Alcohol Use Disorder

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Alcohol Use Disorder

Alcohol use disorder, also referred to as alcoholism, is a problem drinking that becomes severe. It is a common disorder. There is an estimated 16 million people in the United States have alcohol use disorder. Rates of this disorder are greater among adult men than among adult women. Alcohol use disorder is defined by a cluster of behavioral and physical symptoms, which can include tolerance, withdrawal, and craving. If the pattern of drinking that a person indulges in results in repeated significant distress and problems functioning in their daily functioning, you likely have alcohol use disorder. Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of judgement, pleasure, and the ability to exercise control over one's behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones. Alcohol use disorder can be life threatening and can impact not just the individual, but also friends, family, colleagues, etc.

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Alcohol Use Disorder Defined

Alcohol use disorder is a term used to refer to the misuse of alcohol. Several specifically defined conditions better categorize patterns of alcohol misuse. Alcohol use disorder is a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using. Individuals with alcohol use disorder are preoccupied with alcohol and continue to drink alcohol even when it causes problems. To get the same effect of being being intoxicated, individuals with alcohol use disorder have to drink more just to get the same effect, or having withdrawal symptoms when you rapidly decrease or stop drinking. Alcohol use disorder is diagnosed when, over a 12-month period, the patient's drinking has caused clinically significant impairment or distress. Alcohol use disorder, with severity specified as mild, moderate, or severe, depending on the number of diagnostic criteria that have been met. While it can range from mild to severe, even a mild disorder can escalate and lead to serious problems, so early treatment is important.

Different Types of Alcohol Use Disorder:

There are not separate types of alcohol use disorders, but there are levels of severity. These levels are based on which criteria is met, which is listed under symptoms.

Mild: Presence of 2-3 symptoms.

Moderate: Presence of 4-5 symptoms.

Severe: Presence of 6 or more symptoms.

Alcohol Use Disorder Causes:

There can be several causes to alcohol use disorder. Various factors like genetic, psychological, social and environmental factors can all impact how drinking alcohol affects your body and behavior. For certain people drinking has a different and stronger impact that can lead to alcohol use disorder that it may not have on others.

Alcohol Use Disorder Symptoms:

To be diagnosed with an alcohol use disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period.

    1. Alcohol is often taken in larger amounts or over a longer period than was intended.
    2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
    3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
    4. Craving, or a strong desire or urge to use alcohol.
    5. Recurrent alcohol use, resulting in a failure to fulfill major role obligations at work, school, or home.
    6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
    7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
    8. Recurrent alcohol use in situations in which it is physically hazardous.
    9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
    10. Tolerance, as defined by either of the following:
      • A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
      • A markedly diminished effect with continued use of the same amount of alcohol.
    11. Withdrawal, as manifested by either of the following:
      • The characteristic withdrawal syndrome for alcohol.
      • Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Symptoms of alcohol use disorder can include:

    • Being unable to limit the amount of alcohol you drink
    •  Feeling a strong craving or urge to drink alcohol
    •  Wanting to cut down on how much you drink or making unsuccessful attempts to do so
    •  Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount
    •  Spending a lot of time drinking, getting alcohol or recovering from alcohol use
    •  Giving up or reducing social and work activities and hobbies
    •  Failing to fulfill major obligations at work, school or home due to repeated alcohol use
    •  Continuing to drink alcohol even though you know it's causing physical, social or interpersonal problems
    •  Using alcohol in situations where it's not safe, such as when driving or swimming
    •  Experiencing withdrawal symptoms — such as nausea, sweating and shaking — when you don't drink, or drinking to avoid these symptoms

Alcohol use disorder can include periods of alcohol intoxication and symptoms of withdrawal.

