ALCOHOLISM – ALCOHOL ADDICTION & ABUSE
Alcohol addiction is the most common form of substance addiction in the U.S., other than tobacco addiction, which is also a rampant disease that kills many and costs an untoward amount of money, not to mention the severe social costs. Shockingly, caffeine addiction, depending on which organization’s definition is used, may be even more prevalent than nicotine addiction. Moreover, many of those who drink alcohol beverages with sheer wantonness, can’t seem to get enough, and have developed co-existing caffeine and tobacco addictions, in addition to alcoholism. All three of these diseases are treatable for those who have the courage to face tough times.
Alcoholism is defined by the American Psychiatric Association of having a certain number of symptoms on a list, which are then classified as mild, moderate, or severe depending on the number of symptoms that are present. The diagnostic criteria listed below have been taken from the U.S. National Institute of Health (NIH) https://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf, and include:
Symptoms of Alcohol Addiction
- Had times when you ended up drinking more, or longer, than you intended
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t
- Spent a lot of time drinking, or being sick or getting over the aftereffects
- Wanted a drink so badly that you couldn’t think of anything else
- Found that drinking – or being sick from drinking – often interfered with taking care o your home or family, or cause job troubles, or school problems
- Continued to drink even thought it was causing trouble with your family or friends
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink
- More than once gotten into situation while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem, or after having had a memory blackout
- Had to drink much more than you once did to get the effect you want, or found that your usual number of drinks had much less effect than before
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure, or sensed things that were not there
In the above list of characterizations that fit alcoholism, it is astounding to note that none of the items include the number of drinks one has or the frequency of drinking. It is the continued use despite negative consequences that drive the diagnosis of alcohol addiction and abuse. It has been decided that the presence of 2 or 3 symptoms from the list represents a mild alcohol use disorder, 4 to 5 symptoms indicate a moderate alcohol use disorder, and if the patient scores a whopping 6 or more symptoms their disease is considered to be severe.
The reasons those who are addicted to alcohol can’t stop drinking, even though they are hurting themselves, others, and society are many fold. Genetic and environmental factors all come into play when determining the origins of alcoholism. However, once one becomes addicted to alcohol, the brain undergoes several changes, both structurally and chemically, which makes the recovery from alcoholism much more difficult.
It is known that one way or another alcohol affects the brain’s reward system, and although alcohol primarily involved the GABA receptors, it also has complex interactions with the dopamine reward system. It is thought that the euphoria that alcohol induces is related to this system; whereas, the sedative and anxiolytic (anti-anxiety) effects of alcohol are probably mediated through the GABA system. It is this reward and anxiolysis that those who become addicted to alcohol seek. Once alcohol use has progressed, there becomes a point that the brain seeks its presence like a runaway train. Most who attempt to stop on their own are unable to successfully stop this train long-term. It is this exact reason that self-help groups like Alcoholics Anonymous and drug and alcohol treatment centers that offer residential alcohol treatment and inpatient alcohol detox have popped up all over the world.
In addition to therapy and self-help groups, alcoholism also has an array of approved medical treatments, and is considered a medical illness. Because it physiologically changes the normal state of being, it fits into the definition of disease. The widely-accepted definition of a disease is that it has a recognizable cause, a group of identifiable signs and symptoms and that a consistent anatomical alteration of at least one body system takes place. A disease can be defined as meeting at least two of these criteria, but alcoholism meets all three.
Alcohol addiction is not a disease of willpower, but those who do seek to overcome this disease must have a certain amount of courage, insight and desire to change. Or, alternatively, given no choice to change by either a family member, work, or the legal system. Sometimes, severe medical problems will be enough to encourage one to change from these external factors, but not always. There are external factors and internal factors that may push someone in the direction of seeking help and addressing their alcoholism. But, like many other diseases, alcohol addiction has many different levels of severity, a gradient so to speak. It is not dependent upon any particular point this gradient that will provoke one to seek alcohol detox and alcohol treatment, rather it is dependent upon the unique individual.
To complicate matters, there are those who enable alcoholics to continue their use because, consciously, or unconsciously, the alcoholic’s drinking allows the enabler to gain some benefit from the suffering of the alcoholic. Whether that be the ability to control the alcoholic when they are drunk or remorseful of their behavior, to feel like a rescuer, or needing to be needed, whatever the reason, the behaviors of those who are codependent and act as enablers can be as damaging as the alcoholism itself.
Alcoholism is characterized by physical dependence, whereby the body becomes accustomed to having alcohol present and withdrawals in its absence. The withdrawal from alcohol can be severe, and could even lead to death. Those who are addicted to alcohol will also experience cravings and loss of control of the ability to contain their drinking; and, once started, regardless of any other obligations the drinking can continue until the alcoholic passes-out, runs out of alcoholic beverages, or someone else puts a stop to it. But, the drinking generally will start up again at a later date, unless the alcoholic is able to admit that he/she has a problem, understands the consequences, and is willing to commit to personal honesty and honesty with others.
Confronting an alcoholic is dangerous territory for those closest to them. The human brain is programmed to seek rewards. Alcohol is highly rewarding and, as stated above, affects the dopamine reward system. As one progress from use, to abuse, to alcohol dependence, this reward system, as well as other systems such as GABA, become highly affected. The brain begins to seek out alcohol as a survival mechanism. Any threat to the availability of alcohol can be seen as a threat to survival, and the person is likely to exhibit behaviors that are consistent with neuroprotective behaviors, such as aggressiveness, blaming, projection, denial, rationalization, and others. These defense mechanisms are meant to protect the psyche from unwanted anxiety, grief, blows to one’s self-esteem, and others.
Of note, there are some who drink in excess continuously and others who binge on alcohol, with periods of sobriety in between. Binge-type alcohol addiction is usually more difficult to detect and because it doesn’t always affect work or finances, it is more easily denied or the behavior is rationalized by the alcoholic and the support system. In fact, binge-type drinking and alcoholism is responsible for much more of the societal cost of alcoholism than is continuous drinking. Too, binge drinkers are more able to hide their drinking from others, including work and support networks. This is because they may only see other people when they are not drinking or intoxicated and, if they do get drunk in front of others, it can be explained away as a rare occurrence.
Classic signs and symptoms of alcoholism, either continuous or binge-type alcohol addiction
- Blackouts – Memory impairment while intoxicated, or in advanced cases, continued memory impairment
- Tolerance – Needing more alcohol to get the same effects (this is due to receptor downregulation)
- Withdrawal – Acute alcohol withdrawal when stopping drinking, the mildest form being a hangover
- Legal, work, relationship, school or financial problems because of drinking, being treated for drinking, or due to withdrawal
- Injuries to self or others, either intentionally or accidentally while drinking
- Hiding liquor or other alcoholic beverages throughout the car, bags, luggage, closets, lockers, or other strange areas that the person addicted to alcohol has access to
- Not attending events, leisure or otherwise because the alcoholic won’t be able to drink, or because they will be able to drink and the addict is fearful of what they may do when they begin drinking and can’t control it
- Taking risks while drinking, such as working, operating machinery, driving, taking care of children, and others
- Drinking even though you have health problems that are or are not attributed to alcohol
- The person is not able to cut down or stop drinking, even though he/she, or others, is worried about the amount of drinking
- An excessive amount of time spent thinking about drinking, planning drinking, purchasing alcohol (driving excessive distances to purchase it), drinking alcohol, or recovering from alcohol episodes
- Stopping other activities even though you enjoy them because you are ill from drinking, or would rather drink, such as spending time with family and friends, attending sporting events, playing sports, crafts, arts, shopping or any other leisure activity