Alcohol Addiction

Alcohol is a legally controlled and widely available psychoactive substance with dependence-producing properties. Due to the proliferation of alcohol in everyday life, it can be easy to underestimate the unfavorable social and economic impact of alcohol addiction.

Excessive alcohol use is a leading cause of death in the United States. In fact, the Centers for Disease Control and Prevention (CDC) reports alcohol is responsible for more than 140,000 deaths every year. Long-term health problems associated with excessive alcohol consumption are the primary cause of death, with other causes being accidents, falls, suicides due to impaired decision-making, and risk-taking after episodes of binge drinking.

What is Alcohol and Why is it Addictive?

The terminology associated with excessive alcohol use can be confusing. Alcoholism, alcohol abuse, alcohol dependency, and alcohol addiction are all terms used to describe a potentially unhealthy relationship with alcohol. More recently, the term “alcohol use disorder” (AUD) was introduced in reference to a spectrum of alcohol use from mild to severe.

Alcohol has a variety of purposes, including as fuel and a cleaning agent. The fermentation of glucose enzymes in yeast produces alcohol. The only type of alcohol that humans can consume safely is ethanol. And it’s the ethanol that is the intoxicating agent in alcoholic beverages.

Ethanol enters the bloodstream and the brain, acting as a central nervous system depressant that causes a release of dopamine, the feel-good neurochemical. The pleasant feelings associated with drinking are what lead people to drink even more, but too much alcohol can quickly lead to unpleasant side effects like vomiting, slurred speech, loss of coordination, and impaired decision-making.

Types and Strengths of Alcohol

Alcohol by volume (ABV) is the standard way to identify the strength of an alcoholic beverage. A higher ABV produces feelings of drunkenness more quickly.

The ABV percentages for the most commonly consumed alcoholic drinks are as follows:

Beer

Beer is the most consumed alcoholic beverage in the world. In 2014, beer constituted 49% of all alcoholic beverages consumed in the country. A standard beer has an ABV between 4% and 6%. Some craft beers and ales can have between 6% and 8%, whereas “light beers” can be as low as 2% ABV.

Wine

Wine was first produced in 6000 BC and is consumed worldwide today. In the US, it isn’t as popular as beer, but sales have been growing steadily since the end of Prohibition. The ABV of wine is between 10% and 14%, with red wine generally having a higher ABV than white wine, champagne, and sparkling wines. Port, sherry, and vermouth are examples of fortified wines with an ABV of around 20%.

Spirits and Liquors

The majority of popular spirits and liquors have an ABV of approximately 40%, and include brandy, whiskey, gin, rum, vodka, and tequila. Some distilled drinks have stronger versions, including “overproof” rum, which can have around 75% ABV. Absinthe and Everclear are examples of drinks with high alcohol content, sometimes up to 90% ABV.

How Much Alcohol Can You Have?

The term “standard drink” is used to identify alcohol intake. It’s not the size of the drink that matters, it’s the amount of alcohol in it. The pure alcohol in a “standard drink” is around 14 grams, equating to 12 ounces of regular beer, 5 ounces of wine (about 12% ABV), and 1.5 ounces of spirits with about 40% ABV.

Alcohol has no nutritional benefit, so there’s truly no need for humans to consume it. But this notion is unrealistic, so public health departments from various countries around the globe provide guidelines for moderate drinking limits. In the US, men are advised not to drink more than 196 grams, or 14 standard drinks, per week. Women are advised to drink no more than 98 grams, or 7 standard drinks, per week.

Caution is still recommended, though, as the 2020-2025 dietary guidelines for Americans state that even drinking within the recommended limits may increase your overall risk of death from various causes, including several types of cancer and some forms of cardiovascular disease.

How Much Alcohol is Too Much?

Excessive alcohol consumption is a drain on society and the economy. It significantly impacts healthcare, workplace productivity, and criminal proceedings, resulting in an annual loss of $249 billion to the US economy.

The number of drinks consumed within a given period indicates the type of excessive alcohol use:

Binge Drinking

For a male, binge drinking typically means five or more drinks in two hours; for females, it means four or more drinks in two hours. The Center for Disease Control and Prevention (CDC) Fact Sheet on Binge Drinking states this is the most common, costly, and deadly pattern of excessive alcohol use in the United States. One in six US adults binge drinks, with 25% reporting binge drinking on a weekly basis. Binge drinking can lead to potentially life-threatening alcohol poisoning, which requires immediate medical attention.

