Over the years, there has been a move in diagnostic psychiatry and psychology to recognize the fact that many of the disorders classified as clinically significant mental health disorders are related. In the current manifestation of the American Psychiatric Association’s diagnostic scheme regarding addiction and substance abuse, the notion of separate but related conditions no longer exists. Instead, the two concepts are considered to be visualized as a continuum of one psychological or psychiatric disorder that varies in its seriousness. Diagnostically, there is no longer a separation between the notions of abuse and addiction (or dependence), but instead the issue is viewed as one disorder that varies according to severity and the number of symptoms that an individual displays.
The current diagnostic terminology uses the term substance use disorder to relay this notion of one specific disorder that varies in its severity. The number of consistent symptoms an individual displays determines the severity of the disorder. Even though the terms substance abuse and addiction (or dependence) are still used colloquially, the diagnostic process requires that these terms no longer be used formally. Thus, the terms of substance abuse and addiction (or dependence) are now merged into one singular concept that varies in severity on a continuum based on the number of symptoms an individual displays.
Alcohol Use Disorder
The figures regarding alcohol use and the consequences of alcohol use disorders make it clear that alcohol abuse is a major issue in the US. In 2013, according to the National Institute of Alcohol Abuse and Alcoholism:
- Nearly 87 percent of people aged 18 or older reported that they drank alcohol at some point in their lifetime. Nearly 71 percent of people reported drinking alcohol in the past year, and over half reported drinking alcohol in the previous month.
- Nearly a quarter of people 18 and older reported that they engaged in a binge drinking episode within the prior month.
- Nearly 17 million of adults aged 18 or older met the diagnostic criteria for an alcohol use disorder. Men are significantly more likely to develop an alcohol use disorder than women; however, that trend is slowly changing. It is estimated that nearly 11 million men and 6 million women met the criteria for an alcohol use disorder in 2013.
- The cost of alcohol use disorders is staggering. It is estimated that the total cost for alcohol use disorders due to issues like lost productivity, health problems, insurance burdens, and criminal activity is more than $200 billion.
What Is an Alcohol Use Disorder?
When the problematic use of alcohol becomes severe and leads to a number of negative consequences and dysfunctional behaviors, the person is given the medical diagnosis of an alcohol use disorder. This is a formal diagnosis that describes a series of dysfunctional issues associated with alcohol use.
Because it is a formal diagnosis and because the American Psychiatric Association continues to follow the notion of a medical disease model in the diagnosis of psychological/psychiatric conditions, there are discrete sets of symptoms that need to be met in order for a formal diagnosis to be made. The issues and symptoms that lead into a formal diagnosis include the following:
- The person often drinks larger amounts of alcohol, or drinks for a longer period of time, than intended.
- The person spends a great deal of time drinking alcohol, recovering from the effects of alcohol use, or seeking out alcoholic beverages.
- The person repeatedly has cravings for alcohol.
- The person unsuccessfully tries to control alcohol use.
- The person continues to use alcohol despite having personal, career, or financial issues related to its use.
- The person’s alcohol usage results in them not completing major obligations in their personal life, at work, at school, and so forth.
- The person repeatedly uses alcohol in situations where it is dangerous to do so.
- The person gives up or reduces participation in important activities in life as a result of alcohol use.
- The person develops symptoms of physical dependence on alcohol.
There are 11 formal diagnostic criteria for an alcohol use disorder. In order to qualify for diagnosis of an alcohol use disorder, the individual has to consistently display two or more of these formal diagnostic criteria over a period of one year. Of course, individuals can display more than two symptoms. The severity of the alcohol use disorder is defined by the number of symptoms that the person consistently displays over the course of a year. This diagnostic scheme results in the designation of the severity index associated with an alcohol use disorder:
- Someone with a mild alcohol use disorder displays 2-3 formal diagnostic symptoms consistently over the course of one year. This is consistent with the older notion of a substance abuse or alcohol abuse problem.
- Someone with a moderate alcohol use disorder consistently displays 4-5 symptoms over the course of one year. This category is transitional between abuse and addiction, depending on the severity of the symptoms and the clinical determination.
- Individuals displaying 6 or more of the symptoms consistently over the course of one year fall into the severe alcohol use disorder These individuals would fall into the older conceptualization of an actual formal addiction or alcoholism.
Signs of a Problem
A diagnosis of an alcohol use disorder can only be reliably given by a trained mental health professional. Because individuals with substance use disorders will typically try to hide their behaviors, deny their substance use, and justify for the ramifications of their substance use issues, most individuals are unable to even realize the extent of the problem. However, there are some qualitative and quantitative changes in behavior that may signify the need to engage in formal treatment.
For instance, the Substance Abuse and Mental Health Services Administration has published qualifiers for the designation of heavy drinking and binge drinking. The development of an alcohol use disorder begins with patterns of drinking that become more and more dysfunctional over time. These patterns are quantitatively different than what occur with non-dysfunctional alcohol use. These guidelines can be useful for adults over the age of 21, as they can allow them to look at patterns of drinking and decide if they may be developing an alcohol use problem. In individuals who are under the age of 21, for whom drinking alcohol is illegal, any signs of recurrent use should be taken to indicate a potential problem. The designations are:
- Moderate drinking consists of up to one drink a day for women and up to two drinks a day for men.
