Alcohol abuse and Addiction

Also referred to as ethanol or ethyl alcohol, alcohol is a psychoactive depressant with a high capacity to form a dependence. Alcohol can be found in various forms, such as beer, wine, and hard liquor. This substance is formed when the yeast ferments and breaks down the sugar in food.

Alcohol in high doses acts as a central nervous system (CNS) depressant that slows down mental and physical processes. In lower doses, alcohol acts as a stimulant that generates a feeling of euphoria, talkativeness, and self-confidence, and thus it is commonly dubbed as a social lubricant.

Alcohol in today’s world is a routine and socially accepted practice. Although alcohol is associated with violence and anti-social behavior in certain societies, in contrast, it is seen as a peaceful and harmonious practice in others. This mindset varies largely due to the social and cultural norms in each society.

Beer is an alcoholic beverage that is mainly made of water, hops, barley, and yeast. Compared to hard liquor or wine, beer has the lowest content of alcohol by volume (ABV). The ABV of beer generally ranges from 2 to 12 percent. Commonly consumed beers such as Budweiser, Coors Light, Miller Lite, Corona, and Busch falling in between 4 to 6 percent of ABV. On average, it takes around 3 to 5 beers to be over the legal driving limit.

Beer has become the focal point of many activities in American culture. From college parties to professional events, there is no social event without beer. With the rise of craft beers, beer consumption is now a fashion statement, with microbreweries and home brewers bringing in new flavors. However, one of the tragic side effects of the craft beer revolution is that the beers may now have a considerably higher content of alcohol compared to the average domestic draft, with some being as high as 11 or 12 percent.

Unfortunately, due to the addictive nature of alcohol, even those who consume alcohol in social settings are at risk of developing an alcohol use disorder. This is particularly true when social drinkers continue to drink despite everyone stopping or drink to tackle boredom or uncomfortable situations.

Most commonly sold as red or white with a wide range of flavor profiles, wine is yet another alcoholic beverage made from fermented grapes, pomegranates, or berries. Wine varieties are based on the type of grape used and the region it’s produced. Chardonnay, Moscato, Pinot Grigio, and Riesling are some of the examples of white wines, while Merlot, Zinfandel, Cabernet, and Pinot Noir are some of the examples of reds. Often served as a pairing or part of a meal, the “classy” status of wine makes it harder to detect when someone has a problem with it.

In terms of alcohol content, wine has a more concentrated amount of alcohol than beer. For instance, the alcohol content of an average pour of wine (5 oz.) is equivalent to that of a 12 oz beer.

Women account for 59 percent of wine drinkers in America and are often the targeted audience of aggressive marketing campaigns. Adequate body water is required to diffuse alcohol content. However, as women tend to have less body mass and water content than men, women tend to have a higher percentage of alcohol concentrations in their bloodstream. This causes women to get impaired quicker than men when drinking wine and consequently expose their brain and organs to more alcohol before it is broken down. Although either gender can develop a problematic relationship with wine, women tend to possess a higher chance of developing an alcohol use disorder.

Liquor is a broad category consisting of hard alcoholic spirits, such as gin, whiskey, vodka, rum, and tequila. Liquor is often consumed by mixing in with soda, water, or juice, and consist of a much higher ABV in comparison to wine or beer. As carbonation accelerates the absorption process of alcohol into the bloodstream, mixing sodas to liquor can result in a quicker intoxication. Consuming liquor on its own is referred to as “neat” or “shot.” The lower liquid content in shots increases the chance of consuming more of the substance, resulting in a higher risk of abuse and drunkenness.

Although some individuals claim that different liquor induces different feelings of intoxication, science has yet to prove this association. Considering that studies show all forms of alcohol generate the same effects in everyone regardless of the type of drink consumed, the social setting in which an alcoholic drink is consumed may have a significant impact on the drinker’s perception of their own intoxication. Someone drinking a glass of wine at dinner is likely to feel relaxed and happy, while a few tequila shots at a high-energy party is bound to bring about a different kind of intoxication.

Alcohol abuse refers to any use of alcohol, which leads to negative consequences to the user. This includes both physical effects, such as alcohol-induced accidents and bad hangovers, as well as social effects, such as saying or doing regrettable things while under the influence. However, just because someone abuses alcohol does not mean they are addicted or dependent upon it, although abuse is generally the first step towards dependence, tolerance, and addiction. When alcohol abuse becomes more frequent, it can rapidly transform into addiction.

