alcoholism definition essay

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Alcohol use disorder is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol or continuing to use alcohol even when it causes problems. This disorder also involves having to drink more to get the same effect or having withdrawal symptoms when you rapidly decrease or stop drinking. Alcohol use disorder includes a level of drinking that's sometimes called alcoholism.

Unhealthy alcohol use includes any alcohol use that puts your health or safety at risk or causes other alcohol-related problems. It also includes binge drinking — a pattern of drinking where a male has five or more drinks within two hours or a female has at least four drinks within two hours. Binge drinking causes significant health and safety risks.

If your pattern of drinking results in repeated significant distress and problems functioning in your daily life, you likely have alcohol use disorder. It can range from mild to severe. However, even a mild disorder can escalate and lead to serious problems, so early treatment is important.

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Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms you experience. Signs and symptoms may include:

• Being unable to limit the amount of alcohol you drink
• Wanting to cut down on how much you drink or making unsuccessful attempts to do so
• Spending a lot of time drinking, getting alcohol or recovering from alcohol use
• Feeling a strong craving or urge to drink alcohol
• Failing to fulfill major obligations at work, school or home due to repeated alcohol use
• Continuing to drink alcohol even though you know it's causing physical, social, work or relationship problems
• Giving up or reducing social and work activities and hobbies to use alcohol
• Using alcohol in situations where it's not safe, such as when driving or swimming
• Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount
• Experiencing withdrawal symptoms — such as nausea, sweating and shaking — when you don't drink, or drinking to avoid these symptoms

Alcohol use disorder can include periods of being drunk (alcohol intoxication) and symptoms of withdrawal.

• Alcohol intoxication results as the amount of alcohol in your bloodstream increases. The higher the blood alcohol concentration is, the more likely you are to have bad effects. Alcohol intoxication causes behavior problems and mental changes. These may include inappropriate behavior, unstable moods, poor judgment, slurred speech, problems with attention or memory, and poor coordination. You can also have periods called "blackouts," where you don't remember events. Very high blood alcohol levels can lead to coma, permanent brain damage or even death.
• Alcohol withdrawal can occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to 4 to 5 days later. Signs and symptoms include sweating, rapid heartbeat, hand tremors, problems sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms can be severe enough to impair your ability to function at work or in social situations.

What is considered 1 drink?

The National Institute on Alcohol Abuse and Alcoholism defines one standard drink as any one of these:

• 12 ounces (355 milliliters) of regular beer (about 5% alcohol)
• 8 to 9 ounces (237 to 266 milliliters) of malt liquor (about 7% alcohol)
• 5 ounces (148 milliliters) of wine (about 12% alcohol)
• 1.5 ounces (44 milliliters) of hard liquor or distilled spirits (about 40% alcohol)

When to see a doctor

If you feel that you sometimes drink too much alcohol, or your drinking is causing problems, or if your family is concerned about your drinking, talk with your health care provider. Other ways to get help include talking with a mental health professional or seeking help from a support group such as Alcoholics Anonymous or a similar type of self-help group.

Because denial is common, you may feel like you don't have a problem with drinking. You might not recognize how much you drink or how many problems in your life are related to alcohol use. Listen to relatives, friends or co-workers when they ask you to examine your drinking habits or to seek help. Consider talking with someone who has had a problem with drinking but has stopped.

If your loved one needs help

Many people with alcohol use disorder hesitate to get treatment because they don't recognize that they have a problem. An intervention from loved ones can help some people recognize and accept that they need professional help. If you're concerned about someone who drinks too much, ask a professional experienced in alcohol treatment for advice on how to approach that person.

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Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder.

Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones.

Risk factors

Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s, though it can start at any age.

Risk factors for alcohol use disorder include:

• Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-related problems or alcohol use disorder.
• Starting at an early age. People who begin drinking — especially binge drinking — at an early age are at a higher risk of alcohol use disorder.
• Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems with alcohol. This may be influenced by genetic factors.
• Depression and other mental health problems. It's common for people with a mental health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances.
• History of trauma. People with a history of emotional trauma or other trauma are at increased risk of alcohol use disorder.
• Having bariatric surgery. Some research studies indicate that having bariatric surgery may increase the risk of developing alcohol use disorder or of relapsing after recovering from alcohol use disorder.
• Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it's OK to drink too much. For young people, the influence of parents, peers and other role models can impact risk.

Complications

Alcohol depresses your central nervous system. In some people, the initial reaction may feel like an increase in energy. But as you continue to drink, you become drowsy and have less control over your actions.

Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you're taking certain medications that also depress the brain's function.

Impact on your safety

Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including:

• Motor vehicle accidents and other types of accidental injury, such as drowning
• Relationship problems
• Poor performance at work or school
• Increased likelihood of committing violent crimes or being the victim of a crime
• Legal problems or problems with employment or finances
• Problems with other substance use
• Engaging in risky, unprotected sex, or experiencing sexual abuse or date rape
• Increased risk of attempted or completed suicide

Impact on your health

Drinking too much alcohol on a single occasion or over time can cause health problems, including:

• Liver disease. Heavy drinking can cause increased fat in the liver (hepatic steatosis) and inflammation of the liver (alcoholic hepatitis). Over time, heavy drinking can cause irreversible destruction and scarring of liver tissue (cirrhosis).
• Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It can also interfere with your body's ability to get enough B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis).
• Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause serious irregular heartbeats (arrhythmia) called atrial fibrillation.
• Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin or some other diabetes medications to lower your blood sugar level.
• Issues with sexual function and periods. Heavy drinking can cause men to have difficulty maintaining an erection (erectile dysfunction). In women, heavy drinking can interrupt menstrual periods.
• Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamin). A thiamin deficiency can result in other brain changes, such as irreversible dementia, if not promptly treated.
• Birth defects. Alcohol use during pregnancy may cause miscarriage. It may also cause fetal alcohol spectrum disorders (FASDs). FASDs can cause a child to be born with physical and developmental problems that last a lifetime.
• Bone damage. Alcohol may interfere with making new bone. Bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding.
• Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss.
• Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia.
• Increased risk of cancer. Long-term, excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, esophagus, colon and breast cancers. Even moderate drinking can increase the risk of breast cancer.
• Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.

Early intervention can prevent alcohol-related problems in teens. If you have a teenager, be alert to signs and symptoms that may indicate a problem with alcohol:

• Loss of interest in activities and hobbies and in personal appearance
• Red eyes, slurred speech, problems with coordination and memory lapses
• Difficulties or changes in relationships with friends, such as joining a new crowd
• Declining grades and problems in school
• Frequent mood changes and defensive behavior

You can help prevent teenage alcohol use:

• Set a good example with your own alcohol use.
• Talk openly with your child, spend quality time together and become actively involved in your child's life.
• Let your child know what behavior you expect — and what the consequences will be for not following the rules.

Alcohol use disorder care at Mayo Clinic

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For many, beer, wine, and spirits conjure up thoughts of social gatherings and tipsy fun. But alcohol is a nervous system depressant and easily alters behavior, culminating in some cases in the emotional pain and physical disintegration of alcohol addiction , colloquially known as alcoholism. Experts continue to debate the benefits and risks of drinking and passionately argue over whether moderation or complete abstinence is the best option for those who struggle with alcoholism.

Alcohol Use Disorder is a pattern of disordered drinking that leads to significant distress. It can involve withdrawal symptoms, disruption of daily tasks, discord in relationships, and risky decisions that place oneself or others in danger. About 15 million American adults and 400,000 adolescents suffer from alcohol use disorder, according to the National Institute on Alcohol Abuse and Alcoholism. But treatment and support are available to help those suffering begin to heal.

For more information on symptoms, causes, and treatment of alcohol use disorder see our Diagnosis Dictionary .

• Signs, Symptoms, and Diagnosis
• Causes and Risk Factors
• The Effects of Alcohol
• Treatment and Recovery
• Supporting Someone with a Drinking Problem

Alcoholism most often refers to alcohol use disorder—a problematic pattern of drinking that leads to impairment or distress—which can be characterized as mild, moderate, or severe based on the number of symptoms a patient has, such as failing to fulfill obligations or developing a tolerance. Mild is classified as 2 to 3 symptoms, moderate is classified as 4 to 5 symptoms, and severe is classified as 6 or more symptoms, according to the DSM-5 .

Alcohol use disorder is a problematic pattern of alcohol use that leads to distress in one’s daily life, according to the DSM-5. The symptoms that can lead to a diagnosis include drinking more alcohol than intended, failing to cut back on alcohol use, devoting substantial time and effort to drinking and recovering from drinking, strong cravings for alcohol, failing to fulfill obligations at work, school, or home, disengaging from relationships and activities, and developing tolerance or withdrawal, among others. Experiencing at least two symptoms throughout the course of a year merits a diagnosis, from mild to moderate to severe.

The later stages of addiction can yield physical changes, but behavioral signs can help detect it early on. People with an addiction often develop rigid routines that revolve around uninterrupted access to alcohol and other drugs; they may be irritated by schedule changes and blame their frustration on others. They may have powerful mood swings that seem to change their personality . Relationships may deteriorate, as their social circle narrows to other drug or alcohol users. Their work may decline as well, and they may lose a spiritual or religious practice they once valued.

If the drinking world is conceptualized as a spectrum, normal social drinking is one on end (a few drinks per month, almost always in a social context) and alcohol use disorder is on the other end. But there’s a large gray area in the middle, in which drinking can cause problems for someone’s health, job, or loved ones, but not to a clinical extent. An example would be a father who falls asleep on the couch after having several drinks three or four days a week, missing out on time with his kids and wife. Another would be a college student who repeatedly has trouble making it to class because she was drunk the night before. These individuals, sometimes called “almost alcoholics,” may not see the connection at first but would often benefit from help and support.

Alcohol use disorder affects millions of people, but it often goes undetected. Substance use frequently co-occurs with mental illness, but some research suggests that psychiatrists only treat addiction for around half of the patients who have both mental illness and substance use problems. This discrepancy highlights the obstacles in addiction care, such as that clinicians may be unaware of the signs of substance use or not want to alienate patients by bringing it up, and patients may not want to reveal their substance use, among other hurdles.

Like all addictions, alcohol use disorder is linked to a complex combination of biological, social, and psychological factors. Research highlights a genetic component to the disorder, as about half of one's predisposition to alcoholism can be attributed to genetic makeup. People may turn to alcohol as a way to cope with trauma or other, often unrecognized psychological disorders. Socially, alcoholism may be tied to family dysfunction or a culture of drinking.

Before it becomes problematic, why do people turn to alcohol in the first place? A number of factors can motivate people to drink. One is simply its rewarding consequences, such as having fun or escaping social anxiety . Having an impulsive personality plays into the decision to seek rewards despite negative repercussions. Another factor is stress , because alcohol can alleviate distressing emotions. Social norms, such as drinking during a happy hour or on a college campus, and positive experiences with alcohol in the past (as opposed to getting nauseous or flushed) play a role as well.

The chance of developing any health problem is related to the genetic code we are born with. Just like some people have a greater risk of developing cardiovascular disease or cancer, others have a greater risk of developing an alcohol use disorder. Someone with a family history of alcohol problems, someone prone to anxiety or depression , someone who is highly impulsive and takes risks, and someone who needs more alcohol than average to experience its effects has a higher likelihood of developing the disorder.

Childhood trauma can fuel problematic drinking in adulthood, because the person might use alcohol to cope with feelings of anger , depression, anxiety, loneliness , or grief . Compared to people without a drinking problem, men and women who sought treatment for alcohol addiction had a higher prevalence of childhood trauma , research finds. Furthermore, the greater the abuse or neglect experienced, the more severe their drinking problem was. Therapy can help people who suffered as a child to address those challenges and develop healthier coping skills.

Alcohol is a powerful substance, with the capacity for positive experiences, such as bursts of creativity and fun, as well as harmful repercussions, such as addiction and health problems. Becoming dependent on alcohol can lead to challenges for both the mind and the body.

