While half of all Americans drink, fewer than 7% have a serious alcohol use disorder (AUD). Yet alcohol has a far greater impact on mortality and disease than that small fraction suggests.
According to the Centers for Disease Control and Prevention (CDC), from 2006 to 2010, alcohol was the fourth leading cause of preventable death. Alcohol is also a factor in other top causes of preventable death, including cancer, suicide, cirrhosis, and chronic liver disease.
Not all drinking is bad. Most physicians believe moderate consumption – two drinks per day for a man, one for a woman – has a very low risk of abuse or health problems. If you can’t stop at that, or if you need to drink every day, you may have alcohol use disorder. The sooner you stop, the better.
What is Alcohol Use Disorder?
Alcohol use disorder is any problematic use of alcohol, occasional or chronic, not just alcohol dependence or addiction. In 2015, more than 15 million adults and 600,000 people between ages 12 and 17 met the medical diagnosis of alcohol use disorder (AUD), characterized by:
- A compulsion to drink alcohol.
- A loss of control over how much alcohol one drinks.
- Feeling bad when not drinking.
Alcohol use disorder doesn’t mean you are falling-down drunk all of the time. It doesn’t even mean you are alcohol dependent or an alcoholic. Just two or three drinks a day may indicate AUD. For some people, one drink may be too much.
One of the deadliest AUDs is binge drinking: five drinks in two hours for men, four for women. In 2017, one in four U.S. adults, ages 18 or older, had at least one such “heavy drinking day.” This kind of drinking often leads to compulsive and un-thoughtful decision making, one example being drunk driving.
Most binge drinkers are not dependent on alcohol; they drink for other reasons, from social pressure to feeling awkward in social settings. By one reckoning, more than half of all alcohol is consumed in binge drinking sessions. Over time, this can cause serious brain damage.
What is a Drink?
A drink is not a standard measure of any type of alcohol. Different forms of alcoholic beverages have different amounts of alcohol by volume. According to the National Institute on Alcohol Abuse and Alcoholism, one standard drink “contains about 14 grams of pure alcohol (about 0.6 fluid ounces or 1.2 tablespoons).” That’s approximately:
- 12 ounces of beer
- 5 ounces of wine
- 1.5 ounces of distilled spirits
Signs of Alcohol Use Disorder
- Using alcohol more often or in larger amounts than intended.
- Trying to but can’t reduce alcohol usage.
- Spending a lot of time obtaining alcohol or recovering from its usage.
- A strong desire to use alcohol.
- Alcohol use that interferes with home, work, or school obligations.
- Alcohol use that causes or exacerbates social or interpersonal problems.
- Alcohol use that reduces participation in social or work activities.
- Alcohol use that continues even when it is physically hazardous (driving, operating machinery).
- Alcohol use that continues even when it causes or exacerbates physical or psychological problems.
- Tolerance: the same amount of alcohol no longer has the same effect.
- Experiencing withdrawal symptoms when the alcohol wears off.
Two or three symptoms indicate a mild AUD, four to five is moderate, and more than half is severe.
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What is Tolerance?
One sign of developing AUD is tolerance to alcohol. In time, the amount of alcohol necessary to feel good or intoxicated increases and the individual drinks more. It becomes a vicious cycle.
Alcohol has what doctors call a depressive effect on your system. It slows down brain function and changes the way your nerves send messages back and forth. Over time, your central nervous system adjusts to having alcohol around all the time. Your body works hard to keep your brain in a more awake state and to keep your nerves talking to one another.
When the alcohol level suddenly drops, your brain stays in this keyed-up state. That’s what causes withdrawal.
The Difference between Alcohol Dependence and Addiction
Dependence and addiction are two different things. You can be dependent on alcohol and not have an addiction. However, if you are addicted, you are also likely dependent.
Physical dependence means your body has adapted to alcohol’s effects and needs it to function or it will begin to go through withdrawal. You may not even want alcohol.
Mental dependence means your mind feels it needs alcohol to function. Maybe you don’t think you can go out in public or interact with people or give a presentation at work without it.
Addiction is a chronic brain disease. People who are addicted to alcohol often neglect their responsibilities so they can drink or recover from drinking. Alcoholics take dangerous risks like driving while under the influence of alcohol.
Alcohol addiction means it’s not just your body that is dependent on alcohol. Your mind compels you to drink alcohol, too. Addiction is:
- Compulsive alcohol use despite evidence of its harmful consequences
- The inability to stop using alcohol
- The failure to meet work, social, or family obligations because of alcohol use
If you feel like you are experiencing alcohol tolerance, dependence, or addiction, there is help available for you.
What is Withdrawal?
Once tolerance reaches a certain tipping point, consuming alcohol is no longer a choice but a necessity. Alcohol use turns into alcohol dependence. The body no longer just enjoys alcohol; it needs it to function. If the individual stops taking alcohol or doesn’t increase the amount enough, the body experiences withdrawal symptoms such as:
- Shaky hands
- Nausea and vomiting
- Racing heartbeat
- High blood pressure
- Hallucinations and delusions
- Delirium tremens (DTs)
If you experience withdrawal symptoms, it’s highly likely you have alcohol dependence or alcohol addiction.
How Addictive is Alcohol?
In a 2007 report in The Lancet, alcohol was ranked the fifth most addictive substance. Alcohol increases dopamine levels, a chemical in our brains that encourages us to repeat pleasurable activities. The more you drink, the more dopamine increases.
The problem is that alcohol, like other drugs, rewires your brain. It stops producing dopamine except through alcohol use. That’s why more than one-fifth of people who take a drink will become alcohol dependent.
Drinking alcohol also causes surges in the release of endorphins, natural morphine-like “feel-good” chemicals in the brain. Because these spikes are more intense than the endorphins released from healthy activities, the brain is conditioned to prefer the artificial high.
Another report in The Lancet, this one from 2010, declared alcohol the most harmful drug, more dangerous overall than heroin or cocaine (the two most addictive substances in the earlier report).
Alcohol is so addictive that it can be dangerous for a heavy drinker to stop all alcohol use too abruptly without medical advice and supervision. You don’t have to fight alcoholism on your own.
Helping a Loved One
People with AUD don’t always realize it and don’t always acknowledge it. Many are functional and can control their drinking enough to appear sober much of the time. That doesn’t mean they don’t need help.
If you suspect a loved one has an alcohol use disorder, look for these signs:
- Swelling or redness in palms
- Frequent infections and skin sores
- Lowered sexual desire
- Antisocial personality
- Flushed skin
- Numb or tingling feet and hands
- Intense cravings for alcohol
- Temporary blackouts
- Headaches, anxiety, or insomnia when not drinking
- Increased risk-taking while drinking
- Deteriorating health
- Frequent money problems
If you notice these signs, an intervention may be needed, either one-on-one or by a group of friends and relatives accompanied by an addiction professional.
If you can, help the drinker seek out treatment immediately. Behind the door to recovery is a healthier, fuller life.
Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.
Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.
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