Alcohol consumption is common in the United States. In fact, according to data reported by the National Institute on Alcohol Abuse and Alcoholism, 86.3 percent of adults in the United States have consumed alcohol during their lives, and just over half had consumed alcohol within the previous month, as of 2018.
While drinking a glass of wine with dinner or occasionally going out for a drink can be part of a healthy lifestyle, some people may drink excessively, which can become problematic. In 2018, 26.5 percent of American adults reported binge drinking within a given month, and nearly 7 percent admitted to drinking heavily, which experts define as five or more instances of binge drinking in a month.
Binging and drinking heavily may be socially acceptable in American culture, but they are concerning from a public health standpoint. People who continuously engage in heavy drinking are at risk of developing an alcohol use disorder, which is the term professionals use to describe a diagnosable alcohol addiction. Such a condition can have significant consequences and requires professional intervention.
Signs and Symptoms of an Alcohol Use Disorder
Not everyone who consumes alcohol has an addiction, but there are signs that alcohol use has progressed to a concerning level. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, lists 11 different diagnostic criteria for an alcohol use disorder. To be diagnosed, a person must meet just two of the 11 criteria. Furthermore, the diagnosis is classified as mild among people who meet two to three of the criteria, moderate among those meeting four or five, and severe in people who meet six or more of the criteria.
Examples of diagnostic criteria for an alcohol use disorder are as follows:
- Cravings for alcohol
- Being unable to reduce drinking
- Drinking more than intended
- Having trouble with family or at work due to drinking
- Drinking even if it causes psychological or physical health issues
- Experiencing withdrawal symptoms when not drinking
- Giving up usual hobbies in favor of drinking
- Drinking even when it leads to dangerous situations, such as risky sex or drunk driving
The above list is not exhaustive, but it provides an overview of symptoms of an alcohol use disorder. Someone who displays several of the above symptoms or has additional problems resulting from alcohol consumption likely has a clinical alcohol addiction.
Unfortunately, alcohol use disorders are probably not uncommon among people who engage in binge drinking every weekend. For instance, it would not be unusual for an every-weekend drinker to be giving up usual activities to drink, which is one symptom of an alcohol use disorder, and driving home under the influence, which is a second diagnostic symptom.
Risk Factors for Alcohol Use Disorders
Several risk factors can increase a person’s chances of developing an alcohol use disorder. One such risk factor is drinking in excess. Government guidelines recommend that people consume alcohol moderately, which is defined as one daily drink for women and up to two for men.
Binge drinking, which is four or more drinks for women and five or more for men over a two-hour period, increases the risk that a person will develop an alcohol use disorder.
Beyond the amount of alcohol consumed, mental illness can make a person susceptible to an alcohol addiction. According to a 2018 report in Frontiers in Neuroscience, schizophrenia, depression, and personality disorders are highly correlated with alcohol use disorders. The authors of the report concluded that memory problems, negative emotions, impulsiveness, and difficulty with cognitive control can make a person vulnerable to alcohol addiction, explaining why people with these mental health conditions are at risk.
An earlier study in Archives of General Psychiatry found that the following factors are linked to alcohol addiction:
- Being male
- Being aged 15-24
- Not being married
- Being employed
- Having a higher education level
- Family history of alcohol abuse
- Having an anxiety disorder, especially among young adults
The research provides important information about who is most likely to develop an alcohol use disorder, but even people without risk factors can become addicted to alcohol with heavy drinking. Those who have risk factors, such as a family history or a mental health condition, should be especially cautious about alcohol use to ensure that it does not become excessive and lead to an alcohol use disorder.
Prevalence of Alcohol Use Disorders
Per the National Institute on Alcohol Abuse and Alcoholism, 14.4 million American adults met the criteria for an alcohol use disorder in 2018. This figure represents 5.8 percent of the adult population in the United States. Among those with an alcohol use disorder, 9.2 million were men, and 5.3 million were women.
Perhaps even more concerning is that alcohol use disorders can occur in youth. According to the same data that included rates of alcohol addiction for adults, 401,000 children aged 12-17 had an alcohol use disorder in 2018. Boys made up 173,000 of this number, and 227,000 girls had an alcohol use disorder.
