Simply stated, alcoholism is an addiction to consuming alcohol. It entails an inability to control drinking due to a physiological and cognitive/emotional dependence on the substance. In a general sense, it is the point of no return at which individuals no longer drink for fun but as a literal means of survival.
Treatments for alcoholism include inpatient care, outpatient care, therapy (most frequently cognitive behavioral therapy), and sometimes medication. Types of treatment will depend on the severity of symptoms as well as what treatment(s) an individual is willing to comply with.
Signs of Alcoholism: What It Looks Like
Drinking among legal adults is widely accepted in the United States. In a 2018 National Survey on Drug Use and Health (NSDUH) 86.3% of those surveyed reported consuming alcohol at least once in their lives while 70.0% reported consumption within the past year. 1 Given its legality, acceptance, and easy access, alcohol is one substance that can slowly but surely begin to consume someone.
Alcoholism in Teens
Adolescence is marked by rapid physical and psychological changes. With this comes significant stress and a desire to fit in with one’s peer group. Without the ability to make appropriate decisions based on potential risk factors, teens may be easily swayed to consume alcohol. Because they are younger and less or inexperienced drinkers, their tolerance is low at first, making it easy to become intoxicated. Over time, the quantity necessary to become intoxicated increases and the days of consumption increase.
Alcoholism in Older Adults
Older adulthood brings along new challenges. Regardless of how one has lived life, all older adults face increased physiological challenges, loss, and the inevitable facing of one’s mortality. For some, the stress may lead toward increased mental health complications (e.g., depression), which may make alcohol an attractive candidate for coping.
Alcoholism in Men vs Women
Although it is still more common for men to become heavy drinkers than women, 2 “found that over that period of time [2002-2012], differences in measures such as current drinking, number of drinking days per month, reaching criteria for an alcohol use disorder, and driving under the influence of alcohol in the past year, all narrowed for females and males.” It is important to note that the female body metabolizes alcohol differently, which leads toward faster intoxication.
Symptoms of Alcoholism
There is no one look of someone who is afflicted with alcoholism. While there is the stereotypical struggling person who appears tattered and torn, many are quite affluent and functional. The signs and symptoms of alcoholism may vary minimally to significantly from one individual to the next. Diagnostically, alcohol use disorder (AUD) is conceptualized on a continuum from mild to moderate to severe. This rating is dependent upon the number and severity of symptoms present.
According to Mayo Clinic,3 signs and symptoms may include:
- Being unable to limit the amount of alcohol you drink
- Wanting to cut down on how much you drink or making unsuccessful attempts to do so
- Spending a lot of time drinking, getting alcohol, or recovering from alcohol use
- Feeling a strong craving or urge to drink alcohol
- 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
- Giving up or reducing social and work activities and hobbies
- Using alcohol in situations where it’s not safe, such as when driving or swimming
- Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount
- Experiencing withdrawal symptoms—such as nausea, sweating, and shaking—when you don’t drink, or drinking to avoid these symptoms
Causes & Triggers of Alcoholism
Research continues to struggle insofar as pinpointing an exact cause for alcoholism; however, it is known that causes and triggers of alcoholism vary widely. Such factors may be categorized as those of biological, environmental, social, and psychological origin. While there may be a single isolated factor, oftentimes there is a combination of factors present.
It should also be noted that susceptibility to alcoholism is not demographic specific, meaning that any person at any time in life may develop AUD. What we do know for certain is that continued excessive drinking places one at potential risk for developing AUD. The more alcohol one consumes, the more pronounced the physiological changes on the brain and body—leading toward cognitive/emotional impairment as well.
Potential Risk Factors
Potential risk factors, like causes and triggers, vary from one person to the next. For some there is trauma, and drinking helps one forget. For others there may be social anxiety, and drinking allows one to become the life of the party. Then for others, a casual weekend drinking habit slowly but surely increases into daily consumption.
Many with diagnosable mental health conditions submit to alcoholism as a way of coping while others develop substance induced mental health disorders from their consumption. Regardless of causes and triggers, however, the pathway to addiction is the same.
Common risk factors of alcoholism include but are not limited to:
- Being the child of a parent with AUD
- Genetic predisposition
- Steady drinking over time leading to increased consumption
- Peer group where most or all parties regularly consume alcohol
- Having an undiagnosed or diagnosed mental health disorder
- Low self-concept (i.e., confidence, image, esteem, etc.)
- After experiencing loss or trauma
- Attempting to cut back or abstain from illegal drugs to a legal substance
- Stress due to work, toxic relationships, finances, et cetera.
