ALCOHOL USE DISORDER – SYMPTOMS, CAUSES, AND TREATMENT

WHAT IS ALCOHOL USE DISORDER?

Alcohol use disorder is a pattern of alcohol use that includes problems controlling your drinking, being preoccupied with alcohol, or continuing to use alcohol even when it causes problems. This disorder also includes having to drink more to get the same effect or having withdrawal symptoms when you quickly decrease or stop drinking. Alcohol use disorder includes a level of drinking that is sometimes known as alcoholism.

Unhealthy alcohol use includes any alcohol use that puts your health or safety at risk or causes other alcohol-associated problems. It also involves binge drinking — a pattern of drinking where a male has five or more drinks within two hours or a female has at least four drinks within two hours. Binge drinking results in significant health and safety risks.

If your pattern of drinking leads to repeated significant distress and problems functioning in your daily life, you likely have alcohol use disorder. It could range from mild to severe. However, even a mild disorder can escalate and lead to severe problems, so early treatment is important.

SYMPTOMS

Alcohol use disorder could be mild, moderate, or severe, based on the number of symptoms you experience. Signs and symptoms might include:

• Being unable to restrict the amount of alcohol you drink
• Wanting to cut back on how much you drink or making unsuccessful attempts to do so
• Spending lots of time drinking, getting alcohol, or recovering from alcohol use
• Feeling a strong craving or desire to drink alcohol
• Failing to fulfill major obligations at work, school, or at home because of repeated alcohol use
• Continuing to drink alcohol even though you know it is causing physical, social, work, or relationship issues
• Giving up or decreasing social and work activities and hobbies to use alcohol
• Using alcohol in situations where it is not safe, like when driving or swimming
• Developing a tolerance to alcohol so you require more to feel its effect or you have a reduced effect from the same amount
• Experiencing withdrawal symptoms — like nausea, sweating, and shaking — when you do not drink, or drinking to avoid these symptoms

Alcohol use disorder could involve periods of being drunk (alcohol intoxication) and symptoms of withdrawal.

• Alcohol intoxication occurs as the amount of alcohol in your bloodstream increases. The greater the blood alcohol concentration is, the more likely you are to have bad effects. Alcohol intoxication causes behavior issues and mental changes. These might include inappropriate behavior, unstable moods, poor judgment, slurred speech, issues with attention or memory, and poor coordination. You can also have periods known as “blackouts,” where you do not remember events. Very high blood alcohol levels could lead to coma, permanent brain damage, or even death.
• Alcohol withdrawal could occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to four to five days later. Signs and symptoms include sweating, rapid heartbeat, hand tremors, trouble sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms could be severe enough to impair your ability to function at work or in social situations.

WHAT IS CONSIDERED 1 DRINK?

The National Institute on Alcohol Abuse and Alcoholism refers to a standard drink as any one of these:

• 12 ounces (355 milliliters) of regular beer (about five percent alcohol)
• 8 to 9 ounces (237 to 266 milliliters) of malt liquor (about seven percent alcohol)
• 5 ounces (148 milliliters) of wine (about twelve percent alcohol)
• 5 ounces (148 milliliters) of wine (about twelve percent alcohol)

WHEN SHOULD YOU SEE A DOCTOR?

If you feel that you sometimes drink too much alcohol, or your drinking is causing issues, or if your family is concerned about your drinking, talk with your health care provider. Other ways to get help include talking with a mental health professional or seeking help from a support group like Alcoholics Anonymous or a similar type of self-help group.

Because denial is common, you might feel like you do not have a problem with drinking. You might not recognize how much you drink or how many problems in your life are associated with alcohol use. Listen to relatives, friends, or co-workers when they ask you to examine your drinking habits or ask for help. Consider talking with someone who has had an issue with drinking but has stopped.

Many people with alcohol use disorder hesitate to get treatment because they do not recognize that they have a problem. An intervention from loved ones could help some people recognize and accept that they need professional help. If you are concerned about someone who drinks too much, ask a professional experienced in alcohol treatment for advice on how to approach that person.

CAUSES

Genetic, psychological, social, and environmental factors could impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that could lead to alcohol use disorder.

Over time, drinking too much alcohol might change the normal function of the areas of your brain related to the experience of pleasure, judgment, and the ability to exercise control over your behavior. This might result in craving alcohol to try to restore good feelings or reduce negative ones.

