Alcohol Use Disorders (AUDs) — sometimes collectively termed alcoholism — represent a costly and prevalent problem in the United States. The annual cost of alcohol dependence in the United States is over $150 billion dollars,  and about 100,000 people die annually due to alcohol-related causes.

People with alcohol-related medical illnesses have more frequent hospitalizations and longer hospital stays compared with individuals without alcoholism.  In fact, the price of healthcare resulting from AUDs in the United States is estimated at more than $26 billion per year.

Unfortunately, alcohol abuse and dependence are frequently under-diagnosed in the clinical setting, typically due to inadequate screening and the unreliability of self-reported alcohol use.  In one study, retrospective analysis demonstrated that less than 25% of patients admitted to hospital who screened positively for AUD received either inpatient alcohol intervention or a referral for outpatient alcohol treatment.

Alcoholism occurs when a person has developed dependence on alcohol and continues to use it, despite the problems it causes with that person’s job performance, academic performance, or relationships. The National Institute on Drug Abuse states that alcoholism is defined as a “chronic, relapsing brain disease” when the chronic use of a substance causes changes in the structure of the brain and how it works.

An Alcohol Use Disorder starts with drinking to excess on multiple occasions. This may include drinking alcohol to the point of feeling intoxicated or out of control in behavior.   A person can still develop a drinking problem when he or she drinks more than what is recommended for health and safety.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the following are the recommended Maximum Drinking Limits. People, with exceptions noted below, are advised to stay within these limits:

For healthy men up to age 65

  • No more than 4 drinks a day AND
  • No more than 14 drinks in a week

For healthy women (and healthy men over age 65)

  • No more than 3 drinks in a day AND
  • No more than 7 drinks in a week

Abstinence is advised to individuals who:

  • Take prescriptions or over-the-counter medications that may interact with alcohol
  • Have a health condition that may be exacerbated by alcohol
  • Are pregnant
  • Are considering becoming pregnant
  • Are younger than age 21

Signs of Alcoholism

The Diagnostic and Statistical Manual (DSM) is the classification system published by the American Psychiatric Association.  In 2013, the 5th edition was released.  It eliminated the terms Alcohol Abuse and Alcohol Dependence, and it created the broad category of Alcohol Use Disorders (AUD).  In order to meet the criteria for an AUD, a person must have at least two of the following symptoms:

  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) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect b) A markedly diminished effect with continued use of the same amount of alcohol.
  11. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol (refer to criteria A and B of the criteria set for alcohol withdrawal) b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

The presence of at least 2 of these symptoms indicates an alcohol use disorder (AUD). The severity of an AUD is either mild, moderate, or severe, depending on the number of symptoms.

Mild: The presence of 2 to 3 symptoms.
Moderate: The presence of 4 to 5 symptoms.
Severe: The presence of 6 or more symptoms.

Effects of Alcohol

Depending on how much is taken and the physical condition of the individual, alcohol can cause:

  • Slurred speech
  • Drowsiness
  • Vomiting
  • Diarrhea
  • Upset stomach
  • Headaches
  • Breathing difficulties
  • Distorted vision and hearing
  • Impaired judgment
  • Decreased perception and coordination
  • Unconsciousness
  • Anemia (loss of red blood cells)
  • Coma
  • Blackouts (memory lapses, where the drinker cannot remember events that occurred while under the influence)

Alcoholism Treatment

Treatment for drinking problems involves individualized assessment, with treatment tailored to your particular problem and to your goals of moderation or abstinence. There are many effective alcohol treatment options — some based on abstinence-oriented approaches and others based on approaches involving moderation. Which one is right for you will depend on the severity of the drinking problem, external pressures (i.e. health concerns, pressure from a partner, employer or court), and what you have already tried. Abstinence-based treatments continue to be extremely effective for many people.

Alcohol treatment options include individual therapy, therapy groups that support recovery, self-help programs such as AA, and medication to help with drinking urges, anxiety, and depression. Usually a combination of these options is most useful. In addition, collateral treatment in which your spouse or partner attends some sessions with you may further support your recovery.

Along with the focus on drinking, alcohol treatment considers family and work stress, self esteem and loneliness — all of which may contribute to problems with alcohol. And, at times, particularly when feeling isolated, guilty, depressed or anxious, it can be helpful to know that someone understands the complicated feelings that can come up about alcohol use and can help you address these feelings constructively.

Medication for Alcoholism

It may be appropriate to try a medication to stop drinking alcohol.

Therapy for Alcoholism

Cognitive Behavioral Therapy (CBT): A type of therapy most commonly used to treat depression and anxiety, but it has also been shown to be valuable in treating alcoholism and drug addiction, especially as part of an overall program of recovery. Cognitive-behavioral coping skills treatment is a short-term, focused therapeutic approach to helping drug-dependent people become abstinent by using the same learning processes the person used to develop alcohol and drug dependence initially.

Alternatives to AA

SMART Recovery: Alternative to AA with local and online meetings. It uses cognitive-behavioral approaches that help members recognize environmental and emotional factors for alcohol and other drug use (as well as other “addictive” behaviors) and then to respond to them in new, more productive ways. It also incorporates motivational interviewing concepts. Unlike some support groups whose principles remain static, SMART Recovery maintains a philosophy of evolving as scientific knowledge evolves. Although it is an abstinence-based program, SMART Recovery welcomes those who are ambivalent about quitting substance use.

Books on Alcoholism