Alcoholism: Drinking to Despair
A guide to Alcohol Use Disorder symptoms, misconceptions and treatment
Alcohol has had a long and varied history in the United States. It has the power to ruin lives, yet it is a socially acceptable way to relax, socialize, and celebrate. Drinking is quite prevalent in our country, as more than 86% of Americans aged 18 or older have consumed alcohol at some point in life.1 About 70% reported they drank alcohol in the past 12 months, and 56% reported that they drank in the past 30 days.
While many people can drink without it becoming an issue, many others develop unhealthy patterns of drinking. Problem drinking can then become an alcohol use disorder (AUD), more commonly known as alcoholism.
Ancient History of Alcohol
The manufacture of alcohol has been traced as far back as 10,000 years ago. In the Caucasus mountains in Eurasia, grapes were grown for winemaking as far back as 6000 BC. Around 4000 BC in the Middle East, winemaking was a popular way to make money. By 3000 BC, people in Egypt and Rome were making and shipping wine around the world.2
Ancient Greek Alcohol
Around 1500 BC, the Greeks began to worship Dionysus, the god of harvesting grapes, wine, and winemaking. In Roman mythology, his name is Bacchus because of a frenzy he induces called a bakkheia. Even today, the English derivative of the word “bacchanal” is a label used for a drunken celebration.
Ancient China, India, and the Middle East
As early as 1116 BC, China was making and using alcohol in their celebrations, as well as selling it. In 800 BC, India began producing beer. Between 500 BC and 300 BC, Hebrews accepted it as part of their celebrations, as a medicine, and it became part of their ceremonies.
Alcohol in the Middle Ages
Throughout the Middle Ages, wine, beer, and mead (an alcoholic drink derived from honey) were popular. By the 16th century, it was in wide use around the world. Called spirits at the time, alcohol use was mainly medicinal. In the 18th century, Britain passed laws encouraging the manufacture of grain spirits. British gin consumption skyrocketed and alcoholism became widespread.3
The History of Alcohol in the United States
In the United States, alcohol use can be traced as far back as the colonial settlers who emigrated from England. Cider, beer, whiskey, and rum were the preferred drinks in colonial times. Drunkenness and alcoholism were dealt with within a social context rather than using punishment.4
The Temperance Movement
The year 1826 saw the emergence of the temperance movement in the United States. By the 1840s, the movement was lobbying for complete abstinence from alcohol. In the mid-1800s, 13 states had passed alcohol prohibition laws.
In 1917, the temperance movement reached its goal when Congress passed the 18th Amendment that prohibited producing, selling, transporting, importing, or exporting liquor to or from the United States. By 1919, the 18th Amendment was ratified by the states and, officially in 1920, the United States was a “dry” country.
Despite it being illegal, Americans still wanted to drink liquor. Citizens who were willing to take the risks began producing alcohol for sale on the black market. Huge profits were made as alcohol was in high demand. Organized crime grew powerful and rich from illegal sales. Liquor was also smuggled into the United States from other countries. By the 1930s, the sentiment that the government was being too intrusive into people’s private lives and the depressed economy pushed ahead the 21st Amendment.
Passed in early 1933 by Congress and ratified by the states in the same year, the 21st Amendment repealed the 18th Amendment.5 The 21st Amendment shifted the lawmaking to the states. Many states passed their own prohibition laws during the 1930s, but by 1966 all these laws had been stricken. Regulating liquor is now mainly handled locally.
What is Alcoholism?
The term alcoholism has been largely replaced in the professional treatment community with the term alcohol use disorder or AUD. AUD is used to describe problem drinking that develops into a severe medical condition. AUD is a chronic brain disease that is characterized by compulsive alcohol use, loss of control over intake, and a negative emotional state when not drinking. AUD is a relapsing disease.
AUD is a large problem in the United States, with millions of adults and hundreds of thousands of adolescents struggling with alcohol problems. According to the 2015 National Survey on Drug Use and Health:6
- 15.1 million adult Americans 18 and older had AUD. This includes almost 10 million males and over 5 million females.
- Approximately a little less than 7% of adults with AUD received treatment in the last 12 months.
- About 623,000 youths ages 12-17 had AUD. This number includes almost 300,000 males and 323,000 females.
- Approximately 5% of adolescents with AUD in the past 12 months received treatment.
