Guide to Alcohol Abuse: Understanding the Disease of Alcoholism

Although drinking alcohol is widely accepted and legal in the U.S. for those older than the legal drinking age, alcohol use disorder can be a scary and dangerous addiction to recover from.

Alcohol Use Statistics

In 2018, 139.8 million Americans aged 12 or older reported drinking any alcohol in the past 30 days. In the same study it was estimated that, over 14.8 million individuals 12 years old and up in the last year had an alcohol use disorder.¹

To learn about how alcohol may affect the body, about alcohol withdrawal, and about alcohol use disorder and some possible treatment options for it, read on.

Physical Effects of Alcohol

Alcohol depresses the central nervous system.² Effects you may experience from consuming too much alcohol include:^{2, 3, 4, 5, 6}

• Confusion
• Difficulty concentrating.
• Impaired judgment.
• Trouble with coordination.
• Delayed reaction time.
• Speech slurring.
• Memory loss.
• Nausea and/or vomiting.
• Breathing slowly.
• Loss of consciousness.

The amount you drink correlates with how strongly you are affected: your level of impairment is greater when more alcohol is in your blood.⁷ Other things also may impact a person’s reaction to drinking, such as the speed of drinking, using drugs or medications with alcohol, the person’s age, and more.²

Drinking can have some subjectively positive effects: it can make people feel good, relax, feel less stress, and be more sociable.^{4, 9} However, for individuals who do not already use alcohol, beginning is not advised.²

Underage drinking, heavy drinking, binge drinking, or drinking while pregnant are types of problematic drinking. Indicators of a problem with drinking include it causing school problems, relationship issues, trouble with social activities, or difficulty with one’s thoughts and emotions.²

Some terms related to alcohol use are listed below and explained.

Signs of Alcohol Poisoning or Overdose

Alcohol overdoses can be fatal. If you think you or someone else may have overdosed on alcohol, call 911 at once.⁸

Possible symptoms of alcohol poisoning or overdose include:⁸

• Vomiting.
• Marked confusion.
• Trouble staying conscious.
• Not waking up.
• Reduced responses (e.g. lack of gag reflex).
• Decreased heart rate.
• Less than 8 breaths in a minute.
• 10 seconds or longer in between breaths.
• Low body temperature.
• Bluish or pale skin.
• Skin that feels clammy.
• Seizures.
• Coma.
• Death.

Standard Drink

In the U.S., one “standard drink” is defined as a drink with 14 grams or 0.6 fluid ounces of pure alcohol. For a beer that is 5% alcohol, 12 ounces would be a standard drink. For a liquor that is 40% alcohol, 1.5 ounces would qualify. For a wine that is 12% alcohol, a 5-ounce pour would do the trick. Knowing what counts as a standard drink can assist a person in applying health guidelines.¹⁰

Moderate Drinking

Two drinks or less on any day for men and one drink or less on any day for women is considered moderate drinking.^{2, 11}

Binge Drinking

Binge drinking constitutes drinking an amount of alcohol that leads your blood alcohol concentration to reach 0.08% or higher, which would generally correlate with women drinking 4 drinks or a larger amount, or men drinking 5 or a larger amount all on one occasion. This level of consumption generally needs to occur within approximately 2 hours.^{2, 11}

Alcohol Use Disorder

Only a medical professional can officially diagnose an alcohol use disorder. With that in mind, the signs, symptoms, and behavioral changes used to diagnosis an alcohol use disorder include:¹²

• Using more alcohol than intended or for longer than intended.
• An ongoing desire or unsuccessful attempts to cut back or control the use of alcohol.
• Spending a lot of time getting alcohol, drinking, or recovering from drinking.
• Strong cravings to drink.
• Alcohol getting in the way of fulfilling responsibilities at home, school, or work.
• Continuing to drink after having ongoing issues with other people caused or made worse by alcohol.
• Giving up or cutting back on social, work, or leisure activities due to drinking.
• Continuing to drink in situations that can be dangerous, such as driving.
• Drinking despite awareness that it has caused or is worsening a physical or mental problem.
• Tolerance, where you need more alcohol to get intoxicated or are feeling fewer effects with the same amount of alcohol.
• Experiencing withdrawal symptoms when cutting back or stopping alcohol use.

