Part of the complete guide to understanding addiction
Alcoholism
Alcoholism or alcohol use disorder, is a disease that causes out of hand drinking and a near constant craving for alcohol. Alcoholics will often prioritize drinking over their personal safety, their relationships, and their careers. Alcoholism can cause debilitating side effects and may have an overall detrimental effect on the sufferers quality of life. Treatment is available for alcoholism, and long term recovery is achievable.
What Alcohol is: A Brief Introduction
Alcohol has wielded an oversized influence on world history ever since the beginning of time. It has featured prominently in every century, every region, and almost every culture, religious and secular alike. Although there are three distinct forms of alcohol, ethanol (ethyl alcohol) is the form found in alcoholic beverages and the only one that humans can safely ingest. It is made by breaking down sugars with yeast chemically, or by way of fermentation. Alcohol can be created from plants such as grain, wheat, and barley, and from sugar-rich fruits such as the classic grape.
In the United States, resistance to unchecked alcohol use began in the form of “The Temperance Movement”. In 1785, Benjamin Rush, renowned physician and signer of the Declaration of Independence, penned a remarkable essay entitled “An Inquiry into the Effects of Ardent Spirits Upon the Human Body and Mind.” First into the fray in a country that viewed alcohol consumption as a way of life, he touches on modern concepts such as addiction as a disease model, triggers, and environmental influence.
The movement gained steam on a national level in the 1830’s and culminated close to a century later with the passing of the ill-fated eighteenth amendment, known as Prohibition. Although it initially succeeded in significantly reducing American alcohol use, black market distilling and home stills proliferated rapidly. The new lack of regulation (due its illegal status) and sacramental or medical loopholes were heavily exploited, and the corollary decline in safe production processes led to an estimated 10,000 deaths and increased levels of alcohol abuse throughout the country. In 1933 Prohibition was repealed, and America has been indulging unabated ever since.
In 1956, the American Medical Association (AMA) first recognized alcoholism as a disease. In the early stages of understanding alcohol abuse as a disease, the Diagnostic and Statistical Manual of Mental Disorders (DSM) ruled that tolerance or withdrawal symptoms were obligatory for a diagnosis of alcoholism. With the release of its fourth edition in 1994, the framework was expanded to loss of control and inability to abstain, and upon arrival of the DSM-5, all forms of alcohol addiction were consolidated under the term Alcohol Use Disorder (AUD).
Alcohol, although not recognized in any substance schedule under the Controlled Substance Act (CSA) and entirely unregulated statewide, is the culprit in millions of deaths and is among the leading causes of preventable deaths [1] in the United States. It is estimated to be imbibed by over 2 billion people daily.
Forms of Alcoholic Beverages
Undistilled alcohol is the state of a beverage upon completion of fermentation. Beer, possibly the oldest and most consumed alcoholic beverage in the world, is a prime example of undistilled alcohol [2]. The most popular drink in the world after water and tea, its alcohol by volume (ABV) is an average of 4.5 percent [3].
Wine is another member of the undistilled alcohol family. Its average ABV is 11.6 percent [3]. There are wines that are fortified with distilled alcohol, such as Port, Madeira, and Vermouth. Such variations can push the alcohol volume up to around 20 percent.
Sake, a Japanese beverage made from fermenting rice, and hard cider -derived from apple and pear juice- are other forms of alcohol in its undistilled state.
Distillation is accomplished by separating (concentrating) alcohol from water and its chemical components upon fermentation. This significantly raises the alcohol content and is how hard liquors and spirits are manufactured. Vodka, bourbon, rum, and scotch are all distilled alcoholic beverages. There are bottles of Bacardi rum that reach an ABV of over 75 percent.
How Alcohol Intoxicates
Although alcohol is considered to be a depressant, the initial phases of intoxication mimic the effects of a stimulant substance. It will instruct the brain to release dopamine at heightened levels, therefore inducing euphoria and lowering inhibitions.
Eventually, however, it will increase the effects of a neurotransmitter known as Gamma-Aminobutyric Acid (GABA) [4]. GABA dampens brain response and inhibits the body’s performance, causing the clumsiness and speech impairments alcohol is famous for. It is thus classified as a Central Nervous System (CNS) depressant.