The low percentages of people battling alcohol issues that received treatment demonstrates that more awareness, prevention and treatment programs are needed.
Do You Have an Alcohol Use Disorder?
In the past year, have you:
If you answer yes to any of these questions, your drinking may be problematic. The more symptoms you have, the more urgent the need for treatment to change your drinking patterns. Consult a healthcare professional for an assessment to see if you have AUD.
How Much Alcohol is Too Much?
For men, a risky drinking pattern is drinking more than 14 alcoholic beverages weekly, or more than 4 drinks in one day at least once a month. For women, a risky drinking pattern is drinking more than 7 alcoholic beverages weekly, or more than 3 drinks in one day at least once a month.
How Alcohol Works on the Brain Short-Term
The psychoactive drug ingredient in alcohol is ethanol. When a person drinks, ethanol relaxes and also produces feelings of euphoria. When a person drinks in excess, intoxication occurs, and pronounced feelings of relaxation and euphoria give way to exhaustion, hangovers, depression, vomiting, and sometimes passing out. These effects occur because alcohol works on the neurotransmitters in the brain.
When a person drinks, the ethanol depresses brain function between the excitatory and inhibitory neurotransmitters. Alcohol increases inhibitory neurotransmission and decreases excitatory neurotransmissions. The depressant effects manifest as intoxication: mood changes, drowsiness, reduced ability to pay attention, and memory issues. If the person continues to drink, the depressive effects progress to lethargy, confusion, amnesia, loss of sensation, breathing difficulties, and possibly death.
When alcohol depresses the excitatory neurotransmission, it results in a reduction of social inhibitions. The person becomes less shy, more talkative, bolder, and may do things he or she would not ordinarily do in social situations.
How Alcohol Works on the Brain Long-Term
Prolonged consumption decreases the functioning of the GABA-A receptors in the brain that leads to a decrease in the sensitivity the brain has to neurotransmission. This loss of functioning leads to tolerance as well as alcohol withdrawal syndrome if the individual tries to stop drinking.
Tolerance is where the person needs to drink more to gain the same previous effects. This happens because the brain is compensating for the alcohol’s effects on its functions. The GABA-A receptors attempt to resist the effects, so the person increases the amount he or she is drinking to overcome this compensatory response.
Alcohol Withdrawal Syndrome
Since certain neurotransmissions that control hyperactive responses are no longer balanced by the inhibitory effects of alcohol, the symptoms of withdrawal appear. When a person suddenly stops drinking, withdrawal symptoms that may follow can include:
- Delirium Tremens (DTs)
When an individual gets pleasure from drinking alcohol and repeats the behavior to obtain more pleasure, this repetition can lead to the brain adapting to ever-present alcohol. When consumption is abruptly stopped, the brain’s adaptive response is to send out feelings of discomfort and cravings. These adaptive responses spur the individual to seek out alcohol. Complex, repetitive interactions between neurotransmitters in the brain drive alcohol-pursuing behaviors. When these behaviors constantly cycle (drink – stop – cravings – drink), it is a fully active addiction.
AUD and Cancer
Alcohol has been associated with different types of cancer. Drinking alcoholic beverages is considered consuming a known human carcinogen, according to the US Department of Health and Human Services.7 Studies show that the more a person drinks, especially those who drink regularly, the higher the risk of developing a cancer that is associated with drinking.
In 2009, about 3.5% of deaths due to cancer in the United States (19,500 deaths) were alcohol-related. Cancers that can occur due to heavy drinking include:
- Head and Neck Cancer
- Esophageal Cancer
- Liver Cancer
- Breast Cancer
- Colorectal Cancer
Other Health Risks Caused by Alcohol Use Disorder
Drinking every day or binge drinking can have many adverse effects on the body’s major organs. It can negatively affect the appearance of the brain and how it works. These effects can change behavior, mood, coordination, and thinking.
Heart damage can happen when heavy drinking occurs over a long period of time. Binge drinking in one episode can also damage the heart. Heavy drinking can also damage the liver and lead to liver problems that include fatty liver, cirrhosis, and alcoholic hepatitis. Alcohol also causes the pancreas to produce toxins that can gradually cause pancreatitis, a harmful inflammation of the pancreas that stops proper digestion.
Which Alcohol Treatments Are Most Effective?
