Alcoholism, clinically known as alcohol use disorder (AUD), is a term that is often thrown around as a stereotype. When many people hear the word alcoholic, they picture a homeless man with a bottle in a brown paper bag or the partier who is frequently falling-down drunk and cures a hangover with another drink. However, alcoholism is often not so obvious or so easy to quantify. This is why American Addiction Centers (AAC) strive to help people understand what alcohol use disorder is and how it manifests.
AUD Is a Disease
One of the very first things to understand about AUD is that it is a disease. As the National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines it, AUD 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.”
What this means is simple – having AUD or the inability to drink socially is not a choice. Since 6.2% of the American adult population (15 million adults) had AUD as of 2015, the majority of people who drink can do so socially, without any long-term problems. This can make it difficult for social drinkers to understand how some people can’t do the same. And it’s not just adults that are affected. A whopping 623,000 adolescents ages 12-17 also had AUD as of 2015.
AUD Is Progressive
People with AUD don’t just wake up one day and start drinking heavily, consuming drinks for breakfast and binging every day. AUD begins slowly. Nearly 8 million of those suffering with a substance abuse disorder also have a co-occurring mental health disorder, and drinking often serves as a coping mechanism for those with AUD.
AUD begins with early stage drinking, moves to chronic alcoholism and severe drinking, and ends with complete life- and/or health-disrupting drinking that requires professional treatment. There are many individuals with AUD who don’t end up surviving the disease. The Centers for Disease Control and Prevention (CDC) states that the lives of those who drink excessively are shortened by an average of 30 years. With this in mind, let’s take a look a more detailed look at AUD.
How is AUD Diagnosed?
One of the easiest ways to determine whether you have a problem with your drinking is to answer the questions provided in the NIAAA’s Diagnostic and Statistical Manual of Mental Disorders ( ). There are 11 questions, each of which indicates a symptom of AUD. Answering “yes” to any of these questions indicates you have those symptoms of AUD. The more symptoms you have, the more severe your AUD, as follows:
- Mild – 2-3 symptoms
- Moderate – 4-5 symptoms
- Severe – 6 or more symptoms
The severity of AUD often corresponds to the stages of the progression of the disease. It’s important to understand the more you progress through these stages, the more difficult it will be to stop drinking.
The earliest years of AUD are defined by occasional binge drinking, defined as four drinks for women and five drinks for men within a two-hour period. This is enough alcohol to raise a person’s blood alcohol content (BAC) to 0.08 g/dL. During this time, it is difficult to determine whether the drinking is the standard social activity of the teen or young adult or whether it will develop into AUD. When it comes to the DSM-5, the person could have 0-2 of the symptoms listed.
Young people who have one or both parents with AUD, live in an environment with excessive alcohol and/or drug intake, experience violence or conflict in the home, and/or have mentally ill parents are at a higher risk of developing AUD. Those who binge drink regularly are also at a higher risk.
People with AUD generally progress to a chronic level of drinking and their alcohol consumption is directly related to their emotional or psychological state. This can generally be differentiated from a person who simply likes a drink with dinner. At this point, based on the DSM-5, the person is experiencing 3-5 symptoms of AUD, and they often to maintain control over their drinking.
At this stage, the drinking becomes more and more severe and they exhibit 6 or more or the DSM-5 symptoms. Many people with AUD begin to lose the things in life that are most valuable to them and it is common for drinking to result in disruption to the person’s daily activities, but this is not always the case.
It’s important to understand that an estimated of these people are considered highly functioning alcoholics. They can continue their drinking but still hold their job and maintain relationships. However, that doesn’t mean this will last indefinitely. These people are still at a high risk of bottoming out and needing treatment. They are also at risk for the many potential long-term health effects that can result from excessive drinking, such as:
- Heart disease and stroke
- High blood pressure
- Infectious diseases
- Nerve damage
- Cirrhosis of the liver
In addition, a person may not be physically dependent on alcohol at this point. If they are physically dependent, stopping drinking will lead to withdrawal symptoms. People at this stage, highly functioning or not, physically dependent or not, are at risk of completely losing control, which defines the next stage of the progression.
Many people with AUD, particularly those in the recovery community, refer to this as “hitting bottom.” This stage is usually accompanied by a partial or complete inability to sustain normal life activities, such as relationships, a job, and household responsibilities. The need to consume alcohol overpowers and overwhelms everything else in life and the withdrawal symptoms are so bad and come on so easily, they drink just to avoid them. In addition, the risk of severe physical health conditions becomes much higher, particularly cirrhosis of the liver (severe liver damage). .
In addition to this, when a person does choose to stop drinking, the withdrawal symptoms can cause more than just severe discomfort. Alcohol is one of two substances (the other being benzodiazepines) for which the withdrawal symptoms can cause death. The cause of death is generally either a stroke or seizures. The importance of this cannot be overstated – it is not safe for people with AUD to self-detox. Professional treatment is critical.
There Is Help
No matter what stage of AUD has been reached, there is help and there is hope. Treatment will take longer and be more challenging the more advanced AUD is, but recovery and a good, long life is still possible. The important thing to understand is that AUD is never only about the alcohol. There is a psychological aspect to the disease that must be treated along with the physical dependence on alcohol.
This is the approach used by AAC, which strives to offer a holistic treatment in their many treatment centers located across the U.S. AAC always takes into account not only the stage of AUD the patient has reached, but also co-occurring mental health conditions, environment, lifestyle, and physical health. As a publicly traded organization, AAC has achieved a recovery success rate that is double the national average.
As part of AAC, is a resource available to people with AUD and to the general public. Their mission is to help people understand what alcoholism is and how pervasive it is and to address and challenge the drinking culture within the U.S.
If you or someone you know has experienced blackouts more than once and you feel you need help, please call us on our 24/7 helpline for the public at 1-800-ALCOHOL. For more information visit americanaddictioncenters.org.