Understanding Alcohol Addiction | Nova Recovery

In 2012, an estimated 6.5 percent of Texans over the age of 12 had an alcohol use disorder, and 28 percent of all clients admitted to public treatment programs in the state cited alcohol as their primary substance of abuse.1 While over 17 million Americans have an alcohol use disorder, fewer than eight percent get the help they need to enjoy successful long-term recovery.2

The first step in recovering from an alcohol addiction is understanding what it is, how it develops and what it takes to overcome it.

A Brief History of Alcoholism

History is full of dire warnings about excessive alcohol use. The Egyptians cautioned against it, and between 1100 B.C. and 1400 A.D., the Chinese passed 41 laws carefully governing winemaking. Plato and Aristotle both warned of the consequences of the effects of problem drinking. Excessive drinking was considered a sin by both Protestant and Catholic leaders in the 1500s and beyond.

Before the Industrial Revolution, strong family ties and strict social mores prevented many people from developing an alcohol addiction. While drinking alcohol was acceptable, being drunk was not. But with the Industrial Revolution came weakened family ties, and problem drinking became widespread.

The term “alcoholism” was created in 1849, and organizations like the Women’s Christian Temperance Union and the Anti-Saloon League sprouted up to address growing concerns about alcohol abuse. In 1919, the 18th Amendment was ratified, banning the production and sale of alcoholic beverages altogether.

According to the Journal of Public Health, one unintended consequence of Prohibition was that disenfranchised young people changed the public perception of drinking through their contributions in books, film, magazines, music and other popular culture outlets.3 As a result, when Prohibition was repealed in 1933, the stigma of drinking was all but nonexistent, and even women now felt free to drink in public.

The number of people addicted to alcohol grew exponentially during and after World War II. In 1935, Alcoholics Anonymous was formed to make it easier for those with a drinking problem to get the help they needed to recover from an alcohol addiction.

Alcohol Use Disorder Criteria

Before 2013, when the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, was published, alcohol abuse and alcohol addiction were considered to be two distinct disorders.4 With the new edition of the DSM, alcohol abuse, addiction and dependence became a single disorder known as alcohol use disorder, or AUD. Depending on how many of the 11 diagnostic criteria are met, the AUD is classified as mild, moderate or severe.

To be diagnosed with an AUD, two of the 11 criteria must be met during a 12-month period. Meeting two or three of the criteria leads to a “mild” AUD diagnosis. A moderate AUD diagnosis requires that four or five of the criteria are met, and a severe disorder is diagnosed when six or more of the criteria apply.

The eleven criteria for an AUD are:

  • Experiencing times when you ended up drinking more alcohol or for a longer period of time than you intended.
  • Wanting to stop drinking but finding that you can’t.
  • Spending a lot of time either drinking or recovering from drinking.
  • Wanting a drink so badly you can’t think of anything else.
  • Finding that drinking or recovering from drinking interferes with responsibilities at home, work or school.
  • Drinking even though it’s causing problems in relationships with family or friends.
  • Giving up activities you once enjoyed so that you can drink.
  • Engaging in risky behaviors or getting into dangerous situations while under the influence.
  • Continuing to drink despite related mental or physical health problems.
  • Developing a tolerance so that more alcohol is needed in order to get the desired effects.
  • Experiencing the onset of withdrawal symptoms when you quit drinking.

Although the term “alcohol use disorder” is now in common use, most mental health and medical professionals and government institutions still use the terms “alcohol abuse,” “addiction” and “dependence” when discussing AUDs.

Knowing the difference between abuse, addiction and dependence is central to understanding how addiction develops and how it’s treated.

Knowing the difference between abuse, addiction and dependence is central to understanding how addiction develops and how it’s treated.

Alcohol Abuse

Alcohol abuse is any use of alcohol that results in:

  • Problems at work, home, or school
  • Engaging in risky situations while under the influence
  • Getting into legal trouble due to drinking alcohol
  • Relationship problems with friends or family

Binge drinking is the most common form of alcohol abuse. Binge drinking is defined by the Centers for Disease Control as a pattern of drinking that brings your blood alcohol level to .08 percent over the course of two hours.5 For women, this typically occurs after four drinks, and for men, it typically occurs after five drinks.