Some of the signs of alcohol intoxication are:

• Slurred speech
• Bloodshot eyes
• Difficulty standing up or walking
• Lack of co-ordination
• Agitation or anxiety
• Disorientation
• Glassy or blank stares
• Rambling or repetitive statements
• Flushed skin

Since alcohol is widely accepted in many communities, diagnosing an addiction to alcohol can be quite difficult. Heavy drinking often leads to dependence, but a heavy drinker may or may not have an AUD (as per the clinical definition of DSM-V.)

Alcoholism is usually diagnosed according to a spectrum. There are 11 criteria for identifying an addiction, with the severity depending on the number of criteria met.

Below are the 11 criteria that medical professionals use for diagnosing alcoholism in patients:

• Drinking alcohol in large quantities or for longer than intended.
• Wanting to stop or reduce alcohol, but being unable to do so.
• Spending a considerable amount of time getting, using, or recovering from alcohol.
• Experiencing intense cravings and urges to use alcohol.
• Not being able to manage life at home, work, or school due to alcohol abuse.
• Continuing to use alcohol, even though it creates problems in relationships.
• Giving up important occupational, social, or recreational activities because of alcohol abuse.
• Using alcohol more often, even when it puts you in danger.
• Continuing to drink alcohol, even when you know you have a psychological or physical condition that could worsen with alcohol consumption.
• Requiring more and more alcohol to attain the desired effect (tolerance).
• Developing withdrawal symptoms, which can be alleviated by drinking more alcohol.

When an individual meets only two or three of the criteria mentioned above, he/she is regarded as having a mild alcohol use disorder. Four or five is considered moderate, whereas anything more is regarded as severe. Individuals meeting more than five criteria are traditionally regarded as alcoholics.

Prolonged consumption of alcohol can lead an individual to the development of dependence and tolerance to the substance. The build-up of tolerance can cause an individual to consume higher amounts of alcohol to achieve the desired effects as their body grows accustomed to the lower doses. During the stage of dependence, individuals may feel intense physical and psychological sensations when they try to abruptly quit their alcohol consumption. These sensations are referred to as withdrawal and are caused by the body’s reliance on the chemical effects of alcohol to function on a day-to-day basis. Alcohol addiction is a chronic disease that affects many on a global scale.

Most individuals fail to comprehend the damaging effects of alcohol since it is quite prevalent in today’s society. However, the negative effects of alcohol are evident in many forms across the country. Long-term alcohol abuse can impose serious effects on the brain and body, as every organ is affected due to it. However, organs such as the liver and brain are usually more affected than others.

Although many individuals indulge in alcohol to enjoy the buzz, the consequences of alcohol abuse usually prevail long after the initial period of intoxication.

Some of the short-term side effects of alcohol abuse are:

• Trouble breathing
• Distorted vision and hearing
• Headaches
• Impaired judgment
• Blackouts
• Nausea

The long-term effects of alcohol abuse are far more serious and can include irreversible damage that can result in death.

Some of the long-term effects of alcoholism are:

• Depression
• Permanent brain damage
• Neurological impairment
• Psoriasis
• Anxiety disorders
• Hand tremors
• Compromised immune system
• Cirrhosis of the liver
• Chronic pancreatitis
• Vitamin B1 deficiency
• High blood pressure
• Sexual dysfunction
• Nerve damage
• Malnutrition
• Gastritis
• Alcohol poisoning
• Cancer of the throat and mouth
• Accidents such as falls, burns, car crashes, and drowning
• Injuries due to sexual assault, mishandling firearms, and domestic violence

Alcohol abuse can also cause various non-medical effects, some of which can have life long consequences.

Some of the non-medical effects of alcohol abuse are:

• Legal issues
• Financial issues
• Feeling shameful or guilty about drinking or the actions done under the influence of alcohol
• Strained relationship with friends, family, and significant others
• Issues at work, such as a decrease in productivity, tardiness, and absenteeism
• Needing alcohol to relax or feel better
• Prone to violence
• Victimized due to intoxication
• Giving up important professional, social, or recreational activities due to alcohol abuse

As it is prevalent across many cultures in today’s world, alcohol is often abused with other drugs. Alcohol in itself can be dangerous, but it can be fatal if combined with other substances. It is particularly lethal when combined with other forms of CNS depressants, such as benzodiazepines or painkillers, as it increases the chances of an overdose.

