All You Need to Know About Alcohol Abuse and Treatment
Several studies and surveys have shown that alcohol is still the most commonly abused substance in the U.S. Despite the intensified focus on abusive drugs, alcohol abuse is still a persistent problem in the country.
In 2014, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported that about 16.3 million adults ages 18 and older suffered from Alcohol Use Disorder (AUD) while 679,000 adolescents between the ages 12 and 17 were found with the same fate. Meanwhile, excessive alcohol drinking accounts for the deaths of approximately 88,000 annually.
What is AUD?
Previously known as alcoholism or alcohol dependence, AUD is a medical condition characterized by a compulsive pattern of heavy drinking over a period of time. This condition leads to serious potential health risks and impairs the patient's ability to perform regular activities in daily life. The disorder may be classified as mild, moderate, or severe, depending on the criteria prescribed by the American Psychiatric Association in the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) issued in May 2013:
- The concurring presence of at least two out of the 11 criteria within any given year is sufficient to conclude a diagnosis of mild AUD.
- Having at least four of those symptoms signifies that the patient has moderate AUD.
- Having six or more indicators means that the patient has a severe disorder.
Signs of Alcohol Abuse
Diagnostic indicators that point to AUD include the following:
- Having frequent cravings for alcohol consumption
- Having high tolerance for alcohol
- Giving up normal or usual activities
- Neglecting to perform responsibilities and obligations
- Experiencing physical or psychological problems associated with alcohol use
- Experiencing social and interpersonal issues related to alcohol intake
- Dedicating long periods of time to drinking activities
- Consuming larger amounts than initially intended
- Repeated attempts to quit or control alcohol use
- Suffering from withdrawal symptoms or entering a withdrawal state after cessation of alcohol use
- Using alcohol persistently regardless of known or experienced hazardous effects
Frequent episodes of heavy drinking and binge drinking are also suggestive of AUD. Binge drinking refers to the consumption of four or more drinks (for women) and five or more drinks (for men) during a single occasion.
Dangerous Consequences of Alcoholism
When left untreated, AUD aggravates over time and may result in perilous consequences that affect several aspects of the individual's life. It also disturbs the lives of immediate family members, friends, co-workers and acquaintances.
Some of these threatening consequences include the following:
- Health risks
The immediate effects of alcohol abuse include slurred speech, dizziness, blurred vision, disorientation or confusion, lack of muscle coordination, altered perception and judgment, impaired memory, vomiting, and respiratory depression. It also causes increased levels of blood alcohol content (BAC) that can cause breathing difficulties, coma and, in worse cases, death.
Continued consumption of large amounts of alcohol increases the risks of serious health conditions such as cardiovascular diseases, hypertension, liver diseases (including cirrhosis and fatty liver), hepatitis, gastrointestinal conditions (like gastritis, pancreatic and ulcers), certain cancers (such as liver, colon, pancreas, throat, esophagus, and breast), dementia, stroke, brain atrophy, diabetes, anemia, abnormal weight loss, and malnutrition.
AUD is also associated with psychiatric ailments such as insomnia, anxiety, chronic depression, bipolar disorder, and similar conditions. Failure to cope with or manage these conditions intensifies the probability of suicide attempts.
- Family life
Parental alcoholism negatively impacts inter-family relationships and is one of the underlying sources of recurrent antagonism in the home. Left unaddressed, this can lead to domestic violence and abuse, child neglect, loss of parental authority and child custody, separation and divorce.
Children of alcoholic parents are predisposed to anxiety, depression and social isolation. These conditions may be manifested in academic underperformance, bullying and association with cliques or even gangs. The latter is resorted to by the child or teenager as an attempt to fill in the void caused by parental neglect.
Moreover, studies show that a child exposed to drinking by a family member or relative is three times more likely to develop alcoholism during teenage or adult life. Thus, the home can be a cradle of alcohol dependence.
- Social disorder
Among the most common disturbances that can result from alcohol abuse is the occurrence of road mishaps and vehicular accidents. According to the Traffic Safety Facts 2014 Data of the US Department of Transportation, National Highway Traffic Safety Administration (NHTSA), alcohol-impaired driving accounted for 31 percent of traffic-related deaths in the United States in 2014.
Aside from death, motor vehicle crashes also result in physical injuries, trauma and property damage.
Because increased alcohol intake impairs rational judgment, alcohol abuse provokes acts of violence such as homicide, suicide and sexual assault. It also leads to risky behavior such as engaging in unprotected sex or having sex with multiple partners that can increase risks of unwanted pregnancy and HIV.
- Economic costs
Alcohol abusers are a liability in the workplace. Compared to their other co-workers, alcoholics are more given to absenteeism, tardiness and low work efficiency. These affect the overall productivity that can lead to business downturns.
