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Untreated Alcoholism: 5 Vital Questions, Answered

By Gillian Tietz
If you are drinking excessively, you are more likely to jeopardize your health and safety.

Alcohol Use Disorder (AUD) is compulsive alcohol consumption that goes beyond drinking in moderation. If left untreated, alcohol use disorder can have short-term and long-term effects on your health.

"Since alcohol use disorder is a progressive condition, it typically gets worse the longer it goes untreated," says Brian Wind, Ph.D., co-chair of the American Psychological Association. "People can suffer anything from minor, short-term consequences to severe, more complicated ones."

Chronic Physiological Effects of Alcohol Use

According to the National Institute on Alcohol Abuse and Alcoholism, alcohol interferes with the brain’s communication pathways, how the brain works, and the appearance of the brain. Long-term heavy drinking can reduce the size of neurons, thus reducing the overall size of the brain. Chronic, heavy drinking also increases the risk of developing alcohol use disorder (AUD). Read on to learn more about the difference between daily or binge drinking and AUD, how AUD affects your health, and AUD treatment options.

1. Are all daily drinkers alcoholics?

It can be tempting to try to diagnose yourself, especially if you're drinking every day. However, it's important to note that Alcohol Use Disorder is classified by the DSM-5, and professionals must evaluate you for the presence of the disorder's scientifically-established symptoms in order to give an official diagnosis. 

So, when it comes to your alcohol intake, “It's not the quantity. Any trait or habit becomes a ‘disorder’ when it has a significant adverse effect on the person or people around them.” explains Laurence Miller, PhD licensed clinical and forensic psychologist from Miller Psychological Associates.

Said another way, “The Alcohol Use Disorder diagnosis criteria evaluate consumption, but importantly, also factor in how alcohol is actually impacting a person's life.” Dr. Allen Masry, MD, DFPAPA, FASAM Medical Director at All In Solutions Counseling Center.

“So, at least on paper, a person could be a daily drinker who falls under the label of heavy alcohol use, but not be diagnosed with alcohol use disorder. And, in my opinion, that makes sense. As clinicians treating addiction, consumption frequency and amount are not as important as the pattern or behavior associated with substance use (so long as there are no medical complications resulting from the drug/alcohol use),” Masry says.

According to the DSM-5, there isn’t a set quantity or frequency of drinking that means you have AUD or you don’t. The development of AUD is marked by experiences like increased tolerance to alcohol, the presence of withdrawal symptoms when you try to stop drinking, trying to cut down or quit and being unable to, and continuing to drink despite negative consequences.

2. Is there a difference between an alcoholic and a heavy drinker?

“Although there are similarities among those who would classify as a heavy or daily drinker as opposed to someone diagnosed with alcohol use disorder (AUD), which is classified as an alcohol addiction, the primary difference is that an AUD diagnosis indicates a lack of control.” Dr. Matt Glowiak, PhD, LCPC at Choosing Therapy tells WebMD Connect to Care.

“Individuals struggling with AUD are those who ultimately build their lives around consumption. Accordingly, they continually experience intense cravings/urges to drink and withdrawal symptoms while not under the influence,” Glowiak adds.

“Despite a desire or attempts to stop, they cannot. Amid important life obligations and otherwise previously enjoyed social events, healthy activities, and otherwise; they choose alcohol. Essentially, alcohol becomes as--if not more--important than anything else. It is as essential as the food one eats, air one breathes, water one drinks, and sleep. This is the primary difference. Although alcohol consumption in moderation, though not the healthiest thing in the world, can help one decompress and have fun socializing, all control is lost,” Glowiak says.

And what about binge drinking? “Heavy drinking aligns with binge drinking where one consumes mass amounts of alcohol--sometimes potentially risking overdose--but can control oneself throughout the day-to-day. Here, one may drink a lot on weekends and social events but still attend to important life obligations,” Glowiak says.

It’s important to speak with professionals to see if your symptoms meet the criteria for AUD, but you also shouldn’t be apathetic about your alcohol use in the absence of a professional diagnosis. If you drink daily or have binges, your alcohol use could escalate into a disorder.

“Daily drinking may or may not be problematic depending on the amount consumed. A glass of wine or beer per day, or even two, may not lead to issues. At the same time, heavy drinking and daily consumption does put one at risk for an increased likelihood of AUD. A daily habit of two glasses of wine could easily transition to three, a whole bottle, or more without one realizing it.” Glowiak cautions.

3. In what stage of alcoholism does the drinker face serious health problems?

“The truth is that alcohol is much more dangerous than many people think. Because it is socially (and even culturally) accepted in many contexts and readily accessible, people believe it is less dangerous than other substances of abuse. In reality, it is much more dangerous than many other drugs.” explains Dr. Glowiak.