Heavy drinking can fuel changes in the brain—about half of people who meet the criteria for alcoholism show problems with thinking or memory, research suggests. The ability to plan ahead, learn and hold information (like a phone number or shopping list), withhold responses as needed, and work with spatial information (such as using a map) can be affected. Brain structures can shift as well, particularly in the frontal lobes, which are key for planning, making decisions, and regulating emotions. But many people in recovery show improvements in memory and concentration , even within the first month of sobriety.

The idea that altered forms of consciousness such as mania or alcohol can enhance creativity is a popular belief. And it turns out there’s some evidence for that idea. Researchers found that participants who had a few drinks were better and faster at creative problem solving than their sober counterparts. The reason may be that alcohol tamps down working memory and therefore sparks people to think outside the box.

As anyone who has had even a glass of wine can attest, alcohol can have a noticeable influence on mood. Drinking releases endorphins which can lead people to feel happy, energized, and excited. But alcohol is also classified as a depressant and can cause fatigue, restlessness, and depression. It may shift from stimulant to sedative in line with whether blood alcohol content is rising or falling. Given the power of alcohol on the brain, people who drink heavily may come to rely on it to regulate their mood.

One recent analysis found a sobering relationship between alcohol and health. People who drank seven to 14 alcoholic drinks a week lowered their life expectancy by about six months, people who drank 14 to 24 drinks a week lowered their life expectancy by one to two years, and consuming more than 24 drinks a week lowered life expectancy by four to five years. Alcohol consumption was also linked to a greater risk for stroke, coronary disease, heart failure, and fatally high blood pressure. However, it’s difficult to discern if drinking was the primary problem, or whether lifestyle choices such as diet and exercise influenced health outcomes as well.

In some cases, the first step in treating alcohol use disorder is detoxification—experiencing withdrawal in a safe setting with medical professionals. Following withdrawal, there are many paths to recovery.

Some people are able to stop drinking on their own. There are many organized programs that provide the support of peers, usually through frequent meetings. Alcoholics Anonymous is one example; it offers a structured 12-step path toward recovery with a community of support from those who have dealt with similar challenges.

Cognitive behavioral therapy is another path, available in person or online. Non-abstinence-based recovery models—such as Moderation Management —advocate for reducing one's alcohol consumption rather than abstaining completely.

The biggest barrier to therapy of any kind that patients may face is shame and stigma ; most programs address such concerns directly.

Some people prefer to try cutting back or quitting on their own before committing time and money to rehab. And there are a few approaches that can identify and combat drinking at an early stage. People can focus on education and support, such as through Alcoholics Anonymous, or take on a sobriety challenge. People can learn mindfulness ; rather than trying to soothe uncomfortable feelings with alcohol, mindfulness encourages techniques such as breathing, visualization , and meditation .

In a clinical setting, motivational interviewing, which cultivates the drive to change behaviors, and Screening, Brief Intervention, Referral, and Treatment (SBIRT), which funnels patients to treatment, are also helpful options.

A few empirically validated practices can help identify strong treatment programs. Treatment centers should ideally have rigorous and reliable screening for substance use disorders and related conditions. They should have an integrated treatment approach that addresses other mental and physical health conditions. They should emphasize linking different phases of care, such as connecting patients to mental health professionals, housing, and peer support groups when transitioning out of the acute phase of care. They should also have proactive strategies to avoid dropping out, involve the family in treatment, employ qualified and certified staff, and be accredited by an external regulatory organization.

Find a treatment center using the Psychology Today Therapy Directory.

Alcoholics Anonymous is a decades-old treatment, but one that research shows is effective. A recent review found that Alcoholics Anonymous led to higher rates of abstinence from alcohol long term compared to other treatments. One of the key reasons, according to the data, is that people continue to participate for years after they have completed the 12-step program. AA is not for everyone and there are plenty of different treatment options, but it can be successful and meaningful for those who choose it.

Some have criticized Alcoholics Anonymous and other 12-step programs because they are rooted in religious ideology rather than scientific principles. Some also disagree with the notion of admitting powerlessness to God or a higher power and completely ceding control, and the belief that addiction is a disease, a point vigorously debated in the clinical and scientific communities.

Some people may be hesitant to seek treatment because they don’t want to abstain entirely. Moderation management or moderation treatment can be an effective approach, in which people learn responsible drinking habits through a structured program. Research suggests this form of treatment can help people shift from heavy to moderate drinking, improve quality of life, and enhance emotional well-being.

For the past several years, evidence has been growing that ketamine might help those with severe depression. Research has also targeted ketamine’s effect on substance and alcohol use: One recent study found that the combination of ketamine and motivational enhancement therapy had higher rates of abstinence, longer time to relapse , and fewer days of heavy drinking than people who received a control (midazolam). Another found that ketamine could effectively interfere in creating alcohol-related memories.

The American Society of Addiction Medicine defines recovery as “an active process of continual growth that addresses the biological, psychological, social and spiritual disturbances inherent in addiction.” SAMHSA defines it as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” As popular opinion about the nature of addiction shifts from a moral failing to a health issue, that conversation should incorporate recovery as well, and the many forms of treatment available to get there.

Relapses are very common, especially in the first year of sobriety. Slips can be fueled by withdrawal symptoms, mental health challenges, and drug-related cues, such as spending time with old drinking partners or visiting old drinking locations. Triggers become engrained in addiction, so it’s valuable to recognize these cues, avoid them, and replace them with new behaviors, such as calling a sponsor or loved one when craving alcohol, which can help avoid a relapse .

In addition to ongoing mental health support, enhancing an individual’s “recovery resources” is also important. Providing education, job training and employment connections, supportive housing, physical activity, and social integration in families and the community can all help individuals stay in remission. Research in animals shows that having more self-determination and control over one’s environment can help facilitate adaptive brain changes after ending substance use.

The pathway to healing and recovery is often a process that occurs over many years. Addiction not only involves the individual suffering, but their partner, their family, and their friends as well. Loved ones can provide immeasurable support, but they almost take care of themselves throughout an often difficult journey.

Very few people easily and quickly accept the conclusion that they have a problem. Most struggle against it and craft a variety of arguments to demonstrate that they don’t have a problem. These arguments often rely on misdirection—moving the focus onto someone or something else.

A few common arguments to deny an alcohol problem include: “All my friends drink more than I do,” “I only drink when…,” “But I’m too functional,” “I haven’t hit rock bottom like so and so...,” and “I’ve stopped for long periods of time before.” Recognizing these misleading statements can be the first step in having an honest conversation and helping the person eventually explore treatment.

If you’re concerned that a friend or family member is misusing alcohol, you can begin by doing research. Learn about the nature of the disorder, terms that reduce stigma (avoid “alcoholic”), and different treatment options. Carefully consider when and how you’ll talk to them; for example, bringing it up while they’re intoxicated risks an overly emotional and negative response. Rehearse what you plan to say. Frame the conversation as worry and care for the person. Offer to help them deal with what might be driving their drinking, and volunteer to take concrete steps with them like calling a therapist for a consultation. (Of course, if someone is in immediate danger, call 911 or seek medical attention.)

Loved ones are an integral part of the addiction recovery process, but they need to balance their own needs in addition to providing support. To do that, they can set boundaries around their emotional, physical, and financial relationship, for example that the house will remain an alcohol-free zone. They can research alcoholism to understand the underpinnings of the disorder, the signs of an overdose, and other important information. They can discuss co-occurring mental illnesses such as anxiety and depression. They can seek help from peer support groups and mental health professionals as well.

It can be difficult to know whether or not to abstain from alcohol to support a loved one in recovery. Treatment settings teach patients to cope with the realities of an alcohol-infused world. Just like any other illness, it is ultimately the responsibility of the individual to learn how to manage it. However, loved ones often want to help, such as by showing solidarity or hosting a gathering that feels safe for their loved one. Whenever possible, it’s best to have an open, respectful, and direct conversation with the individual in recovery, and ask how they feel about alcohol being present. Doing this in advance will allow time for both people to process the discussion and set clear expectations.

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Personal Perspective: It's always good to revisit the brutal memories of my alcoholic drinking. They help me see how far I've come and remind me to be grateful.

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Alcohol's Effects on Health

Research-based information on drinking and its impact.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

The cycle of alcohol addiction.

Alcohol addiction is a chronic relapsing disorder associated with compulsive alcohol drinking, the loss of control over intake, and the emergence of a negative emotional state when alcohol is no longer available. Alcohol use disorder (AUD) is a condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It is a spectrum disorder and can be mild, moderate, or severe and encompasses the conditions that some people refer to as alcohol abuse, alcohol dependence, or the colloquial term, alcoholism. Alcohol addiction refers to the moderate to severe end of the AUD spectrum.

How Does Addiction Develop in the Brain?

Alcohol, like other drugs, has a powerful effect on the brain, producing pleasurable feelings and blunting negative feelings. These feelings can motivate some people to drink alcohol again and again, despite possible risks to their health and well-being. For example, research shows that over time, drinking to cope with stress—while it may provide temporary relief from emotional discomfort—tends to enhance negative emotional states between bouts of alcohol consumption. These changes can motivate further drinking and cause an individual to become stuck in an unhealthy cycle of alcohol consumption. 1,2

As individuals continue to drink alcohol over time, progressive changes may occur in the structure and function of their brains. These changes can compromise brain function and drive the transition from controlled, occasional use to chronic misuse, which can be difficult to control. The changes can endure long after a person stops consuming alcohol, and can contribute to relapse in drinking.

Stages of the Addiction Cycle

Addiction can be framed as a repeating cycle, with three stages. Each stage is linked to and feeds on the others. These stages primarily involve three domains: incentive salience, negative emotional states, and executive function. The domains are reflected in three key regions of the brain: the basal ganglia, the extended amygdala, and the prefrontal cortex, respectively. A person may go through this three-stage cycle over the course of weeks or months, or progress through it several times in a day. 3,4,5 Note also that a person can enter the cycle of addiction at any one of the following stages:

1. Binge/Intoxication Stage: reward, incentive salience, and pathological habits

• During this stage, a person experiences the rewarding effects of alcohol, such as euphoria, the reduction of anxiety, and the easing of social interactions.
• Repeated activation of the basal ganglia’s reward system reinforces alcohol drinking behavior, increasing the likelihood of repeated consumption. The basal ganglia play an important role in motivation as well as in the formation of habits and other routine behaviors.
• This repeated activation of the basal ganglia also ultimately triggers changes in the way a person responds to stimuli associated with drinking alcohol, such as specific people, places, or alcohol-associated cues such as certain glassware or images or descriptions of drinking. Over time, these stimuli can trigger powerful urges to drink alcohol.
• Repeated alcohol consumption also results in changes in the basal ganglia that lead to habit formation, ultimately contributing to compulsive use.

2. Negative Affect/Withdrawal Stage: reward deficits and stress surfeit

• When a person who is addicted to alcohol stops drinking, they experience withdrawal symptoms—or symptoms that are opposite to the positive effects of alcohol that are experienced when drinking it. These symptoms can be physical (sleep disturbances, pain, feelings of illness) and emotional (dysphoria, irritability, anxiety, and emotional pain).
• The negative feelings associated with alcohol withdrawal are thought to come from two sources. First, a diminished activation in the reward systems—or a reward deficit—of the basal ganglia makes it difficult for people to experience the pleasures of everyday living. Second, an increased activation of the brain’s stress systems—or a stress surfeit—in the extended amygdala contributes to anxiety, irritability, and unease.
• At this stage, the person no longer drinks alcohol for the pleasurable effects (“high”), but rather to escape the “low” feelings to which chronic alcohol misuse has contributed.

3. Preoccupation/Anticipation Stage: craving, impulsivity, and executive function

• This is the stage at which an individual seeks alcohol again after a period of abstinence. A person becomes preoccupied with alcohol and how to get more of it, and looks forward to the next time he or she will consume it.
• The prefrontal cortex—an area of the brain responsible for executive function, including the ability to organize thoughts and activities, prioritize tasks, manage time, and make decisions—is compromised in people experiencing alcohol addiction. As a result, this area of the brain plays a key role in this stage.

