Alcohol Use Disorder

Alcohol Use Disorder (AUD) is both a medical and a mental health condition that is characterized by an inability to decrease or discontinue the consumption of alcohol, even when distress and adverse consequences occur as a result. An individual with AUD continues to drink, despite significant distress or impaired functioning in important areas. These include decreased functioning or impairment in social, occupational, and academic areas. In addition, physical and psychological problems may develop or worsen, due to chronic alcohol abuse. Some individuals deny or minimize the problem and continue drinking. Others acknowledge the problem but fail in their attempts to stop. In either case, professional help is recommended to address the problem.

When an individual experiences symptoms of more than one condition

There are several reasons that mental health conditions sometimes occur together. First, the presence of AUD can set in motion a constellation of new symptoms. For example, alcohol is a central nervous system depressant, so it stands to reason that AUD and depression are often found together. Alcohol also disrupts the healthy progression of the sleep cycle, resulting in an impaired ability to get to sleep and stay asleep. For that reason, AUD and insomnia can go hand in hand. AUD can also lead to heightened symptoms of anxiety, thus AUD and anxiety are frequent companions. The same can be said of AUD and an array of other conditions across the mental health spectrum.

On the other hand, untreated mental health symptoms can set the stage for self medicating with alcohol, in a misguided attempt to alleviate distressing symptoms. Ultimately, drinking is not a long term solution and tends to compound the problem.

The question of whether chronic alcohol use causes mental health conditions, or whether untreated mental health symptoms lead to AUD is often debated. The resolution to this chicken or egg conundrum is best sorted out with the help of a professional addictions or mental health treatment provider.

What it looks like

Alcohol Use Disorder, (AUD), is a progressive medical and psychiatric condition. AUD is characterized by an inability to decrease or discontinue alcohol consumption, despite significant distress or impaired functioning in important areas. These include social, occupational, academic and legal domains, as well as the development or worsening of medical and psychological conditions.

The prevalence of AUD in the United States is significant. According to a 2019 NIAAA study, 14.1 million adults or 5.6 percent of adults and 1.6 percent of adolescents in the United States had an alcohol use disorder.

The Diagnostic and Statistical Manual of Mental Disorders, DSM-V, defines an Alcohol Use Disorder as a “. . . problematic pattern of alcohol use leading to clinically significant impairment or distress as manifested by at least two of the following, occurring a 12 month period.” Although there are twelve diagnostic criteria, only two are required for a diagnosis of an Alcohol Use Disorder.

Consuming more alcohol or drinking longer than the person planned
Failed attempts to decrease or stop drinking
Excessive time spent on alcohol related activities including obtaining, consuming, becoming intoxicated, or recovering from the effects of alcohol
Craving alcohol or an urgent desire to use that makes it difficult to think of other things, often resulting in more use.
The inability to fulfill important obligations to family or function at school or work; impaired social functioning and relationships, academic problems, or problems at work due to absenteeism or poor functioning
Continuing to drink, despite relationship or social problems that are created or worsened due to alcohol use
Neglecting family, work, or hobbies in order to make more time for alcohol consumption and recovering from alcohol related effects
Drinking despite knowing that it causes or worsens medical problems, such as liver disease, gastric conditions, or hypertension; psychological problems, such as anxiety or depression; social/relationship problems, such as violent arguments with family members or child abuse, or legal problems
Drinking when it is physically hazardous, including driving, operating machinery, or engaging in sports, such as swimming
Having withdrawal symptoms may include hallucinations and seizures. Other symptoms may include profuse sweating, hypertension, anxiety, shaking, hot and cold flashes, nausea and vomiting, insomnia, Withdrawal can be life threatening, require medical supervision, and, in some cases, inpatient alcohol detoxification.
Symptoms of withdrawal can occur approximately 4-12 hours after prolonged or heavy drinking. Withdrawal symptoms are uncomfortable and sometimes painful and can motivate continued drinking to alleviate the discomfort.
Tolerance: requiring greater quantities of alcohol to produce the same effect

An Alcohol Use Disorder can range from mild to severe. In general, the more symptoms a person has, the more severe the AUD is considered to be. AUD is considered mild with 2-3 of the above symptoms; moderate with 4-5 symptoms, and severe if there are 6 or more symptoms.

