Alcohol Abuse

Alcohol is the most common substance abused in America. A significant portion of the population has had alcohol at some point in his or her life, and alcohol often plays an important role in social events, such as parties and celebrations. Due to its legality and commonplace existence, it can be very difficult to know when a person's use of alcohol turns to abuse. At the very basic definition, abuse happens any time a person consumes a substance in order to alter his or her mood. Therefore, having a drink after a stressful day at work technically constitutes abuse. However, for most people this singular drink or two after a tough day does not lead to problems. It is when drinking disrupts a person's daily life, work, relationships, and other aspects of life that signals a potential problem requiring help.

Every year, the Substance Abuse and Mental Health Services Administration (SAMHSA) conducts a report on drug and alcohol abuse and dependence. The latest data comes from the Results from the 2012 National Survey on Drug Use and Health, and it reveals 82 percent of the population has had a drink at some point in their lives, while 66 percent have consumed it in the past year, and 52 percent in the past month. Additionally, 17.7 million meet the criteria for either alcohol abuse or dependence, which is 6.8 percent of the population, and 3.3 percent, or 8.6 million people, have alcohol dependence.

Problem drinking, which includes heavy drinking and binge drinking, increases a person's risk of developing a drinking problem. In the past month, 59.6 million (23 percent) Americans have engaged in binge drinking, and 17 million (6.5 percent) engaged in heavy alcohol use. Breaking those numbers down by age, 7 percent of people between the ages of 12 to 17 have engaged in binge drinking in the past month, and 1.3 percent has engaged in heavy drinking.  That number raises to 39.8 percent and 12.7 percent respectfully in ages 18 to 25. For those 26 and older, the rates are a bit lower, with 22.1 percent binge drinking and 6.1 heavy drinking. The report also found that 18 million people needed treatment for alcohol abuse or dependence, but only 1.5 million received it. That left 16 million people who did not received treatment, which meant only 8.2 percent of those who needed treatment received it.

The data from the SAMHSA report is based on an annual survey of the civilian, non-institutionalized population. The data from the survey is used to create national estimates. Although it is widely recognized as one of the standard statistics of substance abuse and dependence, it does have the potential for inaccuracies.

Alcohol Abuse or Alcohol Dependency?

There are many words that are used when discussing alcohol abuse and addiction problems. Colloquially, people refer to problems with alcohol as alcoholism, or addiction, but alcohol abuse can be harmful as well. The diagnostic manual for professionals, the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V) published by the American Psychiatric Association, contains a spectrum of disorders under the heading substance use disorders that includes abuse and dependency. The most recent edition of the diagnostic manual no longer uses the term substance abuse; instead, it combines substance abuse and substance dependence into one disorder: substance use disorders.

When professionals discuss dependency, they typically refer to a physical or emotional dependency upon a substance. A person who abuses alcohol does not necessarily develop dependence upon alcohol. However, if the abuse is not treated, then he or she has a high risk of developing one. Dependency is typically defined as building up tolerance for a substance and exhibiting withdrawal symptoms when that substance is not consumed. Tolerance means that a person has to consume higher amounts to achieve the same effect. Although not everyone who has an alcohol abuse problem will become an alcoholic, it is a significant risk factor. Engaging in binge drinking or heavy drinking also increases a person's risk of developing alcoholism.

The simplest sign of an alcohol abuse problem is that drinking interrupts a person's life and relationships. There are several other signals that a person might have a drinking problem. If someone regularly drinks more than he or she meant to drink and frequently blacks out or forgets certain experiences that happened while they were drinking, then he or she might have a problem. Feelings of guilt or shame, including lying and hiding drinking habits, are also red flags. The need to drink in order to feel better, including relying upon it as a way to relax or stress relief, also could be signs of a problem developing. Drinking even after it causes problems, including legal problems, also signals that a person has a problem. Neglecting responsibilities, work, responsibilities, and one's health, as well as drinking even though it is dangerous are additional symptoms of alcohol abuse. Changes in mood or no longer enjoying favorite activities could also be a sign of a problem.

In the DSM-V, there is a list of 11 criteria for the disorder, of which a patient must meet at least two to be diagnosed. There is a spectrum of the disorder, from mild (meeting 2-3 criteria), moderate (meeting 4-5) and severe (meeting 6-7). The criteria include:

  1. Continuing to abuse alcohol regardless of the negative personal consequences.
  2. Inability to carry out obligations at school, work or home due to alcohol abuse.
  3. Recurrent use, even in physically hazardous situations.
  4. Continual to consume alcohol despite interpersonal or social problems that are caused or made worse by drinking.
  5. Tolerance to alcohol, meaning a person needs a markedly increased amount in order to achieve the same effect, or feels a diminished effect when using the same amount.
  6. When go for a period of time without drinking, exhibiting withdrawal symptoms that appease if consume alcohol once again.
  7. Drinking more alcohol, or for longer than intended. Increased cravings and unsuccessful when trying to cut down or control how much is consumed.
  8. Spending an increased time to obtain use or recover from consuming alcohol.
  9. No longer engaging in certain social, occupational or recreation activities because of drinking.
  10. Continues to consume alcohol despite acknowledgement of physical or physical problems.
  11. Strong desire or craving to drink.


