Alcohol Addiction and Treatment
Information About Alcoholism and Recovery
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Basic Facts About Alcohol
The alcohol in beer, wine, and liquor is produced when the sugars, yeasts, and starches from grain, fruits, or plants are fermented. Known as ethyl alcohol, this is the intoxicating ingredient in standard alcoholic beverages (Drugs.com, 2014). Different forms of liquor vary in the amount of alcohol they contain. For example:
- One beer (12 oz) contains about 5% alcohol.
- One light beer (12 oz) contains about 4.2% alcohol.
- One glass of wine (5 oz) contains approximately 12% alcohol.
- One serving of distilled liquor (1.5 oz) contains approximately 40% alcohol (NIAAA, 2014).
Drinking in Moderation
Research has shown that there are positive and negative personal effects of using alcohol. The Harvard School of Public Health has said that, "alcohol is both a tonic and a poison. The difference lies mostly in the dose." Drinking in moderation is the point at which there are only positive benefits and no negative consequences. Moderate drinking is usually considered to be no more than one to two drinks per day for men, and no more than one drink per day for women. Research has suggested that some of the positive effects of moderate drinking are improved cardiovascular health, improved digestion, and protection against diabetes and gallstones (Harvard School of Public Health, 2014).
The Immediate Effects of Drinking
Feelings of relaxation and euphoria are typically the most sought-after effects of drinking. Every individual who drinks alcohol, however, will have a somewhat unique experience. One's physical condition, for example, is a significant factor in determining what effects drinking will have. Some people have a greater tolerance for alcohol than others, for instance. Others may have illnesses that cause unusual reactions when alcohol is consumed. Additionally, people who take medication can have unusual and sometimes severe reactions when they drink.
There are other factors that determine the immediate effects of drinking. One's mental and emotional state contributes to the effect drinking will have, for example. When angry, for instance, one person may relax after drinking, but another may become angrier or even aggressive. Also, the setting in which one is drinking can affect what happens when a person becomes intoxicated. One may become less inhibited when drinking, for example, and respond to others in ways that are not one's usual habit. For example, a usually shy and socially awkward person may become outgoing and flirtatious at a party after consuming alcohol. Also, individuals with a mental health condition can experience increased symptoms, unusually severe mood swings, and unusual thoughts when using alcohol.
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Intoxication and Functioning
Intoxication is the point in drinking where noticeable changes in a person's mood and physical and mental abilities occur. This is because of the alcohol's effect upon the brain and nervous system. The amount of alcohol in one's system—the Blood Alcohol Content (BAC)—indicates the degree of intoxication and the general effects of drinking. For example, a BAC of .056 is considered the level where "positive, relaxed, euphoric effects of the alcohol are experienced. When a BAC of .056 is exceeded, the negative…effects of alcohol take place" (University of Notre Dame, 2008).
Higher BAC levels cause a loss of abilities and can result in harm to one's self, others or property.
Consequently, there are legal definitions of intoxication. A BAC of .08 is considered to be intoxication (University of Notre Dame, 2008) and indicates a "state in which a person's normal capacity to act or reason is inhibited by alcohol or drugs" (Gale Group, 2008).
Signs of intoxication can be observed by others and include:
- Facial flushing
- Slurred speech
- Slowed reactions
- Disorderly conduct
- Impaired judgment
- Impaired coordination
- Slowed mental processes
- Perception problems (World Health Organization, 2014)
Moderate drinking is usually considered to be no more than one to two drinks per day for men, and no more than one drink per day for women.
Drinking to Excess
Drinking alcohol above the recommended levels can have serious health consequences. For example, drinking in excess can cause cardiovascular problems (high blood pressure, stroke and heart attack); liver problems, and increased risks for some types of cancers (NHS, 2014). Drinking in excess contributes significantly to fatal traffic accidents, depression, violence, and damage to unborn children (Harvard School of Public Health, 2014).
