohol treatment include but are not limited to Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Rational Emotive Behavioral Therapy (REBT) and other behavioral therapies as well as Motivational Interviewing. Furthermore, many individuals with an alcohol use disorder also have a diagnosis of a mental health issue such as depression, anxiety, PTSD and other disorders. As such, mental health issues are treated concurrently with alcohol dependence in order to mitigate chances of relapse and improve overall wellbeing.
Recovery coaches for alcohol, also sometimes termed sober coaches, are another popular form of support for alcohol recovery; however, one should know that recovery coaches and sober coaches are usually not therapists or medical professionals, and usually serve as a good additional source of support to traditional alcohol treatment and/or aftercare plan. The same is true of mutual help groups such as Alcoholics Anonymous, SMART Recovery or Refuge Recovery. While many individuals can and do get sober solely through such mutual help groups, traditional treatment is encouraged for individuals with moderate to severe alcohol use disorder.
For more information on various treatment approaches for alcohol addiction please read, “A Guide to the Different Pathways of Addiction Recovery.”
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