It should be noted that, in some cases, the severity of AUD can progress from mild to moderate to severe in a relatively short period of time. An example of this is the high school or college student who engages in binge drinking, drinking games, or other activities where tolerance is quickly built. This progression can be disrupted with treatment.

Having AUD is nobody’s fault

The stigma of AUD remains powerful and prevalent. The message of stigma is one of shame and blame for the fact of having AUD. Sadly, those suffering from AUD often internalize these negative messages and suffer for far too long before they are able to break through the grip of stigma and reach out for treatment.

In the past, many of those working in the field of addictions, bought into and perpetuated this destructive stigma. With antiquated attitudes and limited treatment options to offer, it is not surprising that people are still reluctant to seek treatment.

Fortunately, today’s addiction treatment has evolved to one of a compassionate, respectful, and structured approach with a range of proven medications and therapies available. Look for a shame-free treatment environment that offers well researched and proven comprehensive treatment options.

Outlook

We are living in an exciting time of exploration into the workings of the brain and alcohol’s impact on brain chemistry. Recent discoveries in neuroscience have led to innovative and effective treatment protocols for AUD. The gold standard of AUD treatment is a complete psychiatric evaluation and concurrent treatment of the AUD together with any other condition that may be present. An integrated treatment plan, consisting of psychotherapy and medication management, where indicated, is the standard of care.

In good company

Many prominent people reportedly have/had AUD, such as actor Ben Affleck, singer Tim McGraw, and actress Edie Falco, among many other luminaries.

The current thinking on what causes AUD

A number of risk factors for developing AUD have been identified and are listed below. Before beginning a discussion of risk factors, it is important to note that having one or more risk factors does not mean that AUD is inevitable. Neither is it a life sentence or reason to succumb to AUD. Effective tools for mitigating and treating the impact of these factors are available. Key among these risk factors is genetics. The role of genetics has been studied extensively. Identical twin studies and adoption studies suggest that genetics increases the likelihood of developing AUD by more than 60 percent.

Environment is another risk factor. Growing up in an environment where family members abuse alcohol can normalize the behavior. The interplay between genetics and environment compounds the risk.

Age of the onset of drinking is a predictor of AUD. The younger a person starts drinking, the higher the lifetime risk of AUD. According to an NIAAA study, people who begin drinking before age 15 have more than a five times greater risk of AUD when compared to those who delayed alcohol consumption until after age 21.

Having an untreated mental health condition, such as Major Depressive Disorder, Generalized Anxiety Disorder, ADHD, Post Traumatic Stress Disorder, Bipolar Disorder, Insomnia, and others, plays an important role in the development of AUD. On a positive note, treating the other condition and alleviating the symptoms can significantly decrease that risk.

The relationship between trauma and alcoholism has been well documented.

Having untreated symptoms of PTSD, such as flashbacks and nightmares, sets up a vulnerability to developing AUD. Eye Movement Desensitization and Reprocessing (EMDR) has been studied and shown to be effective in the treatment of PTSD. Cognitive Behavioral Therapy and Exposure Therapy have also proven effective by reducing the urge to drink. Problems coping with stress, difficulty communicating boundaries, and the inability to manage strong emotions are additional drivers of AUD.

The presence of risk factors is, by no means, one’s destiny. It is true that having a risk factor, like genetics, is out of anyone’s control. What is within our control is the decision to obtain treatment. Taking these actionable steps can go a long way to reducing one’s vulnerability to developing AUD or treating the problem when it arises.

Next: Finding The Right Treatment