A recent study cited by The Dallas Morning News found that the financial impact of alcohol abuse in Texas exceeds $26 billion, or around $700 per resident.6

How Alcohol Abuse Transitions to Addiction

Alcohol acts on the memory and reward systems in the brain. Beginning with the first time you use alcohol, the brain associates its consumption with pleasure, and the association is strengthened each time alcohol is used. Soon, you may begin to crave alcohol, and eventually, these cravings may become very intense.

You may feel compelled to drink even though you know doing so is compromising your quality of life. Although you may want to stop, and even despite trying, you’ll likely find that you can’t. This is the main indication that an addiction has developed.

How Alcohol Abuse Transitions to Dependence

Alcohol affects the function of brain chemicals, which are known as neurotransmitters. GABA is a neurotransmitter that produces feelings of relaxation and well-being, and initially, alcohol increases the amount of GABA. Meanwhile, it suppresses the effects of glutamate, a neurotransmitter responsible for feelings of excitement.

When you chronically abuse alcohol, the brain compensates for its effect on these neurotransmitters by suppressing the activity of GABA and increasing the activity of glutamate. The result is that increasingly larger amounts of alcohol are needed to get the same effects. This is known as building up a tolerance.

At some point, brain function may shift so that the brain now operates more “normally” when alcohol is present than when it’s not. At this point, stopping alcohol use will result in withdrawal symptoms that set in as brain function rebounds. Withdrawal is the primary indication that you have developed a physical dependence on alcohol.

Long- and Short-Term Effects of Alcohol Abuse

Chronic alcohol abuse and addiction have far-reaching effects for your health and for society. According to the Centers for Disease Control, around 88,000 people lose their lives each year as a result of excessive drinking.7

Chronic alcohol abuse and addiction have far-reaching effects for your health and for society.

Drunk driving is a major problem in the U.S. that causes 28 deaths every day. Alcohol-related traffic fatalities in Texas in 2015 represented nearly 41 percent of all traffic deaths in the state, and 15,687 people were injured in alcohol-related automobile accidents.8

In addition to alcohol-related traffic deaths, short-term health risks of alcohol abuse include:

  • Alcohol poisoning
  • Violence
  • Risky sexual behaviors
  • Miscarriage and other pregnancy complications
  • Injuries or death suffered as the result of falls, drownings and burns

In the long-term, alcohol abuse leads to a number of devastating health problems, including:

  • High blood pressure
  • Heart disease
  • Stroke
  • Liver disease
  • Cancer of the breast, throat, esophagus, mouth, liver and colon
  • Depression, anxiety and other serious mental health problems
  • Social problems like lost productivity, unemployment and relationship troubles
  • Alcohol addiction and dependence

Alcohol Addiction: A Chronic and Relapsing Disease

Alcohol addiction is a chronic and relapsing disease of the brain, according to the widely accepted disease model of addiction. The disease model was presented around the end of World War II, shortly after the repeal of Prohibition. This theory postulates that alcohol addiction can be systematically diagnosed, observed, treated and prevented.

Alcohol addiction is a chronic and relapsing disease of the brain.

While the initial decision to drink is a personal choice, once an addiction sets in, choice is no longer an issue. Just as certain lifestyle choices can lead to diabetes and heart disease, certain lifestyle choices can lead to addiction.

Like other chronic diseases, alcoholism can be sent into remission through treatment, and it can relapse afterwards. In fact, relapse rates for alcohol addiction are similar to those for other chronic diseases. Relapse should always serve as an opportunity to identify and develop the sobriety skills that were lacking to help prevent another relapse.

The disease theory of alcoholism strives to remove the stigma of alcohol addiction and treat it like any other chronic illness that requires medical attention. As such, treating addiction and preventing relapse requires understanding the disease, making meaningful lifestyle changes and developing skills and strategies to maintain long-term recovery.

Why Professional Treatment is Essential for Alcohol Addiction and Dependence

According to the National Institute on Drug Abuse, professional help is almost always necessary for successful long-term recovery from an addiction.9 Willpower and good intentions are rarely enough to overcome an addiction, which changes the way the brain functions and fosters compulsive substance abuse.

Willpower and good intentions are rarely enough to overcome an addiction.