Some of the other negative effects of excessive drinking include:
- Unintentional injuries to one's self due to accidents such as falls and burns
- Self-harm due to depression and suicidal thinking
- Non-protection of children
- Job failure and loss
- Work accidents
- Poor performance on the job or in school
- Brain damage
- Poor nutrition
- High risk behaviors
- Alienation of others
- Failure to fulfill duties, obligations and responsibilities (Foundation for a Drug Free World, 2006-2014)
Alcoholism (Alcohol Use Disorder)
Alcoholism is the common term for the medical condition of an Alcohol Use Disorder (AUD). If given the diagnosis of alcoholism or AUD, one is considered to have used alcohol to the point of being clinically impaired or distressed. Some of the impairments and stressors a person with an AUD may experience include negative impacts to:
- Physical health
- Mental health
- Emotional health
- Social relationships
- Family relationships
- Occupational or academic life
- Legal status
- Financial life
The toll that alcoholism can take on family relationships is especially concerning. Many children of alcoholics grow up feeling abandoned, insecure, and guilty. Parental alcoholism can have severe long-term consequences for children, even well into their adulthood.
Alcohol Addiction Symptoms
The symptoms of an alcohol use disorder reflect a pattern of maladaptive use of alcohol. This pattern continues even though there are problems caused by using alcohol. To receive the diagnosis of an AUD, at least 2 of the following must occur within a 12-month period:
- Alcohol use causes failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household).
- Alcohol is used in situations that are physically hazardous such as driving or operating machinery.
- One continues to use alcohol despite problems with others caused by using alcohol or made worse by using it, such as marital conflict about alcohol use or arguments and fights with others.
- There are tolerance changes such as a person needs more alcohol to feel the desired effect or feels less effect while continuing to drink the same amount.
- Withdrawal is experienced when use is reduced or stopped.
- More alcohol is consumed—over a longer period of time—than was originally intended.
- There is a persistent desire to cut down or stop drinking, or unsuccessful efforts to cut down or stop drinking.
- A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
- One continues to drink despite knowledge of having a physical or psychological problem that is likely to have been caused or worsened by drinking.
- One craves alcohol or has a strong desire or urge to use alcohol (American Psychiatric Association, 2013).
Alcoholism vs. Alcohol Abuse
The differences between alcoholism and alcohol abuse aren't always easy to spot—unless you know what to look for. Despite sharing many commonalities, at least one big factor separates the two problem-drinking conditions: physical dependence. That's usually the main difference in how each condition is defined.
A typical alcohol abuse definition includes mention of several problematic signs and symptoms. For example, an abuser of alcoholic beverages may neglect important responsibilities, harm close relationships, take dangerous actions when drunk, get into legal trouble as a result of drinking, or consistently use booze as a way to cope with stress or avoid bad feelings. At this stage, a person is still able to control his or her liquor consumption, which means that he or she is not physically dependent on alcohol yet.
An alcoholism (or alcohol addiction) definition typically includes mention of all or most of the same symptoms of alcohol abuse. However, it also includes the fact that people with this condition physically depend on the regular consumption of alcohol. That is, true alcoholics or alcohol addicts rely on booze to function and typically can't control their consumption of it. As a result, they frequently try to rationalize their harmful actions, blame other people, or deny that they have a drinking problem.
Other major warning signs of alcoholism that are over and above the signs of alcohol abuse include:
- A high and growing tolerance to alcohol—Over time, people who become physically dependent on alcohol often need to consume higher and higher amounts of booze in order to feel any effects from it. As a result, many of them are able to drink a lot more liquor than other people before becoming drunk. That's why, in some cases, an especially high tolerance to alcohol can be one of the most telltale signs of an alcoholic.
- Physical withdrawal symptoms—People who are truly addicted to alcohol will experience physical symptoms if they aren't able to consume it. For example, a person with chronic alcoholism who stops drinking may experience symptoms such as:
- Trembling or shakiness
- Bad headaches
- An upset stomach
- Extreme tiredness
- An inability to sleep
- Excessive sweating
- A loss of appetite
- Mental or emotional withdrawal symptoms—An alcohol addict who isn't able to consume booze may also experience symptoms such as increased irritability, a quicker temper, or moderate or severe depression.
In extreme cases, an alcoholic may experience other withdrawal symptoms like seizures, confusion, or even hallucinations. That's why, if you or anyone you know is showing the signs of alcohol addiction, it's vital to seek professional help.
Why Is Alcohol Addictive for Some People? Who Is at Risk?
