Problematic use of alcohol is all too common across all age groups. In adults, 10% of men and 5% of women meet the criteria for an alcohol use disorder, and children of adults with an alcohol use disorder are four times more likely to develop the disorder at some point in their lives.
Those who drink at a young age are significantly more likely to engage in risky behaviors and to be sexually victimized. Regardless of age, alcohol use disorder can have negative consequences related to home, work, school, and the law.
So why do people continue to drink even when faced with the harm it causes? For many – at least initially – consuming alcohol can result in a pleasurable sedating effect, that will be sought after again and again. However, more chronic drinking behavior can also lead to extreme discomfort and even give rise to dangerous symptoms during withdrawal, often prompting the individual to resume drinking and/or be reluctant to go without alcohol for any length of time. For these reasons and more, alcohol can be difficult to quit without treatment.
Addictive Properties of Alcohol
Alcohol is a central nervous system depressant, which means that consuming alcohol reduces, or inhibits, overall brain activity. The most important way alcohol inhibits brain activity is by increasing signaling by a neurotransmitter called gamma-aminobutyric acid (GABA).
GABA is the main inhibitory neurotransmitter in the brain, and drugs that increase GABA signaling are used as sedatives, muscle-relaxants, and anti-anxiety medications, among other things. Increased inhibitory signaling in the brain due to alcohol is the reason people who drink excessively slur their speech, have difficulty walking, and suffer memory loss or blackouts.
If a person drinks alcohol often, their brain will adapt to the increased inhibition by increasing excitatory signaling through neurotransmitters like glutamate. The neural activity of glutamate essentially opposes that of GABA and results in a generalized increase in brain cell excitation or firing rate. Such adaptations (e.g., secondary excitation that counters the initial inhibition) lead to tolerance in problem drinkers–over time, these individuals must drink more and more to experience the same effects from alcohol. This begins a vicious cycle of increased drinking followed by greater tolerance that eventually leads to dependence and addiction.
Additionally, once a person’s brain adapts to frequent drinking by increasing glutamate signaling, they will experience withdrawal symptoms like tremors, hallucinations, and convulsions if they stop drinking because their brain will be too stimulated. Once drinkers have reached this point, addiction has taken hold and it will be very difficult, even dangerous, for them to stop on their own.
In addition to effects on GABA, alcohol has been shown to increase the release of endorphins. Endorphins are natural chemicals in the brain that activate opiate receptors and cause feelings of relaxation and euphoria. It is thought that alcohol’s effects on endorphins contribute to its addictive effects.
As alcohol is rapidly absorbed into the bloodstream and travels throughout the body, its effects can be felt almost immediately:
- The user will feel subjectively relaxed and, in some cases, may experience a sense of euphoria or heightened wellbeing. Individuals may begin to turn to alcohol as it allows them to pay less attention to feelings of self-consciousness or awkwardness in social situations.
- Inhibitions will lower, making a user feel more confident and capable. With lowered inhibitions often comes an increased risk of poor decision-making and potentially dangerous or harmful outcomes.
- Alcohol can have a sedative effect, calming the mind and body. Some users report “a few drinks” helps them sleep. Beliefs such as this and the fact that these same individuals may get to a point where they are unable to fall asleep without a drink or two provide additional mental obstacles that may hinder their attempts to cut down on, or altogether quit alcohol.
Many casual and heavy drinkers alike first begin drinking to experience the “loosening” effect of alcohol on the body–to feel more comfortable in a social surrounding, to numb feelings of anger or frustration, or to distract the mind from stressful situations. Unfortunately, these euphoric feelings are accompanied by a myriad of unintended effects such as impaired thinking, liver problems, and an insidious deterioration of general physical and mental health. The negative consequences of alcohol use can quickly add up for the unsuspecting drinker.