- Having a lack of meaning and feeling hopeless and/or helpless
- Not having better things to do with one’s time
Health Complications of Alcoholism
While there are studies to support some health benefits to consuming moderate amounts of alcohol, excessive consumption of the binge-drinking type on a single occasion, or chronic use over a period of time, may lead toward a plethora of health complications resulting in illness or even death.
Further, for the pregnant female, excessive consumption may lead toward pre- and post-natal complications resulting in birth defects, such as fetal alcohol spectrum disorders (FASDs), which involve chronic health and development complications. Pregnancy-related complications may include premature birth, miscarriage, and still birth.
Depending on the pattern of consumption, such health complications may present subtly over time or have immediate effect. For instance, brain damage which can become permanent if not treated early, called Wernicke-Korsakoff syndrome (WKS), results from a lack of vitamin B-1, which is a common factor for those with AUD.4
Liver disease also occurs over a period of excessive consumption and can become irreversible. In cases where individuals binge-drink to excessive amounts on a single occasion, the result may be accidental injuries, violent acts, risky sexual behaviors, or alcohol poisoning, which may lead to death. 5
According to Mayo Clinic, 3 health problems associated with excessive alcohol consumption include the following:
- Liver disease
- Digestive problems
- Heart problems
- Diabetes complications
- Sexual dysfunction and menstruation issues
- Eye problems
- Birth defects
- Bone damage
- Neurological complications
- Weakened immune system
- Increased risk of cancer
- Medication and alcohol interactions
How/When Is Alcoholism Diagnosed?
Alcohol use becomes abuse when the primary purpose of consumption is to attain a desired level of intoxication. Abuse, then, shifts toward addiction once there is a lack of control over when, where, and why one drinks. Essentially, there is a total loss of control over one’s drinking.
As the brain continues to transform from frequent alcohol abuse, alcohol consumption becomes as essential as one’s basic survival needs—satiation, nourishment, breathing, sleeping, and sex.6 To this extent it should also be noted that when the body is dependent on alcohol, individuals who stop or reduce use abruptly may experience withdrawal symptoms, such as tremors, anxiety, insomnia, abnormal heart rhythm, high blood pressure, seizures, and a state of confusion, agitation, and hallucinations called delirium tremens. Severe alcohol withdrawal without appropriate treatment has a likely outcome of death.
The earlier that alcoholism is diagnosed, the better prognosis for recovery. Unfortunately, the opposite holds true as well. Accordingly, early intervention is critical.
General signs that you or a loved one have progressed from alcohol use to abuse and potentially AUD may include any combination of the following:7
- Experiencing temporary blackouts or short-term memory loss
- Exhibiting signs of irritability and extreme mood swings
- Making excuses for drinking such as to relax, deal with stress or feel normal
- Choosing drinking over other responsibilities and obligations
- Becoming isolated and distant from friends and family members
- Drinking alone or in secrecy
- Feeling hungover when not drinking
- Changing appearance and group of acquaintances you hang out with
Should such factors be present, it is recommended to seek support immediately. While professional help is strongly encouraged, support groups such as Alcoholics Anonymous (AA) and others have also shown promising results.
Treatment of Alcoholism
There is no “one size fits all” approach to treatment. Treatment of alcoholism varies dependent upon the severity of the condition, individual motivation, and resources available. Accordingly, what works for one may not work for others. It is imperative to not force one particular type of treatment if the individual is unwilling to engage in one type and not the other. At the same time, it is critically important that the individual engages in a level of treatment that is necessary given the severity of symptoms.
Residential treatment entails living at the treatment center. This may include inpatient hospitalization as well as sober living communities such as halfway houses. Generally, residential treatment is reserved for the most severe cases of impairment. These individuals benefit from 24/7 monitoring and support. Such environments are typically structured and include a team of professionals who provide various forms of counseling, support groups, and medication (if required). Thirty, 60, and 90-day programs are quite common for this type of treatment.
Outpatient therapy may prove ideal for most mild and moderate cases of alcoholism. It is also commonly used as a follow-up from residential treatment. Such therapy may include outpatient counseling visits (comprised of 30-, 45-, or 60-minute appointments); intensive outpatient therapy (IOP, which requires multiple weekly sessions lasting at minimal several hours each); and partial hospitalization (which mimics residential treatment schedule but allows for individuals to work during the day, sleep at home at night, etc.).
The amount of time spent in therapy ultimately depends on one’s motivation. A general rule of thumb is that therapy lasts as long as one has suffered the addiction prior to shifting into more of a maintenance approach.
