There are several variations on problem drinking – physically and emotionally harmful consumption of alcohol – but one of the most publicized is alcoholism, which is referred to clinically as alcohol use disorder (AUD). This condition is an addiction to alcohol, which not only involves consistent, high-volume drinking, but also a physical dependence on alcohol and compulsive behaviors around acquiring and drinking.
The National Institute on Alcoholism and Alcohol Abuse (NIAAA) notes that 15.1 million adults in the United States, as of 2015, have AUD – 9.8 million men and 5.3 million women – and around 623,000 adolescents also struggle with this addiction.
Problem Drinking and Alcohol Consumption Patterns
Alcohol use disorder, like other addictions, is caused by a complex interaction between genetics, family history, and current environment. Medical researchers have discovered genes associated with a higher risk of alcohol abuse. Having a close family member struggle with addiction or mental illness puts one at a higher risk of also developing a substance use disorder, including AUD. A high-stress environment, such as being in a very competitive career field, can also trigger AUD. However, having these risk factors does not automatically mean that a person will develop AUD.
Understanding problem drinking is one of the first steps to understand AUD. The Centers for Disease Control and Prevention (CDC) and other health organizations measure when drinking becomes problematic by discussing servings of alcohol per hour.
- 12 ounces of beer
- 5 ounces of wine
- 5 ounces of hard liquor
The liver metabolizes one serving per hour, so if a person consumes two servings of alcohol in one hour, their blood alcohol concentration (BAC) will begin to rise. Binge drinking occurs when a woman consumes more than four servings, or a man more than five servings, of alcohol on one occasion, typically leading to much more alcohol than the liver can process per hour. Heavy drinking, another form of problem drinking, involves consuming more than eight drinks per week for women, or more than 15 drinks per week for men, typically in the form of two or three alcoholic beverages per day. AUD may appear as consistent, extreme heavy drinking, or as binge drinking several times per month.
Many Americans consume far too much alcohol and put themselves at risk for developing AUD. One study found that 30 percent of American adults do not drink alcohol at all, and another 30 percent consume less than one drink per week, which is much less than “moderate” drinking. However, the study found that the top 10 percent of American alcohol consumers drank extremely heavily, leading to severe health problems and indicating potential AUD. In the study, 24 million adults consumed an average of 75 servings of alcohol per week, which amounted to about 10 drinks per day. This not only causes serious internal damage to the liver, kidneys, stomach, heart, and even lungs, but it can also cause brain damage, including but not exclusive to addiction.
The amount of alcohol one craves or consumes can indicate alcohol dependence or addiction. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists criteria for clinicians to diagnose a potential AUD.
Criteria for Alcohol Use Disorder
A therapist or physician can use the 11 criteria for AUD in the DSM-5 to determine if an individual struggles with alcohol dependence or addiction.
For AUD to be diagnosed, the individual must struggle with at least two of these criteria for a year:
- Consuming larger quantities of alcohol than intended
- Wanting to stop drinking, but being unable to do so
- A lot of time and money devoted to acquiring and consuming alcohol
- Intense cravings for alcohol
- Alcohol abuse causing problems at work, at school, or with social obligations
- Ongoing alcohol abuse even though loved ones become concerned or relationships with loved ones change
- Giving up important cultural, social, occupational, or recreational activities in favor of drinking
- Continuing to abuse alcohol even when in physical danger (e.g., drunk driving)
- Continued abuse of alcohol even though it causes mental or emotional problems
- Tolerance, meaning the person needs to drink more alcohol to achieve the original effects
- Withdrawal symptoms when the person does not, or is unable to, drink
There are three different levels of AUD possible: mild, moderate, and severe. A mild AUD is diagnosed when an individual is found to experience two or three of the above symptoms; moderate AUD is diagnosed with four or five symptoms; and severe AUD is six or more of the above symptoms being present for at least 12 months.
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Help to Overcome Alcohol Use Disorder
Having concerns about how much alcohol one consumes may be the first indication of a potential problem with the substance. Feeling guilty or sad due to consistent alcohol consumption, or losing friends or close relationships due to problem drinking, may indicate a potential AUD.
The National Council on Alcoholism and Drug Dependence (NCADD) has an online test for people who are worried about their alcohol consumption. This can help individuals to better understand if their patterns indicate a problem; however, diagnosis of AUD is ultimately up to a medical professional. Speak with a therapist or physician to begin the process of getting help.
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