Alcohol abuse is, perhaps not surprisingly, common among college students. According to the National Institute on Alcohol Abuse and Alcoholism, 54.9 percent of college students aged 18-22 had consumed alcohol in the previous month as of 2018, which is higher than the rate of alcohol use among people in this age group who are not enrolled in college full-time.
Even more concerning is the fact that 36.9 percent of college students report binge drinking in a given month, and 9.6 percent drink heavily. Given these facts, it is probably not surprising that about one-fifth of college students meet diagnostic criteria for an alcohol use disorder.
Consequences and Risks Associated with Alcohol Abuse
Rates of alcohol use disorders in the United States are alarming, especially given the individual and societal consequences associated with alcohol abuse. For example, the National Institute on Alcohol Abuse and Alcoholism reports that alcohol misuse results in costs of $249 billion per year in the United States, mostly from the consequences of binge drinking.
It is responsible for 88,000 deaths per year, with nearly 10,000 of these being from a vehicular accident. Perhaps even more alarming is that alcohol is the third leading cause of death in the United States, falling behind only tobacco use and poor diet and exercise habits as a top killer.
The health problems associated with alcohol abuse are many and can be deadly. For example, data from the National Institute on Alcohol Abuse and Alcoholism show the following:
- About half of deaths from liver disease are linked to alcohol.
- Among those in the age range of 25-34, 76.5 percent of deaths from cirrhosis of the liver are related to alcohol.
- Alcohol abuse elevates the risk of oral cancer as well as cancers of the esophagus, pharynx, larynx, liver, and breast.
- There has been an increase in number of infants born with fetal alcohol syndrome from 0.5 to 3 cases per 1,000 births in 1996 to 2-7 cases per 1,000 births more recently.
Another significant consequence of alcohol abuse is the negative impact it has on children who are exposed to their parents’ alcohol consumption. Research shows that one-tenth of children live in a home where a parent abuses alcohol. Unfortunately, a review of the research, which was published in a 2015 edition of the Journal of Child and Family Studies, found that there is a variety of negative outcomes that are more likely when a parent abuses alcohol:
- Female children of alcoholic parents have more emotional problems, such as difficulty with stress and anxiety.
- Male children with alcoholic parents tend to struggle with external behaviors, such as aggression.
- Some research shows reduced self-esteem and difficulty with self-regulation among children whose parents abuse alcohol.
- Children who live in homes where alcohol abuse occurs tend to perform worse in school.
- Parental alcohol abuse can harm parent-child relationships through poor communication, children’s negative attitudes toward parents, and children’s distrust of their parents.
Maternal alcohol abuse can create problems for children before they are even born. As mentioned previously, rates of fetal alcohol syndrome appear to be on the rise, and experts have cautioned that women should not consume any alcohol during pregnancy, as they have not established any levels of alcohol that are safe for a developing baby.
When women drink during pregnancy, they increase their babies’ risk of developing a fetal alcohol spectrum disorder (FASD), which is linked to numerous mental and physical health problems. These can include any of the following, according to the Centers for Disease Control and Prevention (CDC):
- Coordination Problems
- Learning Disabilities, Particularly in Math
- Low Intelligence
- Low Body Weight and Short Stature
- Small Head Size and Abnormal Facial Features
- Problems Seeing and Hearing
- Memory Problems
- Speech Delays
- Impaired Judgment
- Health Issues Involving the Heart, Bones, and Kidneys
Issues arising from alcohol abuse can continue when children head off to college and become consumers themselves. According to the National Institute on Alcohol Abuse and Alcoholism, about a quarter of college students have struggled academically because of alcohol use, facing challenges such as missing class, falling behind on coursework, and earning low grades on papers, exams, and in classes in general because of their drinking.
Some consequences of alcohol abuse among college students are even more severe and traumatic. The research shows that in a given year, 696,000 college students will be victims of an assault related to alcohol abuse. Furthermore, 97,000 students will suffer from a sexual assault or date rape linked to alcohol. In addition, 1,825 college students die yearly from injuries arising from alcohol abuse, such as those sustained during a car accident.
The research shows that alcohol use is linked to accidents and violence on college campuses, and it is also associated with domestic violence in relationships. In fact, a report in a 2018 edition of the Psychology of Violence found that alcohol abuse increased the risk that a person would be either a victim or perpetrator of domestic violence.