Cognitive behavior therapy (CBT) continues to be the “gold standard” of therapy for alcoholism. CBT considers how one’s cognitions (thoughts) based upon personal beliefs and values impact one’s emotions to lead toward a particular behavioral outcome. 8
For instance, a typical illogical thought pattern for an adolescent engaging in problematic drinking may be as follows: “Everyone else is drinking, and if I do not as well, I will not fit in. They all drink and are okay. So, it must be safe. I will go out drinking tonight.” In this specific example the counselor would challenge the statements that “everyone is drinking,” and “it must be safe.” Doing this will provide the appropriate insight toward making safer decisions.
Dialectical behavioral therapy (DBT) also continues to demonstrate positive results. This form of therapy is similar to CBT but includes an element of mindfulness, which helps keep individuals focused on the present and aware of their internal and external environment.
Not everyone being treated for AUD warrant medication. For those that do, however, it is highly recommended to seek the appropriate medication and take it as prescribed. Some medications offer help in preventing withdrawal symptoms during the detoxification process, while others may be used to address associated mental disorders or prevent relapse by diminishing cravings or causing aversion to alcohol.
Traditional medications such as Antabuse (disulfiram) discourage alcohol consumption by interfering with the degradation of alcohol so that those who drink it feel ill. Vivitrol (naltrexone), a monthly subcutaneous injection, has also demonstrated some positive results with reducing cravings. For those with diagnosable mental illness that requires medication, it is important to take medications as prescribed, as individuals may drink to cope if not properly treated.
Stages of Treatment for Alcoholism
Motivational interviewing (MI) is a commonly used approach to begin engagement in therapy. “The approach upholds four principles—expressing empathy and avoiding arguing, developing discrepancy, rolling with resistance, and supporting self-efficacy ( individuals belief that they can successfully make a change).”9 Here counselors meet people where they are at—examining one’s personal meaning toward attaining and maintaining recovery. Through meaning comes motivation, which personally drives the individual toward change.
Alongside MI is Prochaska and DiClemente’s Transtheoretical Model (TTM)10—better known at the “stages of change,” which conceptualizes the stages many go through when undergoing therapeutic change. These stages include precontemplation, contemplation, preparation, action, maintenance, and in many cases, relapse.
They may be defined as follows:
- Precontemplation is the point at which the person has no intention of changing behavior.
- Contemplation is where the person is now aware of the problem but has not made a commitment to change.
- Preparation is where the problem is acknowledged, and a commitment has been made. Here a plan is designed to begin therapeutic change.
- Action is where the person begins actively working on everything laid out during the preparation stage.
- Maintenance is the period whereby sustained change occurs and new behaviors replace old ones.
- Relapse occurs when the individual returns to the old problematic behavior.
How to Get Help for Alcoholism
Getting help for alcoholism involves a level of awareness. First and foremost, there must be an awareness of the problem. Second, it is important to be knowledgeable of resources available for treatment. Consider if there are any nearby providers offering outpatient therapy or whether agencies or hospitals are offering IOP, inpatient hospitalization, or partial hospitalization programs.
Consider if there are any nearby support groups that are accessible in terms of location and scheduled availability. In adjunct to or if none of these options are readily available, it may be useful to consider tele-mental health offerings and/or online support groups. The bottom line is that most any treatment is more effective than no treatment at all.
How to Get Help for a Loved One
If you believe that a loved one may be afflicted with alcoholism, it is important to be as supportive as possible. How one approaches a loved one does make a difference. It is important to utilize encouraging rather than discouraging language. For instance, statements that label one as an “alcoholic” are oftentimes poorly received. The conversation may begin by stating that you are concerned about one’s wellbeing and would like to offer support. Resistance is still likely.
Rather than go on the attack, the next part of the conversation may be discussion around some options for support and collaborating with one another on what might work best. Ultimatums are generally discouraged, and the individual may feel attacked. Interventions may be necessary but should be reserved as a last resort. Remember that unless in the event of a life-threatening emergency or legal mandate, adults must consent to treatment.
How to Get Help for a Teen
Similar considerations made for adults should also be in place for teens. Again, supportive language and collaboration may increase willingness to participate. One major difference however, is that parents and guardians may involuntarily commit teens to treatment. It is important to consider the most appropriate form of treatment here as well, as a less intensive environment may allow for continued drinking while a more intensive than needed program may actually influence increased consumption with the potential to try other substances.
Parents and guardians should be as involved with the treatment as possible. Such involvement prepares all individuals with communication and boundary-setting tools while also providing a safe space for everyone to speak and reflect. In the case where parents/guardians are struggling with alcoholism as well, participation in one’s own recovery program also increases the likelihood of success. It is important to be in this together by setting a positive example and supporting one another.