Health issues will show up in cases of severe AUD, but depending on genetics and pre-existing conditions, they could show up sooner. According to American Addiction Centers, potential health troubles from heavy drinking can include:

  • Cardiovascular disease
  • Anemia
  • Dementia
  • Cirrhosis
  • Cancer
  • Seizures
  • Depression
  • High blood pressure
  • Nerve damage
  • Pancreatitis
  • Gout
  • Infectious diseases

4. What are the signs of end of life for an alcoholic?

According to American Addiction Centers, as someone progresses through the stages of alcohol use disorder, they go from living to drink, to drinking to live. At the end stage, withdrawal symptoms may be so severe that the individual may continue drinking just to avoid them.

Serious diseases, like cirrhosis, can mark the end of life for someone with AUD. After years of liver damage from heavy alcohol use, the liver produces scar tissue that replaces healthy tissue. Over time, this scar tissue prevents the flow of blood into the liver and prevents the liver from removing toxins from the blood, controlling infections, and processing nutrients.

“Those with AUD who are nearing the end of their life, we notice a reverse tolerance.” continues Dr. Glowiak. “Rather than needing mass quantities of alcohol built up from tolerance, minimal amounts get them intoxicated. This indicates potential liver and/or kidney failure. Individuals may experience hallucinations and delusions of grandeur.”

The end stage of alcohol use also puts a person at higher risk of self-harm. The loss of control over drinking and accumulation of consequences can cause the individual to feel powerless and depressed.

 

5. What is the first step toward getting treatment for alcohol addiction?

If you have noticed that your drinking is negatively impacting your life and you have tried to cut back or quit without success, then it may be time to get help. Options for the first step towards getting help for alcohol use include:

  • Discussing your concerns with your doctor
  • Discussing your concerns with a therapist
  • Attending a support meeting either in person or virtually, depending on your comfort level and the options in your area

Once you have decided to get help for your drinking, you can consider the following AUD treatment options.
 

AUD Treatment Options

There are many options for treatment depending on the severity of you or your loved one’s drinking, how many attempts have been made to stop before, and the time and cost you can commit to treatment. Treatment options include:

  1. Medical detox and inpatient treatment.Detox is often a necessary first step to help the individual withdraw from alcohol safely. According to American Addiction Centers, detox doesn’t address the thoughts and behaviors that contributed to alcohol use, so additional treatment is recommended. Inpatient treatment involves living in a facility and receiving constant support and intensive therapy.
  2. Support groups like Alcoholics Anonymous (AA). “Support groups such as Alcoholics Anonymous (AA) are widely popular but best serve those who have some management over their condition.” explains Glowiak. “They acknowledge struggles with alcohol and are willing to fight the good fight toward recovery. But AA, especially for those with more severe conditions, is best served as a supplement to therapy with an addictions specialist/therapist.” Other options for support groups include Smart Recovery, Recovery Dharma, The Luckiest Club, and Sober Mom Squad.
  3. Intensive outpatient treatment (IOP). According to American Addiction Centers, when someone enters outpatient, treatment they continue living at home and attend regularly-scheduled group and individual therapy sessions. This is a good option for people with job and family responsibilities that don’t allow them to enter inpatient treatment.
  4. Inpatient treatment followed by sober living homes. After inpatient treatment, sober living homes can help with the transition back into everyday life and allow the individual to practice the tools and skills they learned in treatment while still receiving some support.
  5. Medication assisted treatment. MAT combines medications with counseling and/or behavioral therapy. FDA approved medications that can assist in the treatment of AUD include:
    • Antabuse (Disulfiram): this medication interferes with the way alcohol is processed by the liver and causes the individual to have unpleasant symptoms like flushing, headache, or nausea if they consume alcohol.
    • Naltrexone: blocks the rewarding and reinforcing effects of alcohol, so even if alcohol is consumed, it doesn’t cause euphoria.
    • Acamprosate (Campral): can reduce cravings for alcohol
  6. Therapy (individual, group, or family) with a therapist who specializes in addiction. “Motivation Enhancement Therapy can help aid AUD recovery,” Michelle Caldwell, Associate Clinical Counselor at Theara tells WebMD Connect to Care. “It helps a person understand their reasons for drinking and identify their motivations to change. A therapist will work with their client to create a specific plan and help them to build the skills and confidence needed to stick to it.” Cognitive Behavioral Therapy (CBT) is another commonly-used therapy in addiction recovery that focuses on changing the thought and behavioral patterns that lead to drinking.

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