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When Drinking Becomes Alcoholism

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Worldwide alcohol use and abuse statistics are staggering. The single highest risk factor for premature death and disability for individuals between 15 and 49 years old across the world is alcohol abuse.1 In the United States, 1 in 10 children live with a parent who has a drinking problem, and over 15 million adults abuse it or suffer from alcoholism.2,3

Binge and problem drinking can easily progress to an alcohol use disorder (AUD),4 commonly referred to as alcoholism. The fine line between casual consumption, problem drinking, dependence, and alcoholism can be hard to assess and, in many cases, one can worsen to the next without the drinker even noticing.

If you or someone you love are struggling to control drinking, or showing signs and symptoms of alcoholism, contact us today at 1-888-744-0069 for expert support in selecting the best treatment options available.

Casual vs. Problem Drinking

Man sitting on floor holding alcohol bottle with other empty bottles

Data show that many Americans regularly drink alcohol. According to results from nationwide surveys of 70,000 randomly selected individuals (age 12+) in 2005 and 2012, in both years approximately 56% report drinking in the past month.5 Just as the overall number of people who drink has held steady in the last decade or so, there continues to be a significant percentage of people already experiencing problems with it through abuse and dependence.5

While many people consume alcohol in moderation, binge drinking is common and raises the risk that the drinker will eventually become dependent on it.15

One definition of binge drinking is having 5 or more drinks on the same occasion (4 drinks for women) on at least 1 day in the past month. Binge drinking 5 or more times in a month constitutes heavy alcohol use.6

In 2015, of the approximately 138 million Americans (age 12+) who drink alcohol, over 66 million (24%) report binge drinking and more than 17 million (6%) report heavy use.5 The rates of women engaging in this over the past decade has escalated enormously, increasing more than 17% in contrast to less than 5% for men.7

How can you tell if you are drinking normally or if you have progressed to a problematic level?

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines state that low-risk drinking is consuming a maximum of:

  • 3 drinks in a single day and 7 drinks in a week (for women).
  • 4 drinks in a single day and 14 drinks in a week (for men).

If your drinking habits easily fall within these limits, you are likely not a problem drinker; only about 2 in 100 people who drink within these limits will become alcoholics at some point.8 If you’re drinking beyond these limits, you may have progressed to problem usage/abuse.

Getting Drunk on a Regular Basis? You May Need Help.

Alcohol takes a major toll on the body when consumed in excess. As the amount of alcohol in your blood stream increases, intoxication results, with higher levels of impairment related to higher blood alcohol concentration (BAC). If you’re drinking more than the amount defined by the NIAAA as ‘low-risk’ and experiencing the following signs of intoxication on a regular basis, you’re likely to experience a host of health problems and may have an issue with drinking:

  • Impaired judgment.
  • Risk taking.
  • Vision problems.
  • Reduced coordination and memory.
  • Slurred speech.
  • Inappropriate behavior.
  • Impaired sexual functioning.
  • Blackouts.
The CAGE Screening Tool

Identifying the signs of alcoholism can be difficult when drinking is so normalized in our society. An easy-to-use evidence-based screening tool that physicians access called CAGE is a good place to start.

Using CAGE—which is an acronym for Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers—is as simple as asking yourself 4 questions.

Have you ever:

  1. felt the need to cut down your drinking?
  2. felt annoyed by criticism of your use?
  3. had guilty feelings about drinking?
  4. taken a morning eye opener?

Used for over 25 years to help screen for alcoholism, the CAGE questionnaire is deceptively simple but accurate. If you answer yes to 2 to 3 of the 4 questions, there is a high likelihood you have a problem with alcohol; a score of 4 is “virtually diagnostic for alcoholism”.9

It is important to note, however, that the CAGE assessment serves as a screening tool rather than as a method to provide an official diagnosis—scores between 2 and 4 will indicate the need for further evaluation. If you suspect you have a problem, speak to your doctor or an addiction specialist with whom you can discuss in depth your drinking patterns and related behaviors.

Alcoholism Defined

Alcoholism, like other addictions, is a chronic, recurring condition that is “…characterized by an inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response”.10

The Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V) outlines a cluster of symptoms as the criteria used to diagnosis someone with an alcohol use disorder. These symptoms, while varying, all indicate a negative effect on:

  • Your health.
  • Your daily life/personal obligations.
  • Your capacity to function as normal.
  • Your ability to positively engage with friends, family and work colleagues.

Specific Signs of an Alcohol Use Disorder

The spectrum of AUD can range from mild to severe based largely on the number and severity of symptoms experienced. These include:11

  • Cravings for alcohol.
  • Consistently drinking more than intended.
  • Excess time spent consuming and obtaining it.
  • Increased time recovering from alcohol use.
  • Continuing to drink despite interpersonal, physical, and work-related problems.
  • Drinking in risky situations such as driving or using dangerous machinery.
  • Consuming more alcohol to feel the same effect (developing tolerance).
  • Experiencing withdrawal symptoms when not drinking.

How Does Drinking Progress to Alcoholism?

