Defining Alcoholism
What Is Alcoholism?
KEY TAKEAWAY
The term alcoholism refers to the consumption of alcohol to the extent that the person is unable to manage their own drinking habits or patterns, resulting in side-effects that are detrimental to the quality of life and health of the alcoholic, or those around them.
An alcoholic is someone who continues to compulsively abuse alcohol in this way, despite the negative consequences to their lives and health.
Someone with an alcohol problem will usually exhibit:
Alcohol Use Disorder
Since "alcoholic" is perceived by many as an unhelpful word, "alcohol use disorder" is used instead, in the medical world.
The extent to which someone is suffering from Alcohol Use Disorder, is defined by DSM-5 criteria, as the number of symptoms they experience from a list; where:
Under these guidelines, an alcoholic is someone who fulfils any 2 or more criteria from this range, within the same 12 month time span:
DSM-5 Criteria For Alcohol Use Disorder
1) Consuming more alcohol over time, or for longer than you intended.
2) Having a desire to stop drinking, but being unable to achieve this in practice.
3) Excessive time spent on obtaining, using, or recovering from alcohol use.
4) Experiencing cravings and strong urges for alcohol.
5) Being unable to fulfil obligations at home, school, or work, because of alcohol use.
6) Continuing to use alcohol, even when it causes relationship or social problems.
7) Neglecting important activities at work, socially, or recreationally, because of hamful substance use.
8) Exposure of self to risk, or danger, because of repeated alcohol use.
9) Continuing to drink, even when you know you have a somatic or psychological problem that could have been due to alcohol.
10) Needing more alcohol to get the same euphoric effect (developing tolerance).
11) Development of withdrawal symptoms, which can be relieved by drinking more alcohol.
What Is Binge Drinking?
Binge drinking refers to a pattern of excessive but temporary drinking for condensed periods over time.
Binge drinkers may exhibit signs of long standing alcohol addiction, but rationalise their drinking due to celebrations or other external occasions.
Binge drinking is considered a significant precursor to, and risk factor for, alcohol use disorder.
Binge drinking can be classed as:
What Is Heavy Drinking?
Heavy drinking can be classed as:
SAMHSA define heavy drinking as binge drinking for 5 or more days in the last month [1].
Warning Signs
Based on our knowledge of working with thousands of clients since 2005 at our services, if you answer yes to 2 or more of the following questions, you may have an alcohol problem.
This is based on qualitative research data through subjective encounters with our client group at our center / program, as opposed to quantitative research data.
Alcoholism Signs & Symptoms
Since AUD is behavioural, the signs can be recognised as behaviours, alongside how these manifest physically, later.
Emotional & Behavioural
Physical
Impact on the body is normally proportionate to quantity of alcohol consumed, and the pattern or frequency of usage.
Effects can include:
Short Term Effects Of Alcohol Abuse
Blood Alcohol Concentration
Although dependent on the past, Blood Alcohol Concentration (BAC) counts of up to .12% usually develop into increased sociability, elevated mood, and somewhat delayed motor feedback.
As alcohol consumption increases, and BAC count rises, effects can vary from co-ordination and balance problems, to coma, and danger to life.
Health Effects Of Alcohol Abuse
Alcohol abuse causes many health conditions. Some health conditions include; Liver damage, starting with fatty deposits, progress in later stages to cirrhosis, hepatic portal vein blockage, and ascites.
Alongside alcohol abuse run increased risks of pancreatitis or pancreatic cancer, stroke, memory loss (short term and long term memory), diabetes, heart problems, hepatitis, anemia, gout, gastritis, ovarian or prostate cancer, and central or peripheral nervous system dysfunction, significantly damaging to a persons health.
Diagnostic Tests / Tools For Alcoholism
Gov.uk FAST Alcohol Screening Program
FAST is a Gov resource which provides the best start to testing, it is a small questionnaire used by emergency departments in the UK. It consists of a sub-set of questions from the major AUDIT (Alcohol Use Disorder Identification Test).
A score of 3 or more on the first or all 4 questions indicates a positive result, requiring completion of the remaining AUDIT questions.
AUDIT
The remaining six questions in the AUDIT indicate risk or likelihood of alcohol dependence.
National Institute on Alcohol Abuse and Alcoholism (NIAAA) 11 Point Checklist
In the United States, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) provide the following checklist for categorisation of alcohol use disorder as mild, moderate, or severe, including the following statements:
How many times in the past year have you:
*Taken from the National Institute on Alcohol Abuse and Alcoholism (NIAAA)
CAGE
The CAGE questionnaire is a easily applicable group of questions, most often used in primary care settings.