Hyperkatifeia

Hyperkatifeia is a word that can be used to describe the negative emotional state associated with drug withdrawal. This overactive negative emotional state is hypothesized to drive the consumption of alcohol to find relief from this emotional state, and it may be caused by profound changes in the brain reward and stress systems.

Why Should We Be Concerned About AUD and Alcohol Addiction?

Alcohol consumption is linked to many health and social consequences , including interference with personal relationships, heart and liver diseases, cancers, motor vehicle collisions and other accidents, alcohol overdose, violence, homicide, and suicide. If a person has AUD, particularly if it is moderate to severe and involves alcohol addiction, they are more likely to regularly consume alcohol in levels associated with these effects on health.

Young people are especially at risk for AUD. Using alcohol during adolescence (from preteens to mid-20s) may affect brain development, making it more likely that they will be diagnosed with AUD later in life. However, most people with AUD—no matter their age or the severity of their alcohol problems—can benefit from treatment with behavioral health therapies, medications, or both .

For more information about how alcohol affects the brain, please visit Alcohol and the Brain , and for more information about available evidence-based treatments for AUD, please visit the NIAAA Alcohol Treatment Navigator .

1 Armeli, S.; Sullivan, T.P.; and Tennen, H. (2015). Drinking to cope motivation as a prospective predictor of negative affect. Journal of Studies on Alcohol and Drugs 76(4):578–584, 2015. PMID: 26098033

2 Wardell, J.D.; Kempe, T., Rapinda, K.K.; et al. Drinking to cope during COVID-19 pandemic: The role of external and internal factors in coping motive pathways to alcohol use, solitary drinking, and alcohol problems. Alcoholism, Clinical and Experimental Research 44(10):2073–2083, 2020. PMID: 32870516

3 S. Department of Health and Human Services. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf . Accessed December 8, 2021.

4 Koob, G.F.; and Volkow, N.D. Neurobiology of addiction: A neurocircuitry analysis. Lancet Psychiatry 3(8):760–773, 2016. PMID: 27475769

5 Koob, G.F., Powell, P., and White, A. Addiction as a coping response: Hyperkatifeia, deaths of despair, and COVID-19. The American Journal of Psychiatry 177(11):1031–1037, 2020. PMID: 33135468

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Alcohol use disorder.

Sara M. Nehring ; Richard J. Chen ; Andrew M. Freeman .

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Last Update: August 8, 2023 .

• Continuing Education Activity

Alcohol use disorder (AUD) remains a significant issue in the United States, affecting many individuals. Although the exact cause of AUD is not fully understood, several factors are believed to contribute to its development. These factors include the home environment, peer interactions, genetic predisposition, cognitive functioning, and the presence of certain personality disorders. This activity provides a comprehensive review of the evaluation and management of AUD, emphasizing the crucial role of the interprofessional team in recognizing and effectively managing this condition.

• Screen patients for alcohol use disorder using validated assessment tools (eg, AUDIT and CAGE questionnaire) to identify individuals at risk.
• Apply appropriate pharmacological and non-pharmacological treatments (eg, Alcoholics Anonymous or 12-Step programs) for individuals with alcohol use disorder.
• Collaborate with interdisciplinary teams of healthcare providers to develop comprehensive treatment plans and provide integrated care for individuals with alcohol use disorder.
• Coordinate and facilitate appropriate follow-up care, relapse prevention strategies, and ongoing support and counseling services for individuals with alcohol use disorder.
• Introduction

Alcohol use disorder (AUD) is a prevalent psychiatric condition in the United States, characterized by problematic and unhealthy patterns of alcohol consumption. It is a well-recognized disorder that encompasses a broad spectrum of symptoms and behaviors associated with alcohol misuse. AUD affects a significant portion of the population, making it one of the most widespread psychiatric disorders in the country. The consequences of alcohol misuse extend beyond individual health, impacting various aspects of society, including social dynamics, economic factors, and public health.

Estimates of complications related to alcohol misuse vary; however, certain studies indicate that up to 40% of individuals have experienced adverse effects associated with alcohol misuse. According to the data obtained from the 2015 National Survey on Drug Use and Health, it was found that out of the surveyed population, approximately 138.3 million individuals aged 12 and older reported active alcohol use in the United States. Among this group, 48.2% of individuals admitted to having engaged in binge-drinking episodes within the 30 days preceding the survey. Among those who reported binge drinking, 26% of individuals acknowledged heavy alcohol use, defined as engaging in binge drinking for 5 or more days within the previous 30 days, accounting for 12.5% of the total alcohol users surveyed. These data indicate that 5.9% (or 15.7 million) of individuals in the United States aged 12 and older meet the criteria for AUD (refer to the image for the specific criteria). In addition, alcohol-related issues contribute to more than 85,000 deaths annually in the country. [1] [2] [3]

Furthermore, motor vehicle accidents, dementia, depression, homicide, and suicide have all been linked to AUD.

Diagnosis of AUD

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), AUD is classified based on the presence of 2 or more of the following criteria within 12 months:

• Alcohol is often taken in more significant amounts or consumed longer than intended.
• A persistent desire or unsuccessful efforts exist to reduce or control alcohol use.
• A significant amount of time is spent on activities necessary to obtain or use alcohol or recover from the effects of alcohol.
• Craving or a strong desire or urge to consume alcohol.
• Regular alcohol use leads to an inability to meet essential responsibilities at work, school, or home.
• Continued use of alcohol despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
• Significant reduction of important social, occupational, or recreational activities due to alcohol use.
• Recurrent alcohol use in situations in which it is physically hazardous.
• Continued use of alcohol despite knowing a persistent or recurrent physical or psychological issue is likely to have been caused or exacerbated by alcohol.
• The need for significantly increased amounts of alcohol to attain intoxication or the desired effect.
• A substantial reduction in the desired effect even with continued use of the same amount of alcohol.
• The presence of the typical withdrawal syndrome of alcohol.
• Frequent consumption of alcohol (or a closely related substance, such as a benzodiazepine) to alleviate or prevent the onset of withdrawal symptoms.

Based on the number of criteria met, a patient can be classified as having a mild AUD (if they meet 2 or 3 criteria), moderate AUD (if they meet 4 or 5 criteria), or severe AUD (if they meet more than 6 criteria).

According to the 2015 National Survey on Drug Use and Health, 11.8% of survey respondents met the criteria for AUD. Among individuals with AUD, the severity of the disorder varied. Specifically, 67.4% had mild AUD, 18.8% had moderate AUD, and 13.8% had severe AUD. [4]  Notably, patients with the most severe form of AUD often seek treatment more frequently and experience a chronic relapsing course. [5]

Although the pathogenesis of AUD is not completely understood, multiple factors are believed to contribute to its development. These actors encompass environmental influences such as home environments, peer interactions, genetic elements, and cognitive functioning. AUDs also occur with psychiatric disorders such as schizophrenia, depression, and various personality disorders. [6] [7] [8] [9]  Co-occurrence of these psychiatric disorders and AUDs often leads to a worsened prognosis for both disorders. [7]

Evidence supports the influence of specific genes on an individual's susceptibility to developing AUDs. Variants of alcohol dehydrogenase ( ADH1B ) and aldehyde dehydrogenase ( ALDH2 ) genes are considered to have a protective effect against the development of AUDs. [10] [11]  Certain genes identified as potential risk factors associated with increased susceptibility to developing AUDs include, but are not limited to, GABRG2 and GABRA2 , COMT Val 158Met , DRD2 Taq1A , and KIAA0040 . [12] [13] [14] [15]   

• Epidemiology

According to the 2016 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Administration, an estimated 43 million individuals in the United States aged 12 and older were reported to have a substance use disorder. Among them, 29 million individuals had an AUD, while 2.7 million had a disorder related to illicit drug use. These statistics establish alcohol as the most prevalent substance misused in the United States.

Among individuals diagnosed with both AUD and an illicit drug disorder, 1.8 million were adolescents (aged 12-17), 5.5 million were young adults (aged 18-25), and 16.8 million were adult individuals (aged 26 or older). Furthermore, out of those with a substance use disorder, 19.4 million individuals (aged 18 or older) also experienced a co-occurring mental illness. [16] [17] [18]

In general, AUDs tend to be more prevalent in individuals with lower levels of education and lower income.

On a global scale, AUDs impact a significant number of people, with an estimated 240 million individuals being affected worldwide, notably in regions such as Europe and the Americas.

• Pathophysiology

Multiple theories have been proposed to explain the development of AUDs in individuals. Some evidence-supported theories include positive-effect regulation, negative-effect regulation, pharmacological vulnerability, and deviance proneness.

Positive-effect regulation theory suggests that certain individuals consume alcohol to seek positive rewards, such as to experience euphoria or pleasure. They may use alcohol to enhance positive emotions or social experiences.

Negative-effect regulation theory suggests that individuals may turn toward consuming alcohol to cope with negative emotions or distressing situations. [19]  Alcohol consumption can be a self-medication strategy to alleviate symptoms of depression, anxiety, or feelings of worthlessness.

Pharmacological vulnerability theory emphasizes individual differences in how they respond to the acute and chronic effects of alcohol. Specific individuals may be more susceptible to the rewarding effects of alcohol or have a reduced capacity for efficient alcohol metabolism, thereby increasing their vulnerability to developing AUDs.

Deviance proneness theory proposes that individuals with a history of deviant behavior or inadequate socialization during childhood may be more prone to developing an AUD. In this theory, alcohol consumption can become a strategy for self-medication to alleviate symptoms of depression, anxiety, or feelings of worthlessness. 

In addition, an individual's gender can also influence the development of AUDs. [20]  

• Toxicokinetics

The metabolism of alcohol (ethanol) primarily occurs in the liver by the enzyme cytosolic alcohol dehydrogenase (ADH). This enzymatic reaction involves the reduction of nicotinamide adenine dinucleotide (NAD+) and produces acetaldehyde as a byproduct.

Acetaldehyde is subsequently metabolized by the enzyme aldehyde dehydrogenase (ALDH), which oxidizes it to form acetate. Acetate then enters into various metabolic pathways. ADH is also present in the gastrointestinal tract, contributing to the initial metabolism of ethanol during its ingestion, also known as first-pass metabolism. [21] [22]  

The cytochrome P450 system, particularly the enzyme CYP2E1, plays a role in alcohol metabolism, although to a lesser extent than ADH. In chronic alcohol users, this pathway is upregulated, leading to an increased rate of alcohol metabolism. [21] [22] [23]

The metabolism of alcohol is affected by various factors. Generally, females tend to eliminate alcohol consumption faster than males. However, females have a slower first-pass metabolism due to lower levels of ADH, resulting in higher initial blood alcohol concentration following alcohol consumption. [24]  

During pregnancy, the fetal liver metabolizes alcohol slower due to incomplete expression of enzymes CYP2E1 and ADH. As a result, the developing fetus is exposed to alcohol for a prolonged period, increasing the risks of fetal alcohol spectrum disorders.

In addition, there is evidence of a potential age-related decline in alcohol elimination. [22]  Furthermore, certain studies propose that Native Americans may metabolize alcohol faster due to the expression of beta-3 Class 1 ADH isoforms than individuals who express only the beta-1 Class 1 ADH isoform.

