Alcohol Abuse: When Drinking Becomes a Problem

Full-blown alcohol addiction, commonly known as alcoholism, doesn’t happen all at once. Typically, alcohol abuse—a pattern of harmful drinking—begins the process. Abuse then progresses to dependency and addiction. The danger signs are well understood: They can provide a chance at early intervention, although problem drinkers face many challenges in overcoming the disorder.

What’s Social Drinking?

Social drinking is characterized by controlled, moderate drinking. Social drinkers can choose how much alcohol they drink and when.

Health and nutrition experts often advise the public to drink “moderately.” According to the USDA’s 2015-2020 Dietary Guidelines for Americans, moderate drinking means up to two drinks per day for men and one drink per day for women.

That could mean a standard serving of beer (12 ounces) or wine (5 ounces) with dinner—and a “No thanks” to a second. While out of the home, it means handing over the car keys to a friend when you feel tipsy—or not drinking at all if you have to drive.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines normal or low-risk drinking as follows:

  • In men, no more than four drinks on any single day and no more than 14 drinks per week.
  • In women, no more than three drinks on any single day and no more than seven drinks per week.

NIAAA research shows that only about 2 percent of people who drink within these limits have a serious drinking problem.

When Does Alcohol Abuse Become Problem?

According to the National Institutes of Health (NIH), alcohol abuse is marked by excessive consumption of alcoholic beverages that causes problems in your life—personal relationships, work, school, legal, financial, and social.

Binge drinking is a form of alcohol abuse. NIAAA defines binge drinking as consuming enough alcohol in a two-hour period to raise your blood alcohol level to the legal limit, which is 0.08 grams per deciliter. That means five or more drinks in two hours for men and four or more for women.

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines “heavy” drinking as “binge drinking on five or more days in the past month.”

What Is Alcoholism?

Alcohol abuse (including binge drinking) and full-blown alcohol addiction are now categorized by scientists as alcohol use disorders (AUDs). The NIH estimates that 17 million Americans 18 or older may fit the criteria for diagnosis of AUD.

The current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) explains that a person meets the diagnostic criteria for AUD if they answer yes to any two of the following questions. In the past year, have you:

  • Had times when you ended up drinking more, or longer than you intended?
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  • Spent a lot of time drinking? Or being sick or getting over the after effects?
  • Experienced craving (a strong need, or urge, to drink)?
  • Found that drinking (or being sick from drinking) often interfered with taking care of your home or family, or caused you trouble at work or school?
  • Continued to drink even though it was causing trouble with your family or friends?
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
  • Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
  • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

Symptoms of Alcohol

With continued alcohol abuse, a person can cross the line from abuse to addiction. The symptoms of alcoholism include:

  • Craving: A strong desire or need to consume alcohol.
  • Loss of control: Not able to stop or moderate drinking once you start.
  • Physical dependence: Experiencing withdrawal symptoms such as anxiety, irritability, sweating, and other physical problems.
  • Tolerance: It takes more and more alcohol over time to get the same effect.

Alcoholism Treatments

There are a number of treatments for alcohol use disorder. They include individual and group therapy, medication, and self-help groups and other social support. Many people combine different approaches to create a recovery program that works for them. The root causes of alcohol abuse vary, so what works for one person may not work for another.

  • Counseling: Psychotherapy and other behavioral treatments can help some problem drinkers to change their harmful drinking behaviors. An approach that has shown general effectiveness is cognitive-behavioral therapy (CBT). CBT helps a person identify feelings and situations (cues) that lead to heavy drinking, and also manage stress that can lead to relapse.
  • Medication: Three medications are approved by the U.S. Food & Drug Administration (FDA) to help people reduce drinking or reduce the chance of relapse once they become abstinent. The drugs can be used in combination with therapy and social support groups.
    • Acamprosate (Campral) helps to prevent return to drinking (relapse) in problem drinkers who have stopped consuming alcohol. (There is also an injected form called Vivitrol.) A review by the prestigious Cochrane Collaboration found good evidence that Campral prevents relapse.
    • Disulfiram (Antabuse) has been in use since the 1950s. The drug prevents the breakdown of alcohol in the body. A person who drinks alcohol while on Antabuse will become very ill, with nausea, vomiting, skin flushing, racing heart, and other very unpleasant symptoms.
    • Naltrexone (Revia) suppresses cravings and blocks the effects of alcohol on the brain. In studies, people on naltrexone slightly decreased daily drinking, heavy drinking, the number of drinking days, and the amount of alcohol consumed.

An anti-seizure medication called topiramate (Topamax) has also shown promise in research, though it’s not specifically approved by the FDA for alcohol problems. Some, but not all, randomized clinical trials found that Topamax decreases number of drinking days, heavy drinking days, and drinks per day based on two randomized trials.

As with all medications, drugs used to treat symptoms of alcohol use disorder have side effects, some potentially serious.

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