More specifically, problems with alcohol, such as dependence or abuse, were associated with being a victim of domestic violence in a relationship, whereas alcohol increased the risk of a person committing a violent act against an intimate partner, regardless of whether or not the person was dependent upon or abusing alcohol.
Research and statistics regarding alcohol consumption show that drinking is not just a carefree weekend activity. For some people, it can lead to abuse, addiction, and serious consequences, such as health problems, violence, or even death. Furthermore, these consequences affect everyone, from young children, to adults, to society as a whole. Even those who do not abuse alcohol or have close relationships with those who do may suffer if they become involved in a car crash with another individual who is driving while under the influence.
Diagnosis of Alcohol Use Disorders
Given the significant problems that alcohol can cause for individuals, families, and society as a whole, those who have an alcohol use disorder benefit from seeking treatment to help them to stop drinking and recover from the harmful effects of alcohol. The treatment process usually involves a diagnosis of an alcohol use disorder.
A professional working in the medical or addiction field must provide a diagnosis, using the Diagnostic and Statistical Manual of Mental Disorders. Some people may receive a diagnosis from a primary care physician, whereas others may see a clinical social worker, a psychologist, or a psychiatrist for diagnosis. Regardless of who makes the diagnosis, meeting criteria for a clinical alcohol use disorder means that a person has a legitimate medical condition that requires treatment. A diagnosis simply identifies the problem and allows treatment providers to bill insurance for services.
Treatment for an Alcohol Use Disorder
Treatment for an alcohol use disorder will vary from person to person, and the specific treatment process depends upon a person’s history of alcohol abuse, their support system in the community, and the severity of their alcohol use disorder.
People who are in recovery from an alcohol use disorder will likely first enter a detox treatment program. During detox, the goal is to keep patients as comfortable as possible as their bodies rid themselves of alcohol and undergo the withdrawal process. Detox programs also ensure that patients remain safe as they withdrawal.
To understand the need for detox, it is first necessary to learn about what happens during alcohol withdrawal. According to a 2015 publication in the journal Drugs, alcohol relaxes the nervous system and slows its activity by increasing levels of a brain chemical called GABA while simultaneously hindering the activity of another brain chemical called glutamate, which propels the nervous system into action. When a person stops using alcohol and begins to withdraw, this disrupts the homeostasis of the nervous system and creates withdrawal symptoms.
About half of those who stop drinking after a period of alcohol abuse will experience withdrawal symptoms, and for many people, these will be mild and dissipate on their own. These mild symptoms typically appear six to 12 hours after a person stops drinking, and they include the following:
Following these initial symptoms, withdrawal may progress to include hallucinations, which can begin 12 hours to a day after a person ceases drinking.
Alcohol withdrawal becomes especially concerning when it progresses beyond these initial symptoms toward more serious side effects. For example, a patient may begin to experience withdrawal seizures one to two days after giving up drinking. These seizures can be a warning sign of impending delirium tremens, which is a serious and potentially fatal condition that involves dangerously elevated blood pressure, high body temperature, psychosis, hallucinations, seizures, and coma.
Not everyone who withdraws from alcohol will experience severe side effects like seizures or delirium tremens, but those who do will require medical intervention to prevent complications and avoid serious consequences, such as coma or death. Seeking professional advice is recommended even among those whose initial alcohol withdrawal symptoms appear mild, as the effects of withdrawal can worsen over time.
Someone who has been drinking daily, engaging in heavy drinking, or consistently drinking beyond what is considered “moderation” should consult a medical professional prior to stopping drinking to determine whether medical intervention is necessary. If it is not, it is still helpful to be in contact with a treatment provider who can monitor symptoms and provide additional intervention should a patient’s condition worsen.
For those who do require medical intervention, the detox process can occur on either an inpatient or an outpatient basis. According to a report in American Family Physician, a physician or addiction professional will typically first conduct an assessment using a tool like the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). A patient scoring in the mild withdrawal range can usually receive outpatient care without medication, and a medical team will monitor symptoms and provide support as needed.
Someone with moderate severity withdrawal per an assessment can also receive outpatient treatment, but a doctor will likely provide medications to alleviate withdrawal. Those who receive outpatient detox services typically will report to a clinic each day for symptom monitoring and medication. A patient who scores in the severe withdrawal range will typically require inpatient detox services, in which staff provides medications as well as additional care to address any complications arising from withdrawal.
