Signs Of Alcohol Abuse (Known As Alcohol Use Disorder)

In the US, alcohol often plays an integral role in social life for many people, and the line between a moderate amount of alcohol and substance use can seem difficult to distinguish. According to the Centers for Disease Control (CDC), moderate drinking means one drink or less daily for women and two or less for men. However, many people don't realize their alcohol intake is at a high or concerning level. 

How alcohol misuse can happen

Since alcohol is a legal substance, people tend to forget it is a substance that can be overused with grave consequences. When it comes to determining if someone is drinking too much alcohol, it can be beneficial to understand how alcohol dependence can develop and how to receive support if you're impacted.

Alcohol use disorder definition

Alcohol use disorder is a substance use disorder within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It may be diagnosed when someone's excessive drinking causes them distress or harm, leading to difficulties at home, work, or school. Many people with alcohol use disorder find it difficult to stop or reduce their alcohol cosumption, despite the negative consequences on their lives and health.

The stages of addiction 

There are three stages of alcohol dependency linked to the brain. People can go through this cycle for weeks or months, but some go through it multiple times daily. Note that addiction and dependency are chemical processes and are not a choice; while people can decide to stop drinking, they often cannot easily end their addiction.

Addiction changes the brain's chemistry and can make it challenging to stop using a substance. Below are the stages that people living with alcohol dependency might experience. 

Stage one: The binge and intoxication stage 

During the first alcohol addiction stage, the person might start using the substance more, experiencing happiness, decreased anxiety, and increased comfort in social situations when they drink alcohol. They might feel this way because substance use affects the basal ganglia, the part of the brain that controls voluntary movements, decision-making, reward, and addiction. 

Repeated activation of the brain's reward system reinforces alcohol use, building connections between drinking alcohol and different places, people, and other cues that, in time, incite the urge to drink excessive alcohol when encountered. 

Stage two: Alcohol withdrawal stage 

When someone with an alcohol dependency stops drinking, they may go through withdrawal symptoms that are the opposite of the positive effects they experienced in the alcohol intoxication stage. These symptoms can include headaches, nausea, vomiting, anxiety, agitation, tremors, and visual disturbances, among others. 

These adverse health effects happen for two reasons. The first is that there is a diminished reward response in the basal ganglia as the person's alcohol tolerance increases, which also makes it more difficult to experience pleasure without drinking alcohol. In addition, alcohol causes increased activation of the brain's stress systems, which causes anxiety and irritability. At this point in the process, the person may no longer consume alcohol for the pleasurable effects but to prevent the low feelings and adverse physical and mental health consequences of withdrawal. 

Stage three: Preoccupation stage 

At the preoccupation stage, the person may have chosen to become sober and starts to crave alcohol again. After a period of abstinence, they become preoccupied with getting more alcohol. This stage relates to having a compromised prefrontal cortex, which is the area of the brain responsible for helping people organize thoughts and activities, make decisions, and prioritize tasks.  

What contributes to alcohol misuse? 

When someone overuses alcohol, they exhibit a pattern of drinking too much in an unhealthy, reckless manner (such as binge drinking). This excessive alcohol use may lead to increased risk to their health and safety and negatively impact their life. For instance, misusing alcohol may lead to missing work to drink, having risky sex, or drinking while driving can be risky behaviors associated with alcohol use. People may also engage in excessively heavy drinking or engage in mixing alcohol with other substances.

If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text "START" to 88788. You can also use the online chat. 

How do you define dependency? 

The DSM-5 changed the classification of alcohol use. The earlier edition, the DSM-4, described alcohol use and alcohol dependence as two separate disorders. The DSM-5 established one condition called alcohol use disorder that encompasses all forms of alcohol dependence and established whether the condition is mild, moderate, or severe. 

The following questions based on the DSM-5 may be used to assess the presence and severity of alcohol use disorder by professional health services:

• Have you had times when you drank more drinks or for more time than you intended?
• Have you wanted to cut down on drinking or stop drinking alcohol altogether but struggled to do so? 
• Have you spent significant time drinking or had prolonged hangovers or periods of sickness after drinking? 
• Have you wanted a drink so badly that you couldn't think of anything else?
• Have you found that drinking—or being sick from drinking—often interfered with taking care of your educational, professional, or social life? 
• Have you ever continued to abuse alcohol even though it was causing interpersonal conflict?
• Have you given up on or cut back on activities that were important to you to drink? 
• Have you gotten into situations during or after drinking that increased your chances of getting hurt (such as driving/motor vehicle accidents, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
• Have you ever continued to drink even though it was making you feel depressed or anxious or adding to other health problems? 
• Have you ever had to drink much more than you once did to get the effect you want? 
• Have you found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, paranoia, or a seizure? 