Alcohol intoxication:

Alcohol intoxication is a result of the what happens when the amount of alcohol in your bloodstream increases. The first episode of alcohol intoxication is likely to occur during the mid-teens. The higher your blood alcohol concentration is, the more impaired you become. Very high blood alcohol levels can lead to comas or even death. Alcohol intoxication causes behavior problems and mental changes. When intoxicated, individuals can also have periods called "blackouts," where you don't remember events.  To be diagnosed with alcohol intoxication, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

1. Recent ingestion of alcohol.

2. Clinically significant problematic behavioral or psychological changes (e.g., inappropriate sexual or aggressive behavior, mood liability, impaired judgement) that developed during, or shortly after, alcohol ingestion.

3. One (or more) of the following signs or symptoms during, or shortly after, alcohol use:

      • Slurred speech.
      • Incoordination.
      • Unsteady gait.
      • Nystagmus.
      • Impairment in attention or memory.
      • Stupor or coma.

4. The signs or symptoms are not attributable to another medical conditioning are not better explained by another mental disorder, including intoxication with another substance.

Alcohol withdrawal:

Alcohol withdrawal can occur when alcohol use has been heavy and prolonged and is then significantly reduced or stopped. The span of alcohol withdrawal can occur anywhere from within several hours to four or five days later. To be diagnosed with alcohol withdrawal, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged.

B. Two (or more) of the following, developing within several hours to a few days after the cessation of (or reduction in) alcohol use described in Criterion A:

      1. Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm).
      2. Increased hand tremor.
      3. Insomnia.
      4. Nausea or vomiting.
      5. Transient visual, tactile, or auditory hallucinations or illusions.
      6. Psychomotor agitation.
      7. Anxiety.
      8. Generalized tonic-clonic seizures.

C. The signs of symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

How to Approach a Loved One:

There is not a perfect way to approach a loved one that you assume or know is struggling with alcohol use disorder. Many people with alcohol use disorder hesitate to get treatment because they don't recognize they have a problem, so approaching them to tell them that they do have a problem can be difficult. An intervention from loved ones can help some people recognize and accept that they need professional help. If you're concerned about someone who drinks too much, ask a professional experienced in alcohol treatment for advice on how to approach that person. You can not force someone to seek professional care, but you can always offer your support and encouragement. Even though you may not be able to prevent your loved one from developing an alcohol use disorder, you can still talk with them about treatment options. For more help on how to approach loved ones visit https://www.healthline.com/health/most-important-things-you-can-do-help-alcoholic#approach.

Types of Alcohol Use Disorder Treatment:

There are effective treatments for alcohol use disorder. The first step in treatment is being able to recognize that you have have an alcohol use problem, which can be difficult for most individuals. Many individuals reach this realization at very low point brought upon by alcohol use disorder. Even with treatment, there is a probability that you may return to alcohol use. This is more likely to occur if you spend time with people who drink alcohol or you're in environments where alcohol use is common. A key part of recovery for alcohol use disorder is continued support.

Aftercare programs and/or support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. If you feel that you'll start to use alcohol again, contact your mental health professional or sponsor right away to prevent a relapse. Lifestyle changes are also crucial in recovering from alcohol use disorder. Doing things that don’t involve alcohol and replacing activities you usually partake in that involve alcohol with something else is necessary. Ensuring that your family and friends are aware that you are no longer drinking alcohol and develop a support system of friends and family who can support your recovery, now impair your recovery. If you have people in your life that socially drink that do not support your recovery may impact your course of treatment and recovery. Finally, continuing to engage in other healthy habits is necessary for treatment. This can include managing stress in a healthy way, good sleep habits, maintaining a schedule, or regular physical activity can make it easier for you to recover from alcohol use disorder.

 

Detox and withdrawal

The first step in treatment is enrolling in a program to begin detoxification or detox. This process is medically managed, which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital.

 

Psychotherapy

Psychotherapy, also known as talk therapy or psychological counseling is used to identify the patterns of behaviors, thoughts, triggers, etc. that may impact individuals with alcohol use disorder. In therapy, individuals learn skills and establishing treatment plans that usually involve alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center. In therapy or counseling, it may help individuals better understand their problem with alcohol and support recovery from the psychological aspects of alcohol use. Alcohol use disorder commonly occurs along with other mental health disorders, like depression and anxiety, which can be discussed in therapy.