Heavy Drinking

For males, heavy drinking constitutes more than four drinks daily or more than 14 weekly. For females, it is more than three drinks per day or 7 per week. According to the Behavioral Risk Factor Surveillance System, around 16% of adults binge drink, and 6% report heavy drinking. Nearly all adults who drink heavily also binge drink. Excessive alcohol use also incorporates any alcohol consumed by pregnant women or people under 21.

What Are the Risks of Excessive Alcohol Consumption?

The short and long-term effects on health from excessive alcohol use are varied and potentially severe. Some of the most prominent health impacts are as follows:

Short-term Health Effects of Alcohol 

• Increased Risk of Injury: Alcohol use can impair decision-making abilities. The risk of involvement in falls, drownings, burns, and vehicle crashes increases.
• Involvement in Violent Incidents: Examples of violence include homicide, suicide, and sexual assault. The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) reports that 40% of people who died violently had alcohol in their bloodstream.
• Risky Sexual Behavior: Binge drinking can cause people to have unprotected sex leading to a risk of sexually transmitted infections with multiple partners and unintended pregnancy.
• Fetal Alcohol Syndrome: Alcohol use during pregnancy can result in pregnancy and birth complications, and Fetal Alcohol Syndrome, whereby the child has physical problems and issues with behavior and learning. As no safe amount of alcohol has been identified, health professionals recommend that pregnant women do not consume any alcohol.

Long-term Health Effects of Alcohol

• Heart Problems: Prolonged excessive alcohol use can cause heart disease, high blood pressure, and an increased risk of stroke.
• Reduced Brain Function: Alcohol slows down communications within the brain, which decrease brain activity. Over time, people can develop learning, memory, and mental health problems.
• Increased Cancer Risk: The National Cancer Institute (NCI) states that there is a strong scientific consensus that alcohol drinking can cause several types of cancer. Alcohol can increase the risk of developing mouth, esophagus, colon, rectum, and breast cancer, amongst others.
• Poor Liver Function: The liver cleanses the blood, and too much alcohol can lead to fatty liver disease, cirrhosis, and hepatitis.

When Does Alcohol Abuse Become an Addiction?

The majority of people who drink excessively do not have an alcohol addiction; however, binge drinking and heavy drinking can increase an individual’s risk of developing an addiction to alcohol. Now health professionals diagnose alcohol addiction or AUD when a person continues to drink alcohol despite it causing significant distress or harm. AUD can change a person’s brain and impair decision-making abilities, making them more likely to behave in a way that is detrimental to themselves or others. It also increases the formation of habits that make it harder to abstain from alcohol consumption.

SAMHSA found that 5.3% of people aged 12 or older had an AUD in the 12 months. This is a decline from 2002 when the number was 7.7%. The 2019 figure still equates to 14.5 million people, though, meaning that AUD is a common condition that directly and indirectly affects an enormous number of Americans.

What Are the Risks of Becoming Addicted to Alcohol?

The reasons a person becomes addicted to alcohol are unique to that person. Factors that could impact your risk of alcohol addiction won’t be the same factors that impact another person’s risk. That said, there are recognized risk factors known to increase the chances of developing an addiction to alcohol.

Those risk factors include:

Family History of Alcoholism

Studies have found that children of alcoholics are 4 times more likely to experience issues with alcohol themselves. Genetics plays a part in this, but other factors also have an influence. There is an increased risk of developing AUD if an alcoholic parent has co-occurring mental health concerns, openly uses drugs and alcohol in front of their child, or is violent and aggressive.

Mental Health Conditions

About half of the people who experience a Substance Use Disorder (including AUD) will also experience a co-occurring mental health disorder such as depression, anxiety, Bipolar Disorder, or Post Traumatic Stress Disorder (PTSD). For some people, alcohol helps them to cope with the symptoms of their mental health conditions, whereas, for others, excessive alcohol consumption can cause them to develop mental health concerns such as depression and anxiety.

Social and Cultural Influences

Heavy drinking is connected to a person’s socioeconomic status, with alcohol consumption levels increasing alongside measures of disadvantage, lower education, and living in poverty. There are, however, nearly 20% of alcoholics in the US who are high-functioning. These people retain stable jobs and home lives and appear to have control over their drinking. In reality, they often struggle with intense cravings and may drink in secret.