• Adults who first consumed alcohol before they turned 15 are seven times more likely to develop alcoholism than adults who first drank alcohol at the age of 21.
• Over 40 percent of all emergency room visits made by individuals under the age of 20 were due to alcohol abuse.
• More than 2-million individuals received treatment for alcohol addiction in 2011.
• According to the Centers for Disease Control and Prevention (CDC), drunk driving claims around 28 lives every day in the US.
• Alcohol abuse has contributed to over 3 million deaths each year globally.

Alcohol withdrawal is a set of symptoms that appear when binge drinkers and alcoholics reduce or quit alcohol consumption abruptly. Depending on the severity of one’s addiction, withdrawal symptoms may range from mild to life-threatening. The sudden absence of alcohol in the body can shock the nervous system and cause a chemical imbalance. The effects of withdrawal are sometimes so intense that addicts usually relapse during this stage. Overcoming withdrawal is generally the first step towards recovery.

Some of the common withdrawal symptoms of alcohol are:

• Anxiety
• Fatigue
• Confusion
• Heightened blood pressure
• Headaches
• Heart palpitations
• Nausea and vomiting
• Insomnia
• Irritability
• Shaking and tremors
• Sweating

Delirium Tremens (DTs) is a condition that is generated by extreme alcohol withdrawal. This extreme version of withdrawal can be potentially fatal as it triggers seizures. About 1 in every 20 individuals who undergo alcohol withdrawal will also experience delirium tremens. The condition is more common in people who are severely addicted to alcohol and have undergone alcohol withdrawal in the past. Most symptoms of delirium tremens emerge within two to three days after quitting alcohol use. Since the symptoms tend to be quite fatal, it is imperative to seek help right away.

Some of the symptoms of delirium tremens are:

• Emotional distress
• Hallucinations
• Fatigue
• Fever
• Intense agitation or irritability
• Intense confusion
• Seizures (generally within one day of the last drink)
• Hypersensitivity to sound, touch, and light

Most alcohol withdrawal symptoms emerge within six hours after quitting alcohol use and may last for a week.

The best way to overcome addiction to drugs, including alcohol, is to stop using it. Alcohol detoxification is the process of removing all traces of the abusive substance from the body to help an individual gradually adjust and function without it. Alcohol detox can be dangerous, distressing, and painful as it requires the patient to endure the full range of withdrawal symptoms. Detox is the initial and crucial stage of all addiction recovery.

Due to the intensity of alcohol withdrawal symptoms, individuals are highly advised to seek the supervision of a medical professional if they wish to successfully quit their addictive habit. Patients detoxing under the supervision of a medical professional are highly likely to overcome the withdrawal process safely and successfully.

Detoxification can take place safely in both inpatient and outpatient settings. However, round-the-clock medical supervision that is generally provided through an inpatient treatment center is crucial for heavy alcohol users.

Three stages of detox:

Medically assisted detox helps alleviate the intensity of withdrawal symptoms and drastically decreases the chances of a relapse. Medications are also essential in treating or avoiding adverse health complications that may occur during detox. There are currently three FDA-approved medications in the US for the treatment of alcohol addiction. Benzodiazepines, such as Librium, Valium, and Ativan, are widely used in alcohol treatment as they minimize withdrawal symptoms and prevent seizures caused by alcohol withdrawal. As seizures largely contribute towards fatality in alcohol withdrawal, additional anti-convulsant medications, such as Keppra, are also often used along with benzodiazepines.

Although benzodiazepines are proven very effective in treating and preventing certain alcohol withdrawal symptoms, it is crucial for recovering individuals to only use as prescribed as they are addictive as well.

Although many withdrawal symptoms are controlled or stripped through medically-assisted detox, some are unavoidable. Symptoms of withdrawal generally emerge during two stages of alcohol detox.

Detoxing from alcohol cold-turkey by oneself can be dangerous and even fatal, particularly for long-term alcohol abusers. Some of the severe side effects of detox, although rare, are:

• Liver or kidney dysfunction
• Seizures
• Heart arrhythmias
• Intense cravings
• Anxiety
• Hallucinations
• Extreme nausea
• Fever
• Aspiration pneumonia
• Headache
• Insomnia

After the completion of alcohol detoxification, patients must undergo further treatment at an inpatient or outpatient treatment center that specializes in alcohol addiction. Although detox helps patients overcome the physical aspect of dependence, they would require further therapy and counseling to overcome the psychological aspect of addiction. The duration of treatment may vary depending on the severity of a patient’s addiction.