Alcoholism

Also referred to as alcohol use disorder (AUD), is a condition where an individual experiences a compulsive desire or physical need to consume alcohol despite its negative impacts on his/her life. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes alcohol use disorder as a chronic relapsing brain disorder consisting of a problematic drinking habit that gets severe overtime.

Individuals with alcohol use disorder tend to prioritize alcohol use over all other obligations in life. They are usually aware of the negative impact of alcohol in their lives but may still find it difficult to give up on it. The consumption of alcohol to the point of causing negative consequences on one’s personal and professional life is known as abuse. Prolonged abuse of alcohol can lead to the development of dependence. However, not all who abuse alcohol are dependant on it.

In the past, an individual with alcoholism was typically labeled as an “alcoholic.” However, this was widely seen as an unhelpful and negative label, prompting health professionals to rename this condition as “alcohol use disorder.”

An individual with AUD may exhibit the following behaviors:

• Drinking alone
• Gradually increasing the alcohol intake to attain the desired effects (tolerance)
• Becoming angry or violent when someone questions about their drinking habits
• Eating poorly or not eating at all
• Not caring about personal hygiene
• Missing work or school because of drinking
• Being unable to control alcohol consumption
• Making excuses to drink
• Continuing to drink despite it causing legal, economic, or social problems
• Giving up important occupational, social, and recreational activities in favor of alcohol consumption
• Neglecting responsibilities at home and work

An individual with AUD will also display the following physical symptoms:

• Cravings for alcohol
• Withdrawal symptoms when discontinuing alcohol use
• Tremors (involuntary shaking) during a hangover
• Frequent memory lapses (blacking out) after a night of drinking
• Illnesses, such as alcoholic ketoacidosis and cirrhosis

Alcohol misuse can damage the body and its organs, especially the liver, in many ways. Some of the health complications of AUD are:

• Damages to brain cells
• Bleeding in the gastrointestinal (GI) tract
• Cancer in the GI tract
• Dementia
• Depression
• High blood pressure
• Inflammation of the pancreas (Pancreatitis)
• Nerve damage
• Changes in mental status, including Wernicke-Korsakoff Syndrome (A brain disease that leads to vision changes, confusion, or memory loss)

There are many factors that directly or indirectly contribute to alcoholism. Alcohol use disorder usually develops due to prolonged chemical changes in the brain. As the body grows accustomed to these chemical changes, an individual is no longer able to function on a daily basis without its effects. This stage is referred to as dependence.

The euphoric sensations experienced by consuming alcohol makes one want to drink very often, regardless of its potential to cause harm. Abrupt cessation of alcohol consumption during this stage can cause a chemical imbalance in the user’s internal system that generates intense and adverse sensations referred to as withdrawal symptoms. Most individuals will continue to indulge in alcohol solely to prevent these distressing withdrawal symptoms.

There are also studies that associate AUD with genetics. Research shows that genes are partly responsible for making an individual susceptible to developing AUD. Although genes alone do not completely contribute to alcoholism, it does play a role.

Although the exact cause of AUD is yet unknown, certain factors are known to increase and influence the risks of developing an AUD.

Some of these factors are:

• Consuming more than fifteen drinks per week for men.
• Consuming more than twelve drinks per week for women.
• Binge drinking (consuming more than five or more drinks per day at least once a week).
• Having a parent or close relative with AUD.
• Having mental health conditions, such as schizophrenia, anxiety, or depression.
• Consuming alcohol as a teenager.
• Having low self-worth or self-esteem.
• Going through high levels of stress.
• Living in a family or culture that regularly consumes alcohol.

An individual’s human traits, behavioral and physical characteristics, are greatly determined by his/her genetic structure, also known as DNA. These genetics are generally passed onto an individual through his/her parents.

One of the behavioral traits that parents can pass onto their children is a predisposition towards alcoholism or alcohol abuse. Individuals who are genetically predisposed to alcoholism have a higher risk of developing an AUD. Scientists refer to this gene as an “alcoholism gene.” However, social and environmental factors also play a major role in determining one’s susceptibility.

Although genetics plays a part in influencing the likelihood of developing AUD, it is not determined for certain. Not all with this gene suffer from alcoholism, and not all who suffer from this disease have the gene.

