Alcohol Dependence

Alcohol Dependence

Alcohol Dependence

Alcohol use disorder (AUD) is, in general, any dependence on or abuse of drinking alcohol. AUD results in many mental and/or physical health problems. According to the 2018 National Survey on Drug Use and Health (NSDUH), 14.4 million adults ages 18+ and 401,000 adolescents ages 12–17 had AUD.

How much alcohol is too much?

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines a standard drink as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits. Men may be at risk of AUD if they exceed 14 standard alcoholic drinks per week, and women if they drink more than seven.

Prevalence

In the United States, AUD affects approximately 7% of adults and 3% of people aged between 12 and 17 years, and it is more common in males than in females.

The Good News

Recovery is possible. About 33% of people treated for AUD suffer no additional symptoms, and thousands have reduced their drinking consumption to fit within healthy limits, even if they relapse a few times before they get to that place.

Symptoms (signs of abuse or dependency):

AUD is often used interchangeably with alcoholism. AUD is now seen as one disorder consisting of alcohol abuse and/or alcohol dependence, with mild, moderate, and severe subclasses.

  • Alcohol abuse = repeated alcohol use despite recurrent adverse consequences.
  • Alcohol dependence = alcohol abuse + at least three of the following over a one-year period:
  • Tolerance – increasingly more amounts of alcohol needed to have the “hit”
  • Physiological withdrawal symptoms – excessive sweating, nausea and vomiting, generalized aches and pains, shaking, and sleep disturbances
  • Drinking greater amounts of alcohol or over a longer period of time than originally intended
  • Unproductive efforts to reduce the amount of alcohol taken or an inability to control use — an intense or strong craving to drink alcohol
  • A lot of the day/night spent getting, drinking, or recovering from alcohol use
  • Social-, work-, or leisure-related activities ended or lessened – to the extent that one is unable to fulfill one’s responsibilities
  • Continued drinking despite awareness of harmful physical, relational, or psychological consequences such as depression or gastrointestinal issues
  • Alcohol usage that compromises safety such as when driving, swimming, walking in unsafe areas, operating machines or power tools, or spending time with unknown people

Causes of Alcohol abuse (or dependency):

The exact cause of AUD remains unknown; however, genetic and environmental factors have both been implicated. A person with a parent or sibling who has AUD is three to four times more likely to develop the condition him or herself.

Community, cultural, and behavioral influences are also factors that increase the risk of developing AUD, as do high stress levels and anxiety, the low cost of alcohol, and how easy it is to buy.

Diagnosis of Alcohol Dependence:

A primary care physician will often use the CAGE questionnaire — a simple screening tool that can be used to identify potential problems with alcohol drinking — and consists of the following four questions:

  • 1 – Have you ever felt you should Cut down on your drinking?
  • 2 – Have people Annoyed you by criticizing your drinking habits?
  • 3 – Have you ever felt bad or Guilty about your drinking?
  • 4 – Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?

If the answer is yes to two or more of the questions above, or one if you are a female, than the amount of alcohol you are drinking may be problematic and you should seek professional help immediately.

Risk Factors for Alcohol Dependence:

AUD can result in mental illness (like major depressive disorder, delirium tremens — seizures and hallucinations, Wernicke–Korsakoff syndrome — a condition characterized by the triad of memory problems), visual disturbances and changes in the way a person walks, irregular heartbeat, an impaired immune response, liver cirrhosis, and increased cancer risk.

9,967 people died because of drunk driving in 2014. AUD also reduces a person’s life expectancy by approximately ten years and is the third leading preventable cause of death in the US.

 

Alcohol dependence treatment:

Many factors contribute to deciding on the best treatment plan, with most professionals recommending an inpatient program if the patient is in poor health, has no or little access to family and social support, is in a questionable housing situation, and transport is difficult. If legal or justice issues related to AUD are also a factor, inpatient treatment is preferred too.

There are several treatment options available for people who have AUD. Because of the common problem of relapsing, persistence with the treatment options below is the key factor in recovery. Ultimately, about 33% of those who go through a treatment plan have recovered within the year.

  • Detox – Alcohol detoxification must be closely monitored and carefully controlled by professional alcohol and drug addiction services, due to complications that can arise during alcohol withdrawal. A standard inpatient detox and rehab program takes 28 days.
  • Medication – Meds approved for treating AUD are nonaddictive and help most patients overcome AUD.

    • Chlordiazepoxide helps detox the body. It can be either given while in a healthcare setting or while a person remains at home with 24-hour support by a family member and/or responsible adult.
    • Disulfiram prevents the body from processing alcohol and causes the body to react unpleasantly (all the feelings of a hangover) following even a small amount of alcohol consumption.
    • Acamprosate or naltrexone helps to reduce craving of alcohol and may be used for relapse prevention purposes
  • Therapy and support – Once alcohol detoxification is achieved, the individual receives aftercare as part of the goal to prevent relapse, stabilize, and develop harm reduction strategies.