Risk Factors for Alcohol Use Disorder

Several factors may affect an individual’s alcohol use disorder risk.¹³ Some are listed below.

Genetic

Genetics can impact a person’s alcohol use disorder risk.¹³ If you have a close relative with alcohol use disorder, you may be more likely to develop it yourself, and in people whose relatives have more severe issues connected to alcohol, who are more closely related genetically to the individual with an alcohol use disorder, and who have more relatives with alcohol use disorders, alcohol use disorder is even more prevalent.¹²

Developmental

Risky behaviors might be more likely during the teenage years since parts of the brain that govern judgment, control of oneself, and making decisions are still in development.¹¹ Young individuals that drink alcohol have a higher chance of having an alcohol use disorder when older.¹⁴

Environmental

Prevalent cultural views on drinking and drunkenness, how easy it is to obtain alcohol, and whether the people an individual spends time with abuse alcohol might impact an individual’s alcohol use disorder risk.^{12, 13}

Psychological

Low self-esteem, stress, impulsivity, and methods used to handle stress may impact an individual’s risk of alcohol use disorder.^{9, 12, 13} Conditions such as depression, bipolar disorder, or schizophrenia may raise a person’s alcohol use disorder risk.^{12, 13}

Other Potential Health Effects of Alcohol

Consuming too much alcohol can negatively affect your health in a variety of ways.^{15, 16} Alcohol use disorder, dependence, and overdose are not the only possible risks of excessive alcohol consumption.^{7, 8, 13, 15} Some of the adverse health effects alcohol may have include:

• Brain issues. Alcohol can impact the functioning of the brain.¹⁶ It may alter your mood and behavior, cause memory issues, hinder coordinated movement, result in learning difficulties, and/or impair clear thought. ^{15, 16}
• Impaired immune system. Excessive drinking may make you more likely to get sick; even just consuming a lot of alcohol once may, for up to a day, make you more prone to infections.¹⁶
• Heart problems. The heart may suffer harm from too much alcohol, and consuming too much alcohol may result in cardiovascular issues such as the heart irregularly beating (arrhythmia), elevated blood pressure, increased stroke risk, cardiomyopathy (muscle of the heart stretching and sagging), and associated heart disease risks.^{12, 15, 16}
• Increased risk of cancer. Alcohol is a known carcinogen and might raise a person’s risk of certain cancers, including throat, oral cavity (except lips), larynx, esophageal, liver, breast, and colorectal cancers.^{9, 16, 17}
• Liver problems. Fibrosis, alcoholic hepatitis (inflammation of the liver), fatty liver, and cirrhosis (scarring of the liver that progresses) are potential results from using alcohol heavily.^{9, 16}
• Nerve problems. Consuming alcohol heavily may lead to neuropathy (a person with neuropathy may experience muscle weakness, pain, tingling, and/or lessened sense of feeling).^{12, 13}
• Drinking heavily may bring about pancreatic inflammation, which can be painful and dangerous and can interfere with normal digestion.^{12, 13, 16}
• Stomach issues. Alcohol consumption might result in irritation of the stomach’s lining, and this might then trigger reactive gastritis; consuming alcohol also may raise a person’s likelihood of getting a peptic ulcer, worsen a peptic ulcer, and/or make it take longer to heal.¹²

Alcohol Withdrawal

In cases of significant physical alcohol dependence, suddenly stopping alcohol use or markedly decreasing the amount you use may result in withdrawal.¹⁸ Withdrawal from alcohol can be uncomfortable and, in some cases, dangerous or deadly.^{6, 18}

Possible alcohol withdrawal symptoms include:^{6, 12}

Individuals who may be experiencing withdrawal from alcohol should right away see a medical provider experienced in managing this condition.⁶ Call 911 in an emergency—remember alcohol withdrawal may be deadly.