Regardless of the detox treatment setting, patients receiving medication for withdrawal will usually be prescribed a benzodiazepine drug, like Valium, Ativan, or Librium, as this is the preferred drug for treating withdrawal, according to the authors of the report in American Family Physician. This class of drugs is effective for preventing and treating seizures and delirium tremens, and physicians can administer it either on a fixed dosage schedule or in response to specific symptoms.
For example, some providers may give a dose of a benzodiazepine only when symptoms reach a certain level of severity. This may be the preferred option, as research suggests that giving benzodiazepines in response to symptom severity reduces both the total amount of medication a patient needs, as well as the length of treatment.
In addition to taking prescribed medications, patients in alcohol detox programs will also receive medical care to ensure that they maintain adequate fluid and electrolyte levels and receive proper nutrition. Some patients with severe withdrawal may require intravenous fluids in order to replenish those lost due to elevated body temperature, sweating, and vomiting. Some people may require magnesium supplements to address deficiencies, and experts recommend that patients in withdrawal also receive a multivitamin and a thiamine supplement.
Detox is only the first step in the process of recovering from an alcohol use disorder, so patients will need to transition into an ongoing treatment program after undergoing withdrawal. According to the experts writing for American Family Physician, detox programs do not treat underlying issues contributing to alcohol abuse and therefore are not promising for ensuring lasting sobriety.
The type of treatment that is most effective will depend upon each patient’s unique needs. Those with a milder alcohol use disorder may benefit from brief outpatient interventions. On the other hand, a patient with a severe alcohol use disorder may require inpatient or residential treatment.
Regardless of whether a person engages in inpatient or outpatient treatment, the program will likely involve a combination of group and individual therapies. In group therapy, people can learn from others who are experiencing the same problems with alcohol, as well as learn about relapse prevention and the underlying causes of alcohol abuse.
Specific therapies used in alcohol abuse treatment may include cognitive behavioral therapy, in which a person learns to overcome negative thoughts that have contributed to alcohol abuse and to learn new ways of coping with stress. A 2019 report in the Journal of Consulting and Clinical Psychology assessed the results of 30 different studies and found that this type of therapy is significantly effective for treating alcohol and other substance use disorders.
Another program that may be helpful for individuals with alcohol use disorders is Alcoholics Anonymous. This program involves working through 12 steps that people must practice in order to overcome an alcohol addiction. Participants discuss the program and these steps at regular group meetings, and they have the opportunity to receive sponsorship and support from other members who have a longer period of sobriety.
The research supports this form of treatment; a 2020 report in Cochrane Systematic Reviews analyzed numerous studies conducted on Alcoholics Anonymous and found that this program is associated with lasting abstinence from alcohol.
In addition to attending groups and receiving therapy for alcohol abuse, some people may take medications in order to help them maintain sobriety. According to the National Institutes of Health, doctors may prescribe the following medications to those who are recovering from an alcohol use disorder:
- Topiramate- This medication is thought to increase levels of GABA, which calms the body, and to reduce levels of glutamate. Research shows that it is linked to abstinence from alcohol as well as a reduction in heavy drinking.
- Acamprosate- According to experts, this medication improves abstinence among people dependent upon alcohol and treats symptoms like anxiety, sleep problems, and restlessness.
- Disulfiram- Serving to discourage people from drinking alcohol, this medication stops the body from breaking down alcohol and therefore creates unpleasant effects, such as nausea, if a person drinks. It may require that a spouse or other important person monitor to ensure a person is taking the medication.
- Other Medications- In addition to medications used specifically to treat alcohol abuse, some doctors may prescribe drugs to treat co-occurring or underlying mental health conditions, such as anxiety, depression, or bipolar disorder, as these can contribute to alcohol addiction.
Regardless of the specific types of medication a person takes during recovery from an alcohol use disorder, experts from the National Institutes of Health have explained that the risk of relapsing is high during the first six months to a year after a person stops drinking. That being said, it is appropriate for patients to continue taking medications for a year or longer if they are helpful for recovery.
Frequently Asked Questions (FAQ’s)
Research has contributed to the understanding of what causes alcohol use disorders, what the consequences of these disorders are, and how professionals can treat them, but there are additional FAQ’s that people may have regarding alcohol abuse.
