Alcoholism & Alcohol Use Disorder Defined
Alcohol use disorder, (AUD), known as alcoholism when its effect is obvious, occurs when a person has developed dependence on alcohol and continues to use it, despite the problems it causes with that person’s job performance, academic performance, or relationships. The National Institute on Drug Abuse states that alcoholism is defined as a “chronic, relapsing brain disease” when the chronic use of a substance causes changes in the structure of the brain and how it works.
An Alcohol Use Disorder starts with drinking to excess on multiple occasions. This may include drinking alcohol to the point of feeling intoxicated or out of control in behavior. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the following are the recommended Maximum Drinking Limits. People, with exceptions noted below, are advised to stay within these limits:
For healthy men up to age 65
• No more than 4 drinks a day AND
• No more than 14 drinks in a week
For healthy women (and healthy men over age 65)
• No more than 3 drinks in a day AND
• No more than 7 drinks in a week
Abstinence is advised for anyone who:
• Take medications that may interact with alcohol
• Have a health condition that may be exacerbated by alcohol
• Are pregnant
• Are younger than age 21
• Are considering becoming pregnant
How much drinking is too much?
According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), “low-risk” alcohol use is defined as up to two drinks daily for healthy adult men and one drink daily for healthy adult women. (One drink equals one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits). Any drinking while pregnant is defined as “excessive drinking.”
Signs of Alcoholism
The Diagnostic and Statistical Manual (DSM) is a classification system published by the American Psychiatric Association. The most recent version, DSM 5, refers to Alcohol Use Disorders (AUD) rather than “Alcohol Abuse” and “Alcohol Dependence”. The DSM-5 sets the criteria for having AUD as having at least two of the following symptoms:
Alcohol is often taken in larger amounts or over a longer period than was intended.
There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
Craving, or a strong desire or urge to use alcohol.
Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
Recurrent alcohol use in situations in which it is physically hazardous.
Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect b) A markedly diminished effect with continued use of the same amount of alcohol.
Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol (refer to criteria A and B of the criteria set for alcohol withdrawal) b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
Everyone should decide how much they want to drink. Some people may have more trouble that others with their decision, and some people may need help to reach their goal. It can help to weigh the pros and cons of drinking using the interactive worksheet provided by the National Institutes of Health (NIH). Everyone with alcohol use disorder has a unique story of how their problem developed, and everyone has their own best solution. If you decide to cut down or quit, you'll find many helpful suggestions on this website.
Whatever you do, don't wait to "hit bottom," before you decide to make a change. Many factors contribute to a person's desire to drink, and many factors influence treatment success. Alcohol Recovery Medicine recognizes the importance of individualized care, and if you live in Maryland or Virginia, make an appointment so our physicians can help you consider the options that fit you best. If you are not able to talk to a physician today, you can evaluate your situation using the tools on a website sponsored by the NIH. Whatever you do, carefully consider your goals so you can make the choices that are right for you.
Keeping an accurate record of how much you drink is important when you are receiving treatment for alcohol use disorder. An accurate record can help you and your physician see how medicine is helping you reach your goals. Many people find that by making a record of each drink, they come to realize the circumstances that led them to drink more than they intended. You can track your alcohol consumption in a notebook or a spreadsheet such as those available online. If you have a smartphone, there are a number of apps that can help you keep track of how much you drink, including apps for Android and for iPhone. (Note: Using web resources such as these apps may create a risk to your privacy; they are provided by private vendors.)
Measuring you desire for drinking using scientifically developed craving scales can help you see the effect of the changes you are making. These scales often detect the effect of medications given for A.U.D, and can help guide your physician's treatment recommendations. Making gradual but definite steps towards a healthy lifestyle can also make a difference over time. Following our 2018 Rules for Recovery has helped many people on the P.A.T.H. to recovery.
There are many paths to get help for alcohol use disorder. Talk to a knowledgeable physician to find the therapy that best fits you. There are many types of treatment, and finding quality treatment is not always easy. If you are acutely ill and in withdrawal, you may require hospitalization to save your life. If your situation is not immediately critical, you can take advantage of scientifically based dietary and lifestyle recommendations. If you drink alcohol in response to past traumatic events in your life, psychological therapy may be critical for recovery.
A knowledgeable physician can guide your treatment and help you decide if medical therapy is appropriate for your situation. Learn about the many medications which have been shown to help those with alcohol use disorder. If your physician prescribes naltrexone, you can learn about the targeted use of this pill, a method of using naltrexone often known as The Sinclair Method, by watching the TEDx talk by Claudia Christian or reading books like "The Cure for Alcoholism".
Enlist the help of family, friends, and skilled counselors for healing, encouragement, and continued motivation. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has developed extensive resources to help you learn more about alcohol use disorder and find help. Getting involved in a support group can be a life changing decision. Support groups are also available for family members. Check out the resources available on the NIAAA web site and the on-line information on the Alcoholrecoverymedicine.org resources page.
If you are in Maryland or Virginia, you can contact Alcohol Recovery Medicine at (240) 801-3636 to schedule a telemedicine video appointment with Dr. Umhau. Alternatively, your personal physician may be knowledgeable about offering medicine to help you stop drinking. This website has a page designed for physicians to learn more about treating alcohol use disorder with medication.