Alcoholic employees are more likely to incur health care costs due to their recurring medical issues. These expenses can be a heavy burden for employers who provide medical subsidy or health insurance.
Termination and unemployment are also associated with alcohol abuse. With a high probability of being displaced from their homes and workplaces, alcohol abusers are constrained to seek housing and financial aid from various government-sponsored shelters and social programs.
When to Seek Medical Help
Confronting the issue in its early stages can be challenging as the signs of alcohol dependence may differ from person to person. Alcohol abusers are quick to deny their addiction to the substance, and in the early phases of abuse, they will adopt means to conceal their drinking. They will rarely seek treatment voluntarily. In most cases, intervention by family members or close friends is necessary to address the problem.
When the frequency of drinking begins to interfere with professional or social life, or when it moderately affects mental and physical health, then it is best to seek medical assistance.
In recognizing alcohol abuse, it is helpful to consult the list of criteria suggested by the DSM-5 document. The presence of any two markers coupled with the incidence of any of the problems associated with alcohol use (i.e.unemployment, financial distress, violent behavior, or involvement in vehicular accidents) indicates that professional help for the patient must be sought.
While covering up for the abuser or tolerating his behavior may be well-intended, it will only worsen the addiction to the detriment of the patient's well-being. Difficult as it may be, it is best to face the problem head-on.
AUD Treatment Options
It is imperative to entrust the treatment of AUD to physicians and professional healthcare workers with specialized training in addiction medicine. These experts have received the proper instruction necessary to clinically diagnose the condition, address the symptoms and handle episodes of alcohol withdrawal. Complications arising from alcohol withdrawal syndrome can be life-threatening and are best managed by trained professionals.
According to NIAAA, more than 700,000 people in the U.S. are treated for alcoholism per day. Patients may choose between confinement at treatment centers or outpatient therapy.
For more severe cases of alcohol dependence, the recommended option is confinement for a specific period of time at a medically-managed treatment or rehabilitation center. These centers offer and implement detoxification and rehabilitation programs.
Detoxification refers to the process of eliminating the body's dependence on a particular substance (which, in this case, is alcohol). Because there is an abrupt cessation of alcohol use, the patient may enter a withdrawal state. During this period, the recovering alcoholic may experience various symptoms such as hallucinations, tremors, seizures and delirium, which may require administration of certain drugs in varying doses until the withdrawal syndrome is effectively controlled.
Rehabilitation programs are facilitated and managed by psychiatrists or trained therapists through a mix of individual and group therapy support sessions. During these sessions, alcohol abusers are taught to acknowledge their addiction, identify its causes, explore alternative solutions to overcome it and develop skills for productive living. The end goal of the therapy is for the patient to leave the center with an in-depth understanding of his condition and a strong motivation to avoid its recurrence.
To best benefit from rehabilitation, it is best to enroll in long-term programs or to support the shorter courses by having follow-up and monitoring sessions on a regular basis.
Many alcohol abusers, especially those who could not afford the costs of a structured in-house treatment, may opt to attend outpatient therapy sessions or enlist in mutual-support programs such as Alcoholics Anonymous, Women for Sobriety and SMART Recovery.
However, because the patients are not secluded or isolated from the community, they are more likely to succumb to the temptations of purchasing and consuming alcohol during the treatment period. In outpatient therapy, the chances of rehabilitation are relatively lower compared to inpatient treatment. As a result, this is best recommended for patients who have already successfully accomplished an inpatient treatment program.
In addition to the above-mentioned psychosocial treatment approaches, medication-assisted treatment may also be used. This is especially suggested for patients who experience relapses or cravings despite having undergone detoxification and rehabilitation programs.
Depending on the severity of the physiologic dependence, physicians should consider prescribing at least one of the several medications approved by the Food and Drug Administration (FDA) for the treatment, management and control of alcohol dependence.
The success of the treatment is measured by the patient's ability to maintain sobriety over a longer period of time or to permanently abstain from alcohol consumption after having undertaken therapy. Other crucial factors that contribute to effective recovery are good health, social support and motivation. According to statistics presented in WebMD, approximately 50% of 60% remain abstinent at the end of a year's treatment and a majority of those are able to stay dry permanently.
While medical science and research offer promising developments for the treatment of AUD and alcohol-related health conditions, the costs associated with alcohol abuse remain high. The significant burden it imposes on family, relationships and society cannot always be measured in quantifiable terms.
These costs can only be reduced or avoided by the exercise of prevention methods, the most effective of which is total abstinence from alcohol. Unfortunately, given the easy access to alcohol in the market, abstaining from alcohol may not be viable for long-term addicts. In this case, alcohol users must be aware of the warning signs of alcohol dependence and take proactive steps to curb drinking habits before they cross the border from recreational to abusive drinking.