Alcohol metabolism is generally slower in a fasting state, which is attributed to the decreased levels of ADH observed during fasting. [25]  Conversely, consuming food can enhance liver blood flow, and the presence of sugars, such as fructose, allows a substrate for the regeneration of NAD+ from ADH. This conversion enables NAD+ to participate in the oxidation of alcohol. [25]

The time of day also impacts alcohol elimination from the body, with the highest rates of elimination observed late in the evening. Heavy drinking can affect the rate of alcohol elimination from the body, which is likely attributed to the increased expression of the CYP2E1 enzyme. However, this increase in alcohol elimination rate eventually slows down in individuals with advanced liver disease. [22]

Medications that function as ADH inhibitors can slow down the rate of alcohol elimination. H2 receptor blockers can also inhibit ADH, thereby reducing the first-pass metabolism in the stomach and potentially increasing blood alcohol levels. [22]

• History and Physical

While gathering patient history, it has been observed that individuals with AUDs often report engaging in binge drinking episodes of consuming 4 or more drinks in a single session. To further assess the likelihood of AUDs in individuals, healthcare professionals may utilize screening tools such as the CAGE questionnaire. A score of 2 or greater on the CAGE questionnaire typically indicates the need for further evaluation and potential diagnosis of AUDs. The CAGE questionnaire comprises 4 questions as listed below:  

• Have you ever felt the need to  Cut down on your drinking?
• Have you ever been  Annoyed by people criticizing your drinking?
• Have you ever felt Guilty about your alcohol consumption?
• Have you ever felt the need for an Eye-opener to steady your nerves or get rid of a hangover?

Patients with AUDs may report additional symptoms, including frequent falls, blackout spells, instability, or visual impairment. They may also report experiencing seizures, tremors, confusion, emotional disorders, and a pattern of frequently changing jobs following a few days of abstinence from alcohol. Social challenges such as job loss, separation or divorce, estrangement from family, or homelessness may also arise. In addition, sleep disturbances are also frequently reported.

Patients may be asymptomatic or present with hypertension or insomnia in the early stages. In the later stages, as the condition progresses, patients may report additional symptoms such as nausea or vomiting, hematemesis, abdominal distension, epigastric pain, weight loss, jaundice, or other signs of liver dysfunction.

To screen for AUDs, the US Preventive Services Task Force recommends the following tools:

• The 10-Question AUDIT (AUDs Identification Test)
• The 3-Question AUDIT (AUDIT-C)
• Single-Question Screening Test

During an examination, patients with AUDs may display signs of cerebellar dysfunction, such as ataxia or difficulty with fine motor skills. They may also exhibit other physical manifestations, including slurred speech, tachycardia, memory impairment, nystagmus, disinhibited behavior, or hypotension. Tremors, confusion or changes in mental status, asterixis, ruddy palms, jaundice, ascites, and other indications of advanced liver disease may also be observed in patients with AUDs. Other signs of liver disease associated with AUD may include hepatomegaly or splenomegaly in the early stages and the presence of spider angiomata, the development of cirrhosis, and liver shrinkage in the advanced stage of liver disease. 

Complications arising from alcohol usage may manifest as bleeding disorders, anemia, gastritis, ulcers, or pancreatitis. Laboratory tests may indicate anemia, thrombocytopenia, coagulopathy, hyponatremia, hyperammonemia, or decreased vitamin B12 and folate levels as the advanced liver disease progresses.

Evaluation of patients with suspected AUDs should involve a comprehensive assessment of their alcohol consumption habits. It is essential to inquire about the frequency and quantity of alcohol consumed by the individual. Standardized screening tools, such as the CAGE questionnaire and the screening questions for AUD (see Image . DSM 5 Criteria for Alcohol Use Disorder.), can help identify problematic drinking patterns in individuals with AUDs. Furthermore, obtaining a detailed family history of AUDs and substance use disorders, as well as personal and family history of any psychiatric disorders, is essential for the evaluation process.

The evaluation should include screening for any medical or behavioral complications related to alcohol use. This comprehensive evaluation may involve assessing for potential issues such as macrocytic anemia, elevated liver enzymes, coagulation disorders, pancreatitis, frequent falls, occupational difficulties, relationship issues, and aberrant behaviors (such as risky sexual activity or impulsiveness). [26] [27]

Alcohol biomarkers can assist in the evaluation process in patients with AUDs. Indirect biomarkers, including AST, ALT, GGT, mean corpuscular volume (MCV), and carbohydrate-deficient transferrin (CDT), can provide insights into the extent of alcohol-related organ damage. Direct biomarkers, such as alcohol and ethyl glucuronide levels, can help in the detection of recent alcohol consumption directly. Measuring CDT and phosphatidylethanol (PEth) can serve as a marker for long-term alcohol use or to monitor prolonged abstinence. [28] [29]

• Treatment / Management

Treatment approaches for substance use disorders, including AUDs, often involve a combination of nonpharmacological and pharmacological interventions. Nonpharmacological or psychologically based treatment methods include motivational interviewing, motivational enhancement therapy (MET), and cognitive behavioral therapy (CBT).

Motivational interviewing is a counseling approach that aims to assist individuals in recognizing and addressing their current problems and encourages them to make positive changes in their behavior. This approach is particularly effective for individuals who may feel ambivalent or uncertain about changing their behavior or quitting alcohol.

The primary objective of motivational interviewing is to enhance an individual's intrinsic motivation for change by addressing and resolving their ambivalence. Motivational interviewing is a therapeutic approach that aims to elicit and enhance an individual's intrinsic motivations or self-motivations for making positive changes in their lives. [30] [31]  A Cochrane review conducted on the topic concluded that motivational interviewing is a more effective approach compared to no treatment when it comes to reducing the severity of substance use. [32]  

MET is a manual-based intervention that incorporates the principles of motivational interviewing. It aims to strengthen the motivation and commitment of an individual to change their alcohol use behaviors. Through a personalized assessment, MET helps individuals to explore their alcohol use patterns. On the other hand, CBT is a therapeutic approach that emphasizes the connection between thoughts, behaviors, and emotions. CBT aims to assist patients in recognizing triggers and underlying factors that influence their behavior. [33] [34]

In addition to MET and CBT, other therapies are available to treat patients with AUDs. One of the therapies includes 24-hour residential facilities, commonly known as "inpatient rehab," which provide comprehensive treatment for individuals with alcohol-related medical and psychiatric complications or comorbidities. Furthermore, there are various programs, such as Alcoholics Anonymous (AA) or 12-Step programs, that focus on group support and mentorship. These programs can be valuable sources of assistance for individuals in maintaining abstinence. AUD is a chronic condition; many individuals may experience lapses or setbacks during recovery. Therefore, the intensity and duration of therapy may vary based on individual needs and circumstances. [35] [36]

Several pharmacological options can be combined with nonpharmacological approaches to enhance the treatment outcomes of AUDs. These medications include naltrexone, acamprosate, and disulfiram. [37]  

Naltrexone is a primarily mu-opioid receptor antagonist. It was initially approved by the US Food and Drug Administration (FDA) in 1994 as a pill that can be administered daily. [38]  In 2006, an extended-release injectable formulation of naltrexone was also approved by FDA, which can be administered once every 30 days. Naltrexone works by reducing the effects of endogenous opioids on the reinforcement of drinking alcohol. [39]  Numerous studies have demonstrated the effectiveness of naltrexone in reducing the frequency of drinking days and median drinking days and increasing the number of days of abstinence and continuous abstinence. [40] [41] [42]  Caution should be taken when administering naltrexone to patients with a co-occurring opioid-use disorder, as improperly timed medication administration can result in significant opioid withdrawal.

Acamprosate is a medication approved by the FDA in 2004 to treat AUDs. It is derived from taurine and is believed to function as a glutamate agonist. [43]   Although the exact mechanism by which acamprosate works remains unclear, it is believed to involve the modulation of inhibitory and excitatory neurotransmitters in the brain, promoting a balanced state between them. [44]  Based on a Cochrane review comprising 24 randomized clinical trials, it has been observed that acamprosate reduces the risk of relapse to drinking and enhances cumulative abstinence rates. [45]  

Disulfiram, approved by the FDA in 1951, functions by inhibiting ALDH, resulting in the accumulation of acetaldehyde in the body. When individuals consume alcohol while taking disulfiram, they experience a disulfiram reaction characterized by symptoms such as flushing, headache, shortness of breath, dizziness, and diaphoresis, among other symptoms. In severe cases, these reactions can lead to shock and subsequent death. The primary purpose of disulfiram is to create a fear of these adverse reactions, thereby motivating patients to abstain from alcohol. [46]

Other medications that have demonstrated efficacy in treating patients with AUDs, but have not yet received FDA approval, include gabapentin and topiramate. Gabapentin is typically prescribed as an anticonvulsant and for neuropathic pain management. It is believed to modulate central stress systems and correct dysregulation caused by alcohol use and cessation. [47]  There is also evidence that suggests that gabapentin decreases alcohol cravings. [48]  Topiramate, another anticonvulsant medication, has demonstrated mechanisms of action that make it effective for treating patients with AUDs. However, current literature indicates that topiramate is associated with a reduction in drinking days, an increase in abstinent days, and an overall decrease in alcohol cravings. [47] [49]

According to the American Psychiatric Association practice guidelines: [50]

• Patients with suspected AUDs should undergo evaluation for other psychiatric illnesses and co-occurring substance use.
• Physiological biomarkers should be used as an adjunct to assess the severity of a patient's alcohol use.
• The treatment goals should be discussed and agreed upon between the patient and the healthcare provider.
• The potential risks to oneself and others from continued alcohol use should be openly discussed.
• Hospitalization is recommended for patients experiencing severe alcohol withdrawal symptoms. Admission should also be considered for those with no social support, major psychiatric disorders, and a history of relapse.
• Patients should receive a person-centered treatment plan that includes pharmacological and nonpharmacological treatments, eg, the AA program.
• Patients should be encouraged to remove all alcohol from their homes as a positive step toward supporting their recovery process.
• Naltrexone and acamprosate are first-line pharmacotherapy options for patients who prefer medication and have not responded to nonpharmacological methods.
• Disulfiram can be used for patients who have not responded to naltrexone or acamprosate.
• Second-line medications of choice include gabapentin and topiramate.
• Differential Diagnosis

AUDs often occur concurrently with other conditions as individuals attempt to self-treat 1 or more of these conditions. Common disorders include:

• Posttraumatic stress disorder
• Bipolar disorder
• Panic disorder
• Anxiety disorder
• Dysthymic disorder
• Major depression

AUD is a significant and potentially harmful condition. According to the World Health Organization (WHO), AUDs are responsible for at least 3 million deaths annually, with a higher prevalence in men than women. In addition to the risk of death, AUDs are associated with various adverse outcomes, including:

• Motor vehicle collisions
• Esophageal, oral, liver, and breast cancers
• Homicide and suicide
• Hemorrhagic stroke

Identifying and treating AUDs early can help minimize the risks associated with this condition. Early intervention and timely treatment offer several advantages in mitigating the negative consequences and potential harm caused by AUDs.

• Deterrence and Patient Education

Patient education and deterrence play essential roles in addressing AUDs.

• Individuals with alcohol use disorder often display poor dietary choices, which can result in deficiencies of essential nutrients such as folate. Therefore, addressing and educating patients about the importance of maintaining a healthy diet is crucial.
• While engaging with patients who consume alcohol, it is essential to have open discussions about the risks they pose to themselves and others, including their physical and mental health.
• Patients with AUDs often benefit from regular and frequent engagement to make progress and stay motivated in their treatment.
• Discussions about a patient's AUD should be approached in a non-confrontational and non-judgemental manner to enhance the therapeutic relationship.
• Encouraging a healthy diet comprising fruits and vegetables is essential for individuals with AUDs for their overall well-being.
• Pearls and Other Issues

Here are some additional considerations related to AUDs:

• Complications arising from AUDs extend beyond physical health. They can significantly impact various aspects of a patient's life, including their socioeconomic status, mental health, interpersonal relationships, employment, and overall physical well-being.
• Early intervention in AUD is crucial for preventing further harm and promoting recovery. Regular and ongoing non-judgemental discussions between the patient and healthcare provider are vital.
• Acknowledging the patient's successes along their recovery journey and providing appropriate resources to support their continued efforts during each visit are essential for their well-being.
• Discussions should focus on identifying and addressing the barriers that may prevent individuals with AUDs from seeking cessation or assistance. By understanding these barriers, healthcare providers can collaborate with patients to explore new approaches that can improvise the likelihood of successfully overcoming the challenges associated with AUDs.
• Enhancing Healthcare Team Outcomes

AUD is a highly prevalent condition in the United States. Unfortunately, many individuals with this disorder do not seek medical attention until they encounter health issues or become entangled in legal complications. The consequences of AUDs extend beyond mere addiction, profoundly impacting the lives of family members and friends and causing disruptions in interpersonal and professional relationships.