Effects of Alcohol
Alcohol use affects multiple organ systems in the body–including the brain, heart, liver, and pancreas. As a user continues to consume alcohol, the following will unfold:
- Brain: Alcohol interferes with how the brain reacts to various emotional stressors and other environmental stimuli – this can cause mood swings, difficulty thinking clearly, and give rise to movement disorders, making coordination difficult, sluggish, or labored. Long-term alcohol abuse can even cause portions of the brain to shrink as a result of protracted neural injury.
- Heart: Even a single night out drinking can have serious cardiovascular implications–impacting the heart rate, leading to disturbances in heart rhythm, elevating blood pressure and increasing the risk of suffering a stroke. The long-term effects of alcohol on the heart aren’t good, either. Many chronic alcoholics develop a condition known as alcoholic cardiomyopathy–in layman’s terms, a big floppy heart that doesn’t do its job of pumping blood efficiently through the body.
- Liver: Over time, the cumulative impact of heavy drinking can result in chronic alcoholic hepatitis or inflammation, fatty liver disease, portal vein hypertension, cirrhosis, impaired production of blood lipids and lipoproteins and, ultimately, liver failure.
- Pancreas: Heavy alcohol use, even if its just the occasional binge, can lead to an episode of pancreatitis, which is a dangerous inflammatory process in the pancreas that can lead to the spilling of pancreatic enzymes into the abdominal cavity and a subsequent phenomenon known as ‘auto-digestion’. Those suffering from pancreatitis generally experience excruciating pain, and often require emergent medical care.
Among the many health consequences of alcohol use, drinkers may also experience:
- Intermittent loss of consciousness or blackouts.
- Chronic myalgia or muscle aches.
- Chronic gastrointestinal disturbances leading to frequent nausea, vomiting and gastric discomfort.
- Vertigo and syncope–i.e., dizziness and fainting..
- Chronic tremors and permanent loss of fine motor coordination..
After extended periods of time with heavy use, personality changes may manifest. You may notice:
- Increased tendency toward aggression.
- Inability to function at school or work.
- Unprompted mood swings.
Over time, tolerance to alcohol develops, whereupon the user will require more and more alcohol to achieve desired results. As the drinker attempts to compensate for tolerance, the amount of alcohol consumed may steadily increase. The drinker may not even realize the upward trend but, in doing so, greatly increases their risk of alcohol poisoning and death.
What Does It Mean to be Addicted to Alcohol?
The development of alcohol dependency can be conceptualized as following a general pattern. The following phases may be recognized:
- Pre-alcoholic symptomatic phase, or occasional social drinking that may progress to a perceived need to drink to relax or deal with stressful situations. This, in turn, may lead to an increased frequency and amount of alcohol consumed. Tolerance to alcohol already begins to develop in this early stage.
- Prodromal phase, or the beginning stage of alcoholism, is the start of a user’s preoccupation with alcohol. User may experience some difficulty remembering what happened when drinking, and some feelings of guilt around drinking.
- Crucial phase, or “loss of control” over drinking. Full symptoms of alcoholism appear, including denial, disruptions in work or family life, failed attempts to get help, and periods of both refrain from drinking and excessive drinking.
- Chronic phase, or extended periods of binge or otherwise excessive drinking that leads to prolonged periods of intoxication. Both physical and mental health may follow a sharp decline over the course of the chronic phase. Additionally, users may experience a significant disruption, if not a total disintegration of social interaction and daily routine–often disappearing from family and friends and struggling to maintain jobs, etc.
Withdrawal from Alcohol
Acute alcohol withdrawal can result in the development of serious, if not life-threatening health issues. Some of the symptoms of withdrawal include:
- Fever and sweating.
- Nausea and vomiting.
- Generalized muscular tremor.
Some with a history of heavy drinking may experience the rapid development of a condition known as delirium tremens – or the DTs – as they withdraw from the effects of alcohol. This is an ominous turn of events, recognized by uncontrollable shaking, high fever, cardiac arrhythmia, profound confusion and hallucinations. Vigilant medical supervision and treatment is required for those at-risk, as an unstable patient may ultimately experience prolonged seizures and death.
