Understanding Alcohol Use Disorder -- the Basics

People have been brewing and fermenting alcoholic drinks since the dawn of civilization. Consumed in moderate amounts, alcoholic beverages are relaxing and in some cases may even have beneficial effects on heart health. Consumed in excess, alcohol is poisonous and is considered a drug. It is estimated that between 18 million -- or one in 12 adults -- in the U.S. abuse alcohol or are chronic alcoholics. Nearly 100,000 Americans die each year as a result of alcohol abuse, and alcohol is a factor in more than half of the country's homicides, suicides, and traffic accidents. Alcohol abuse also plays a role in many social and domestic problems, from job absenteeism and crimes against property to spousal and child abuse.

The immediate physical effects of drinking alcohol range from mild mood changes to complete loss of coordination, vision, balance, and speech -- any of which can be signals of acute alcohol intoxication, or drunkenness. These effects usually wear off in a matter of hours after a person stops drinking. Many law-enforcement agencies regard a .08 percentage of alcohol in the bloodstream as evidence of intoxication. Larger amounts of blood alcohol can impair brain function and eventually cause unconsciousness. An extreme overdose, alcohol poisoning, can be fatal.

Alcohol use disorder is a potentially fatal disease, characterized by cravings, tolerance (needing more), physical dependence, and loss of control over consuming alcohol.  Alcohol intoxication may or may not be obvious to observers. Even in highly functional alcoholics, chronic alcoholism can lead to physical problems. Most common is damage to your liver, which over time can lead to cirrhosis (scarred liver). Other risks include depression, stomach bleeds, pancreatitis, high blood pressure, heart failure, numbness and tingling in your feet and changes in your brain. Alcoholism can also increase your risk for infections including pneumonia, tuberculosis, and chronic gastritis.

Alcoholism can also lead to impotence in men, damage to the fetus in pregnant women, and an elevated risk of cancer of the larynx, esophagus, liver, breast, stomach, pancreas, and upper gastrointestinal tract. Because heavy drinkers seldom have adequate diets, they may have nutritional deficiencies. Heavy drinkers typically have impaired liver function, and up to one in five develops cirrhosis.

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The alcoholic's continual craving for alcohol makes abstinence -- an important goal of treatment -- extremely difficult. The condition is also complicated by denial: Alcoholics might be reluctant to admit their excess drinking either because of denial or guilt. Another barrier to receiving care is that physicians screen only about 15% of their primary care patients for alcohol disorders.

Historically, alcoholic behavior was blamed on a character flaw or weakness of will; experts now consider chronic alcoholism a disease that can afflict anyone.

In young people binge drinking is more acceptable, and teenagers tend to drink with friends. Older people are more likely to drink alone, and take medications or have co-morbidities that make drinking more risky. Both situations can make it hard to identify a problem drinker.

What Causes Alcoholism?

The cause of alcoholism seems to be a blend of genetic, physical, psychological, environmental, and social factors that vary among individuals. A given person's risk of becoming an alcoholic is three to four times greater if a parent is alcoholic. Some children of alcohol abusers, however, overcome the hereditary pattern by not drinking any alcohol at all.

WebMD Medical Reference Reviewed by Sabrina Felson, MD on March 15, 2017

Sources

SOURCES: 

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders 4th edition, 2000. 

Alcohol Abuse, Psychiatric Annuls 2005. 

Combs, R. Handbook of Addictive Disorders: A Practical Guide to Diagnosis and Treatment, Wiley, 2004. 

Littleton, J. American Journal of Addiction. 2003.

UpToDate.

The Alcoholism Guide (http://www.the-alcoholism-guide.org/cage-questionnaire.html).

The New York City Department of Health and Mental Hygiene, Vol. 35, 2016.

 

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