Alcohol's Devastating Effects

Alcohol affects the whole body and can lead to serious illness if not treated early enough. When a person drinks alcohol, the stomach and small intestine rapidly absorbs it and sends it to the bloodstream, which takes it not only to the brain but every organ in the body. The most commonly associated illness with alcoholism is cirrhosis of the liver; however, there are many other problems that can develop due to excessive drinking. Most people drink alcohol due to the relaxing effect and the mood altering effects. Alcohol is a depressant, which means it relaxes the body, including essential body systems.

Alcohol can also negatively affect a person's life, damaging relationships, interrupting work, and more. It also increases a person's risk of being involved in an accident, especially in motor vehicle crashes.

Alcohol is a chemical that the body must metabolize and then remove from the body. The chemicals in alcohol can negatively harm many of the major organs and systems, which could lead to serious illness and even death. Drinking large quantities in one occasion or drinking over a longer period of time can cause problems in the heart. It can lead to cardiomyopathy, which is the stretching and drooping of heart muscle or an irregular heartbeat, known as arrhythmia. It can also cause high blood pressure and increase the risk of stroke or a heart attack. Although some studies have shown that moderate drinking can help prevent cardiovascular disease, new studies have countered theses findings. If there are any benefits, they only happen with small amounts of drinking.

The liver is the organ most heavily damaged by drinking. The liver metabolizes 90 percent of the alcohol, while the kidneys eliminate 5 percent and the lungs exhale 5 percent. The liver works hard to detoxify the body. When there is excess alcohol to be metabolized, it can lead to problems in the liver, including cirrhosis, fibrosis, alcoholic hepatitis, and steatosis (fatty liver). With excess alcohol, the pancreas can produce toxins that can lead to pancreatitis, or inflammation of the organ that can prevent proper digestion and cause significant health problems. Drinking can also increase the risk of cancer, especially in the liver, esophagus, throat, breast, and mouth. It also reduces the efficacy of the immune system, increasing the risk of catching diseases, including pneumonia, the cold, and the flu. The depressant qualities of alcohol can also cause a system shut down when too much is ingested at once. This often happens when a person experiences alcohol poisoning, which is when more alcohol is consumed than the liver can metabolize. The heart can shut down, the gag reflex can become too relaxed, and a person can pass out. Without immediate medical attention, a person can die from alcohol poisoning.

As a depressant, alcohol slows down the body's movement, including the brain's response. This is why people have delayed responses when drinking alcohol. The mood altering, "feel good" feelings, and relaxing effects on the brain are often the reason people drink. However, drinking alcohol leads to significant, and sometimes irreversible, problems. In fact, according to a study by Oscar Berman and Marinkovic in 2003, about half of people who meet the diagnostic criteria for alcoholism have memory or thinking problems.

Alcohol affects the neurotransmitters in the brain, namely glutamate and serotonin. Additionally, there are three areas of the brain affected by alcohol: the cerebellum, limbic system, and cerebral cortex. The cerebellum controls a persons' motor coordination, which causes imbalance and stumbling when influenced by alcohol. The limbic system monitors memory and emotion, among other tasks, which is one reason memory and emotion can be affected by alcohol. The cerebral cortex connects the brain to the rest of the nervous system, as well as engages in higher cognitive function such as thinking, planning, and social interaction. Therefore, alcohol causes impaired problem thinking, and learning.

However, alcohol does more than just make a person feel relaxed and calm; it can also inhibit the brain. It can cause an imbalance in the brain chemistry, as the neurotransmitters become over productive due to the reliance upon the chemicals in alcohol. The body wants to be in balance, so when alcohol disrupts the neurotransmitters, the brain learns to adapt to bring it back to balance. However, this leads to tolerance and dependence. This can also cause psychological problems, including depression and anxiety. Alcohol can also cause dementia, stroke and neuropathy. Alcohol has also been shown to damage the brain cells, including reducing the size of neurons, which shrinks the brain mass and increase the size of the inner cavity. This can cause problems with sleeping, mood, coordination, temperature regulation, and cognitive function. Although some of these problems can be reversed by no longer drinking, some of the effects might be irreversible.

According to the Centers for Disease Control and Prevention (CDC), 88,000 deaths happen every year due to alcohol in America. This makes it the third leading lifestyle-related cause of death. Additionally, drinking excessively causes an average of 30 years of potential life lost for each death, which adds up to 2.5 million years of potential life lost every year. More than 40 percent of hospital beds, not counting maternity and ICU patients, are used to treat alcohol-related conditions. Additionally, and estimated 32 percent of car crashes with fatalities are due to intoxication. This leads to almost 13,000 people dying every year due to an alcohol-related accident.

