While it seems the opioid-abuse epidemic is grabbing all the headlines, far more families are affected by alcohol abuse. Nearly 90,000 Americans die each year from alcohol-related causes. That’s almost 10 percent of all deaths in the United States. Drunk driving causes 30 percent of all driving deaths.
Alcohol use disorder (AUD) is the medical term used when a person’s problem drinking has become severe. The National Institute on Alcohol Abuse and Alcoholism defines AUD as a chronic relapsing brain disease. The person cannot control when and how much they drink, feels bad when they aren’t drinking and keeps using alcohol even after it causes serious problems for them. About 17 million Americans have AUD; men comprise about two-thirds of that total.
There are a variety of treatments for AUD. Treatment can help stop or significantly reduce alcohol abuse. Seeking and accepting help is more effective than trying to stop on your own.
Identifying the problem
About 7 percent of U.S. adults say they drink heavily. Heavy drinking means having three or more drinks in one day (or more than seven in a week) for women, or four or more drinks per day for men (or more than 14 in one week). Fully 25 percent of adults reported at least one episode of binge drinking. “Binging” is defined as four or more drinks in one day for a woman; five for a man.
However, the best indicator of a drinking problem is not the number of drinks you have, but how alcohol affects your life. It is strongly associated with many health problems including:
- Liver disease
- Heart disease
- Some cancers
- Injury and disability
- Brain damage
- Bipolar disorder
- Depression or anxiety
- Drug misuse
AUD increases the chances of domestic violence, and child abuse or neglect. In pregnant women or women planning to become pregnant, it can cause the heartbreak of fetal alcohol syndrome. One study reported 77 percent of adults with AUD had one or more other health problems.
Causes are complex
AUD is a disease caused by a complicated mix of genes and environment. While genes or family history can have a strong influence on alcohol use, traumatic events or situations can significantly increase the chance that a person will seek comfort from alcohol. They crave the effect that alcohol can provide.
A well-recognized cause of AUD is a history of adverse childhood experiences (ACEs), or traumatic events that happen before age 18. ACEs include physical, verbal, mental or sexual abuse; living in a dysfunctional household; household members who abuse alcohol or drugs; seeing domestic violence or parental divorce.
However, many people still believe that AUD is caused by a moral failure. This long-held myth has kept many people and their families from seeking help. And, it keeps public-policy makers from providing the support needed to control this very serious and expensive public health problem.
Symptoms of problem drinking
Some people with AUD go to great lengths to hide their problem while others drink openly. Some of the more common indicators that alcohol has become a problem include:
- Frequent falls, accidents, auto accidents
- Temper outbursts
- Memory loss
- Frequent hangovers
- Missing work or unable to keep a job
- Sleeping a lot
- Poor personal hygiene
- Looking for or planning how to get the next drink
- Hiding alcohol or drinking secretly
- Lying about drinking
- Ignoring or forgetting family or personal responsibilities
- Contact with law enforcement.
While some people’s lives are in shambles because of alcohol abuse, others with AUD outwardly appear just fine. They may have a good job, be a responsible member of the community, have a family and friends and be a productive person. Often called “high-functioning” alcoholics, their success leads even people close to them to overlook their drinking. This attitude can significantly reduce their chances of getting help with the disease. No one can drink heavily and maintain major responsibilities over a long period of time. Abusing alcohol eventually catches up with them through mental or physical health problems, or job loss, divorce, or incarceration.
WebMD identifies the following behaviors as symptoms of a person with an alcohol problem. They can be present in a person whose life is falling apart or in a high-functioning alcoholic:
- Says he/she has a drinking problem or jokes about alcoholism
- Not keeping up with major responsibilities at home or work
- Loses friendships or has relationship problems due to drinking, but doesn’t quit drinking
- Has legal problems related to drinking, such as a drunk-driving arrest
- Needs alcohol to relax or feel confident
- Drinks in the morning or when alone
- Gets drunk without intending to; can’t stop drinking once they start
- Forgets what they did or what happened while drinking
- Denies drinking, hides alcohol, or gets angry when confronted about drinking
- Causes loved ones to worry about or make excuses for their drinking
Admitting the problem
It’s hard to admit that someone you love – even yourself – has a drinking problem. But it can be even harder to tell that person you think they need help or should “do something” about their drinking. Rarely does an alcohol abuser recognize that they have a problem. Usually the recognition comes from family, friends or a work supervisor. Even if you understand that AUD is a disease and not a moral failure, denial of AUD is still common.