Past Trauma

Experiencing traumatic events can increase a person’s chance of developing AUD. Early-childhood trauma, in particular, is strongly associated with the development of alcohol dependence later in life. Increasingly, medical professionals view Substance Use Disorder as less of a life-long disease and more as a result of previous trauma. Many treatment programs now aim to address these traumatic events and, in doing so, the substance addiction that has resulted from it.

Underage Drinking

Studies have shown that those who start drinking before age 15 are at a higher risk for developing AUD later in life. This risk is especially true for those with a family history of alcoholism or mental health issues.

What Are the Stages of Alcohol Addiction?

Alcohol addiction does not occur immediately; it follows a similar pattern of increased use for most people. Addressing the situation at the earliest stage possible reduces the chance of progressing to the next stage and ultimately to full addiction.

The five stages of alcohol addiction are:

Occasional use

For most people, experimentation is the first stage on the path to alcohol addiction. Often this occurs during adolescence and involves trying different types of alcoholic drinks. It is usually at this stage that binge drinking occurs.

Regular Use

At this stage, a person has moved from occasional drinking at social events to drinking regularly. They drink every weekend or daily, either with others or by themselves.

Detrimental Use

A person’s life may become detrimentally affected by their use of alcohol. They are now drinking frequently with often little control over the quantity they consume or the level of their drunkenness. Their relationships with others, work or school performance, health, and finances are starting to suffer.

Dependency

Dependency and addiction are terms that are often confused. Dependence is a normal physiological adaptation to repeatedly taking a substance. At this stage, a person may have developed a tolerance and need more alcohol to achieve the same effect. They may also have withdrawal symptoms that extend beyond the period of a usual hangover.

Alcohol Addiction

At this stage, alcohol affects all aspects of a person’s life. They are consumed by the physical and psychological need to consume alcohol. Cravings are constant, and withdrawal symptoms are severe.

Questions To Ask if You Think That You or a Loved One Is Addicted to Alcohol

If you or a loved one are potentially experiencing issues with AUD, consider the following questions about drinking habits (specific to the past 12 months). AUD is diagnosed when a person answers “yes” to two or more of the questions.

In the past year, have you:

• Spent a lot of time drinking alcohol or recovering from the effects of alcohol?
• Found that drinking or being hungover often interfered with the responsibilities of your home or family? Caused job or school troubles?
• Continued drinking despite it making you feel anxious or depressed?
• Experienced physical withdrawal symptoms, including insomnia, shaking, nausea, or sweating?
• Continued to drink despite the problems it causes you physically and emotionally?
• Wanted to stop drinking or tried to stop drinking, but couldn’t?
• Drank more than you intended on more than one occasion?
• Increasingly needed to drink more and more alcohol to get the same effects?
• Experienced cravings for alcohol?
• Chosen to drink alcohol instead of participating in activities you normally would have enjoyed?
• Found yourself in potentially dangerous situations while under the influence of alcohol?

The NIAAA’s Alcohol Treatment Navigator says that alcohol use disorder is present if you answer “yes” to two or more of the questions above. The more questions that you answer yes to, the more severe the problem – and the more urgent the need for help.

Treatment Options for Alcoholism

Treatment plans for alcohol addiction are designed to meet your own unique needs. There is no “one size fits all” plan that suits everyone. Medical professionals and therapists will work with you to evaluate your situation and ensure that your time in alcohol rehab supports your well-being and long-term recovery.

There are several different levels of care for treating alcoholism. Inpatient rehab requires you to live at the alcohol rehab for the duration of your program. Alternatively, there are also outpatient programs which allow you to continue living at home while attending treatment at the rehab facility or in an office setting several times per week. The types of therapy offered in both inpatient and outpatient rehab are similar. Those options include individual therapy, group therapy, multiple forms of cognitive behavioral therapy (CBT), and a host of holistic and alternative therapies like meditation and yoga.

Alcohol addiction affects millions of people worldwide; it’s not something to be ashamed of, and treatment is widely available. The most important thing to remember is that the sooner you seek out professional help, the greater your chances of successful recovery. Addressing your relationship with alcohol now will help to improve many elements of your life and ensure a healthier future.