A professional treatment program uses various traditional and alternative therapies to address the highly complex issues that underlie an alcohol addiction, including mental illness, trauma, stress and family dysfunction.

Clients in a treatment setting are fully educated about addiction and how it affects brain function, and they learn the skills and strategies necessary to prevent relapse.

The First Step in Recovery: Medical Detox

If a physical dependence on alcohol has developed, medical detox is the essential first step of recovery. Detox is the process of allowing all traces of alcohol to leave the body so that brain function can begin to return to normal.

Trying to withdraw from alcohol without medical supervision can be dangerous, and in severe cases, it can be fatal. Symptoms like intense cravings, nausea, headaches, seizures, hallucinations and tremors often send an individual right back to drinking. However, these symptoms can be effectively treated with medications that reduce their severity.

Once the detox process is complete, you’re no longer physically dependent on alcohol, but the hard work is only just beginning.

Once the detox process is complete, you’re no longer physically dependent on alcohol, but the hard work is only just beginning.

The Second Step in Recovery: Treatment

Once detox is complete, attention turns to treating the addiction. Various therapies are used to delve into the complex issues behind the addiction. These include:

  • Behavioral therapies like cognitive-behavioral therapy, which helps clients learn to identify false beliefs and harmful thoughts and behaviors and replace them with healthier ways of thinking and behaving.
  • Alternative therapies like meditation, acupuncture and yoga to reduce stress and foster healthy lifestyle changes.
  • Alternative therapies like art, music or outdoor therapy to help clients better synthesize experiences, look at various issues in a different way and reduce stress.
  • Relapse prevention programs that help clients identify triggers and develop skills and strategies to avoid or cope with them.
  • Family therapy to help restore function to the household, repair damaged relationships and improve communication among family members.
  • Group therapy to draw on the experiences of peers, address common issues and foster a sense of belonging and camaraderie.
  • Participation in a support group to increase a sense of personal accountability and develop healthy relationships with other non-users.

The Third Step in Recovery: The Essential Aftercare Plan

A high-quality treatment program ends with an aftercare plan that’s designed to help prevent relapse. The aftercare plan is a highly individualized, ongoing recovery program that addresses an individual’s multiple needs and draws on the momentum and motivation gained in treatment.

A typical aftercare plan will include:

  • Ongoing individual and group therapy to continue working through issues and increase self-awareness
  • Ongoing family therapy to continue to strengthen family relationships and improve the functioning of the household
  • Ongoing monitoring of any co-occurring mental illnesses and the medications used to treat them
  • Participation in a 12-step or similar program to develop a strong, long-term support system, continue addressing issues as they arise, foster a higher sense of personal responsibility and accountability and promote personal growth.

Other components of the aftercare plan are added as needed and may include:

  • Vocational training to develop the skills needed to improve employability
  • Educational assistance
  • Legal assistance
  • Time spent in a sober living facility to ease the transition from a highly structured treatment setting back to regular life
  • Parenting classes

A Brief Word About Alcohol Addiction and Mental Illness

Chronic alcohol abuse almost always worsens an existing mental illness, and it can even cause the onset of a mental condition where it didn’t previously exist.10 When an alcohol addiction co-occurs with a mental illness, it’s known as a dual diagnosis. Successful recovery depends on a specialized treatment program that addresses the addiction in the context of the mental illness, and vice versa. Dual diagnosis treatment is a collaboration among the individual and the treatment teams, which work together to treat both disorders.

The Principles of Effective Treatment

The National Institute on Drug Abuse has developed 13 principles that should guide any treatment program. These include acknowledging that:

  • Addiction is a complex, relapsing brain disease that affects behavior and brain function.
  • No single treatment is right for every individual. Treatment must be tailored to an individual’s needs and issues to promote successful functioning as a family member, employee, parent, student and other life roles.
  • Treatment must address the multiple needs of an individual, not just the addiction. Medical and legal problems, vocational and educational needs and social issues must be identified and addressed in a culturally appropriate setting.
  • Remaining in treatment for an adequate period of time is essential for successful long-term recovery. Most individuals need at least three months of treatment for the best possible outcome. Therefore, high-quality programs will strive to keep clients engaged in treatment.
  • Behavioral therapies in individual, group and family settings are essential for addressing underlying issues, increasing the motivation to change, providing incentives for abstinence and developing skills and strategies for coping with relapse triggers now and in the future.
  • An individual’s treatment plan must be continually assessed and amended to reflect changing and emerging needs.
  • Co-occurring mental illnesses must be addressed at the same time as the addiction, and each disorder must be treated in the context of the other.