Drinking is socially acceptable in most places. It is included in many social gatherings and helps people be more sociable. Millions of people can drink responsibly and never have a problem.
How can you tell if drinking has become a problem? There are several short self-tests that can help determine if you’re abusing alcohol. They consist of simple questions such as the screening test below.
In the past year, have you:
- Had times when you drank more or for longer than you meant to?
- Tried (or wanted to try) multiple times to cut back or stop drinking, but you couldn’t?
- Spent a lot of time drinking or getting over the effects of alcohol?
- Felt a strong need, urge, or craving to drink?
- Found that drinking or its effects kept you from working or taking care of your family?
- Continued to drink even when it caused tension with family and friends?
- Skipped out on or decreased activities you enjoy so you could drink?
- More than once found yourself doing risky things during or after drinking, like driving or having unsafe sex?
- Kept drinking even though it made you black out, feel sad or anxious, or made another health problem worse?
- Had to drink more than you once did to get the same effects?
- Felt withdrawal symptoms from alcohol, including trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, sweating, a racing heart or seeing/hearing things that were not there?
If you answered yes to any of these, you may have AUD.
Another self-test is the Michigan Alcohol Screening Test (MAST), available here.
Be sure to share the self-test results with your doctor. This is a good way to get the conversation started toward treatment.
For more information about causes and ways to get help and stay sober read an excellent article, “Me, Alcohol and Hope” written by a recovering alcoholic.
Diagnosis and treatments
If you suspect that you, or a loved one, has a drinking problem, start by visiting with a doctor or other health care professional. A routine health check-up should always include questions about alcohol, including your drinking habits, if you binge drink, whether it’s affected your relationships or work, and if you’ve ever done risky things after drinking. Bring up the subject yourself if your doctor doesn’t.
Far too often a doctor first becomes aware of a patient’s alcohol problem when he or she diagnoses health problems such as mild tremor, an enlarged and tender liver, changing blood pressure or a fast heartbeat. There is no lab test to diagnose AUD, but a blood test can check how well your liver is working. Heavy drinking can impair liver function.
Treatment can make a difference, no matter what your age or stage of drinking. Research shows that about one-third of people who receive alcohol treatment have no further symptoms after one year. Many others substantially reduce their drinking and report fewer alcohol-related problems.
Treatment can range from nonaddictive medications that reduce cravings, to individual or group counseling, outpatient care or an inpatient facility stay. Unfortunately, less than 10 percent of people with AUD receive any treatment.
AUD is a chronic disease and relapses are common. Relapse is most likely during stressful periods or when you are exposed to people or places associated with past drinking. Persistence is important to maintaining a nonalcoholic life. Continued follow-up with treatment methods and reinforcement of sobriety skills is important. Relapses are not a failure but should be considered a temporary setback.
Alcohol counseling, also called behavioral treatment, helps change the behaviors that lead to heavy drinking. You’ll develop skills to stop or reduce drinking, learn how to build a strong social support system, and learn to cope with or avoid the triggers that cause you to want a drink. Counseling can be one-on-one or in a small-group setting.
Alcoholics Anonymous (AA) and Al-Anon (for family members of an alcoholic) have helped millions of people recognize they have a problem and learn to cope with it. AA’s 12-Step program provides peer support for those who want to quit or reduce their drinking. AA members work with others like themselves in the group to get sober and maintain it. In general, a 12-Step program supports people helping one another achieve and maintain freedom from alcohol or other substances. AA’s 12-Step method has been successfully adopted by many other groups.
There are AA chapters all over the country and anyone is welcome to attend an open meeting. There is no fee for AA; it’s self-supporting through individual contributions. Try attending a meeting just to listen, you may find you identify with some of the things being said.
AFMC offers a variety of alcohol-related tools, free for anyone to download, in both English and Spanish versions, at afmc.org.
There’s more information at SAMHSA’s National Helpline – 1-800-662-HELP (4357) – a free, confidential, 24/7, 365-day-a-year treatment referral and information service (English and Spanish) for individuals and families facing mental and/or substance use disorders.
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