- Heavy drinking consists of having five or more drinks on the same occasion at least five days out of the month.
- Binge drinking refers to having five or more alcoholic drinks on the same occasion at least one day out of the month.
People who are engaging in binge drinking and heavy drinking are at high risk for symptoms associated with alcohol use disorders. In addition, even individuals who drink according to the above definition of moderate drinking may also experience issues related to an alcohol use disorder.
Again, these designations do not apply to individuals who use alcohol illegally (e.g., underage drinking). There is no “normal” drinking pattern identified for individuals under the age of 21. Any recurrent use of alcohol for underage individuals is a sign that an issue may be developing.
Some more practical symptoms that can signal a potential problem with alcohol use include:
- Changes in one’s overall disposition or personality, such as irritability, resentfulness, impatience, being overly sensitive to criticism, isolating oneself, and so forth
- Repeated signs of the person being physically ill, such as flulike symptoms, headaches, nausea, vomiting, nervousness, lack of appetite, etc.
- Sudden change in peer relationships
- Change in physical appearance, such as no longer attending to hygiene issues or dressing differently
- Drinking alcohol in situations where it is prohibited or dangerous, such as drinking alcohol at work, during lunch, coming into work hungover, driving while intoxicated, etc.
- Cravings to drink
- Using alcohol to cope with normal life pressures
- Obvious signs, such as slurring words, difficulties with motor coordination, continually smelling alcohol the breath, and so forth
Anyone who meets the formal diagnostic criteria for an alcohol use disorder has an issue that necessitates professional help. Moreover, anyone who is teetering on the edge of moderate to heavy usage is at risk for the development of a formal diagnosis. The treatment options for intervening with someone who has been formally diagnosed alcohol use disorder are rather straightforward.
Research indicates that even though some individuals may be able to quit drinking alcohol on their own, the chances for long-term recovery from alcohol use disorder are significantly increased if one engages in a formal treatment program. For most individuals, quitting use of alcohol is extremely difficult and goes against their own personal notions of autonomy as well as notions of the level of control they perceive they have over their alcohol-related behavior. People often do not want to be told they are having issues with self-control when they engage in certain behaviors. Many people believe they can just stop, and when they can’t, they rationalize the reasons they continue to use alcohol. It is not as easy to quit drinking as it is to conceptualize quitting.
In addition, individuals with more moderate to severe alcohol use disorders may suffer issues with physical dependence alcohol (the symptoms of tolerance and withdrawal), which complicate the process. In cases of severe alcohol abuse and addiction, withdrawal symptoms can be dangerous and even life-threatening; hence, professional assistance is needed to ensure safety and comfort throughout the detox process.
Thus, a formal assessment of the actual severity of the problematic drinking, and the development of a customized treatment plan for recovery, is the ideal way to approach the issue. Those who attempt to quit drinking without some form of professional help often experience relapse issues. This often leads to a cycle of short periods of sobriety, followed by worsening periods of relapse.
Treatment Options for Alcohol Use Disorders
Even though there is a general blueprint for recovery, each plan needs to be individualized for the specific person in treatment. There is no single approach that works for everyone in alcohol addiction recovery. Instead, there are a number of formal treatment options that an individual can engage in.
An inpatient or residential treatment option should be available for individuals who need to engage in medical detox from severe alcohol use disorders and for individuals who need to isolate themselves from environmental pressers and issues that may sabotage their early recovery. Inpatient or residential treatment is generally time limited; however, clients should have the option to extend their stays as needed.
Medications may be used during both the detox and ongoing recovery processes for alcohol use disorders. Treatment programs should have doctors on staff to assess clients and prescribe medications as needed.
All individuals seeking formal help in recovery from alcohol use disorders will eventually transition to some form of outpatient treatment program, and many of individuals will only utilize outpatient treatment. In outpatient treatment, clients attend treatment during the day (or a few times per week) and then return home each night.
Therapy makes up the bulk of addiction treatment, and this comes in many forms. Most addiction treatment programs will include both individual and group therapy in addition to various complementary or alternative therapies.
Social support groups are not formal therapy groups, as they do not use professionally trained therapists or counselors. Instead, these peer support groups are generally organized and run by other individuals in recovery. These include familiar 12-Step groups, such as Alcoholics Anonymous. Support groups can also be found online.
Treatment should be available to address co-occurring disorders. Many people who suffer from alcohol abuse or addiction disorders also suffer from a co-occurring mental health issue. It’s important that treatment facilities have the ability to diagnose and treat these other mental health issues simultaneously.
Long-term aftercare should be included in any addiction treatment program, helping to ensure clients are supported once they “graduate” from a structured program. Such a program may consist of a number of supportive measures, such as continued participation in 12-Step meetings like Alcoholics Anonymous, other support groups, or ongoing individual therapy. Recovery from alcohol use disorders requires a long-term commitment. Since alcoholism is not a condition that can be cured, ongoing management is needed for the rest of life. With proper treatment and support, true recovery is possible for anyone suffering from alcohol abuse issues.