RISK FACTORS

Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s, though it could start at any age.

Risk factors for alcohol use disorder include:

• Steady drinking over time – Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-associated problems or alcohol use disorder.
• Starting at an early age – People who begin drinking — particularly binge drinking — at an early age are at a higher risk of alcohol use disorder.
• Family history – The risk of alcohol use disorder is greater for people who have a parent or other close relative who has problems with alcohol. This can be influenced by genetic factors.
• Depression and other mental health problems – It is common for people with mental health disorders like anxiety, depression, schizophrenia, or bipolar disorder to have problems with alcohol or other substances.
• History of trauma – People with a history of emotional trauma or other trauma are at higher risk of alcohol use disorder.
• Having bariatric surgery – Some research studies indicate that having bariatric surgery might increase the risk of developing alcohol use disorder or of relapsing after recovering from alcohol use disorder.
• Social and cultural factors – Having friends or a close partner who drinks regularly can increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also might send the message that it is OK to drink too much. For young people, the influence of parents, peers, and other role models could impact risk.

COMPLICATIONS

Alcohol depresses the central nervous system. In some people, the initial reaction might feel like an increase in energy. But when you continue to drink, you become drowsy and have less control over your actions.

Too much alcohol affects your speech, muscle coordination, and crucial centers of your brain. A heavy drinking binge might even cause a life-threatening coma or death. This is of particular concern when you are taking certain medications that also depress the brain’s function.

Impact on your safety

Excessive drinking could reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including:

• Motor vehicle accidents and other types of accidental injury, like drowning
• Relationship problems
• Poor performance at work or school
• Higher likelihood of committing violent crimes or being a victim of a crime
• Legal problems or issues with employment or finances
• Problems with other substance use
• Engaging in risky, unprotected sexual intercourse, or experiencing sexual abuse or date rape
• Increased risk of attempted or completed suicide

Impact on your health

Drinking too much alcohol on a single occasion or over time could cause health problems, including:

• Liver disease – Heavy drinking could cause increased fat in the liver (hepatic steatosis) and inflammation of the liver (alcoholic hepatitis). Over time, heavy drinking could cause irreversible destruction and scarring of liver tissue (cirrhosis).
• Digestive problems – Heavy drinking could result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It could also interfere with your body’s ability to get enough B vitamins and other nutrients. Heavy drinking could damage your pancreas or lead to inflammation of the pancreas (pancreatitis).
• Heart problems – Excessive drinking could lead to high blood pressure and increases your risk of an enlarged heart, heart failure, or stroke. Even a single binge can cause severe irregular heartbeats (arrhythmia) known as atrial fibrillation.
• Diabetes complications – Alcohol interferes with the release of glucose from your liver and could increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin or some other diabetes medications to reduce your blood sugar level.
• Issues with sexual function and periods – Heavy drinking could cause men to have difficulty maintaining an erection (erectile dysfunction). In women, heavy drinking could interrupt menstrual periods.
• Eye problems – Over time, heavy drinking could cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamin). A thiamin deficiency could result in other brain changes, such as irreversible dementia, if not promptly treated.
• Birth defects – Alcohol use during pregnancy might cause miscarriage. It might also cause fetal alcohol spectrum disorders (FASDs). FASDs could cause a child to be born with physical and developmental problems that last a lifetime.
• Bone damage – Alcohol might interfere with making new bone. Bone loss could lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol could also damage bone marrow, which makes blood cells. This could cause a low platelet count, which may result in bruising and bleeding.
• Neurological complications – Excessive drinking could affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss.
• Weakened immune system – Excessive alcohol use could make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia.
• Increased risk of cancer – Long-term, excessive alcohol use has been linked to a greater risk of many cancers, including mouth, throat, liver, esophagus, colon, and breast cancers. Even moderate drinking could increase the risk of breast cancer.
• Medication and alcohol interactions – Some medicines interact with alcohol, increasing its toxic effects. Drinking while taking these medications could either increase or decrease their effectiveness, or make them dangerous.