Two positive responses to any of the above questions indicates existence of an alcohol problem that should be further explored.
Health Tests
The Liver Function Test (LFT) is a health test which can show deranged attributes such as Bilirubin levels, or high blood levels of the enzyme Gamma Glutamyl Transferase which can indicate damaged bile ducts related to alcohol misuse.
Untreated Alcohol Use Disorder
Key indicators of long term alcoholism gone untreated (dry drunk syndrome) are:
Reasons People Drink
Indulging in the odd drink for a celebration is different to how someone in active addiction drinks alcohol.
So why are people content to abuse alcohol in an addictive way?
Dependence
Like any drug, during the early stages, alcohol causes the user to feel pleasant sensations such as relaxation, euphoria, increased sociability, etc.
In the long run, the neurotransmitter mechanisms which are triggered by alcohol become 'habituated', meaning it needs greater and greater amounts of the harmful substance for the person to feel the same cascading effects on other centres.
This leaves the person chasing the original sense of gratification wanting to feel what they first experienced, although these are never achievable in reality.
KEY TAKEAWAY
The brain and nervous system ultimately become used to the external substance abuse of alcohol, and expect it to be ongoing, for the processes of generating other neurotransmitters, and signalling other systems.
If alcohol is suddenly removed from the system, or not enough is there, this develops into side-effects consistent with under-representation of certain neurotransmitters and modulators, meaning effects such as trembling, headache, blood pressure changes, cardiac and breathing issues, etc, appear.
When an alcohol addiction goes unchecked in this way for long enough, withdrawal from alcohol for even a little time, can lead to chronic symptoms, without warning.
At this point drinking is not in order to attain pleasurable feelings, but to avoid much more serious withdrawal symptoms which can be a health risk. The person is now alcohol dependent.
Co-occurring Mental Health Issues
Some will start to drink too much to compensate for mental health disorders which are really at the centre of the issue.
In the absence of other solutions, e.g. a medical diagnosis of non-complex anxiety or depression disorders, or an issue with coping skills or isolation/loss of connection with others.
In some instances, they have been diagnosed by a medical professional with a challenging psychological complaint such as bipolar disorder, a personality disorder, an eating disorder, or similar.
In these instances, it becomes very difficult to know which came first - the emotional issue, or the addiction.
Sometimes, complications mean that the issue has become compounded by alcohol, but, pre-dated alcohol use.
Other's struggle is such that it seems as though alcohol use in some ways causes the emotional issue.
Individuals with a confirmed medical diagnosis of a complex mental health issue like this, can find themselves in a position where mental health workers / medical staff refuse to progress treatment for (e.g.) anxiety or depression, until the addiction is resolved which leads to further complications.
However, they can feel that taking away the coping mechanism of alcohol, will increase anxiety or depression to an unmanageable degree and damage their mental health.
Causes Of Alcoholism
Environmental
Upbringing & Beliefs
In our own work, therapeutic breakthroughs with alcoholics often reveal that self-esteem problems formed early on can lie beneath the continuous use of a coping mechanism like alcohol.
Exposure to alcohol use from a young age may increase possibility of alcohol use in adulthood, and children can develop a conclusion about alcohol such that "the way to deal with stress, is to drink alcohol."
Secondary beliefs children develop from observational learning can also corroborate the normalisation of drinking alcohol. When young people witness the rationalisation of the side-effects of alcohol use, this can perpetuate false beliefs around alcohol, and allow the abuse of the harmful substance abuse to continue unchallenged.
Psychological Factors
Continuous stress raises blood cortisol levels which can in turn increase probability of alcohol abuse, especially where alcohol has previously been used as a coping mechanism [2].
A background of trauma including abuse can indicate a higher risk for addiction, in order to handle unresolved emotional problems.
A history of depression or other more complicated mental health problems, such as bipolar disorder, schizophrenia, or borderline personality disorder, may coincide with greater incidence of alcohol addiction.
Social Group
This often manifests as a desire to help a loved-one avoid discomfort in the short haul, e.g. attached to an event. In this way, the alcoholic can gain access to money or resources needed to carry on abusing alcohol, in order to overcome a challenges.
However, this action only ends in the alcoholic concluding that:
Later, when the addiction has spiralled out of control, these beliefs will often lead to manipulative or other malicious behaviour, in order for the alcoholic to carry on accessing alcohol.
Thus, the cycle has been lengthened, and the addiction enabled, by the family members.