The hundreds of genes present in an individual’s DNA may amplify the risks of developing an AUD. Detecting these genes can be quite difficult as each gene plays a small role in a much larger picture. However, studies have indicated that a certain set of genes have a strong link to alcoholism.

The behavioral genes passed down can also influence the propensity for developing alcoholism. Mental illnesses such as depression and schizophrenia are quite common in individuals with these genes. Individuals with mental illnesses retain a higher risk of turning to substance abuse to cope with their conditions. Mental illnesses can be hereditary (environmental), which partly emphasizes the complex relationship between addiction and genetics.

The hereditary behaviors of an individual interact with environmental factors to determine the choices we make. Certain individuals are more sensitive to stress, making it difficult for them to handle unhealthy relationships and fast-paced jobs, and turn towards alcohol to self-medicate.

However, even those with a high predisposition to substance abuse must first be forced by a non-hereditary factor to engage in it. The driving force that leads to alcohol abuse is usually an environmental factor, such as stress, anxiety, or even trauma.

Generally, the higher the risk factor, the greater the chance of the individual developing an alcohol use disorder. There are also a few protective factors that help reduce a person’s risk of alcoholism. Risk and protective factors can either be environmental or biological.

Some of the risk factors are:

• Poor social skills
• Poverty
• Alcohol availability
• Lack of parental supervision
• Drug and alcohol experimentation
• Aggressive behavior during childhood

Some of the protective factors are:

• Neighborhood resources
• Good self-control
• Parental support and monitoring
• Education
• Anti-alcohol policies

Some of the environmental factors that are especially risky for those who are genetically predisposed to alcoholism are:

• Witnessing violence
• Peer pressure
• Drug accessibility
• Physical or sexual abuse

The  NIAAA (National Institute of Alcohol Abuse and Alcoholism) has been funding the Collaborative Studies on Genetics of Alcoholism (COGA) since 1989, with the sole purpose of discovering the specific genes that influence alcohol use disorder. In addition to that, the NIAAA also funds the investigators’ research in this particular area and has an in-house research emphasis based on the interaction between genes and the environment. The NIAAA is committed to discovering the precise relationship between genetics and AUD, so that appropriate treatment can be developed.

Individuals with a family history of alcoholism have the highest risk of forming an alcohol use disorder. If you have more than one family member who has an alcohol or substance use disorder, you too may have inherited the genes that put you at risk of developing an AUD.

However, just because someone has a high genetic predisposition towards alcoholism does not mean that he/she is predestined to that lifestyle. Although no one can control or change their genetic structure, one can always take measures to prevent addiction. Some of the best ways to stop a genetic predisposition from turning into a disastrous alcohol addiction are:

• Managing stress
• Reinforcing strong family ties
• Maintaining healthy friendships
• Seeking relationship counseling
• Being aware of the history of substance abuse within the family
• Understanding the symptoms of addiction

A doctor or healthcare provider can help diagnose an alcohol use disorder. They may first perform a physical exam and question you about your drinking habits.

The questionnaire may include:

• Have you driven any vehicles while drunk?
• Have you missed work or college due to drinking?
• Do you require more alcohol to feel its effects?
• Have you experienced blackouts as a result of drinking?
• Have you tried to quit or reduce drinking but were unable to do so?

Generally, a diagnosis for alcohol use disorder does not require any other diagnostic tests. However, your doctor or healthcare provider may run a few blood tests to check your liver function to determine if you show any signs of liver disease.

As alcoholism is a complex and chronic disorder, treatment for it usually requires long-term therapy. AUD treatments can vary from one rehab to another, but the primary goal of all treatment programs is to help you stop drinking in a safe and effective manner.

AUD treatments usually occur in stages such as:

• Detoxification to remove alcohol from the body.
• Rehabilitation to develop new coping skills and behaviors.
• Counseling to address the emotional issues that may cause relapses.
• Support groups, including 12-step programs such as the AA (Alcoholics Anonymous) to provide a sense of community and safe space.
• Medical treatment for any health issues associated with the AUD.
• Medications to help minimize or control addiction.