Hospitalization or admission to another treatment setting able to provide some form of round-the-clock medical care may be necessary for the adequate management of alcohol withdrawal.⁶  

Treatments for Alcohol Use Disorder

Detox is often an important start to recovery, but on its own does little address the underlying issues that lead to alcohol use disorder. To be most effective, detox should be followed up with further treatment.⁶

Possible treatment types include:¹⁹

• Inpatient treatment, such as hospital-based treatment programs are able to provide the most intensive levels of supervision and support throughout the rehabilitation process.
• Residential treatment, another inpatient treatment setting that may be relatively less restrictive than more hospital-based programs. Residential treatment programming commonly includes an intensive schedule of group therapy and individual therapy sessions.
• Outpatient treatment, where you can attend a relatively less time-intensive schedule of group sessions and weekly individual sessions while returning home during non-treatment hours.^{14 p35} After finishing inpatient treatment, many people attend outpatient treatment for additional support. This option gives you the flexibility to continue to work, attend school, and manage your responsibilities at home while still receiving treatment.

Behavioral therapies that may effectively help an individual include:¹⁴

• Cognitive behavioral therapy (CBT). This approach teaches you to identify what triggers your cravings, how to cope, and how to avoid situations that put you at risk for relapse.^{14 p48–49}
• Contingency management. This strategy rewards positive behaviors (like abstinence) with tangible rewards.^{14 p50}
• Community reinforcement approach plus vouchers. This technique uses family, social, vocational, and fun reinforcers and incentives to make sobriety more appealing than drinking while teaching sober life skills.¹⁹
• Motivational enhancement therapy. This technique helps people become more motivated to engage in treatment and maintain sobriety at their own pace.^{14 p54–55.}

FDA-approved medications that can help individuals in recovery from alcohol use disorder avoid relapse include:¹⁹

If you think your alcohol use may be an issue (or think a person that you know may have an alcohol use issue), discuss this with a healthcare provider.⁷ Recovery can be difficult, but it is possible.

References:

1. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.
2. Centers for Disease Control and Prevention. (2018). Frequently asked questions.
3. Department of Biochemistry, VCSG Government Institute of Medical Science & Research, Srinagar, Pauri Garhwal, Uttaranchal-246174, India. (2013). Alcoholism and its effects on the central nervous system. Current Neurovascular Research, 10(3), 256-62.
4. National Highway Traffic Safety Administration. Drunk driving.
5. National Institute on Alcohol Abuse and Alcoholism. Parents—talk with your high school grads about celebrating safely.
6. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. Rockville, MD: Center for Substance Abuse Treatment.
7. National Institute on Alcohol Abuse and Alcoholism. Overview of alcohol consumption.
8. National Institute on Alcohol Abuse and Alcoholism. (2018). Understanding the dangers of alcohol overdose.
9. National Institute on Alcohol Abuse and Alcoholism. (2000). Health risks and benefits of alcohol consumption. Alcohol Research and Health, 24(1), 5–11.
10. National Institute on Alcohol Abuse and Alcoholism. What is a standard drink?
11. National Institute on Alcohol Abuse and Alcoholism. Drinking levels defined.
12. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
13. S. National Library of Medicine. (2019). Alcohol use disorder.
14. S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2018). Report to congress on the prevention of underage drinking.
15. Centers for Disease Control and Prevention. (2018). Fact sheets – alcohol use and your health.
16. National Institute on Alcohol Abuse and Alcoholism. Alcohol’s effects on the body.
17. National Cancer Institute. (2018). Alcohol and cancer risk.
18. Becker, H.C. (2008). Alcohol dependence, withdrawal, and relapse. Alcohol Research & Health, 31(4), 348-361.
19. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: a research-based guide (third edition).