Symptoms generally begin as soon as eight hours after the last drink, and those suffering from severe alcohol dependence should prepare beforehand to detox under professional medical supervision. Supervision and pharmaceutical intervention (if required) may last for a few days, as the severe symptoms of acute alcohol withdrawal can potentially appear somewhat later in some cases (24-72 hours post-abstinence).
A dual diagnosis, or mental illness in addition to substance abuse, may further complicate withdrawal, and should be considered carefully when choosing a detox program. If a user is dealing with symptoms of depression, anxiety, psychosis, or other drug dependence, treatment should focus on the precursors to use and consider both the mental health/wellness and physical complications listed above.
In addition to the aforementioned physical risks, users who choose to detox from alcohol may also face a number of mental health developments:
- Psychologically (mental health), users going through detox can experience hallucinations, delusions, depression, and anxiety.
- Emotionally, users doing through detox can experience confusion, shame, guilt, or regret.
All told, the symptoms from withdrawal can persist for a few weeks, but generally a user will begin to feel some relief from physical symptoms in about 72 hours. The length of withdrawal is highly dependent on how long a user was heavily drinking, and each person metabolizes alcohol differently. There is no way to precisely predict how each individual will withdrawal from alcohol, further underscoring the need for medical supervision on a case-by-case basis.
Benzodiazepines – such as Librium or Valium,- may be used to manage the delicate period of withdrawal to lower the risk of dangerous outcomes and manage the discomfort that may lead to relapse.
How to Get Help for Alcohol Addiction
There are multiple ways to get help from alcohol dependence, including treatment, medication, and behavioral intervention. Often, the user is one of the last to recognize or realize his or her use is a problem, often thinking “I have this under control”. Once an alcohol use disorder has developed, however, it can be extremely to quit without help. Fortunately, there are ways to get help.
Medications that may help with the treatment of alcohol abuse and associated symptoms include:
- Disulfiram (Antabuse): This drug blocks the body’s ability to metabolize alcohol and causes an intensely unpleasant reaction when both are taken in concert. However, it does not reduce cravings for alcohol.
- Naltrexone (Vivitrol): Reduces the reward that comes from drinking by reversing the activation of opiate receptors by endorphins.
- Acamprosate (Campral): Helps to restore the balance of glutamate-GABA signaling in the brain. This medication helps to reduce withdrawal symptoms such as insomnia, anxiety, and restlessness.
Any medication use requires the supervision of a medical professional and a prescription, and it should be noted that the most success is found when medications are used in conjunction with treatment.
Treatment programs include:
- Inpatient: Users are checked into a residential facility (usually for 30-90 days, depending on user choice or requirement by law in the cases of treatment mandated by a court). Some courses of residential treatment may actually begin in a hospital setting.
- Outpatient: Users attend a program but are allowed to reside outside of the treatment facility, often attending daily to start and then following a tiered schedule (five days a week, three days a week, one day a week).
- Support Groups: Users attend meetings as often as needed, through groups such as Alcoholics Anonymous (aa.org) Other non-12 step support groups or recovery programs are available as well, including SMART Recovery. Support groups are usually done in kind with other treatment, such as during the course of residential treatment or to support the transition into outpatient. Most recovering alcoholics find attending support groups a long-term commitment in support of their sobriety.
- Extended Support Groups: Al-Anon (alanon.org), a support group for families of addicts, offerings meetings in which loved ones can find assistance in their journey loving an addict.
Relapse will be a temptation for many drug and alcohol abusers. During treatment, the possibility of relapse will be openly discussed and addressed. The ability to remain sober despite relapse temptations is closely related to coping skills learned during treatment. Ongoing therapy offers the best recovery course for former alcohol abusers, especially when combined with support groups, as finding the support from others who understand the difficulties and rewards associated with recovery is integral to continued abstinence for many.