What to Know About Alcohol Use Disorder

According to the National Institutes of Health, an alcohol use disorder (AUD) is defined as a “chronic relapsing brain disease” that causes a person to drink compulsively despite adverse consequences to daily life and overall health.

Alcohol use disorder replaced the designations that had previously been separately defined as "alcohol abuse" and "alcohol dependence."

Symptoms

It is common for people to deny that they misuse alcohol. Furthermore, you may not recognize the signs of an alcohol use disorder in yourself or in someone else.

The "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition," (DSM-5), published in 2013, has created a list of 11 symptoms that indicate an alcohol use disorder. The more symptoms you have, the more urgent the need for help.

• Alcohol is often taken in larger amounts or over a longer period than was intended.
• There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
• A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
• Craving, or a strong desire or urge to use alcohol.
• Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
• Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
• Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
• Recurrent alcohol use in situations in which it is physically hazardous.
• Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
• Tolerance, as defined by either a need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or a markedly diminished effect with continued use of the same amount of alcohol.
• Withdrawal, as manifested by either the characteristic withdrawal syndrome for alcohol, or alcohol (or a closely related substance, such as a benzodiazepine) taken to relieve or avoid withdrawal symptoms.

Diagnosis

Roughly 15 million people in the United States were diagnosed with an AUD in 2018, including 19.2 million men, 5.3 million women, and 401,000 adolescents ages 12–17.

To be diagnosed with an AUD, individuals must experience two of the 11 criteria of AUD as outlined by the DSM-5 during the same 12-month period. Here's a quick summary of the above criteria:

• Drinking more than intended
• Trying to quit without success
• Increased alcohol-seeking behavior
• Missing work or school due to drinking
• Interference with important activities
• Craving for alcohol
• Drinking despite social or personal problems
• Continued use despite health problems
• Drinking in hazardous situations
• Build up of tolerance
• Withdrawals when trying to quit

Causes and Risk Factors

An alcohol use disorder can result from a combination of genetic, environmental, psychological, and social factors, many of which are still being researched. Some of the most common risk factors include:

• Heavy, chronic drinking: Drinking too much alcohol has been found to alter the parts of the brain responsible for pleasure, judgment, and self-control, which can cause alcohol cravings.
• Family history: Children of parents with an alcohol use disorder are two to six times more likely than the general public to develop an AUD. This increased risk is likely due genetics as well as environmental and lifestyle influences shared by members of the family.
• History of trauma: Childhood trauma, including emotional abuse, sexual abuse, physical abuse, emotional neglect, and physical neglect, have all been linked to an increased risk for an AUD in adulthood.
• Psychiatric disorders: People with a mental health disorder such as anxiety, depression, schizophrenia, and bipolar disorder have been found to have higher rates of misusing alcohol or other substances. In fact, studies show that over one-third of patients with schizophrenia meet the criteria for an AUD diagnosis.
• Social and cultural influences: Having parents, peers, partners, and other role models who drink regularly may increase a person’s risk of developing an AUD, especially if the person is exposed to heavy drinking at a young age. 

Another important factor that influences the risk of alcohol on the body is nutrition. Alcohol and nutrition can interact in a number of ways—heavy alcohol use can interfere with nutrition while alcohol/nutrition interacts can impact gene expression.

Types

Alcohol use disorder is sub-classified into mild, moderate, and severe categories.

• Mild: If you have two to three of the 11 symptoms on the list, you could be diagnosed with a mild disorder.
• Moderate: If you have four to five symptoms, you are likely to have a moderate alcohol use disorder.
• Severe: If you have six or more of the symptoms, you have a severe alcohol use disorder.

Treatment

The good news is that most people with AUD can benefit from treatment, which often includes a combination of behavioral treatment, medication, and support. The bad news is that less than 10% of people actually receive treatment , often due to fear of stigma or shame, denial or lack of problem awareness, skepticism about treatment, and lack of accessibility to affordable treatment.

A good first step is talking to your primary care physician, who can assess your overall health, evaluate the severity of your drinking, help craft a treatment plan, refer you to an addiction specialist or treatment program, and determine if you need any medications for alcohol.

Detox and Withdrawal

Depending on the severity of your AUD, you may need to undergo medical detox to help treat the symptoms of alcohol withdrawal, which can range from mild to severe.

Detox can be done on an in-person or outpatient basis and include intravenous (IV) fluids to prevent dehydration and medications to minimize symptoms and treat seizures or other complications of alcohol withdrawal.

Behavioral Treatment

A big part of AUD recovery is working with a trained professional to better understand your relationship with alcohol and to learn how to cope with daily living without alcohol. Behavioral treatment can also help with any co-occurring mental illnesses contributing to the AUD.

• Cognitive behavioral therapy: aims to teach you to recognize and avoid the situations in which you are most likely to drink and to cope with other problems and behaviors that may lead to alcohol misuse.
• Motivational enhancement therapy: aims to help you build your confidence and motivation to stop drinking.
• Family therapy: aims to help families become aware of their own needs and prevents substance misuse from moving from one generation to another.
• Brief interventions: aims to get the person to reduce their level of drinking or change their harmful pattern of drinking.

Medications

There are currently three medications approved by the FDA for the treatment of an alcohol use disorder. While not all people will respond to medication, many find it helpful in reducing cravings and maintaining abstinence, especially when combined with behavioral treatment and support.

• Naltrexone (Revia, Depade, Vivitrol): reduces the craving for alcohol
• Acamprosate (Campral): reduces post-acute withdrawal symptoms during the early stages of alcohol abstinence
• Disulfiram (Antabuse): causes unpleasant symptoms such as flushing, nausea, vomiting, and headache when you drink alcohol

Support Groups

Online and community-based recovery groups can also be helpful during alcohol withdrawal and addiction treatment. A support group, like Alcoholics Anonymous or SMART recovery, can help you feel less isolated and provide an opportunity to learn from and connect with others with similar problems and shared experiences.

Coping

In addition to getting appropriate AUD treatment, there are things that you can do on your own that will make it easier to cope with and sustain your recovery.

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Recognize Your Triggers

Understanding what might trigger you to relapse and having a plan in the place for such triggers is important for staying sober during and after treatment for an AUD.

Some common triggers may include:

• Stress
• Emotional distress
• Environmental cues that result in cravings
• People who are still using drugs or drinking
• Relationship troubles
• Job or financial problems

Practice Self-Care

A big part of recovery is building resilience toward life stressors without turning to alcohol, and practicing self-care (focusing on your physical, social, mental, and spiritual well-being) can help. Taking steps to care for your mind and body will better equip you to live your best sober life.

Seek Support

Social support from friends and family as well as online or in-person support groups can help prevent feelings of isolation and shame and provide a sense of security and hope about your sober future. Family members and loved ones can also benefit from this type of support and may consider groups like Al-Anon and Alateen.