What Is Alcoholism and How to Get Treatment

"Alcoholism" and "alcohol abuse" are terms people use when referring to alcohol use disorder (AUD), a widespread issue in the United States. It affects 12.1% of males 12 and older and 9.1% of females in the same age group.

Healthcare providers define AUD as a brain disorder that affects your ability to regulate or stop drinking alcohol despite adverse impacts on your mental and physical health and professional or personal life.

There are effective ways to treat this disease and steps you can take to help a loved one enter recovery. This article discusses alcohol use disorder symptoms and strategies for treatment and intervention.

What’s Meant By Alcoholism (Alcohol Use/Abuse Disorder)?

AUD is a brain disorder and disease that occurs when people cannot stop or control their drinking despite adverse effects on relationships, work or school, finances, and overall health. Healthcare providers use the umbrella term "alcohol use disorder" to classify a wide range of problematic alcohol use, such as alcohol abuse, dependence, addiction, and severe alcohol use disorder (alcoholism).

When healthcare providers screen for this condition, they look at drinking behavior patterns within the last year to determine a diagnosis. They use a set of 11 criteria established by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to assess alcohol use severity.

• Mild: A person meets two or three criteria.
• Moderate: A person meets four or five criteria
• Severe: A person meets six or more criteria; alcohol use disorder is considered "severe."

Alcohol Use Disorder Symptoms (and Signs in Other People)

When healthcare providers screen for AUD, they look at drinking behavior patterns within the last year to determine a diagnosis. They use 11 criteria established by the DSM-5 to assess alcohol use severity.

• Mild: A person meets two or three criteria.
• Moderate: A person meets four or five criteria.
• Severe: A person meets six or more criteria; alcohol use disorder is considered “severe.”

The more of the following signs you have, the more severe the AUD:

• Drinking more or longer than originally intended
• Repeatedly (more than once) trying to cut down or stop without success
• Spending much time consuming, feeling sick from, or recovering from alcohol
• Craving a drink so much that it’s all you can think about
• Experiencing troubles at home, work, in your personal life, or in public due to drinking
• Continuing to drink despite the adverse effects it’s caused in your work, school, or home life
• Stopping or cutting back on favored activities and things that give you pleasure to drink instead
• Putting yourself in physical danger after drinking (such as driving, falling, etc.) more than once
• Continuing to drink even when depressed, anxious, or you have another health problem
• Having an alcohol-related memory blackout
• Developing a tolerance for alcohol (meaning it takes more drinks than it once did to feel an effect)
• Experiencing alcohol withdrawal symptoms after stopping: shakiness, sleep disorders, restlessness, nausea, sweating, dysphoria (unease or unhappiness), malaise (not feeling well, lacking energy), depression, seizure, or delirium tremens
• Experiencing hallucinations after stopping drinking (a severe symptom of withdrawal)

When Does Alcohol Use Become Alcoholism?

Not everyone who drinks alcohol has substance use disorder. Alcohol use becomes alcoholism when the following occurs:

• You’ve displayed two or more signs of AUD within the past year.
• You drink more than you originally plan to.  
• You’re unable to stop or cut back.
• Your drinking patterns start hurting your professional and/or personal lives.
• Friends or family are concerned about your drinking.
• When you stop drinking, you experience withdrawal symptoms, such as shaking, nausea, restlessness, and feelings of unease and unhappiness.

Risk Factors

In addition, several factors increase your risk of developing an AUD, including:

• Drinking at a young age: Those who start drinking at a younger age are at increased risk of developing severe alcohol use disorder. A recent study noted that beginning to consume alcohol when you’re younger than 18 is a significant risk factor for developing AUD as an adult.
• Family history: Researchers have found that genetics play a central role, accounting for about 50% of the risk of developing an AUD. In addition, parents’ drinking behaviors can also impact those of their children, making family history a significant risk factor.
• Mental health conditions: Depression, anxiety, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD) are all associated with AUD and frequently co-occur. Further, those who’ve had childhood trauma are at increased risk.
• Sex: Men—especially those between 18 and 25—have a higher prevalence of alcoholism than women. However, alcohol use tends to have a more adverse impact on women’s health.

Alcohol Use Disorder Comorbidities

Various diseases and health problems can occur alongside or as a result of heavy alcohol use, including the following:

• Fatty liver disease
• Liver cirrhosis
• Certain cancers
• Dementia, memory problems
• Heart failure
• Injury or death due to accidents or premature death

In addition, some mental health conditions can be caused by and increase the risk for AUD, including:

• Substance use disorder (SUD)
• Anxiety disorders
• Mood disorders
• Sleep disorders
• Post-traumatic stress disorder (PTSD)

Effects of Alcoholism on Others

Alcohol use disorder affects the person with the disease and their social circles (e.g., family, friends, colleagues). Children of those with AUD are particularly vulnerable and more likely to experience neglect, abuse, domestic or partner violence, and the associated mental health issues.