Heavy Drinking vs. Binge Drinking

When discussing drinking behaviors, many professionals use the terms moderate drinking, heavy drinking and binge drinking. The precise quantities that designations the level of drinking differ depending on a person's gender, age and metabolism. A single serving is typically 14 grams of pure alcohol, or .6 ounces. This equates to 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounce of distilled spirits. The liver can only metabolize on average one standard drink per hour. If a person consumes alcohol faster than can be metabolized, it can cause problems, including alcohol poisoning.

According to the National Institute on Alcohol Abuse and Alcoholism, binge drinking occurs when a person drinks excessive amounts in one sitting, causing a blood alcohol concentration (BAC) above .08. This equates drinking 4 drinks for women and 5 for men in two hours. SAMHSA defines it slightly differently: drinking more than 5 drinks on the same occasion during 1 day in a month. According to SAMHSA, heavy drinking is drinking 5 or more drinks on 5 or more days within the past 30 days. To be considered at a low risk for problem drinking, a woman should drink no more than 3 drinks in a single day, and not have more than 7 in one week. For men, the numbers are 4 drinks on a single day and no more than 14 per week.

Cause of Alcohol Abuse

Alcohol abuse is a complicated disorder that does not have one singular cause. Genetics, environment, emotional experiences, biological factors, and psychological state contribute to the development of the disorder. Some people abuse alcohol due to social pressures, and then find they cannot stop. An example of this is college-age binge drinkers, who initially engage in drinking in order to fit in with peers before finding a compulsion to continue. If a person is genetically disposed due to a family history of alcoholism, then he or she has a higher risk of abusing alcohol and developing dependence.

Many people with mental health conditions, such as anxiety or depression, turn to alcohol to self-medicate, which also increases the risk of developing a drinking problem. Some people can handle drinking and abusing alcohol for longer before it becomes a problem, while others will find themselves encountering problems relatively soon after abusing the substance. Early treatment can help to avoid some of the more significant problems associated with drinking and alcoholism.

Risk Factors for Alcohol Abuse

Some people have a higher risk of developing a problem with drinking than others. People who have an increased potential for alcohol abuse should take extra care to prevent problems from occurring. Risk factors for alcohol abuse include:

  1. Mental health conditions, especially depression, anxiety, post traumatic stress disorder (PTSD), and bipolar disorder
  2. Family history of alcoholism
  3. Beginning to drink at an early age
  4. Drinking heavily on a regular basis
  5. Having friends or family members who also drink heavily

Treatment for Alcohol Abuse

Many people believe that a person needs to be addicted to a substance in order to receive, and benefit from, treatment. That is a myth. About half of those who are treated for alcoholism remain abstinent after a year, and most of those continue to abstain from alcohol for the rest of their life. The earlier a person receives treatment, the better chance he or she has of a full recovery. The biggest impediment to treatment is denial of a problem. Alcohol abuse can cause problems in a person life, just like alcoholism. If it is not treated, there is a significant risk it will develop into alcoholism. By entering treatment early, a person has a better chance of overcoming the underlying problems fueling the abuse before the major health, social, and other problems develop or become irreversible.  There are various options for alcohol abuse treatment: rehab, psychotherapy, and 12-step programs. 

The majority of dedicated treatment facilities for alcoholism also treat alcohol abuse. Many of these facilities offer detox and additional services. Clients typically undergo psychotherapy to treat the underlying conditions fueling the alcohol abuse, which is especially beneficial for those using alcohol to self-mediate or de-stress. These programs also teach healthy coping methods and stress relief techniques. Rehab can be done in residential programs, where a person stays on site 24/7, or intensive outpatient programs. Many people who opt for outpatient care help find residing in sober living environments, or homes where alcohol and other addicting substances are not allowed, beneficial.

Psychotherapy is an essential component of treating alcohol abuse, whether it is done in a dedicated treatment facility or with an individual practitioner on a weekly basis. The main type of psychotherapy used for treating alcohol abuse is cognitive behavioral therapy. This type of therapy was developed to help prevent relapse with problem drinking, although it has been adapted to treat other behavioral health disorders. It teaches new behavioral patterns to replace maladaptive ones. Patients identify and correct these behaviors and learn a new range of skills. The therapy teaches self-monitoring to recognize cravings, identify risky situations, and coping mechanism.

Alcoholics Anonymous (AA) was the first 12-step program, and is heavily associated with treatment for alcohol abuse. Most people find benefit from attending the group sessions, and some do not need any additional form of treatment. However, the best type of treatment typically uses AA as a complimentary method that provides a supportive environment for the person as he or she undergoes the early stages of recovery.

Withdrawal from alcohol can be life threatening, and it is one of the few substances that have a dangerous withdrawal pattern. Not everyone with alcohol abuse will go through withdrawal, but if a person has developed a physical dependence upon alcohol, then withdrawal will occur. Symptoms for withdrawal may be mild, such as headaches, nausea, vomiting, trembling, sweating, insomnia, irritability, fatigue, and depression. More severe cases could lead to hallucinations, confusion, and seizures. The most serious withdrawal symptom is delirium tremens (DT) involves seizures, trembles, and hallucinations and other severe mental or nervous system problems. DT can lead to death, which is why alcohol detox should be medically supervised, especially if a person has been drinking heavily for many years.