KEY takeaway
What family members and loved ones need to realise here, is that at this point in the addiction cycle, alcohol has become the *only* way the alcoholic knows how to cope.
It used to be *one* way to get by, but now, it's the *only* way out.
Once the shame of a series of such events begins to compound each other, it's easy to see how a mild addiction escalates into a serious one....as the emotional discomfort of admitting dependence would mean accepting responsibility for behaviours during addiction, and their consequences.
And, for most people, this is too much to bear, especially if access to alcohol is still readily available.
Is Alcoholism A Disease?
Alcoholism was first considered a disease by Dr Benjamin Rush in 1784, who identified alcohol's addictive qualities [17].
Since then, the alcoholism as a disease model has received mixed acceptance, with critics claiming it removes the personal responsibility from the alcoholic, leading to higher rates of alcoholism [18].
Alcohol use disorder is considered to have a genetic link, with studies from the National Institute Of Health stating that alcohol addiction is 50% genetic, with the other half being due to environmental factors [19].
Today, disease theory categorises alcohol abuse as a brain disease that alters a persons thought process, decision making, and feelings, created by the physiological differences between drinkers and non-drinkers, through genetics or the effects of alcohol [20].
However, disease theory has been considered discredited in some parts of the world, with it being practised predominantly in the United States [17].
Research has found that only 25% of medical practitioners believe that alcoholism is a disease, with most believing it to be a social or psychological issue [22].
High Functioning Alcoholism
What Is This Type Of Alcoholic?
Such people are often professionals, they can be thought of as someone who may have a job that pays well, a family and established social bonds, yet still uses alcohol in a way that has detrimental effects on their lives.
Sometimes such people have an emotional deficit that they use a coping mechanism to compensate for, e.g. the workaholic who believes "I'm never good enough," and uses alcohol to numb the emotional residue of the belief, as well as the toll the excess work takes on his body and close relationships.
These people are caught in the same cycle as anyone else suffering from addiction, but their conduct may be perceived as more socially acceptable to others, based on their apparent ability to perform well in different aspects.
Signs Of Alcohlism At This Level
Denial
At this level the alcoholic is content to use the external signs of his/her success as a reason to deny problematic drinking behaviour.
Nevertheless, no matter how outwardly successful the person is, heavy abuse of alcohol over time, will ultimately catch up with the person in the form of physical and emotional problems.
Statistics
The WHO (World Health Organisation) reports an estimated 3.3 million deaths each year globally as a result of alcohol misuse, with 380 million people worldwide suffering from active addiction related to alcohol use [4].
Alcohol Use Disorder is least common in Africa, affecting only 1% of the population; whereas, Eastern Europe is worst affected, with 139,000 deaths in 2013 (same source) [5].
10% of all dementia diagnosis are secondary to alcohol use disorder [6].
Up to 25% of alcoholics suffer from chronic psychiatric problems [7].
Around 12% of American adults have an alcohol problem at some point during their life [8].
Over 50% of all suicide is connected to alcohol or drug addiction [9].
47% of liver disease death in 2015 was correlated with alcohol use of adults [10].
*Numbers indicate external references to statistics research
Alcohol Poisoning
Alcohol poisoning occurs where alcohol intake has reached levels such that vital organs such as the brain and heart, begin shutting down, which can lead to a risk of death.
2,200 people per year, or 6 people daily, die due to alcohol poisoning [11].
Is Alcoholism Preventable?
Problem drinking in adults most often develops slowly, over time.
And since moderate alcohol intake is generally not a sign of emotional or somatic dependence if it's brief, drinking "too much" alcohol can be difficult to perceive clearly, until it's much more advanced.
Nevertheless, there are ways to minimise the risk of active addiction appearing as an issue in your or others' lives.
Treatment Types
Most, but not all treatments include the concept of abstinence.
Which can be described as, ceasing to drink alcohol permanently, and maintaining it over time.
Interventions
Interventions involve having a group of loved ones gather around, to explain and talk about the negative effects the addiction is having, usually with a view to helping them reach a decision about getting external help.
Part of this approach centers around explaining the impact of what may happen to their health, if they do not learn more and do not move forward and seek help.
We released more resources from our professionals about how to help someone in this situation, in our pdf guide "How To Help A Loved One In Denial", available here (PDF Download). Many readers have found this helpful.
Supervised Detox & Rehabilitation Services
Undertaking a controlled detox from alcohol in supervised health services can assist with the most dangerous elements of withdrawing from alcohol, as a springboard to move forward into the therapy work, and aftercare support, needed for full recovery.