It is uncommon for individuals with AUDs to seek help on their own proactively. Most alcoholics never receive necessary medical attention due to a lack of screening by healthcare providers. However, considering the increasing prevalence of AUDs, a national agenda has been established to address this issue. As part of this agenda, all healthcare professionals must be vigilant in identifying individuals with AUDs and making appropriate referrals to ensure they receive the necessary support for their recovery.

Primary care physicians, nurse practitioners, and pharmacists are pivotal in educating patients and raising awareness about the detrimental effects of alcohol consumption. Within inpatient settings, it is essential to offer counseling services, especially to individuals who are identified as having AUDs. Considering many individuals with AUDs may also experience psychiatric issues, including a mental health nurse in their outpatient care is highly beneficial for comprehensive patient support. 

Clinicians should encourage patients to attend AA meetings and consider involving their family members in recovery. If AA attendance alone proves insufficient, clinicians may need to explore pharmacological therapies as an additional intervention to assist patients with AUDs. CBT should also be offered to patients with AUDs. To ensure comprehensive care, adopting an interprofessional team approach involving various healthcare professionals to support individuals with AUDs is necessary.  

AUDs have no therapeutic benefits and pose significant disruptions in families and relationships. By providing appropriate interventions, support, and education, clinicians can actively contribute to the well-being and recovery of individuals affected by AUDs.

The prognosis for many patients with AUDs is challenging, with less than 20% to 30% achieving abstinence. In addition, the organ damage caused by alcohol is irreversible, further emphasizing the urgency of addressing the issue. To mitigate the impact of alcohol, it is crucial to provide comprehensive education to the patient and their family members about the destructive consequences of alcohol use. Referring patients to AA programs is a recommended course of action, as AA provides a supportive community and a structured approach to recovery. However, it is worth noting that compliance with AA attendance is often low, and alternative interventions may be necessary to enhance treatment outcomes. [1] [26]  

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DSM 5 Criteria for Alcohol Use Disorder Contributed by Sara M Nehring

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Recognizing Alcoholism as a Disease

Buddy T is a writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Because he is a member of a support group that stresses the importance of anonymity at the public level, he does not use his photograph or his real name on this website.

John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH).

Image Source / Digital Vision / Getty Images

One of the difficulties in recognizing alcoholism as a disease is it doesn't quite seem like one. It doesn't look, sound or act like most diseases we know. And, generally, alcoholism remains hidden and resists treatment.

However, alcoholism has been recognized for many years by professional medical organizations as a primary, chronic, progressive, and sometimes fatal disease. The National Council on Alcoholism and Drug Dependence offers a detailed and complete definition of alcoholism, but the most simple way to describe it is a mental obsession causing a physical compulsion to drink.

Mental Obsession

Have you ever woken up in the morning with a song playing over and over in your head? It might have been a commercial jingle you heard on television or a song from the radio, but it kept playing ... and playing and playing.

Remember what that was like? No matter what you did, the silly tune kept on playing. You could try to whistle another song, or turn on the radio to listen to another tune, but the one in your head just kept on playing. This thought was taking over your mind, even though you didn't want it there and tried hard to get it out out.

This is an example of a mental obsession – a thought process over which you have no control.

Such is the nature of alcoholism. When the drinking "song" starts playing in the mind of an alcoholic, they are powerless. The alcoholic didn't put or want the thought there, the only way to get it to stop is to have another drink.

The problem is the alcoholic's mental obsession with alcohol is much more subtle than a song playing in one's mind. In fact, a person may not even know it's there. All they know is there is a sudden urge for a drink, a physical compulsion.

The Neurobiology of Alcoholism

In 2016, the U.S. Surgeon General issued a report, "Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health," which details the changes in the regions of the brain of someone with an addiction in a section entitled, "The Neurobiology of Substance Use, Misuse, and Addiction."

According to the report, substance use disorders result from changes in the brain that occur with the repeated use of alcohol or drugs. These changes take place in brain circuits involved in pleasure, learning, stress, decision-making and self-control.

How the Reward System is Affected by Repeated Use

When someone drinks alcohol—or takes drugs like opioids or cocaine—it produces a pleasurable surge of dopamine in the brain's basal ganglia, an area of the brain responsible for controlling r eward systems and the ability to learn based on rewards.

With continued use of alcohol or drugs, nerve cells in the basal ganglia "scale back" their sensitivity to dopamine, reducing alcohol's ability to produce the same "high" it once produced. This is how one builds a tolerance to alcohol , which causes people to consume larger amounts to feel the same euphoria they once did.

The same dopamine neurotransmitters affected by alcohol and other substances are also involved in the ability to feel pleasure from ordinary pursuits such as eating food, having sex, and engaging in social interaction.

When this reward system is disrupted by substance misuse or addiction, it can result in the person getting less and less enjoyment from other areas of life when they are not drinking or using drugs, according to the Surgeon General's report.

Drinking Linked to Other Cues

Another change chronic drinking can cause is "training" the brain to associate the pleasure the person achieves by drinking with other "cues" in the drinker's life. The friends they drink with, the places they go to drink, the glass or container they drink from, and any other habits connected to drinking can all become associated with the pleasure they feel when drinking.

When so many things in life become reminders of drinking, it becomes more and more difficult for people to not think about drinking.

Drive to Avoid Pain

While the brain's dopamine transmitters drive us to seek pleasure, the stress neurotransmitters found in the extended amygdala region of the brain drive us to avoid pain and unpleasant experiences.

Substance abuse, including alcohol use disorders, can disrupt the normal balance between these two basic drives, research has found.

Avoiding the Pain of Withdrawal

As alcohol use disorder progresses from mild to moderate to severe, the drinker experiences increasing distress when they are not drinking. Symptoms from alcohol withdrawal can become very uncomfortable or painful.

Alcohol use can progress to a point where the only thing that can relieve the withdrawal symptoms is more alcohol.

At this stage, the person is no longer drinking to experience pleasure. In fact, drinking may not even bring any feeling of pleasure anymore. The drinker is drinking to avoid pain, not to get those feelings of euphoria.

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The Cycle of Addiction

Alcoholics build such a tolerance that they are no longer able to reach the high they once did, however, the lows they experience when not drinking become lower and lower. Other pursuits in life that once brought pleasure and balanced out the lows no longer do so.

When the drinkers were still relatively healthy, they could control their impulse to drink because the judgment and decision-making circuits of their prefrontal cortex would balance out those impulses. But, once addicted, substance use also disrupts prefrontal circuits.

When this happens, research shows, alcoholics and addicts have a reduced ability to control their powerful impulse to use the substance, even when they are aware it is not in their best interest. At this point, their reward system has become pathological, or, in other words, diseased.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database .

Compromised Self-Control Explained

The Surgeon General's report on the neurobiology of substance abuse, explains alcoholics' loss of self-control in this way:

"It is not a complete loss of autonomy—addicted individuals are still accountable for their actions, but they are much less able to override the powerful drive to seek relief from withdrawal provided by alcohol or drugs."

"At every turn, people with addictions who try to quit find their resolve challenged. Even if they can resist drug or alcohol use for a while, at some point the constant craving triggered by the many cues in their life may erode their resolve, resulting in a return to substance use, or relapse," said the report.

Progressive Disease

Compounding the problem already experienced by those facing alcoholism is the progressive nature of the disease. In the early stages of alcoholism, one or two drinks may be all it takes to get the "song" to stop. But soon it takes six or seven, and later maybe ten or twelve. Somewhere down the road, the only time the song stops is when the person is passed out.

The progression of the disease is subtle, and usually takes place over such an extended period, that even the alcoholic themselves fails to notice the point at which they lost control and alcohol took over their life.

For this reason, denial is an almost universal symptom of the disease. For those who have realized they have a problem, help may be as close as the white pages of the telephone directory. And, for those who need help and do not want it, help is still out there.

Are you worried you or a loved one have a drinking problem? Take a look at the Alcohol Abuse Screening Quiz to see how symptoms compare.

Morse RM, Flavin DK. The Definition of Alcoholism . JAMA. 1992;268(8):1012-1014. doi:10.1001/jama.1992.03490080086030

U.S. Department of Health and Human Services, Office of the Surgeon General. Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health . Washington, DC; 2016.

By Buddy T Buddy T is a writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Because he is a member of a support group that stresses the importance of anonymity at the public level, he does not use his photograph or his real name on this website.

Psychology Discussion

Essay on alcoholism.

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After reading this essay you will learn about Alcoholism:- 1. Meaning of Alcoholism 2. Classification of Alcoholism 3. Consequence 4. Causes 5. Current Methods to Treatment Alcoholism 6. Psychosocial Measures.

• Psychosocial Measures of Alcoholism

Essay # 1. Meaning of Alcoholism:

The problem of alcoholism has posed a serious threat to modern civilization for the very fact that around the world and particularly in the west very swiftly teenagers are turning alcoholics. It is stated that out of every 20 persons in the U.S.A., at least one is an alcoholic.

In India, a study sponsored by the Dep’t of Social Welfare, Govt., of India, in 6 states, Bombay, Delhi, Hyderabad, Madras, Varanasi and Jaipur on a sample of 35,000 showed that the most commonly abused drugs were alcohol, tobacco and pain killers.

In the revised edition of DSM III-R there is no specific diagnostic category called “Alcoholism”. Alcoholism is classified under the general term of “Psychoactive substance use disorder” and the specific syndrome that relate to alcoholism.

Alcohol is the major Psychotic drug used worldwide. Only in the U.S. there are estimated more than 13 million people who are diagnosed as alcoholics. DSM III-R reports that according to the community study approximately 13 per cent of the adults had alcohol abuse or dependence at some point of their life.

Following heart disease and cancer alcoholism is the third largest health problem in the U.S. today. As estimated by DSM III-R about 35 per cent of the American adults abstain, 55 per cent drink less than three alcoholic drinks a week and only 11 per cent drink an average of one ounce or more alcohol a day.

Drinking pattern also vary with age and sex. It is thus obvious that a small percentage of the population consume 20% of the total and 30% of the drinkers consume 80 per cent and 10 per cent of the drinkers consume 50 per cent.

Alcoholism is linked with many social evils including automobile and train accidents, murder, rape, physical assault, molestation, industrial accidents and also homicide and suicide. It disrupts social and familial life.

Cancer and heart diseases occur due to heavy drinking. It is also responsible for lowered efficiency and absenteeism among industrial workers. It is considered as the third major cause of death in U.S.A. The average life span of an alcoholic is 12 years less than of a normal person.

The W.H.O. (1969) has defined alcoholics as excessive drinkers whose dependence on alcohol has attained such a degree that they show noticeable mental disturbance or an interference with their mental and bodily health, their interpersonal relations and their smooth social and economic functioning, or who show the prodromal (beginning) signs of such developments.

Alcohol is a depressant drug which affects the central nervous system immediately. It no doubt produces some stimulation and reduces tension and brings relaxation. But when larger amounts are consumed, sensory motor coordination, balance, vision, speech, thought processes and perceptions are affected.  

