Alcohol Use Disorder
What Is Alcohol Use Disorder?
Alcohol use disorder (AUD) is a medical condition in which people continue to drink alcohol despite negative consequences. AUD may be mild, moderate or severe, referred by some as alcohol misuse or abuse, alcohol dependence, and alcohol addiction or alcoholism, respectively.
Approximately 14.5 million people in the United States were diagnosed with AUD in 2019, including 9.0 million men, 5.5 million women, and 414,000 adolescents ages 12–17.
Is Alcohol Use Disorder A Disease?
Alcohol use disorder is a chronic disease that causes changes in the reward and control centers of the brain robbing a person’s ability to control or stop drinking. AUD has the potential for both return to use and recovery. AUD is not a matter of a person’s unwillingness, character, or lack of willpower to stop drinking.
When a person begins to misuse alcohol regularly, more and more alcohol is needed to achieve the same level of satisfaction. Drinking alcohol becomes ritualistic with every activity, causing problems for them, their family and friends. During this time, progressive changes in the brain hijacks the persons ability to control their use to the point they can no longer choose to stop drinking, even if it means losing everything they cared for.
Is Alcoholism Inherited?
Research shows that genes are responsible for about half of the risk for AUD. Multiple genes play a role in a person’s risk for developing AUD. There are genes that increase a person’s risk, as well as those that may decrease that risk, directly or indirectly. For instance, some people of Asian descent carry a gene variant that alters their rate of alcohol metabolism, causing them to have symptoms like flushing, nausea, and rapid heartbeat when they drink. Many people who experience these effects avoid alcohol, which helps protect them from developing AUD.
However, genes alone do not determine whether someone will develop AUD. Psychological, societal and environmental factors account for the remainder of the risk. Psychological traits such as impulsiveness, low self-esteem, and a need for approval prompt inappropriate drinking. Some individuals drink to cope with or “medicate” emotional problems. Social and environmental factors such as peer pressure and the easy availability of alcohol can play key roles. Poverty and physical or sexual abuse also increase the odds of developing alcohol use disorders.
What Are The Immediate And Long Term Consequences Of Alcohol Use?
Drinking too much alcohol can take a serious toll on your physical, mental, cognitive and social health.
Excessive alcohol use has immediate consequences that increase the risk of many harmful health conditions. These are most often the result of binge drinking and include the following:
- Injuries, such as motor vehicle crashes, falls, drownings, and burns.
- Violence, including homicide, suicide, sexual assault, and intimate partner violence.
- Alcohol poisoning, a medical emergency that results from high blood alcohol levels.
- Risky sexual behaviors, including unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases, including HIV.
- Miscarriage and stillbirth or fetal alcohol spectrum disorders (FASDs) among pregnant women.
Over time, excessive alcohol use can lead to the development of chronic diseases and other serious problems including:
- High blood pressure, heart disease, stroke, liver disease, and digestive problems.
- Weakening of the immune system, increasing the chances of getting sick.
- Learning and memory problems, including dementia and poor school performance.
- Mental health problems, including depression and anxiety.
- Social problems, including lost productivity, family problems, and unemployment.
- Alcohol use disorder, Alcoholism, Alcohol Addiction.
- Cancer of the breast, mouth, throat, esophagus, liver, and colon.
Source: National Cancer Institute
How Do Doctors Diagnose An Alcohol Use Disorder?
Alcohol use disorder doesn’t develop overnight. In most cases, an addiction typically starts with experimental use and progresses over time into a need to use regularly, even at the expense of health and safety. Take the Self-Test to determine how doctors determine if an individual has alcohol use disorder.
What Is The Best Way To Stop Drinking Alcohol?
The most effective treatment is personalizing care to each individual’s needs and integrating services aimed at addressing substance(s) use, medical, behavioral, mental and social health areas to provide long-lasting, positive results for the individual. Most people with AUD benefit from a combination of behavioral therapy and medication.
Are There Withdrawal Symptoms?
Alcohol withdrawal occurs due to the cessation of or reduction in alcohol use that has been heavy or prolonged. Signs and symptoms begin as early as 6 hours after the initial decline from peak intoxication and include tremor, anxiety, insomnia, restlessness, and nausea. In mildly alcohol-dependent individuals, these symptoms may subside without treatment after a few days. More serious withdrawal symptoms occur in approximately 10 percent of individuals and include a low-grade fever, rapid breathing, tremor, and profuse sweating. Seizures may occur in more than 5 percent of untreated individuals in acute alcohol withdrawal. Another severe complication is delirium tremens (DT’s), which is characterized by hallucinations, mental confusion, and disorientation. The mortality rate among patients exhibiting DT’s is 5 to 25 percent.