Alcoholics Anonymous (AA) & Other Mutual Aid Support Groups
Whilst the AA does not offer medically supervised treatment services and progams, their community-driven mutual aid support group links people who wish to learn about Alcoholic Use Disorder and stop drinking. They have been running support groups world-wide, since the 1950s.
AA and other mutual aid groups or centers typically require only that members have an underlying intention to stop drinking. AA do not get involved in any form of treatment, programs, opinion, or funded endeavour in the world of recovery. Links to AA can be found here: alcoholics-anonymous.org.uk
FAQ
What is the prognosis for an alcoholic?
Full recovery from dependence on alcohol is possible, but requires reversing all of the destructive routines, developed over time, during active addiction. How challenging this is, will depend on a person's past with alcohol, and their emotional reasons for adopting alcohol as a coping mechanism in the first instance.
This also does not account for the time taken to reverse any somatic manifestations of addiction, such as damage to the organs.
Are the effects of excessive alcohol use reversible?
This will depend on the extent of destruction to the organs. In some extreme instances hospitalisation and close monitoring are required to stabilise responses until the body has a chance to heal.
In other less extreme instances, a more standardised, common regimen of alcohol detox medication can help restore equilibrium to the body and organs.
The psychological recovery from dependence on alcohol will entail greater amounts of emotional work, over an extended time span. This can be thought more as behavioural affect, rather than a one-off exercise.
What medications are used to treat alcohol abuse?
Different types may be used depending on qualified professional advice, and the intended outcome.
Is drinking every night ok?
People with alcohol use disorder often ask the question in this way, in the hope that the response will rationalise their drinking.
However, the question of "how much is too much" is a qualitative one, as well as a quantitative one. i.e. someone will know if they meet the criteria discussed above, in such as way that they are being impacted upon.
If you are being impacted by alcohol use, and/or, you meet the quantitative guidelines agreed on by recognised bodies, then it is likely you have an alcohol problem, and thus that drinking every night is not ok.
What is the average life expectancy of an alcoholic?
There are a number of individual variables involved in life expectancy which make it impossible to provide a definitive answer to this, e.g. gender, age, co-occurring / related problems, frequency of consumption, co-occurring substance misuse, background of trauma, genetics, family history or trauma, age drinking began for example, college age vs adulthood is very different.
What are the signs that someone may be a problem drinker?
Making excuses about drinking behaviour, prioritising drinking over other things, introducing opportunities to drink into everyday activities, anger upon being challenged about drinking behaviour, denial, escalating expenses around alcohol, more irresponsibility across numerous areas, e.g. finances, diet, health, appearance, lifestyle, etc, are all signs that a person may have a problem with alcohol.
What is it like being an alcoholic?
An alcoholic's daily thought process may revolve around:
Once the active addiction has been in situ for some time, these elements are almost entirely automatic, and unconscious, in the course of daily living.
What if the people around an alcoholic don't see it as excessive drinking?
Sadly, this happens more frequently than we'd like to imagine. Often well-intentioned family members are content to rationalise or normalise, the behaviour of their loved one , in an effort to help them avoid momentary discomfort.
This could mean assisting the alcoholic, financially, practically, or in other ways, to keep drinking in the way they have become used to.
The unfortunate effect of this is usually "a little gain for long term pain", meaning that the alcoholic then develops a belief that their drinking is "ok", "normal" or somehow acceptable, allowing them to keep up the habit.
Why does an alcoholic want to blame others for his/her addiction?
Persons who have a dependence upon alcohol, worry about the consequences of giving up. They are subconsciously aware of, the external fallout their behaviour has had on others, in efforts to keep up their access to alcohol.
Thus, admitting personal responsibility and concern for one of these would mean they are responsible for all such actions, and the guilt of this, can be overwhelming.
It is therefore easier, for an alcoholic to assign an external locus of responsibility, than admit responsibility for one event, which could lead to admission of guilt and a tidal wave of emotions which they are not equipped to handle.
What are the potential effects on appearance?
Those who have had heavy alcohol use for a long time usually manifest symptoms of:
What do alcoholics find enjoyable about drinking so much?
Depending on the stage of addiction they are in, many are not drinking to obtain enjoyment, but to cut out the discomfort of withdrawals, as well as taking responsibility for the destruction their behaviour has inflicted on others.
In this way, a continuous search for, and abuse of alcohol is an escape from pain for the alcoholic, rather than a guilty pleasure.