Essay # 2. Classification of Alcoholism:

I. the alpha alcoholics:.

It is the beginning stage. The alpha alcoholic depends upon alcohol to reduce or relieve emotional tension or physical pain. It does not lose control after the use of the drug. But when he finds that use of alcohol is more important than communicating with others, his interpersonal relationship deteriorates.

ii. The Beta Alcoholics:

In addition to interpersonal difficulties physical problems arise by the excessive use of alcohol like cirrhosis of liver and ulcers, heart troubles. But in this type there is no physical or psychological dependence.

iii. The Gamma Alcoholics:

The gamma drinkers lose control of their drinking and exhibit significant signs of physical, psychological and social deterioration. The physiological dependence in the gamma drinkers is such that when they stop drinking physiological withdrawal symptoms are found.

iv. The Delta Alcoholics:

The delta alcoholic is the most severe type among the four. The drinkers drink right from the morning continuously without any break and cannot abstain from drinking for any period of time. He neglects his food and becomes weak. He is never found to be sober. When the drinking is cleared, it leads to severe physiological withdrawal symptoms.

Essay # 3. Consequences of Alcoholism:

A Japanese proverb says “First the man takes the drink, then the drink takes the man.” The physiological, social, psychological familial and occupational disturbances arise due to the adverse consequences of alcoholism.

Physiological damages include damage of the liver, endocrine glands, heart failure and hypertension etc. The physical effects are so adverse that according to Talbolt (1974) withdrawal from alcohol may lead to death in certain cases. It is also psychologically unpleasant. Hallucinations occur.

There is physical pain. Vision and speech are affected. The nervous system may not automatically continue functioning, breathing may stop and convulsions may occur. When this stage is somehow passed, the person gets back his normal life to some extent and many of the symptoms may disappear. But alcoholic toxicity is still present and needs medical care.

Delirium tremens are the most important psychological symptoms associated with withdrawal of alcohol. These tremens occur in people who are over 30 years age and drinking consistently at-least for 4 years. It is caused by a suaden drop in the intake of alcohol. The symptoms of delirium tremens are restlessness, sleeplessness, night mares, hallucinations, and delusions of terrifying nature.

After the delirium Korsakeff’s psychoses may also occur; with the symptoms of amnesia, disorientation in time and place, distortion of memory or pseudo memory. Due to pseudo memory, the person talks about things that never happened to him and this occurs in women alcoholics more frequently.

Alcohol being a central nervous system depressant like the other anaesthetics, when 0.05 per cent alcohol is found in the blood, thought, judgment and restraints are loosened and sometimes disrupted. Voluntary motor actions by and large become visibly clumsy at a concentration of 0.10 per cent.

When the level of alcohol in blood reaches 0.20 per cent, the function of the entire motor area of the brain is significantly depressed and the parts of the brain controlling emotional behaviour is likely to be affected. At 30 per cent a person is usually confused and may become stuporaous.

At 40 to 50 per cent the alcoholic is in coma and at more higher levels, centres of the brain controlling breaching and rate of heart beat are affected leading to possibility of death. Alcohol also decreases REM sleep and causes insomnia.

Alcoholic paramecia also may occur in some who are predisposed to faulty adjustment and suspicion. Abuse of alcohol may also lead to all sorts of maladaptive characters like jealousy, hatred, fault finding and the adjustive capacity of the person becomes weak day by day.

Essay # 4. Causes of Alcoholism:

It is said that alcohol tends to induce a pleasant feeling tone, brings relaxation, reduces tension and provides physical and mental stimulation to work. Pointing out the physiological effects of wine, a Roman poet wrote, “It discloses secrets, ratifies and confirms our hopes, thrusts the coward forth the battle, ceases the anxious mind from its burden and instructs in arts.”

However, the alcoholic has strong craving for alcohol and this makes him unfit for any job in the sense that his attention is centred around alcohol only.

Why a person becomes alcoholic while others not?

It has several causes.

i. Biological Factors :

Some believe that alcoholism or the tendency for alcohol may be inherited. Findings of the studies by Erickson (1968), Rodgers (1966) and Schlesinger (1966) show certain evidences of the presence of certain genetic components in the occurrence of alcoholism.

Winokur (1970) found that alcoholism does tend to run in families. In a study of 259 hospitalized alcoholics he found that more than 40 per cent had a parent who was an alcoholic. Goodwin (1973, 1974) on the basis of their findings viewed that “it was being born to an alcoholic biologic parent rather than being raised by one that increases the risk of the son becoming an alcoholic.”

It is said that children of alcoholics become alcoholics about 4 times more often than children of non-alcoholics even when they are not brought up by their own parents. In a 30 year longitudinal Swedish study of adopted male children who subsequently become alcoholics, it was found that about 25 per cent had biological fathers who were also alcoholics.

Another Swedish study revealed that monozygotic twins had about twice the coincidence rate of alcoholism as dizygotic twins of the same sex. Studies also indicate a higher craving for alcoholism among dizygotic twins than among non-twin siblings.

Irwin (1968) reported that more than 50 per cent of the alcoholics had an alcoholic parent. On the other hand, Roe, Burks and Mittleman’s (1945)’s findings doubt the genetic hypotheses. Studies of Rose, Burks have supported the above study.

There are majority of cases where children of alcoholic parents do not become alcoholics. Thus Coleman (1981) says, “whether the familial incidence results from shared genes or a shared alcoholic environment is a matter of some controversy.”

The exact role of genetic factors in the causation of alcoholism is therefore not known. It is viewed that constitutional predisposition to alcoholism can be acquired as well as inherited. However, the genetic factors may play their role in predisposing causes.

ii. Psychological and Personality Factors :

Besides the physiological dependence alcohol also produces a strong psychological dependency as well because of the following factors:

(a) Psychological vulnerability:

It refers to a type of personality which makes one vulnerable or predisposed to alcohol under conditions of stress. Instead of using some other defence to adjust with or overcome the stress, these people turn to alcohol.

Personality studies of alcoholics show that they are emotionally immature, they need a lot of praise, appreciation and attention from others and they are very much hurt and disturbed by failures and frustrations.

They feel very in-secured and inferior and have low frustration tolerance. Winokur (1970), Pralt (1972) and Mcclelland (1972) have stated that many young men take to heavy drinking to prove their masculinity and to achieve feelings of adequacy and competency.

According to the findings of James (1968, 1971), Wood uff (1973), antisocial personality and depression may also have some links with heavy drinking.

In-spite of these findings it is not yet established which specific characters are responsible in the development of alcoholism. Nobody can deny that there are also many persons with identical personality characteristics and yet they have not become alcoholics.

However, the role of personality maladjustment in the causation of alcoholism cannot be denied. Since excessive drinking impairs the total life adjustment of an individual, the question arises as to what needs alcohol fulfils that the individual so much depends upon it?

According to the psychological theories alcohol takes the person away from the burdens, responsibilities, heart aches, sorrows and distresses, worries and anxieties of modern life. Alcohol is a vehicle to escape from conflicts, business worries and inferiority complexes.

It gives courage to the coward, confidence to the timid, pleasure to the unhappy and success to failure that is what those who take alcoholics say. In brief, alcohol permits a flight from the disappointments and frustrations of reality. These explanations nevertheless speak only a part of the story.

(b) Stress, tension reduction and reinforcement:

Innumerable observa­tions of the personal lives of alcoholics and quite a number of investigations point out that an alcoholic is dissatisfied with life and has very less frustration and stress tolerance capacity. They probably take it to be away from reality, a reality without hope and meaning for them.

This view has been particularly put forth by the American Medical Association Committee on Alcoholism and Drug Dependency (1969). According to Schafer, alcoholism is a conditioned response to anxiety. When the person finds that each time he takes alcohol it reduces his anxiety, stress and gives him relaxation, he is further reinforced to take it more and more until he becomes alcoholic.

Other experts on the subject reject this view and opine that alcoholism is only a learned maladaptive response which is reinforced and maintained by tension reduction.

Bandura (1969) stated that delayed consequences are very harmful and destructive for the person; yet people are more influenced and controlled by the immediate effect. The immediate reinforcement encourages them to take to drinking more and more.

(c) Marital crisis and other familial problems:

Marital problems pose many crisis for the individual. It not only hurts him, but brings in self devaluation. Divorce, separation, untimely death of children or spouse add to the extra marital relationship of one of the partners, constant quarrel and conflict between husband and wife, poverty and disease may lead to habitual drinking.

Alcohol problems are also correlated with a history of school difficulty, High School dropouts and persons with records of antisocial activity and delinquency appear to be at particularly high risk for alcoholism. Cirhosis data suggest that persons in certain occupation are more likely to develop alcoholism.

Alcoholism is estimated to be associated with at-least 50 per cent of traffic accidents, 50 per cent homicides, 25 per cent of suicides and large number of deaths in a year from alcoholic related diseases.

Persons with a harsh superego turn to alcohol as a means of reducing their unconscious stress. Some alcoholics are fixated at the oral stage of development and relieve frustration by taking substances in mouth. The alcoholic personality is described as shy, isolated, impatient, irritable, anxious, hypersensitive and sexually repressed.

iii. Sociocultural Factors:

The role of sociocultural factors in alcoholism and alcohol abuse has been emphasised by many investigators, particularly in certain societies and cultures, drinking has been considered as a social act. This sociocultural trend encourages many to drink in clubs, parties and in many other social get together.

According to Pliner and Capped (1974) liquor has come to play an almost ritualistic role in prompting gaiety and pleasant social interaction. Different cultures pose different degree of stress for the person. Horton (1943) noted that greater the insecurity level and stress in a culture, greater is the need for taking alcohol to the level of becoming an alcoholic.

Bales (1946) in a quite useful study pointed out 3 cultural factors that play a part in determining the incidence of alcoholism in a given society:

(a) The degree of stress and inner tension produced by that culture.

(b) The attitude towards drinking fostered by that culture.

(c) The degree to which the culture provides the substitute means of satisfaction and other ways of copying with tension and anxiety. To add to this, the effects of rapid social change and social disintegration in a particular culture, with which people are not able to cope, lead to further stress and anxiety.

Eskimos for instance, in many places of rural Alaska, (Time, 1974) are taking to heavy drinking mainly due to the rapid social change in their traditional values and way of life.

In comparison to other countries of the world, alcoholism is said to be a major problem in the United States and Soviet Union. An overall analysis of the various explanations of alcoholism reveals that it is not caused by a single factor. It is an outcome of multiple variables influencing simultaneously. Many more factors of alcoholism are still unknown and future research can only highlight these factors.

Alcoholism is a highly complex disorder involving multifarious causes. Thus, the appropriate approach to the treatment of alcoholism seems to be multidisciplinary. Alcoholism requires flexibility and individualisation of treatment procedures. Hospitalisation and institutionalisation of alcoholics are being treated in community clinics.

When the impairment because of alcoholism becomes severe the patient needs constant care. The risk is 35 per cent of alcoholic pregnant woman having a defective child. Excessive consumption of alcohol also causes her more imbalances leading to the risk of abnormalities.

Treatment can be most successful in patients who voluntarily come to a psychiatrist for treatment because they feel that they need help to give up alcoholism. This conscious feeling that alcohol is undesirable for them is to be aroused by someone since this realisation has a tremendous impact.

Physical punishment is an old type of treatment which does not work. In many plants, however, alcoholic employees are threatened by employers with immediate discharge from job which leads to permanent cure in some cases. Vigilance during the first week of the month may also reduce alcoholism to some extent.

Essay # 5. Current Methods to Treatment Alcoholism:

I. biological measure:.

Medical measures in detoxification include, elimination of the harmful alcoholic substances from the individuals body, treatment of withdrawal symptoms. A drug called chlordiazepoxide has helped a lot in the treatment of withdrawal symptoms like motor excitement, nausea, vomiting, delirium, tremors and convulsions.

It also alleviates tension and anxiety. After detoxification psychological measures like family counselling, employment facilities including other social readjustments are provided.

ii. Aversion Therapy :

The patient is given to drink at regular intervals mixed with emetic drugs; which have extremely uncomfortable effects. Antabuse may also be administered to prevent the return of drinking immediately. It is presumed that since each such drink makes him ill, he will become sufficiently conditioned to stop taking to alcohol.