PREVENTION

Early intervention can prevent alcohol-associated problems in teens. If you have a teenager, be alert to signs and symptoms that might indicate a problem with alcohol:

• Loss of interest in activities and hobbies and a personal appearance
• Red eyes, slurred speech, issues with coordination, and memory lapses
• Difficulties or changes in relationships with friends, like joining a new crowd
• Declining grades and issues in school
• Frequent mood swings and defensive behavior

You could help prevent teenage alcohol use:

• Lead by example in your own alcohol use.
• Speak openly with your child, spend quality time together and become actively involved in your child’s life.
• Tell your child what behavior you expect — and what the consequences will be for not following the rules.

DIAGNOSIS

You are likely to begin by seeing your primary health care provider. If your provider suspects that you have a problem with alcohol, you might be referred to a mental health provider.

To assess your problem with alcohol, your provider will probably:

Ask you some questions associated with your drinking habits – The provider might ask for permission to speak with family members or friends. However, confidentiality laws prevent your provider from sharing any information about you without your consent.

Perform a physical examination – Your health care provider may do a physical examination and ask questions about your health. There are many physical signs that point to complications of alcohol use.

Suggest lab tests and imaging tests – While there are no specific tests to diagnose alcohol use disorder, certain patterns of laboratory test results may strongly suggest it. And you might need tests to identify health problems that may be linked to your alcohol use. Damage to your organs might be seen on tests.

Complete a psychological evaluation – This evaluation includes questions related to your symptoms, thoughts, feelings, and behavior patterns. You might be asked to complete a questionnaire to help answer these questions.

Alcohol use disorder is a pattern of alcohol use that includes problems controlling your drinking, being preoccupied with alcohol, or continuing to use alcohol even when it causes problems.

TREATMENT

Treatment for alcohol use disorder could vary, depending on your needs. Treatment might involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay. Working to stop alcohol use to improve quality of life is the primary treatment goal.

Treatment for alcohol use disorder might include:

• Detox and withdrawal – Treatment might start with a program of detoxification — a withdrawal that is medically managed. Sometimes known as detox, this generally takes two to seven days. You might need to take sedating medications to prevent withdrawal symptoms. Detox is generally done at an inpatient treatment center or a hospital.
• Learning new skills and making a treatment plan – This process generally involves alcohol treatment specialists. It might include goal setting, behavior change techniques, use of self-help manuals, counseling, and follow-up care at a treatment center.
• Psychological counseling – Counseling and therapy for groups and individuals help you better understand your issue with alcohol and support recovery from the psychological aspects of alcohol use. You might benefit from couples or family therapy — family support can be an important part of the recovery process.
• Oral medications – A drug called disulfiram might help prevent you from drinking, although it would not cure alcohol use disorder or remove the urge to drink. If you drink alcohol while taking disulfiram, the drug produces a physical reaction that might include flushing, nausea, vomiting, and headaches.
• Naltrexone, a drug that blocks the good feelings alcohol causes, might prevent heavy drinking and reduce the urge to drink. Acamprosate might help you combat alcohol cravings once you stop drinking. Unlike disulfiram, naltrexone and acamprosate do not make you feel sick after taking a drink.
• Injected medication – Vivitrol, a version of the drug naltrexone, is administered once a month by a health care professional. Although similar medication could be taken in pill form, the injectable version of the drug might be easier for people recovering from alcohol use disorder to use consistently.
• Continuing support – Aftercare programs and support groups help people who are recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This might include medical or psychological care or attending a support group.
• Treatment for psychological problems – Alcohol use disorder commonly happens along with other mental health disorders. If you have depression, anxiety, or another mental health condition, you might need talk therapy (psychotherapy), medications, or other treatment.
• Medical treatment for health conditions – Many alcohol-associated health problems improve significantly once you stop drinking. But some health conditions might warrant continued treatment and follow-up care.
• Spiritual practice – People who are involved with some type of regular spiritual practice might find it easier to maintain recovery from alcohol use disorder or other addictions. For many people, gaining greater insight into their spiritual side is a vital element in recovery.

Residential treatment programs

For severe alcohol use disorder, you may need a stay at a residential treatment facility. Most residential treatment programs involve individual and group therapy, support groups, educational lectures, family involvement, and activity therapy.

Residential treatment programs generally include licensed alcohol and drug counselors, social workers, nurses, doctors, and others with expertise and experience in treating alcohol use disorder.

If you or anyone you know is suffering from alcohol use disorder, our expert providers at Specialty Care Clinics will take care of your health and help you recover.

Call 469-545-9983 to book a telehealth appointment for an at-home check-up.