 

Family therapy: This form of therapy can provide the individual with support, as well as the family in regards to how the alcohol use behaviors affect the family unit. It can provide the family with skills on how to resolve issues that arise and communicate with each other in a healthy manner. Family therapy also provides the individual with support needed for their recovery.

 

Self- Help Groups

There are various self-help groups that are options for individuals to attend, such as Alcoholics Anonymous (AA), Women for Sobriety, and Al-Anon and Alateen. Some people find that talking with others who have an alcohol use problem may be a helpful part of treatment. Through self-help groups, individuals find a forum of peer support, gaining strength as they share their feelings, and experiences with others who are facing the same obstacles as themselves. Self- help groups can also be helpful because you can have a sponsor that will assist in your continued recovery.

 

Medications

There are medications that can assist in the treatment of alcohol use disorder. An injection medication, Vivitrol, is injected once a month by a healthcare professional. Vivitrol is a non-addictive, once-monthly treatment proven to help reduce heavy drinking days in alcohol dependent patients when used with counseling. It can also be administered in pill form. Another drug called disulfiram (Antabuse) may help prevent individuals from drinking. Antabuse is not a cure for alcohol use disorder. This drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Naltrexone is a drug that blocks the good feelings alcohol causes and may prevent heavy drinking, as well as reduce the urge to drink. Acamprosate is a drug that may help individuals combat alcohol cravings once a person stops drinking. Unlike disulfiram, naltrexone and acamprosate don't make individuals feel sick after taking a drink.

 

Residential treatment programs

For serious alcohol use disorder, enrolling in a residential treatment facility may be necessary. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement and activity therapy. These programs will include the collaborative efforts of a team, which typically include licensed alcohol and drug counselors, social workers, nurses, doctors and others with expertise and experience in treating alcohol use disorder.

 

Other practices

While medication, psychotherapy, residential programs and other treatment options are necessary in treatment, research has found that other forms of treatment can also helpful. Partaking in practices like meditation, yoga, your religious beliefs, etc., help individuals gain greater insight into their spiritual side and this is a key element in recovery.

Differences Between Common Disorders:

There are other possible causes of that resemble alcohol use disorder, but would not meet criteria for this disorder. These are common disorders but the differences between them and alcohol use disorder.

  • Non Pathological use of alcohol- A key element of alcohol use disorder is the use of heavy doses of alcohol with resulting repeated and significant distress or impaired functioning. While most people who drink alcohol drink enough to become intoxicated, less than 20% ever develop alcohol use disorder. Consequently, if an individual drinks, or drinks low doses and occasional intoxication, do not qualify for a an alcohol use disorder.
  • Sedative, hypnotic, or anxiolytic use disorder- There are similar signs and symptoms in alcohol use disorder that mirror sedative, hypnotic, or anxiolytic use disorder. The two must be distinguished, however, because the course may be different, especially in relation to medical problems.
  • Conduct disorder in childhood and adult antisocial personality disorder- Like other substance abuse disorders, alcohol use disorder is seen in the majority of individuals with antisocial personality and preexisting conduct disorder. It is important to establish both conditions due to both diagnosis are associated with an early onset alcohol use disorder as well as a worse prognosis.

Resources

Alcohol use disorder. (2018). Retrieved from:
https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/diagnosis-treatment/drc-20369250

Alcohol Use Disorder. (n.d.). Retrieved from:
https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.
(5th ed.) Arlington, VA: American Psychiatric Association.

Drummond, C.  (2018). Alcohol use disorder. Retrieved from:
https://bestpractice.bmj.com/topics/en-us/198

Vivitrol (naltrexone for extended-release injectable suspension). (2018). Retrieved from:
https://www.vivitrol.com/alcohol-dependence/what-is-vivitrol

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