Alcoholism, which is often called alcohol use disorder, is a serious behavioral, physical, and mental health issue. It is characterized by a problematic pattern of using alcohol that is excessive, that causes problems in a person’s life, and that can lead to serious physical health problems, like liver disease. Alcohol abuse is not the same thing, but it can lead to alcoholism, a true addiction.
Treatment for alcohol use disorder is complicated and challenging. Both the body and the mind become dependent on alcohol and stopping drinking is nearly impossible without professional support. Catching problem drinking early is crucial for treating the disease more easily and for avoiding some of the worst health consequences.
What is Alcohol Use Disorder?
Alcohol use disorder, or AUD, is the most up-to-date name for the condition that has historically been called alcoholism. Studies suggest that over seven percent of American adults suffer from some degree of an alcohol use disorder. AUD can be diagnosed by a psychiatric or behavioral health specialist. To be diagnosed requires that a person meet two out of eleven criteria during a 12-month period. Just two criteria indicate a mild AUD, while more can indicate moderate or severe. Examples of the criteria include:
- Drinking more alcohol or for a longer period than intended.
- Wanting to cut back on drinking, but failing.
- Craving alcohol.
- Recurring hangovers.
- Drinking behaviors that interfere with relationships, work, and other aspects of normal life.
- Giving up activities to drink.
- Drinking in spite of dangers it poses, such as accidents or health problems.
Tolerance and Withdrawal
There are many signs of problem drinking, and according to the official definition, meeting any two indicate a person has some degree of alcohol use disorder. Severe AUD is characterized by more severe symptoms, though. These include tolerance and withdrawal. Tolerance refers to needing a greater and greater quantity of alcohol to become intoxicated or to experience desired effects. Withdrawal refers to physical and psychological symptoms that result from not drinking. This can indicate a dependence on alcohol, or addiction in other words.
According to health experts there are many indicators that drinking behavior is unhealthy and may lead to real health problems. Unhealthy drinking may refer to one instance of drinking, or it may be a short- or long-term pattern. For instance, binge drinking is the act of drinking too much in one sitting and is considered unhealthy. Binge drinking is drinking to intoxication and generally means five or more drinks for a man or four or more drinks for a woman within two hours.
Unhealthy drinking may also refer to drinking too much generally. Meeting any of the AUD criteria, for instance, indicates unhealthy drinking. In general, five or more drinks per week for a man and four or more for a woman are considered unhealthy. Any drinking for an under-aged person is also considered unhealthy. According to these guidelines, one drink means 12 ounces of bear, five ounces of wine, or 1.5 ounces of liquor.
Unhealthy drinking, problem drinking, and any degree of AUD can lead to serious health consequences. Binge drinking has immediate consequences, including accidents, injuries, relationship problems, risky behaviors, including unprotected sex, victimization by assault, and even death from alcohol poisoning.
Drinking too much over a long period of time can cause other, more long-term health problems. These include indigestion, sexual dysfunction, vision problems, complications of diabetes, bone loss and weakening, neurological problems, high blood pressure and heart disease, increased risk of certain cancers, and liver disease.
Alcohol-Related Liver Disease
One of the most serious health consequences of heavy and problem drinking is alcohol-related liver disease, or ARLD. Alcohol affects the liver more than other organs because it the liver is responsible for metabolizing alcohol and removing it from the bloodstream. Too much alcohol can damage and kill liver cells. ALRD is a progressive disease caused by too much alcohol. This is a serious disease because it harms a vital organ, but also because symptoms are rare until the damage to the liver is already severe.
ALRD usually begins as fatty liver disease. This is characterized by the deposition of excess fat in liver cells and it doesn’t typically cause a person to experience any symptoms. Even liver function tests are often normal in this stage of the disease. From fatty liver the disease progresses to alcoholic hepatitis, which includes fat deposition as well as inflammation and scarring in the liver. This may cause nausea, jaundice, loss of appetite, fever, and abdominal pain.
Alcoholic cirrhosis is the most advanced form of ALRD. Cirrhosis causes serious scarring in the liver and at this stage there is severe impairment in how the liver functions. For alcoholics in the fatty liver or mild hepatitis stages of ALRD, abstaining from alcohol can reverse the disease and much of the damage to the liver. For severe hepatitis and cirrhosis, stopping drinking can help, but the damage is already done.
ALRD can cause a number of related health complications: internal bleeding, kidney failure, liver cancer, fluid buildup in the abdomen, an enlarged spleen, and ultimately death. These complications usually only occur after years of heavy drinking. Treatment for ALRD includes abstinence from alcohol, dietary changes, and medications to manage complications. In severe cases, a liver transplant may be necessary.
The first step in treating alcoholism is detoxing. This refers to the time period during which a patient stops drinking and all alcohol leaves the body. This is when a patient will experience withdrawal and it can be dangerous, so doing under medical supervision is important. Once detox is done, treatment usually includes therapy and sometimes medications.
Therapy for alcohol addiction treatment is varied. Some people choose to go to residential facilities for weeks- or months-long treatment. Others may choose outpatient therapy one-on-one with a counselor, group therapy, support and 12-step groups, or some combination of these.
Medications have been developed to help people overcome alcoholism. These include disulfram, which when used as directed will cause unpleasant symptoms if alcohol is consumed. It is supposed to deter drinking, but only works if the patient actually takes it. Naltrexone is a drug that blocks the pleasant and intoxicating effects of alcohol, which again can deter drinking, but only if the patient takes it. Acamprosate is designed to reduce cravings for alcohol. None of these drugs can cure alcoholism, but they can be used as aids along with therapy.
Some prescription medications may contribute to liver disease because of side effects or may be used to treat fatty liver and other alcoholic liver conditions. Not all of these are safe for everyone, so it is important to understand the risks and weigh them against the benefits. For instance Actos is a drug used to treat type 2 diabetes, but it carries a risk of damaging the liver or causing further damage. Off-label Actos has actually been given to patients to treat fatty liver, but it may also cause serious side effects like congestive heart failure or bladder cancer.
Statins like Crestor may be dangerous for anyone living with the liver damage caused by excessive drinking. Statins are used to lower blood cholesterol levels, but they can cause serious liver damage by increasing the amount of liver enzymes. Crestor has even been shown to cause hepatitis in a few patients. It is absolutely contraindicated for someone with existing liver damage.
Mixing alcohol with certain prescription drugs can also be dangerous. Benzodiazepines are examples of this, and include anti-anxiety medications like Valium and Xanax. Like alcohol, they are central nervous system depressants. By mixing these drugs with alcohol a person may double the depressant effect on the body to a dangerous degree. This can even lead to respiratory distress and failure.
Alcohol use disorders and problem drinking are very serious health problems. Consistent, long-term, heavy drinking can cause serious and even life-threatening damage to the liver. Mixing alcohol with certain medications can increase the damage and cause other health problems. Getting help and treatment for an AUD is crucial for overall health.