Some common questions and answers about alcohol use disorders may include:
Some people may refer to alcohol abuse as alcoholism, but this is not a clinically relevant term. In professional practice, alcoholism is described with the term “alcohol use disorder.” Typically, when people use a phrase like alcoholism, they are referring to a person who abuses alcohol and experiences significant consequences, much like a person with an alcohol use disorder does. Alcoholism may also refer to the fact that someone is dependent upon alcohol, which also suggests some level of alcohol use disorder.
As described above, a person who abuses alcohol and then stops drinking is likely to experience withdrawal symptoms. The nervous system will become out of balance when alcohol abuse stops after a period of extended drinking, causing the body to undergo changes in levels of brain chemicals. This can lead to mild symptoms such as tremors and insomnia, but some people may experience seizures, psychosis and severe delirium as the body withdraws from alcohol.
While alcoholism may not be a proper clinical term, often times, people are referring to a person with an alcohol use disorder when they use the term “alcoholic.” Given this fact, many people might consider a person who meets diagnostic criteria for an alcohol use disorder as being alcoholic.
Symptoms such as craving alcohol, developing a tolerance for it, continuing to drink despite significant consequences, and suffering withdrawal symptoms when not drinking could be a sign that someone is what most would call an “alcoholic.”
With ongoing alcohol use and the development of alcoholism or an alcohol use disorder, a person often becomes tolerant to alcohol. This means that the person will need more and more alcohol to achieve the same desired effects. Ongoing alcohol abuse also damages the body’s tissues, leading to an increased risk of cancer and liver problems, as discussed previously.
Teenage and young adult alcohol abusers are at risk of brain damage and reduced cognitive or mental functioning, according to a study in Preventive Medicine. Brain damage from alcohol use tends to occur in regions associated with learning and memory.
Receiving a diagnosis of an alcohol use disorder or being an “alcoholic” is not necessarily dependent upon the number of drinks a person consumes in a day. Experts do report that binge drinking, defined as four or more drinks in a two-hour period for women and five or more drinks in a two-hour period for men is associated with alcohol use disorders, especially among those who drink heavily, defined as five or more binge drinking episodes in a month.
While three beers per day does not reach this level, it is above the level of one drink per day for women and two drinks per day for men that the government describes as moderate. Someone who drinks three beers per day may have an alcohol use disorder if he or she meets diagnostic criteria, such as continuing to drink in spite of health problems caused by alcohol or having trouble at work due to alcohol use.
Whether a person who drinks three beers per day is an alcoholic will depend upon meeting diagnostic criteria and individual risk factors for alcohol abuse.
The answer to this question depends upon the amount of alcohol a person drinks every day. If a person drinks moderately, again defined as one drink per day for women and two for men, the risk of an alcohol use disorder and related consequences is significantly reduced.
Given this information, it is possible to enjoy a glass of wine with dinner or to sip a beer in the evening without developing any problems related to alcohol. On the other hand, drinking more than a moderate amount of alcohol or engaging in daily binge drinking can be harmful and increase the risk of an alcohol use disorder.
Alcohol use is common in the United States, with most adults having consumed alcohol at some point during their lives and about half of them drinking alcohol within a given month. The rate of alcohol use disorders is lower than this, falling at about 6 percent among adults. While this number may seem relatively low, the reality is that alcohol abuse has devastating consequences for individuals, families, and communities.
Even if alcohol use disorders appear uncommon, it is concerning that over a quarter of adults admit to binge drinking within a given month, which can increase the risk of a later alcohol use disorder and lead to consequences such as drunk driving, sexual assault, and domestic violence.
High rates of binge drinking also suggest that many adults deem this activity as being socially acceptable, when in actuality it is linked to alcohol use disorders and a variety of consequences, some of which can be deadly. It is important that adults limit their alcohol consumption to moderate levels to avoid serious consequences associated with alcohol abuse. It is also critical that people be aware of their own risk factors for alcohol addiction.
Those who do develop alcohol use disorders are in need of treatment so they can learn new ways of living and coping with stress without turning to alcohol. Alcohol use may be common, but alcohol use disorders are legitimate medical conditions that require quality treatment to help people find a release from the grips of alcohol abuse.
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