Not every alcoholism treatment works for every person. A multiple treatment approach works best for most people struggling with AUD. Attacking the problem on many different fronts can help an individual with AUD lead a sober and successful life. Since AUD affects a person physically, mentally, and spiritually, the treatment approach should address all three aspects.
One of the most easily recognized 12-step groups is Alcoholics Anonymous (AA). Founded in 1935, AA’s principles of following the 12 steps to get and stay sober is still in use today. A few of these steps include turning one’s life over to a higher power and admitting how powerless the person becomes when drinking.
Behavioral therapies can help people recover from alcohol issues by helping them change the way they think. Negative thoughts that lead to destructive behaviors are dissected and reduced, which makes way for positive thoughts and healthier behaviors.
Cognitive behavioral therapy (CBT) is one type of counseling widely used to treat addiction. CBT focuses on anticipating problems and developing effective coping strategies to deal with problems that do not involve alcohol. Counseling sessions may focus on positive and negative consequences of drinking, enhancing the ability to recognize cravings early, identifying and avoiding people and places that may be high risk for drinking, and developing coping skills for dealing with cravings.
Medications that help people recover from alcohol dependence and addiction can be valuable recovery tools. Since neurotransmitter systems are involved in problem drinking, medications that affect different neurotransmitter systems have been shown to help people recover from AUD.
Opiate antagonists such as naltrexone interfere with the pleasurable effects garnered from drinking. They work by blocking euphoria, which then discourages people from drinking because they are not getting the “high” alcohol brings.
Antidepressant medications can help people with alcohol dependence and depression to stop drinking and maintain sobriety because the medications help reduce their depressive feelings.
Acamprosate is a medication used in the treatment of AUD that affects the neurotransmitters involved in maintaining alcohol dependence. Acamprosate can restore normal activity in these systems.
Since the neurotransmitter serotonin is involved in alcohol dependence, medications that increase the amount of serotonin, called SSRIs (selective serotonin reuptake inhibitors) such as Prozac and Zoloft can help treat depression as well as decrease the reinforcing effects of drinking alcohol.
What is Detox from Alcohol Like?
When a person is alcohol-dependent, withdrawal symptoms after stopping can appear very quickly. Withdrawal symptoms manifest which include nervous system arousal, seizures, hallucinations, and delirium tremens (DT). To control or prevent these symptoms and avoid further complications and possibly death, a medically supervised detox in a formal treatment setting is recommended.
The management of alcohol withdrawal syndrome during a detox uses medications. If specific complications arise during alcohol withdrawal such as DTs and seizures, medications are on hand to be instantly administered.
Remember, detox is not a standalone treatment. Once alcohol is safely removed from the body, a rehab program is needed to avoid relapse. Also, home detox is not recommended. Detoxing at home is dangerous because if any serious withdrawal symptoms or complications occur (and they can happen quickly), there is no medical staff on hand to help.
What are Common Struggles When Getting Sober?
One of the most common struggles when getting sober from alcohol is staying sober. Stress can be a powerful trigger for taking a drink once a person is abstinent. Relapse is common among people who are in recovery from AUD.8 The most likely risks for relapse occur during stressful periods, or the recovering person is subjected to places or people associated with drinking in the past.
Another common struggle when getting sober from alcohol is ensuring that co-occurring disorders such as depression are continually treated so that they do not trigger a drinking episode. Many people stop taking pharmacological medications for mental health issues when they feel better. For example, a person with depression may stop taking antidepressant drugs because they don’t feel depressed anymore. Unfortunately, this absence of medications can trigger a depressive episode, which can lead to drinking for symptom relief. It is important for anyone with co-occurring mental health issues to continue to treat these issues to avoid relapse.
Where Can You Find Help With Alcohol Dependence and Addiction?
Finding and getting help starts with the right treatment program. If you or a loved one is struggling with AUD, get as much information as you can about the program before making a treatment decision. If possible, speak to someone who has been through the program to get their thoughts and experiences.
Your choices include:
If you believe a more intensive program is needed to start the recovery journey, look into treatment programs that offer a residential rehab option. Inpatient treatment can last as little as a few weeks to several months or more. Also, a detox center that is part of a comprehensive treatment program will make the transition from detox into treatment much smoother.
Whether this is the first time you are seeking treatment or if you’ve been through multiple rehab programs, make the effort to go through AUD rehab. You are worth the effort and time that it takes to undergo a recovery journey that can be the door to a new and revitalized life free of alcohol.