Despite the attention given to the opiate epidemic in the United States, abuse of alcohol is a far bigger issue. According to the data provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), alcohol abuse is only exceeded by the use of tobacco products.
Data from SAMHSA and the National Institute of Alcohol Abuse and Alcoholism (NIAAA) indicate the following:
- Some level of alcohol use occurs in over 85 percent of people who are over the age of 18.
- Nearly 70 million individuals reported binge drinking at least once within the prior year.
- Over 15 million people in the United States qualify for a formal diagnosis of an alcohol use disorder (the clinical term that combines both alcohol abuse and addiction to alcohol).
- About 7–8 million adolescents between the ages of 12 and 17 report some level of alcohol use.
- Alcohol use is ingrained in numerous aspects of American culture.
- Nearly 100,000 people die every year due to causes that are related to alcohol use.
An alcohol use disorder is a mental health disorder that results from the dysfunctional use of alcohol. Older notions of alcohol abuse, alcohol dependence, and alcoholism are all contained under this new clinical diagnostic category.
The American Psychiatric Association (APA) has presented the diagnostic criteria for numerous substance use disorders, including the diagnostic criteria for an alcohol use disorder. The severity of an individual’s alcohol use disorder is dependent on the number of symptoms they display within a 12-month period. Individuals who only display two or three symptoms would be diagnosed with a mild alcohol use disorder; individuals who display four or five symptoms would be diagnosed with a moderate alcohol use disorder; individuals diagnosed with six or more of 11 total potential diagnostic symptoms would be diagnosed with a severe alcohol use disorder. The designation of a mild alcohol use disorder is directly related to the formal notion of alcohol abuse, whereas individuals with moderate to severe alcohol use disorders are considered to have more significant problems associated with their use of alcohol.
What Constitutes as an Alcohol Use Disorder?
The diagnostic criteria for any substance use disorder, including an alcohol use disorder, are made up of behaviors associated with the person’s use of the substance of interest (alcohol). There are no formal medical tests that can diagnose any substance use disorder; however, medical tests such as urine analysis or liver tests could be used to clarify the severity of the individual’s disorder. Only trained mental health clinicians can actually diagnose an alcohol use disorder in anyone, even if the person’s family and friends are relatively sure that the person has a formal alcohol use disorder, and the person demonstrates numerous functional problems as a result of their alcohol use.
The diagnosis of an alcohol use disorder first requires that the person frequently experiences significant functional problems or significant distress associated with their use of alcohol. The issues that make up the APA diagnostic criteria for an alcohol use disorder are outlined below.
- Problems controlling use of alcohol, such as:
- Expressing a desire to quit alcohol but being unable to do so
- Continuing to drink despite significant problems at work, with educational goals, and in personal relationships because of alcohol
- Continuing to use alcohol despite it causing physical damage or emotional distress
- Spending significant amounts of time using, getting, or recovering from alcohol use
- Giving up important commitments or failing to fulfill important personal commitments due to use of alcohol
- Persistent and frequent cravings to drink alcohol
- Frequently using alcohol in situations where it is hazardous to use it, such as driving under influence of alcohol, mixing alcohol and other drugs, drinking alcohol when caring for children, or drinking alcohol at work
- Significant tolerance to alcohol
- A withdrawal syndrome associated with discontinuing alcohol
Unlike individuals who use prescription medications, the development of tolerance and withdrawal to alcohol should be considered a significant sign that the individual has a serious alcohol use disorder. This is because alcohol is not prescribed for medicinal purposes, and the development of tolerance and withdrawal to alcohol represents a chronic issue with heavy alcohol use.
Withdrawal from alcohol typically includes the following symptoms:
- Nausea, vomiting, and/or diarrhea
- Headaches, aches and pains in the muscles, and tremors, particularly in the hands
- Sweating, increased pulse rate, and/or increased blood pressure
- Jitteriness, irritability, nervousness, and being unable to sit still
- Hallucinations that can be visual, auditory, or tactile (having to do with bodily feelings, such as feeling as if bugs are crawling all over one’s body)
Individuals undergoing withdrawal from alcohol will have significant cravings to drink again and may become very desperate to do so. Seizures associated with alcohol withdrawal can be fatal and should be treated immediately. Again, anyone displaying any level of withdrawal associated with alcohol use has most likely developed a moderate to severe alcohol use disorder.
How Does it Develop?
Individuals who binge drink have the potential to develop alcohol use disorders. Binge drinking is defined for men as consuming five or more alcoholic drinks in a short period of time. This occurs on the same drinking occasion, meaning that the drinks are consumed during the same drinking episode. For women, binge drinking is defined as the consumption of four or more alcoholic drinks in a short period of time.
Individuals who engage in frequent binge drinking behaviorsare more likely to develop significant alcohol use disorders. SAMHSA states that heavy drinking is present when a person binge drinks at least five days in a month. Heavy drinkers are certainly at risk to be diagnosed with alcohol use disorder.
NIAAA defines low-risk drinking for men as drinking fewer than four drinks on any single day, and 14 or fewer drinks within a week’s time, whereas low-risk drinking for women is defined as consuming no more than three drinks on any single day and no more than seven drinks within a week’s time.
There are other factors that can be used to determine the potential that a person who drinks heavily or binge drinks may be at risk to develop an alcohol use disorder. According to numerous sources including the National Institute on Drug Abuse (NIDA), some of the signs that should raise concern include the following:
- Use of alcohol throughout the day in small amounts that do not result in significant intoxication in order to avoid withdrawal symptoms
- Frequent episodes of alcohol intoxication
- Using alcohol early in the morning as an “eye-opener”
- Becoming angry and defensive about one’s drinking
- Feeling guilty about one’s use of alcohol
- Legal issues associated with use of alcohol
- Financial issues associated with use of alcohol
- Smelling like alcohol
- Numerous empty alcohol containers in the trash or around the house
- Most social activities involving alcohol
- A decline in attention to self-care
- Frequent use of alcohol to deal with stress or depression
- Frequent use of alcohol to deal with physical conditions, such as chronic pain
Individuals may begin drinking alcohol at an early age or later in adulthood. Those who begin drinking alcohol early in life are more likely to develop alcohol use disorders; however, an alcohol use disorder can develop at any stage in life, and some people begin drinking heavily later in life.
Very often, heavy alcohol use is associated with some form of personal tragedy or a significant stressor, such as the loss of a loved one, losing a job, being the victim of a crime, or divorce. Individuals who have suffered some form of personal tragedy and do not seek treatment may be an increased risk to develop issues with alcohol abuse.
Some of the other risk factors that are associated with the development of an alcohol use disorder include:
- Family history of alcohol abuse, especially in first-degree relatives like parents or siblings
- Family history of any substance use disorder
- Family history of mental illness
- History of abuse or neglect as a child
- Frequent associations with others who engage in heavy alcohol use (peer pressure)
- Feeling isolated or lonely
- Living in an area where substance abuse is a regular occurrence
- Having a naturally higher tolerance to alcohol than most people do
- Viewing substance use as a viable option to cope with perceived stress
None of these above factors are diagnostic, but they may increase the risk that an individual will develop an alcohol use disorder.
Finally, it should also be noted that the notion of a functional alcoholic is a myth. While some individuals with severe alcohol use disorders may function better than others, by definition, an alcohol use disorder includes some form of significant personal distress or functional impairment. While some individuals with significant alcohol use disorders are able to maintain employment, appear to maintain personal relationships, and appear to function normally, in actuality, they suffer from numerous issues related to their alcohol abuse that affect them, their family members, and others close to them. There is also usually a breaking point where levels of functional ability begin to decline as the alcohol abuse worsens.