Answering yes to two or more of these questions might indicate a mild alcohol use disorder. If you answered yes to four to five, you might have a moderate challenge; if you have six or more, it could be classified as severe alcohol use disorder. However, speak to a mental health professional or doctor before considering a diagnosis. 

Symptoms of alcohol use disorder 

Alcohol affects people differently, but most people face adverse effects when they drink too much alcohol. While the extent (mild, moderate, or severe) of an alcohol misuse problem and the types of symptoms exhibited by an individual with alcohol use disorder can depend on their level of tolerance and their ability to hide the signs, some common behavioral and physical symptoms of alcohol problems can include the following: 

• Engaging in risky or promiscuous behavior
• Having no memory of what happened during a block of time
• Slurring words and sentence
• Purchasing a significant quantity of alcohol 
• Drinking more than four drinks within an hour or two 
• Continuing to drink after feeling distressed, harmed, or numb 
• Experiencing frequent hangovers 
• Having flushed cheeks 
• Having bloodshot eyes
• Experiencing slow reflexes 
• Experiencing symptoms of depression
• Having mood swings
• Giving up activities to drink
• Craving pure alcohol the majority of the day 
• Struggling to stop drinking when you want to stop 

Treatment options

Someone living with alcohol use disorder may not believe they are struggling with an alcohol misuse problem, and they may take offense to well-meaning feedback from family and friends. Often, the people in their life might reach out to provide support, offering encouragement to address the problem or offering resources, such as those offered by the Mental Health Services Administration.

Admitting you are struggling with substance use and recognizing the need for help can be a challenging first step to recovery, but it is possible. There is an abundance of literature about the success of treating alcohol use. Alcohol use disorder is an illness; like other illnesses, it may worsen if left untreated. You may ignore behavioral health statistics regarding alcohol misuse or deny that alcohol has caused any problems in your life, but for people with untreated alcohol use disorder, problems with one’s health, relationships, work, school, and other areas of life can become inevitable.

Despite the challenges that may occur with this condition, you are not alone. According to the National Institute on Alcohol Abuse and Alcoholism, more than 14.9 million people aged 12 and older have alcohol use disorder, and many can recover with treatment. 

Treatment programs vary from person to person. Some people with high physical dependence on alcohol may benefit most from in-patient treatment programs. However, outpatient rehabilitation programs and therapy are also options. Your primary care doctor can work closely with you to create a customized treatment plan to suit your needs. According to NCBI, some of the most popular outpatient treatment options include the following.  

Medication

If recommended, your doctor might prescribe medicine to help you cope with the distressing symptoms of relapse and cravings when choosing to become sober. These medications might be most effective when used in conjunction with counseling. Consult a doctor or psychiatrist before starting, stopping, or changing medications. 

Alcohol misuse psychotherapy 

Psychotherapy or counseling often aims to allow individuals to develop tools to change their thoughts about alcohol and their drinking habits. In addition, the therapist may help the individual examine the factors that could have contributed to alcohol use, such as mental health conditions, depression, family challenges, or trauma. 

Support groups 

Support groups, including 12-step groups like Alcoholics Anonymous (AA), may benefit those looking for social support and accountability. In these groups, you might be paired with a free sponsor who has also gone through the recovery journey and process that can offer peer support and conversation when you're struggling. You can also attend meetings and potentially receive a chip or reward for each milestone you complete. These support groups are often free to attend but may be closed meetings, so look up the closest meetings in your area and reach out for further information. 

Counseling options 

If you believe you might be experiencing symptoms of alcohol use disorder, you're not alone, and many counseling options are available. Many people with substance use disorders prefer online treatment to start, as it can be more discreet and allow you to have more control over your treatment, with options to choose between phone, video, or chat sessions with your therapist. 

Research shows that online therapy effectively treats a range of mental health conditions and disorders. One review showed that online cognitive-behavioral therapy (CBT) led to a 50% improvement in symptoms of depression, generalized anxiety disorder, and panic disorder and could significantly decrease the impact of stress and chronic fatigue. If you're interested in trying online therapy, consider contacting a provider through an online platform like BetterHelp, which can allow you to meet with a provider trained in substance use care.