Survey results of the 2018 annual NSDUH revealed the following about alcohol consumption:11
- An estimated 139.8 million Americans aged 12 or older were current alcohol users
- An estimated 67.1 million Americans aged 12 or older (about 26.45% of the population) were binge drinkers in the past month.
- An estimated 16.6 million Americans aged 12 or older (about 6.6% of the population) were heavy drinkers the past month.
- About 1.2 million adolescents aged 12 to 17 (about 4.7% of the adolescent population) were past month binge drinkers
- 14.4 million adults ages 18 and older had AUD.
- 9.2 million men
- 5.3 million women
- An estimated 401,000 adolescents ages 12-17 had AUD.
The annual survey regularly consists of 67,500 interviews among all 50 states. Participants are broken into three age groups: 25% were adolescents aged 12 to 17, 25% were young adults aged 18 to 25, and 50% were adults 26 or older.
Living with Alcoholism
Many substance use professionals suggest changing persons, places, and things to maximize the likelihood of long-term success. In terms of changing persons, it is beneficial to distance oneself from others who drink to excess as well as toxic relationships. Changing places may include no longer frequenting the bar or events where one is likely to drink. And changing things may entail removing items from the house that may influence one to drink. This may include removing drinkware and alcohol itself from one’s place of residence.
Recovery is an intentional and ongoing process. Alcoholism is a disease that is treatable but has no known cure. As such, it is important to strive toward wellness in a holistic sense. SAMHSA’s eight dimensions of wellness include emotional, environmental, financial, intellectual, occupational, physical, social, and spiritual.12 If kept in healthy balance, individuals generally present as healthier and possess stronger coping skills. Activities that contribute toward wellness in each of these dimensions are those that should be practiced with consistency.
Alcoholism vs Alcohol Use Disorder vs Binge Drinking
When dealing with an alcohol problem, it is important to understand the difference between alcoholism vs AUD or binge drinking, as well as to note common disorders that co-occur with alcoholism.
Alcoholism vs Alcohol Use Disorder
Alcoholism is a term used to define problematic drinking while AUD is a clinically defined term that is based upon a number of diagnostic criteria being met. An individual afflicted with alcoholism may not necessarily meet the criteria for AUD, though there is a probable likelihood.
Alcoholism vs Binge Drinking
Binge drinking is a form of excessive drinking. Binge-drinking is defined as consuming four or more drinks on a single occasion for women and five or more for men while heavy alcohol use is defined as binge drinking on five or more days in the past 30 days.5 Note that the 2018 NSDUH revealed numbers indicating that nearly half of the 139.8 million currently alcohol consuming Americans aged twelve or older were binge drinkers (67.1 million).11 This is a significant risk factor for AUD.
Common Co-Occurring Disorders
Research has demonstrated that individuals with co-occurring disorders generally have shorter stays in treatment with poorer treatment outcomes. With these individuals, a multidisciplinary team that specializes in each diagnosis is recommended for optimal results. Common co-occurring disorders include anxiety, depression, posttraumatic stress disorder (PTSD), bipolar depression, and schizophrenia.
It is important to consider how mental health and substance use disorders reinforce one another. Those with mental health disorders may cope by using, which is reinforcing. For those who have developed alcoholism, substance induced mental health disorders may arise. In either case, both should be treated accordingly.
Alcoholism Tests, Quizzes, and Self-Assessment Tools
If you think you may have a problem with alcohol, there are some ways to self-assess, but be sure to get help from a professional.
Tests Performed by Professionals
There are multiple evidence-based assessments that help determine whether there are clinical criteria for diagnosing AUD and to what severity. Such assessments may include the Alcohol Use Disorders Identification Test (AUDIT), which is a 10-item screening tool developed by the World Health Organization (WHO) as well as the Michigan Alcoholism Screening Test (MAST), which is comprised of 25 questions.
Note that these tests are to be used by professionals as diagnostic tools. Remember that diagnosing should always be entrusted to a health professional.
Quizzes and Self-Assessment
While it is recommended to see a professional should one suspect an issue with alcohol, there are some quizzes and self-assessment tools available online. These should be used with caution, however, and not serve as a means of diagnosis.
One common questionnaire that is used by professionals and may be considered at home is the CAGE questionnaire.
Questions asked in this questionnaire are as follows:13
- Have you ever felt you needed to CUT down on your drinking?
- Have people ANNOYED you by criticizing your drinking?
- Have you ever felt GUILTY about drinking?
- Have you ever felt you needed a drink first thing in the morning (EYE-OPENER) to steady your nerves or to get rid of a hangover?
If the answers to two or more of these questions are “yes,” then there is a likelihood of problematic alcohol consumption and one should consult a professional as soon as possible.
Additional Resources for Alcoholism