Although direct causes of alcohol addiction are not yet known, certain factors do seem related to problematic drinking. They include:
- Genetics—Alcoholism often runs in families.
- Trauma—Many people with alcohol problems have experienced traumatic events such as childhood physical and/or sexual abuse. There is also a strong correlation between people with trauma in adulthood and alcohol use.
- Emotional issues—Many with alcohol problems use alcohol to manage their emotions and cope with stress.
- Self-image and self-esteem issues—Many drink to ease the discomfort of poor self-esteem, lack of confidence, and feelings of low self-worth. Alcohol provides temporary relief from these feelings. There is a temporary ability to have a sense of fitting in, being worthy, and having confidence when drinking.
- Social issues—An environment that encourages excessive alcohol use creates a false sense of safety and normalcy in drinking to excess and gives "permission" to drink irresponsibly.
- Mental health disorders—There is a strong relationship between drinking and depression, anxiety, and PTSD.
- Age—Those who start drinking at earlier ages tend to develop problematic drinking more than those who begin to drink later in life (Mooney, 2014).
Since the factors listed above are fairly common in today's society, it's no surprise that some people eventually become alcoholics. How many? Well, alcohol addiction statistics from 2014 show that over 16 million adults and about 679,000 minors in the U.S. had an alcohol use disorder. Plus, almost 88,000 people in the U.S. die each year from causes related to alcohol. (NIAAA, 2016).
Other Conditions Related to Alcohol Use
Alcohol use can cause a wide range of conditions other than what we typically think of as alcoholism. Many of these are reversible, but some do persist due to brain and nerve damage caused by alcohol.
These include the following, known as Alcohol-Induced Mental Disorders:
- Alcohol-Induced Psychotic Disorder—hallucinations, delusions
- Alcohol-Induced Anxiety—nervousness, fear, dread, worry, excessive concern
- Alcohol-Induced Mood Disorder—depression, irritability, anger, mood changes, mood swings
- Alcohol-Induced Sexual Dysfunction—difficulty with sexual performance such as problems achieving or maintaining an erection and/or orgasm, premature ejaculation
- Alcohol-Induced Delirium—out of touch with reality, disoriented, agitated, disorganized
- Alcohol-Induced Persisting Dementia—memory problems, confusion, communication difficulties, difficulty performing tasks, overall decline in mental functioning
- Alcohol-Induced Persisting Amnestic Disorder—memory impairments
- Alcohol-Induced Sleep Disorder—insomnia, excessive sleeping, non-restful sleep, frequently interrupted sleep. (SAMSHA/CSAT, 2005)
Alcohol Addiction Treatment
The treatment of an alcohol use disorder includes various stages and treatment techniques. Personal preferences, medical necessities, and the degree of need for emotional support during treatment will determine what types of methods and settings are best. An evaluation to determine one's treatment needs and options should be done in collaboration with a treatment professional to begin the process. After the evaluation, a detailed plan of action—the treatment plan—can be made to suit individual needs.
One should consult closely with a healthcare provider before choosing to withdraw from alcohol to determine the safest option to pursue.
Alcohol Withdrawal and Detox
Withdrawal and detox are the initial stages of treatment. Alcohol use is stopped under medical supervision and the body transitions through withdrawal from it. This can be done with the use of alcohol addiction medication to decrease emotional and physical discomfort. Medical monitoring is important during withdrawal from alcohol due to the risks of complications such as high blood pressure, stroke, seizures, and other medical concerns such as malnutrition, sleep disturbances, and depression. All of these possible medical issues can put an individual at high risk for harm if withdrawing from alcohol without medical attention.
Withdrawal and detox are commonly done in a medical setting with licensed medical professionals trained in addiction treatment. Hospitals and inpatient or residential drug and alcohol rehabilitation facilities offer 24-hour medical supervision for withdrawal and detox. One should consult closely with a healthcare provider before choosing to withdraw from alcohol to determine the safest option to pursue.
Counseling and Medical Services
There are many forms of counseling that are useful in recovery from an alcohol use disorder and most people in inpatient or residential treatment will have a combination of them prior to discharge. These most commonly include 1:1 counseling sessions, groups, family sessions, educational sessions, and medical services. All of these types of counseling are also available in outpatient settings.