By means of electric shock aversive conditioning, technique can be applied with success. But unless his emotional problems are solved he may again take to drinking in-spite of the uncomfortable feeling it provides and he will again continue to drink.

Davidson (1974) has viewed on the basis of extensive comparison of available studies that despite a number of positive results there was insufficient data to assess the long range effectiveness of aversion therapy on alcoholism.

iii. Brain Surgery :

Fritz, Roder and his associates (1974) from Gottingen University in Germany have opined “our research have revealed that dependence on drugs or alcohol assumes that proportions of a natural urge after a certain period and the sexual drive or urge to eat, is controlled by a certain brain centre. Neutralizing this centre which is more than 50 cubic millimetre in volume, will cure the patient for all time.”

However, to use brain surgery for the treatment of alcoholism is a controversial matter in view of its dangerous procedure.

Essay # 6. Psychosocial Measures of Alcoholism:

It involves:

(a) Group therapy,

(b) Socio-therapy,

(c) Alcoholics Anonymous.

i. Group Therapy :

The alcoholic must realise that he has a problem which needs his cooperation for its solution. This very recognition of the problem and its undesirable devastating consequences will have the way to therapy. After this through group discussion in the midst of family members and through family therapy treatment may proceed. Here each family member is given a responsibility for cooperating in treatment.

Behaviour therapy:

Through behaviour therapy the alcoholic is taught other ways and methods to reduce anxiety. By the help of relaxation training, assertiveness training, self controlled skills and new strategies to master the environment, efforts are made to reduce anxiety and tension of the alcoholic.

A number of operant conditioning techniques are also used which condition alcoholics to modify their drinking behaviour or abstain from drinking completely. The reinforces in these techniques used are monitory reward, an opportunity to live in an enriched, in-patient environment and access to pleasurable social interaction.

ii. Socio Therapy:

The therapist helps the patient to work out a solution that will give him the satisfaction he is lacking. His aversive life situations are to be alleviated. The therapist must help the patient to reopen the happy chapter of his family life once more having a congenial and cordial relationship with family members, relations and friends.

He should be helped to develop effective methods of adjustment. He should not be allowed in any way to live in high risk environments.

Thus, the aim of socio-therapy is to deal adequately with the hostility, negative attitude of the family, friends and society towards the alcoholic. Keeping this in mind currently community reinforcement approach has developed the main aim of which is to help the problem drinkers to achieve more satisfactory adjustment in personal, professional and social life.

iii. Alcoholics Anonymous:

It is a practical approach to the treatment of alcoholism which has been quite effective. It is mostly a psychotherapeutic programme in which person to person and group relationships are encouraged, spiritual development is the central point of its approach to treatment.

Discussions on the problem are made. It provides for its members an atmosphere of mutual understanding, acceptance and sympathetic fellow feeling. The alcoholics are encouraged to solve their problems without the feelings of isolation and shame.

The alcoholics anonymous technique lifts the burden of personal responsibility from the alcoholic by helping him to realise that “alcoholism like many other problems is bigger than he.

” Regarding the effectiveness of Alcoholic Anonymous Coleman (1981) states “By mutual help and reassurance through participation in a group composed of others, who have shared similar experiences, many an alcoholic acquires insight into his problems, new sense of purpose, greater ego strength and more effective coping techniques.”

Among patients who really want to be cured and whose drinking has been of recent origin, this approach to alcoholism has met with considerable success. Not only treatment, prevention of alcoholism is particularly important in India, keeping in view the widespread misery, wastage, illness and loss of life it causes.

Social consciousness through propaganda campaigns, posters, audio visual aids and education is aroused among people regarding the adverse effects of alcohol. The rural illiterate masses and the weaker sections of the society who have particularly become victims to alcohol should be given special attention.

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What is alcoholism?

There are many different ideas about what alcoholism really is. The explanation that seems to make sense to most A.A. members is that alcoholism is a progressive illness that can never be cured but that, like some other diseases, can be arrested. Going one step further, many A.A.s feel that the illness represents the combination of a physical sensitivity to alcohol and a mental obsession with drinking, which, regardless of consequences, cannot be broken by willpower alone. Before they are exposed to A.A., many alcoholics who are unable to stop drinking think of themselves as morally weak or, possibly, mentally unbalanced. The A.A. concept is that alcoholics are sick people who can recover if they follow a simple program that has proved successful for more than two million people. Once alcoholism has set in, there is nothing morally wrong about being ill. At this stage, free will is not involved, because the sufferer has lost the power of choice over alcohol. The important thing is to face the facts of one’s illness and to take advantage of the help that is available. There must also be a desire to get well. Experience shows that the A.A. program will work for all alcoholics who are sincere in their efforts to stop drinking; it usually will not work for those not absolutely certain that they want to stop.

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Alcoholism Essay Examples

When it comes to writing an essay on alcoholism, choosing the right topic is crucial. The chosen topic will determine the direction of the essay and the depth of research required. It is important to select a topic that is not only interesting but also relevant and meaningful.

Alcoholism is a serious issue that affects millions of people worldwide. Writing an essay on this topic provides an opportunity to raise awareness and educate others about the dangers of alcoholism. It can also shed light on the various causes, effects, and treatment options available. By choosing the right topic, one can make a significant impact in addressing this issue.

When choosing a topic for an alcoholism essay, it is important to consider the target audience and the purpose of the essay. It is also crucial to select a topic that is well-researched and has sufficient information available to support the arguments. Additionally, selecting a topic that is relevant and timely can make the essay more engaging and impactful.

Below is a list of recommended alcoholism essay topics, categorized for ease of reference:

Causes of Alcoholism

• The role of genetics in predisposing individuals to alcoholism
• The impact of family and upbringing on the development of alcoholism
• The influence of peer pressure and social environment on alcoholism
• The genetic predisposition to alcoholism
• The correlation between childhood trauma and alcoholism
• The impact of mental health disorders on alcoholism

Effects of Alcoholism

• The physical health effects of long-term alcohol abuse
• The psychological and emotional impact of alcoholism on individuals and families
• The societal and economic consequences of alcoholism
• The mental health effects of alcoholism
• The impact of alcoholism on family dynamics
• The economic impact of alcoholism on society
• The correlation between alcoholism and crime

Treatment and Recovery

• The effectiveness of different treatment options for alcoholism
• The role of support groups and counseling in the recovery process
• The challenges and successes of alcoholism recovery programs

Prevention and Education

• The role of education and awareness in preventing alcoholism
• The impact of alcohol advertising and marketing on alcoholism rates
• The effectiveness of government policies and regulations in addressing alcoholism
• The importance of early intervention in preventing alcoholism
• The correlation between alcoholism and underage drinking

Special Populations

• Alcoholism among adolescents and young adults
• Alcoholism in the elderly population
• Alcoholism in specific cultural or ethnic groups

Alcoholism and Co-Occurring Disorders

• The relationship between alcoholism and mental health disorders
• The connection between alcoholism and substance abuse
• The impact of alcoholism on individuals with chronic health conditions

Social and Cultural Aspects

• The portrayal of alcoholism in the media
• The stigma associated with alcoholism
• The impact of cultural norms on alcoholism
• The role of alcohol in social gatherings and events
• The correlation between alcoholism and gender

By choosing a topic from the above categories, writers can explore different aspects of alcoholism and contribute to the ongoing conversation about this important issue.

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Not planning to discuss the poetic words of Omar Khayyam when speaking of wine and wisdom, we can say that the problem of alcoholism has always been a menacing part of civilization. It can be approached as the side of culture, yet at the same time, it is a dumb side of human life where aggression, drunk behavior, drunk driving, and grief reflect in many sides of life. When a college student plans to discuss the topic of alcoholism, it becomes an important social issue where a person tries to find the causes like poverty or access to luxury, which seems to plaque both sides of our complex equation.

Of course, the topic of drinking has always been a part of history through decades and generations. It must be noted that even if we approach this problem as the history or anthropology specialists by taking the United States or any other country, we can see that the art of drinking has been dimmed negatively. Is drinking a good practice? It is seen as a form of alcoholism even through the feasts and celebrations. Speaking of our modern times, we can see that this problem is more persistent than ever because we have greater access to alcoholic drinks even among the younger generation. One can take the drinking bans throughout history or research the present times, yet in both cases, we can see that there is no recreational drinking or any apologetics.

We can see many people who have battled drinking in the past. There are such personalities as Daniel Radcliffe of Harry Potter fame, Ben Affleck, Michael Phelps, Tim McGraw, and many others. We can also add Naomi Campbell and Jessica Simpson as famous female persons. It should be added that all these celebrities came out to talk that alcoholism is often a problem that is brought beneath the carpet to hide and ignore. Just like drug addiction, this problem should not be silenced because it requires help and guidance. It is also one of those topics that a college student should approach to find a solution and provide educational norms to make a positive change.

• As we think about why do people drink, we can see some argument that it helps to relax
• It leads to a mental breakdown.
• It is an addiction that distorts your physical image.
• It is a mind-altering substance that makes a person lost and tortured.
• It takes away the life of a person and the lives of those who are around.
• It often resorts to violence and anger.

The pains of alcoholism can only be battled with the help of a different culture, social work, and education. As many modern students grew up in alcoholic households or saw their friends grow up in one, we all have some story to tell. It is sufficient to say that the problem of alcoholism must be addressed from helping the addicts to educating young people about the dangers. For example, by choosing this topic an average student can create a social program that would help people in the local community. Likewise, you can write about the economical side of alcoholism since it also helps certain people earn by promoting alcohol in ads and the mass culture.

It will always depend on your initial subject. You can write about the causes of alcoholism and notice that both poor and rich people can become trapped in this unfortunate circumstance. Your college essay can be reflective by telling about your experience or tell about how dangerous it is to drive drunk after a college party. You can take a look at our free samples that relate to alcoholism as you think about some good subjects. The most important is to provide statistics and keep your writing argumentative to make your alcoholism paper reliable!

It can be approached with the help of special educational projects and studying the shelters for alcoholics. At the same time, your college professor may ask you to write about alcoholism in the 1970s when compared to the present times. It is important to see how American society approached alcohol in the past. An important aspect is seeing how the same methods still remain helpful, including education, talks at school, and the family culture. Uniting various techniques that take root in Psychology, Healthcare, and Education, any student can make a positive change in battling alcoholism.

Relevant topics

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Malibu’s Most Exclusive, Butt-Kicking Spa Is Coming East

The Ranch, which specializes in long hikes, communal vegan meals and snacks of precisely six almonds, is opening an outpost in the Hudson Valley.

By Danielle Pergament

You will wake up at 5:30 a.m. and stretch for 30 minutes. You will eat something vegan and organic for breakfast followed by an hourslong hike on which you will hear words like “verticality.” If you need a snack, you will get six almonds. Not seven — don’t be gluttonous.

In the afternoon, you will take a cold plunge, dunking yourself in water cooled to a painful 55 degrees. The throbbing in your body is not a hangover — there is no alcohol — it’s from the 10 miles you hiked yesterday, or it could be the 12 you hiked the day before. Or maybe it’s the 1,400 calories a day allotted. For all this, you will pay thousands of dollars.

This is luxury wellness in 2024. Some destination spas and high-end retreats are more akin to Navy SEAL prep — or at the very least, basic training — than five-star resorts.

The standard-bearer of this group is the Ranch, 200 acres of nature and trails in the Santa Monica Mountains of Malibu, Calif. For 14 years, the Ranch has been helping 25 people at a time destress, detox and generally rid themselves of the anxieties of life.

“It’s not like any other place,” said Gillian Steel, 69, who sits on the board of the New-York Historical Society and has been to the Ranch nine times. The Ranch, she said, “isn’t just a week-away experience. They manage to be both stylish while pushing you. You meet the most interesting people and get a week to yourself at the same time.”

In late April, the Ranch will open a second property, this time in the Hudson Valley of New York.