Which Medications Are Most Effective For Treating Alcohol Use Disorder?
Three medications have been approved by the US Food and Drug Administration (FDA) to help people with alcohol use disorder (AUD) stop or reduce their drinking and avoid relapse:
- Naltrexone works by blocking the receptors in the brain that are involved in craving alcohol or the rewarding effects of drinking. It comes either as a pill that is taken daily, or as an injection that can be given once per month.
- Acamprosate is prescribed to help people with AUD maintain abstinence from alcohol by alleviating some negative symptoms of prolonged abstinence. It is a pill that is taken three times per day.
- Disulfiram is a pill that causes unpleasant symptoms such as nausea and flushing of the skin when a person drinks. Wanting to avoid those unpleasant effects can help some people refrain from drinking.
Medications used off-label that are not approved by the FDA to treat alcohol use disorder but have good evidence include:
- Topiramate is an off-label agent for AUD. Its on-label indications are for seizure, migraine and obesity. If an individual has these comorbidities, topiramate is worth considering. One strength of topiramate is the possibility of starting treatment while people are still drinking alcohol, therefore serving as a potentially effective treatment to initiate abstinence (or to reduce harm) rather than to prevent relapse in already detoxified individuals.
- Gabapentin is another antiepileptic medication used off-label for AUD. Its on-label indications are seizure and neuropathic pain. Gabapentin may be considered in those with comorbid neuropathy (typically alcoholic neuropathy or even diabetic neuropathy). Gabapentin in combination with naltrexone was found to exhibit additive effects compared to naltrexone alone.
- Baclofen is a medication approved for spasticity treatment. The efficacy of Baclofen for alcohol dependence have yielded mixed results. It is better tolerated than topiramate or gabapentin and there is good evidence to support baclofen use in treating individuals with liver disease.
- Varenicline (Chantix) is approved for nicotine use disorder in the US. Therefore Varenicline may be considered in individuals with AUD and nicotine use disorder. It is unclear how this medication affects symptoms of AUD. However, studies have found evidence to support the utilization of varenicline for reducing alcohol consumption and cravings.
Not all people will respond to one medication and combining medications that utilize different therapeutic mechanisms of action may be essential for individuals with inadequate response to monotherapy. Clinical judgment weighing the risks and benefits is needed in a shared decision-making approach to treatment.
What Kind Of Therapies Are Used To Treat Alcohol Disorders?
Also known as counseling or “talk therapy,” behavioral treatments involve working with a health professional to identify and help change the behaviors that lead to alcohol use disorder (AUD).
- Cognitive-behavioral therapy (CBT) can take place one-on-one with a therapist or in small groups. This form of therapy is focused on identifying the feelings and situations (called “cues”) that lead to heavy drinking, and managing stress that can lead to relapse. The goal is to change the thought processes that lead to alcohol misuse and to develop the skills necessary to cope with everyday situations that might trigger problem drinking.
- Motivational enhancement therapy is conducted over a short period of time to build and strengthen motivation to change drinking behavior. The therapy focuses on helping the patient identify the pros and cons of seeking treatment, form a plan for making changes in drinking behavior, build confidence, and develop the skills needed to stick to the plan.
- Contingency management approaches incorporate tangible rewards that are given to patients who achieve specific, measurable treatment goals. This approach is used to reinforce positive behaviors such as abstinence or regular attendance.
- Behavioral couples and family counseling involve partners and other family members in the treatment process and can play an important role in repairing and improving family relationships. The approaches incorporate positive activities, communication skills training, and identifying relapse triggers.
- Brief interventions are usually delivered in a few short, one-on-one counseling sessions. The physician or counselor provides information about the individual’s drinking pattern and potential risks, and then works with him or her to set goals and provide ideas for helping to make a change.
- 12-Step Facilitation Therapy is an engagement strategy used in counseling sessions to increase a patient’s active involvement in 12-step-based mutual help groups (such as AA), in addition to professionally-led outpatient treatment. The counselor works with the patient to encourage, review, and reinforce their participation in AA, in a structured process that may include reading assignments, journaling, and setting AA participation goals for the week.
- Mindfulness-based relapse prevention (MBRP) combines CBT skill building approaches with mindfulness practices, which promote flexible rather than “autopilot” responses to physical and emotional triggers to drink.
Research shows that combining medication with counseling, known as medication-assisted treatment (MAT) is more effective in treating substance use disorders than either modality alone. Individuals tend to have a healthier lifestyle and be more engaged in therapy, work, school, and other activities.
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- National Institute on Alcohol Abuse and Alcoholism. (2018). Alcohol Use Disorder.
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