The transition from regular use to alcoholism is a complex one that has a lot to do with changes that occur in the brain as the disease progresses. While these changes are complicated and continue to be studied, the main point to understand is that drinking produces reinforcing effects in the brain that contribute to abuse and eventually to dependence and addiction.12

Reinforcement refers to the strengthening of a behavior based on previous experience. So, if you drink alcohol and enjoy the feeling, you’re likely to want to repeat it.12 The more and longer you consume it, the harder it is to make the choice not to drink.13

The more and longer you consume alcohol, the harder it is to make the choice not to drink.

When you repeatedly drink to excess, your brain and body begin to adapt in such a way that it needs alcohol to feel “normal.” This is referred to as dependence, 12 (a condition in which your body must have the drug to function and goes into withdrawal when it doesn’t have it).

An alcohol-dependent person will tend to keep drinking based on both positive reinforcing effects (the pleasurable feeling of being drunk) and negative reinforcing effects (the avoidance of the discomfort that comes with withdrawal). Dependence and continued drinking to prevent or alleviate  the medically dangerous withdrawal syndrome are indications that an AUD is either present or developing.

The path to alcoholism also involves increasing tolerance, a situation in which the drinker needs a constantly increasing number of drinks to get drunk. The more you up your drinks, the more likely you are not only to develop a problem but also to experience severe alcohol poisoning (which can be fatal).

Overall, the inability to stop or cut down your alcohol use despite negative consequences suggests you meet the criteria for alcoholism.14

How Do I Get Help?

Doctor talking to patient about alcohol detoxification treatment

Help for alcoholism is available and treatment works. While various treatment options exist, the stages of alcoholism treatment often include some combination of the following:

  1. Detoxification—Medically managing the withdrawal process that occurs when your body reacts to no longer having a high blood alcohol concentration is extremely important. As outlined above, severe alcoholics can experience severe complications—such as seizures, agitation, and delirium tremens—in association with acute alcohol withdrawal and need expert medical oversight during this process.
  2. Use of medications—As part of the detoxification process, to help with unpleasant symptoms after detox and to further discourage relapse, a number of medications may be used, including select benzodiazepines (e.g., chlordiazepoxide, diazepam), acamprosate (Campral), naltrexone, and disulfiram (Antabuse). Which medication or combination of medications is used depends on the assessment of your addiction and factors such as physical health, risk of complicated withdrawal, strength of family and other sources of supports, and the potential for relapse.
  3. Inpatient addiction programs—There are numerous inpatient and residential treatment centers that provide structured 30-90 day programs with 24/7 supervision and access to medical and mental health care services (including medication management). Throughout, patients will participate in numerous behavioral therapy sessions and other recovery support services. These programs are great options if you are suffering from a severe addiction and lack support at home, or if your home environment is particularly triggering. When you’re getting help at an inpatient center, you can focus completely on your recovery in a substance-free environment.
  4. Outpatient addiction programs—This type of treatment takes many forms and provides more flexible scheduling options if your AUD has not become sufficiently severe to require 24-hour inpatient care. Like inpatient treatment, evidence-based addiction services are provided through outpatient treatment for 90 or more days, but on a daily or weekly basis instead of 24-hour care. This may be a good option for you if you are unable to leave work and/or family for an extended period of time to engage in an inpatient program.
  5. Behavioral or psychological therapy—A key component of alcohol addiction treatment is individual and group therapy. Once the physical dependence to alcohol is addressed, gaining an understanding of the underlying psychological causes of your addiction becomes paramount.  There are a number of different evidence-based therapeutic approaches that have been shown to help improve treatment outcome. Three successful, widely-used approaches are cognitive behavioral therapy (CBT), motivational interviewing (MI) and contingency management.
  6. 12-step groupsAlcoholics Anonymous (AA) is a mutual help and support group that provides fellowship and strategies for avoiding relapse, maintaining sobriety, and pursuing a fulfilling abstinence based life. AA meetings are held multiple times a day around the world and are free.  These groups are often incorporated into residential and outpatient treatment programs.
  7. Aftercare programs—Abruptly ending all treatment may lead you back into drinking, which is why sustaining your recovery efforts through aftercare is so important. Through sustained engagement in individual and group therapy, skills training, wellness programs (such as mindfulness training, yoga, and meditation), support group meetings, and relapse prevention training, long-term recovery can become a reality.

According to the National Institute on Drug Abuse (NIDA), actively choosing treatment (more than which specific treatment type you choose) is a strong predictor of success in staying sober, but you need to understand your options to make an informed decision and move forward with confidence. Trying to figure out the best next step can be overwhelming. For support in selecting the best alcoholism treatment option for you or your loved one, contact one of our rehab placement specialists today at 1-888-744-0069 .

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Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating him to seek a clinical psychiatry preceptorship at the San Diego VA Hospital’s Inpatient Alcohol and Drug Treatment Program. In his post-graduate clinical work, Dr. Thomas later applied the tenets he learned to help guide his therapeutic approach with many patients in need of substance treatment. In his current capacity as Senior Medical Editor for American Addiction Centers, Dr. Thomas, works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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