Alcoholism Symptoms
Signs of alcoholism include but are not limited to:
- Inability to stop drinking when you want to
- Spending a large amount of time drinking or recovering from drinking
- Craving alcohol to the exclusion of all else
- Suffering negative effects in your relationships and career
- Driving under the influence
- Losing large amounts of time in “memory blackouts”
- Suffering withdrawal symptoms when the alcohol wears off
Read more about 3 surprising physical signs of alcohol abuse in our useful resources.
DSM-5 Criteria of Alcohol Use Disorder (AUD)
The DSM-5 uses 11 criteria to diagnose AUD. They are listed here.
In the past year have you:
- Had times when you ended up drinking more or longer, than you intended?
- More than once wanted to or tried to cut down or stop drinking, but couldn’t?
- Spent a lot of time drinking, being sick or getting over other aftereffects?
- Wanted a drink so badly you couldn’t think of anything else?
- Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
- Continued to drink even though it was making you feel depressed or anxious or exacerbating another health problem? Or after having had a memory blackout?
- Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, seizures, or hallucinations?
Under the DSM guidelines, presenting with at least 2 of these criteria indicates an AUD. Meeting 2 criteria is classified as mild: upon reaching 4 to 5 symptoms it is considered moderate, and 6 or more is severe.
Denial of Alcohol Abuse and High Functioning Alcoholics
Denial, while present in all forms of addiction, is perhaps most rampant with alcoholism. In many cases, alcoholics continue to function at high levels and are therefore dismissive of the possibility of struggling with addiction. According to studies by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) [5], almost 20 percent of U.S. alcoholics classify themselves as functional. They are often well educated, middle-aged men who have families and hold stable jobs.
Learn more about the high functioning alcoholic
The fact that drinking is legal and unregulated also contributes heavily to the perception that excessive drinking is not a real problem and certainly not an illness.
Intervention, when done properly, is a highly useful tool in getting the alcoholic to understand the magnitude and ramifications of his alcohol issue. No commitment to recovery can begin until he or she is finally convinced that they do in fact have a problem and need help.
Side Effects of Alcohol Abuse
The range of illnesses linked to alcohol is staggering. Its list contains a veritable who’s who of infamous killers. Cancers, liver and kidney failure, and chronic heart disease all feature prominently and are a mere sampling of the damage caused by alcohol abuse.
Alcohol is metabolized through the liver. With overconsumption, the liver works overtime to process the deluge and can become permanently scarred. This condition is called Cirrhosis and is very common among alcoholics.
Although there are many other dangers associated with AUD, it is well beyond the scope of this article to thoroughly address them all.
Alcoholism Statistics
The NIAA estimates that 14.5 million Americans suffer from AUD. Its mark is felt on adolescents aged 12 to 17 as well, with 414,000 adolescents reported as suffering from the disease in 2019 [1]. Greatly exacerbating the issue, over 90 percent of sufferers of AUD never seek treatment, and in many cases do not have the slightest inkling that they are in fact dealing with a vicious disease [1].
Close to three million lives are lost annually from alcohol-related causes worldwide. In the United States alone, alcohol’s death toll is at 95,000, and it ranks as a leading cause of preventable death [6].
Withdrawal, Detox, and Treatment
Withdrawal symptoms from alcohol can be severe. They include:
- Anxiety
- Shaking extremities
- Nausea and vomiting
- High blood pressure
- Sweating and fever
- Insomnia
- Confusion and hallucinations
Due to the dangers of suddenly quitting alcohol, it is imperative to undergo drug detox treatment in a professional setting under the watchful eye of medical professionals. Once sobriety is accomplished, a recovering alcoholic should enter treatment to learn the tools with which to achieve long term sobriety.
Great care should be taken to choose a facility whose foremost priority is the health of their clients. There are many trustworthy providers in the substance abuse and addiction treatment field who work with integrity and passion. It is vital to ensure that a recovering alcoholic finds such a community; his or her life is at stake. If you know that a loved one has an alcohol addiction, read our article on how to encourage an alcoholic to get help for some pointed guidance.
Learn more about Avenues alcohol detox programs.