Addiction is a Family Disease

The National Council on Alcoholism and Drug Dependence stresses that addiction is a disease that stresses the family unit to the breaking point.11 Chaos and stress are the realities of family life when a loved one has an addiction, and this can lead to serious problems within the family system.

Family members of an addicted individual have typically learned to cope with the addiction in unhealthy ways, and they often enable their addicted family member in a number of ways as well, such as making excuses for them and mitigating the consequences of the addiction. Family members may develop unhealthy coping skills, and they may direct their fear and anger toward other family members, further affecting the health of the family unit.

Family members of an addicted individual have typically learned to cope with the addiction in unhealthy ways.

Family members of an addicted individual benefit from the family counseling that’s usually a part of treatment, but in most cases, they, too, need individual therapy to address the various issues that have developed from the addiction. This is especially true for children of an addicted individual, who are at a higher risk of developing behavioral problems and substance use disorders later on.

Family support is essential for successful recovery, but in order to effectively support their loved one, family members need to be educated about addiction and how it affects brain function as well as learn about what to expect during the early period of recovery.

Many high-quality treatment programs offer psychoeducational classes for family members to fulfill this need. Through individual and family counseling and joining a support group for loved ones of an addicted individual, family members learn the best ways to support their loved one in recovery while recovering from the effects the addiction has had on them.

Hope is the Foundation of Recovery

The Substance Abuse and Mental Health Services Administration cites hope as the foundation of recovery.1 If you or a loved one suffers from an alcohol addiction, holding out hope for a better future is essential. Recovery is always possible, even if your loved one is in denial or you’re suffering from a severe alcohol use disorder and currently feel hopeless about your future.

If you or a loved one suffers from an alcohol addiction, holding out hope for a better future is essential.

Making the decision to enter treatment is, for many, the most difficult part of recovery. You may be afraid of what others will think, or you may be worried that recovery will be too difficult or that treatment won’t work for you. But once you’re in a high-quality program and begin delving into the various issues surrounding your addiction, many things will become clear. You’ll develop a far stronger self-concept, higher self-esteem and a keener sense of self-efficacy.

As long as you have hope for a future free of the many harmful effects of addiction, you can recover. Doing so will vastly improve your relationships, your physical and mental health, your quality of life and your sense of well-being.

Sources:

(1) Maxwell, J. C. (2014, June). Substance Abuse Trends in Texas: June 2014. Retrieved from (https://www.drugabuse.gov/sites/default/files/texas2014a.pdf (2) Facts About Alcohol. (2015, July 25). Retrieved from https://www.ncadd.org/about-addiction/alcohol/facts-about-alcohol (3) Blocker, J. S. (2006, February). Did Prohibition Really Work? Alcohol Prohibition as a Public Health Innovation. American Journal of Public Health, 96(2), 233-243. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470475/ (4) Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5. (2015, July). Retrieved from http://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf (5) Fact Sheets: Binge Drinking. (2015, October). Retrieved from http://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm (6) Landers, J. (2015, June 15). Sobering Statistics Show Heavy Drinking is Up Across D-FW. The Dallas Morning News. Retrieved from http://www.dallasnews.com/business/columnists/jim-landers/20150615-landers-heavy-drinking-up-and-so-are-the-costs.ece (7) Fact Sheets: Alcohol Use and Your Health. (2016, February 29). Retrieved from http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm (8) Drunk Driving Information by State: Texas. (n.d.). Retrieved from http://www.madd.org/drunk-driving/state-stats/Texas.html?referrer=https://www.google.com/ (9) Drug Facts: Understanding Drug Abuse and Addiction. (2012, November). Retrieved from https://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction (10) Comorbidity: Addiction and Other Mental Illnesses. (2010, September). Retrieved from https://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf (11) Family Disease. (2016, February 24). Retrieved from https://www.ncadd.org/family-friends/there-is-help/family-disease (12) Recovery and Recovery Support. (2015, October 5). Retrieved from www.samhsa.gov/recovery