Individual counseling—This includes sessions in which coping skills for remaining alcohol-free are developed. Methods of decreasing stress, solving problems, increasing self-care, managing emotions, and rebuilding relationships are common concerns in individual counseling. Learning to challenge one's "old" thinking and attitudes as well as to identify triggers to drink, how to prevent relapse, and how to replace negative behaviors with more productive ones are also typically addressed.
Group counseling—This type of counseling provides the opportunity to meet with others who have similar issues and to work toward the common goal of becoming and remaining alcohol-free. Participation in group counseling allows one to have support in dealing with emotions, stressors, making decisions, solving problems, and achieving an alcohol-free lifestyle.
Family counseling—This method involves family members in the recovery process, often helping them understand better how to help the recovering person remain alcohol-free. Family therapy can rebuild the strained relationships that occurred during alcohol use and help family members heal from the pain of loving someone with an alcohol disorder.
Education—Education, often called psychoeducation, teaches the dynamics of alcohol use and recovery from alcohol use. It can involve methods for increasing self-care, reducing stress, managing emotions, and improving communication and relationships. Relapse prevention strategies for remaining alcohol free are also significant educational components. Individuals in recovery as well as their family members benefit from such educational opportunities.
Medical services—This can include medical support and supervision through withdrawal and detox and psychiatric services for managing the emotional, mental, and psychological problems associated with an alcohol use disorder. Some will require medication for a while to manage depression or anxiety. Still others, once alcohol free, will be diagnosed with a mental health condition that alcohol use has hidden or that they have tried to self-medicate with alcohol. In this event, treatment of that condition can include psychiatric services and medication.
Many benefit from participating in self-help groups in the community such as Alcoholics Anonymous (AA). These are free and the only membership requirement is the desire to be sober. 12-Step groups are member-run fellowships that use the 12 Steps of Alcoholics Anonymous as a guide to achieving and maintaining sobriety. There is a tradition of sponsorship in AA in which an already established member in the fellowship helps guide a newer member through the program. You can even download a free app such as Meeting Guide to your iOS or Android mobile device and use it to find AA meetings near you.
Alanon is another 12 Step group that uses the 12 Steps of AA. Alanon runs similarly to AA meetings but is for the significant others and family members of alcoholics. Many communities also have self-help support groups that are not affiliated with AA or Alanon.
How to Help Someone With the Signs of an Alcohol Problem
People who have an alcohol problem are not always aware of it. Denial is a significant trait of an alcohol use disorder and it can be frustrating to see the problem when the drinker does not. Also people with alcohol problems are often embarrassed, ashamed, and feel guilty about their problems. They may not want to talk about it right away. Here are some tips for how to help:
- Educate yourself by learning all you can about alcohol problems.
- Talk openly to the person you are concerned about, offer support, and offer help to get them help.
- Continue to express and demonstrate your love and concern.
- Don't expect the person to stop without help.
- Continue your support throughout the recovery process.
Helping someone with an alcohol problem can also take the form of not doing certain things. Here are some tips for what not to do when you are trying to help:
- Don't lecture, threaten, bribe, preach, or moralize.
- Don't be a martyr: avoid emotional appeals that may only increase feelings of guilt and the compulsion to drink or use other drugs.
- Don't cover up, lie, or make excuses for them and their behavior.
- Don't assume their responsibilities: taking over their responsibilities protects them from the consequences of their behavior.
- Don't argue when the person is drinking.
- Don't feel guilty or responsible for their behavior—it's not your fault.
- Don't join them in drinking (NCAAD, 2014).
Start Breaking Your Addiction to Alcohol
You don't have to be controlled by alcohol addiction. Counseling and other forms of help are available and often convenient to access. So use this moment to begin rising up to a better future. A simple phone call to 1‑844‑810‑3700 is all it takes to get started.
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SAMSHA/CSAT. (2005). Substance Abuse Treatment for Persons With Co-Occurring Disorders. Treatment Improvement Protoeol (TIP) Series 42. Rockville, MD: SAMHSA.
University of Notre Dame. (2008). What is Intoxication. Retrieved 2014 September 18 from Center for Student Heatlh Promotion & Well-being.