    This includes attending:

    • Individual or group cognitive-behavioral therapy – to find the cues that tempt a person to drink heavily and change the response to them by changing thought processes
    • Group therapy or a support group – such as Alcoholics Anonymous
    • Individual, couples, or family therapy/counseling – to build familial support
    • Motivational enhancement therapy – planning, encouragement, persistence training

Symptoms (signs of abuse or dependency):

AUD is often used interchangeably with alcoholism. AUD is now seen as one disorder consisting of alcohol abuse and/or alcohol dependence, with mild, moderate, and severe subclasses.

  • Alcohol abuse = repeated alcohol use despite recurrent adverse consequences.
  • Alcohol dependence = alcohol abuse + at least three of the following over a one-year period:
  • Tolerance – increasingly more amounts of alcohol needed to have the “hit”
  • Physiological withdrawal symptoms – excessive sweating, nausea and vomiting, generalized aches and pains, shaking, and sleep disturbances
  • Drinking greater amounts of alcohol or over a longer period of time than originally intended
  • Unproductive efforts to reduce the amount of alcohol taken or an inability to control use — an intense or strong craving to drink alcohol
  • A lot of the day/night spent getting, drinking, or recovering from alcohol use
  • Social-, work-, or leisure-related activities ended or lessened – to the extent that one is unable to fulfill one’s responsibilities
  • Continued drinking despite awareness of harmful physical, relational, or psychological consequences such as depression or gastrointestinal issues
  • Alcohol usage that compromises safety such as when driving, swimming, walking in unsafe areas, operating machines or power tools, or spending time with unknown people

Causes of Alcohol abuse (or dependency):

The exact cause of AUD remains unknown; however, genetic and environmental factors have both been implicated. A person with a first-degree relative — a parent or sibling — who has AUD is three to four times more likely to develop the condition him or herself.

Environmental factors include social, cultural, and behavioral influences. High stress levels and anxiety, as well as the low cost of alcohol and how easy it is to buy, are also factors that increase the risk of developing AUD.

Diagnosis of abuse or dependency:

A primary care physician will often use the CAGE questionnaire — a simple screening tool that can be used to identify potential problems with alcohol drinking — and consists of the following four questions:

  • 1 – Have you ever felt you should Cut down on your drinking?
  • 2 – Have people Annoyed you by criticizing your drinking habits?
  • 3 – Have you ever felt bad or Guilty about your drinking?
  • 4 – Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?

If the answer is yes to two or more of the questions above, or one if you are a female, than the amount of alcohol you are drinking may be problematic and you should seek professional help immediately.

Risk Factors for Alcohol Dependency:

AUD can result in mental illness (like major depressive disorder, delirium tremens — seizures and hallucinations, Wernicke–Korsakoff syndrome — a condition characterized by the triad of memory problems), visual disturbances and changes in the way a person walks, irregular heartbeat, an impaired immune response, liver cirrhosis, and increased cancer risk.

9,967 people died because of drunk driving in 2014. AUD also reduces a person’s life expectancy by approximately ten years and is the third leading preventable cause of death in the US.

Alcohol dependence treatment:

Many factors contribute to deciding on the best treatment plan, with most professionals recommending an inpatient program if the patient is in poor health, has no or little access to family and social support, is in a questionable housing situation, and transport is difficult. If legal or justice issues related to AUD are also a factor, inpatient treatment is preferred too.

There are several treatment options available for people who have AUD. Because of the common problem of relapsing, persistence with the treatment options below is the key factor in recovery. Ultimately, about 33% of those who go through a treatment plan have recovered within the year.

  • Detox – Alcohol detoxification must be closely monitored and carefully controlled by professional alcohol and drug addiction services, due to complications that can arise during alcohol withdrawal. A standard inpatient detox and rehab program takes 28 days.
  • Medication – Meds approved for treating AUD are nonaddictive and help most patients overcome AUD.

    • Chlordiazepoxide helps detox the body. It can be either given while in a healthcare setting or while a person remains at home with 24-hour support by a family member and/or responsible adult.
    • Disulfiram prevents the body from processing alcohol and causes the body to react unpleasantly (all the feelings of a hangover) following even a small amount of alcohol consumption.
    • Acamprosate or naltrexone helps to reduce craving of alcohol and may be used for relapse prevention purposes
  • Therapy and support – Once alcohol detoxification is achieved, the individual receives aftercare as part of the goal to prevent relapse, stabilize, and develop harm reduction strategies.

    This includes attending:

    • Individual or group cognitive-behavioral therapy – to find the cues that tempt a person to drink heavily and change the response to them by changing thought processes
    • Group therapy or a support group – such as Alcoholics Anonymous
    • Individual, couples, or family therapy/counseling – to build familial support
    • Motivational enhancement therapy – planning, encouragement, persistence training
Sources NIAAA – Alcohol Treatment | NIAAA – Alcohol Facts & Statistics | Longdom – Alcoholism | The American Psychiatric Association Diagnostic and Statistical Manual – DSM-5 | WKHS – Self Test | WEBMD – Disulfiram Oral