“For years, our guests kept saying, ‘Please open something on the East Coast,’” said Sue Glasscock, who owns the Ranch with her husband, Alex, both 60. “We kicked the idea around for a long time.”

They eventually found a lakeside estate on 200 acres of forests and trails flanked by state parks near the New Jersey border in the town of Sloatsburg, N.Y. The house, a 40,000-square-foot stone mansion previously known as Table Rock estate, was built in 1902 by J.P. Morgan. (It was a wedding present to his daughter and new son-in-law, the great-grandson of Alexander Hamilton, and was later owned by an order of nuns .)

“It’s an hour from Manhattan, which is just crazy to me,” said Ms. Glasscock.

To the mountains

I met the Glasscocks for lunch at their home at the Ranch Malibu. In the foreground, three bowls of warm cabbage soup, topped with crispy kale and microgreens. In the background was the entirety of the Santa Monica Mountains, and just beyond, a glimmering streak of the Pacific. It was hard not to feel healthier, calmer and more sustainable just being there.

“We don’t think of ourselves as a spa — we never have,” said Mr. Glasscock. “To be honest, I don’t like the word wellness.” Before opening the Ranch, the couple bought and remodeled houses and designed gardens.

The natural world — both in Southern California and the Hudson Valley — is the most important amenity at the Ranch. “Nothing we do is trendy,” said Ms. Glasscock. “The point is that you’re in nature. You’re eating food from the garden, you’re drinking more water, you’re sleeping more, you’re taking time off your devices. And you’re playing.”

Play, she said, is a proven aid to longevity and something adults don’t do enough. At the new location, a hill in the backyard will give guests a chance to go sledding in the winter. “The Ranch is basically like camp for grown-ups,” she said.

But grown-up camp doesn’t come cheap. The Ranch Malibu has a six-night, seven-day minimum and can cost more than $9,000 a week, depending on the package. The price of a stay at the Ranch Hudson Valley will range from $2,575 per person (three nights, double occupancy, low season) to $6,900 per person (four nights, single occupancy, high season). With high prices comes exclusivity.

“It’s hard,” said Mr. Glasscock. Part of the impetus for opening in the Hudson Valley, he said, was to give people the option to come for three days. “Obviously, that lowers the cost, and still gives people time to reconnect to nature.”

From weight loss to longevity

As wellness has gone mainstream, places like the Ranch have played a pivotal role in changing the definition of destination spas.

“In the U.S. in the last 10 or 20 years, destination spas were focused on weight loss and fixing bad habits like alcohol, coffee, smoking and eating too much meat and sugar,” said Linda Wells, the founding editor of Allure magazine and the editor of Air Mail Look , a beauty and wellness newsletter (to which I have contributed). “But the experience boiled down to getting weighed and measured on Day 1 and again on departure day, with a report card of pounds and inches lost at the end. Weight loss and flat abs were the goal, not health — and definitely not longevity.”

But wellness evolved. Even in light of recent controversies , one of the most popular podcasts on Spotify is still “Huberman Lab,” in which a Stanford University neurobiologist discusses cold exposure, sleep hygiene and circadian rhythms. And an increasing number of spas offer an array of high-tech, often medicalized programs .

Other pricey destination spas also take the boot camp approach. There is Golden Door in California, Mii Amo in Arizona, and Miraval and Canyon Ranch , both of which have several outposts. All of these combine spa treatments, exercise programs, special diets and the promise of resetting to a healthier lifestyle. But the Ranch is singular in its simplicity. There are vegan cooking classes, energy healing sessions and infrared saunas, but don’t expect Botox or filler injections.

“I’m not against those things,” said Ms. Glasscock. “It’s just not in our ethos.”

The Ranch is also extremely luxurious and deliberately communal. Arrival and departure dates are set according to weekly packages, so guests see the same faces for a week. Activities — including the daily hikes — are done as a group. And there is only one dining table, so you eat all meals with the rest of the guests.

“I was expecting meditation, heads down, keep to yourself, but it’s not that at all,” said Jillian Spaak, the director of a real estate investment company who lives in Southern California and first went to the Ranch 10 years ago when she was getting divorced. “You’re communing with other people, you’re hiking together, and you’re all eating meals at the same table. You go through peaks and valleys — literally — and you’re all there for the same reason: to feel better, to look better, to be better. ”

“We want to take what we consider the important aspects of health, wellness and longevity and immerse everyone in all of them for a week or three days,” said Ms. Glasscock. “Most people want a silver bullet, but there is no such thing.”

Follow New York Times Travel on Instagram and sign up for our weekly Travel Dispatch newsletter to get expert tips on traveling smarter and inspiration for your next vacation. Dreaming up a future getaway or just armchair traveling? Check out our 52 Places to Go in 2024 .

Exploring the Outdoors, One Step at a Time

Hiking is a great way to immerse yourself in nature and tune out the chaos of city life. the tips below will help you get ready before you hit the trail..

Hiking offers a host of mental and physical benefits. If you’re new to it, here’s how to get started .

Fourteen years and one Apple App of the Year award in, AllTrails has become something rare: a tool that works for both experts and newbies .

Make sure you have the right gear . Wirecutter has recommendations for anything you might need — from hydration packs  to trekking poles . And remember to try on hiking boots  at the right time of the day .

These clever apps and devices  will help you to find your way, triage an injury and generally stay out of trouble on the trail.

Planning to venture out for a nighttime  hike ? Opt for wide, easy-to-navigate paths.

Experts say failing to alert family or friends of your plans is one of the biggest mistakes hikers make. Here are some more safety tips .

What is Definition of Alcoholism

Alcoholism, the most severe form of alcohol abuse, isn’t just about enjoying a few drinks; it’s a complex disorder that can wreak havoc on every aspect of life.

Also known as alcohol use disorder (AUD), it manifests in various forms, from mild to severe, each with its own set of symptoms and consequences.

If left unchecked, alcoholism can spiral into a destructive cycle, causing irreparable harm to health, relationships, and overall well-being.

Deciphering the Warning Signs

Identifying alcoholism isn’t always straightforward, as the signs can be subtle or masked by other factors.

However, recognizing the warning signs early on is crucial for initiating effective treatment and preventing further deterioration.

Common Indicators of Alcoholism

• Lack of Control : Struggling to manage alcohol consumption despite attempts to cut back.
• Cravings : Feeling an intense urge or desire to drink even when not actively drinking.
• Prioritizing Alcohol : Putting alcohol ahead of personal responsibilities, such as work, family, or social obligations.
• Increased Tolerance : Needing to drink more alcohol to achieve the same effects as before.
• Financial Impact : Spending a significant amount of money on alcohol, often at the expense of other necessities.
• Behavioral Changes : Exhibiting noticeable changes in behavior or personality after consuming alcohol.

Exploring the Motivations Behind Alcohol Consumption

Alcohol abuse is a multifaceted issue influenced by a myriad of factors, ranging from stress and grief to social pressures and unresolved trauma.

Understanding the underlying reasons why individuals turn to alcohol is crucial for addressing alcoholism and promoting healthier coping mechanisms.

Relieving Stress: A Double-Edged Sword

• Escape from Reality : Many individuals resort to alcohol as a means of alleviating stress and temporarily escaping life’s pressures. While alcohol may initially provide a sense of relaxation and relief, frequent consumption can lead to dependence and exacerbate stress levels over time.
• Tolerance Buildup : Continued reliance on alcohol to cope with stress can result in tolerance buildup, necessitating higher alcohol consumption to achieve the desired effects.

Seeking Pleasure and Comfort

• Emotional Relief : Alcohol can offer a fleeting sense of euphoria and pleasure, serving as a temporary distraction from underlying emotional pain or distress.
• Risk of Dependency : Relying on alcohol as a sole source of comfort or joy can quickly escalate into a dangerous pattern of dependency, leading to addiction and adverse health consequences.

Coping with Loss and Trauma

• Grieving Process : Following the loss of a loved one or experiencing trauma, individuals may turn to alcohol as a coping mechanism to numb emotional pain and facilitate the grieving process.
• Unresolved Trauma : Traumatic experiences, whether from childhood or adulthood, can significantly impact mental health and contribute to the development of alcohol use disorder. Addressing underlying trauma is essential for long-term recovery and healing.

Social Isolation and Connection

• Loneliness : Feelings of isolation and disconnectedness from others can drive individuals to seek solace in alcohol, believing it will alleviate loneliness and foster social connections.
• Escalating Dependency : Despite initial perceptions of social lubrication, excessive alcohol consumption can further isolate individuals and hinder genuine interpersonal connections.

Navigating Shame and Guilt

• Temporary Escape : Alcohol may offer a temporary reprieve from feelings of shame and guilt, providing a fleeting sense of numbness or detachment.
• Reckless Behaviors : However, alcohol-induced recklessness can exacerbate feelings of shame and guilt, perpetuating a vicious cycle of self-destructive behavior and emotional distress.

Understanding Trauma and its Impact

• Pervasive Influence : Trauma, in its various forms, is a common underlying factor in addiction, profoundly affecting mental health and contributing to maladaptive coping mechanisms.
• Healing and Recovery : Addressing unresolved trauma is paramount in the journey to recovery, as it enables individuals to confront and process painful experiences in a supportive environment.

Also Read: The Maasai Tribe Facts: Blood Drinking, Lion Hunting All about The Maasai Tribe in Kenya

Unveiling the dangers of excessive drinking.

Alcohol, often viewed as a social lubricant, can harbor profound risks when consumed irresponsibly. From short-term impairments to long-term health consequences, the effects of alcohol abuse can be far-reaching and potentially life-threatening.

Short-term Impacts: A Momentary Lapse with Lasting Consequences

• Impaired Functioning : Excessive alcohol consumption can impair motor skills, reaction time, and coordination, leading to dangerous situations such as drunk driving accidents.
• Risk of Accidents : Alcohol-induced impairment can distort perception, making individuals more susceptible to accidents and injuries, both to themselves and others.

Long-term Ramifications: Hidden Dangers Lurking Beneath the Surface

• Chronic Health Conditions : Prolonged alcohol abuse can contribute to a myriad of health conditions, including liver disease, cardiovascular issues, neurological disorders, and mental health concerns.
• Delayed Manifestation : Some health complications from alcohol abuse may remain asymptomatic for years, gradually manifesting as irreversible damage to vital organs and bodily functions.

Embarking on the Road to Recovery: Treatment Options for Alcoholism

Choosing to confront alcohol addiction is a monumental decision, marked by a commitment to reclaiming control over one’s health and well-being. Fortunately, there are various treatment avenues available to support individuals on their journey to sobriety.

Detoxification: Navigating the First Hurdle

• Professional Guidance : Detoxification, the initial phase of alcohol addiction recovery, should be supervised by medical professionals to manage potentially severe withdrawal symptoms safely.
• Medication Assistance : Medical interventions, including medications to alleviate withdrawal symptoms, may be prescribed to ease the detox process and enhance comfort.

Rehabilitation: Building a Foundation for Lasting Sobriety

• Inpatient Rehab : Intensive residential treatment programs offer immersive care and support, typically spanning 30, 60, or 90 days, providing individuals with a structured environment conducive to recovery.
• Outpatient Rehab : Flexible outpatient programs allow individuals to receive treatment while maintaining their daily routines, offering therapy, counseling, and support group participation.

Maintenance: Sustaining Sobriety for the Long Haul

• Continued Therapy : Long-term sobriety necessitates ongoing therapy and support, encompassing individual counseling, group therapy sessions, and participation in support groups such as Alcoholics Anonymous (AA) .
• Holistic Approach : Embracing a holistic approach to recovery involves addressing underlying emotional and psychological factors contributing to alcohol abuse, promoting comprehensive healing and sustained sobriety.

In the journey from alcohol addiction to sobriety, every step forward represents a triumph over adversity and a commitment to embracing a healthier, more fulfilling life.

By accessing the necessary support and resources, individuals can embark on a path towards recovery, reclaiming agency over their health and happiness.

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