Alcohol use disorder in parents can cause lifelong mental and physical health problems in their children. In a longitudinal study of over 28,000 adults who had grown up in homes with parental alcohol problems, the researchers found higher rates of:

• Family dysfunction
• Communication problems
• Lack of trust in others
• Alcohol or substance abuse
• Perception of childhood as difficult

AUD can cause unintended consequences even before a child is born. Drinking while pregnant can seriously harm the developing fetus, raising the risk of fetal alcohol syndrome, premature birth, and miscarriage.

Additionally, alcohol use disorder can affect family members and lead to the following feelings and experiences:

• Guilt
• Anxiety
• Embarrassment
• Difficulty forming close relationships
• Confusion
• Anger
• Depression and loneliness

Steps to Treating Alcohol Use Disorder

As harmful and debilitating as AUD can be for both the person with the disease and their loved ones, there are many approaches that you can take to manage the condition. Everyone’s road to recovery differs; treatments can occur in an inpatient or outpatient medical settings, individual or group sessions with therapists, or other specialty programs.

Primary Care

If you or a loved one is struggling with AUD, make an appointment with a primary care provider such as a medical doctor or nurse practitioner. People with severe AUD who have used alcohol long-term may experience severe withdrawal symptoms that require medical evaluation and treatment. A healthcare provider can evaluate the AUD severity and its health impacts, refer you to specialists, and determine the appropriate treatment.

Medications

In the United States, healthcare providers can prescribe three medications to help people with AUD stop drinking or prevent relapses. These medications are often used alongside other therapies and include:

• Vivitrol (naltrexone)
• Campral (acamprosate)
• Antabuse (disulfiram) 

Behavioral Therapies

Under the direction of licensed therapists or counselors, behavioral therapies involve psychological strategies to modify drinking behaviors. The therapy goals are to develop the skills needed to manage your habits, build social support, set and work toward realistic goals, and deal with or avoid things that trigger drinking.

There are many types of behavioral therapies for AUD, including the following common approaches:

• Cognitive behavioral therapy (CBT)
• Motivational enhancement therapy
• Family/marital therapy

Mutual Support Groups

Finding social support can be a critical aspect of managing AUD. Knowing that others are going through what you are can help with the loneliness and stigma and support you when you’re struggling.

Alcoholics Anonymous (AA) or other 12-step programs can offer that social support. There are regular, free group meetings in most cities and towns. In addition, some groups meet online. Alongside other therapies, such groups can play a critical role.

Support for People With Alcoholism

Undergoing treatment for AUD can be challenging, and there’s always a risk of relapse. Making such a significant life change can cause emotional turmoil, including guilt for past behaviors or burdening others.

As the loved one of someone struggling, remember that it’s ultimately up to them to manage the condition. Don’t forget to take care of yourself, too; consider seeking out your systems of support or even medical help if you’re having trouble.

Here’s what you can do to support a loved one in AUD recovery:

• Offer and show support: Demonstrating that you are ready to support your loved one and sympathize with what they’re going through can help them overcome the disease.
• Be patient: It’s important to remember that recovery from AUD is a long-term process, and persistence is vital. Relapse is expected, so it should be viewed as a temporary setback rather than a failure; be patient with your loved one if they experience this.
• Acknowledge improvement: When your loved one is doing better, make a point to acknowledge it; this can provide positive reinforcement.

Many avenues, ranging from non-profit organizations to governmental programs, offer support and information for those struggling with AUD. These include the following:

• National Institute of Alcohol Abuse and Alcoholism (NIAAA)
• Substance Abuse and Mental Health Services Administration (SAMHSA), which has a 24-hour, seven-day-a-week helpline you can call at 800-662-HELP (4357)  
• Alcoholics Anonymous
• National Council on Alcoholism and Drug Dependence (NCADD)
• Al-Anon Family Groups  

Summary

Severe alcohol use disorder (alcoholism) is an alcohol use disorder (AUD) characterized by an inability to control or stop drinking alcohol despite adverse effects on your personal or professional life, finances, and physical and mental health.

Not only does AUD affect the health of the person with the disease, but it also impacts the lives of those around them. Medications, behavioral therapies, and social support groups are among the strategies to combat this disorder.