This article is reused by permission by Recovery Village Cherry Hill
Alcohol is the most popular recreational drug in America, with nearly 90% of adults having consumed alcohol at some point, and nearly 60% of adults and 20% of teenagers reporting that they consume alcohol at least monthly. In spite of its popularity, alcohol is a potent toxin that is associated with substantial risks to the health and wellbeing of people who consume it excessively.
35% of people with alcohol use disorders will develop advanced liver disease, and alcoholic liver disease is the number one reason why people need to get a liver transplant. The liver is not the only organ that is damaged by excessive alcohol consumption: Cardiovascular disease, hypertension, stroke, autonomic dysfunction, some types of cancer, and pancreatic disease are all linked to excessive alcohol use. In addition, recent studies have shown that chronic alcohol intake is linked to cognitive decline in older adults.
Can alcoholism kill? Alcohol is the third most common cause of preventable death in the US. 88,000 people die every year from alcohol-related causes, and 31% of driving fatalities involve alcohol. The Centers for Disease Control and Prevention (CDC) reported that six people die every day from alcohol poisoning.
What is Alcoholism, or Alcohol Use Disorder?
According to the 2018 National Survey on Drug Use and Health (NSDUH), approximately 15 million adults meet the criteria for alcohol use disorder (AUD, also known as alcoholism), but less than 10% receive any form of professional treatment. The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) defines AUD as a “problematic pattern of drinking leading to clinically significant impairment and distress for at least 12 months,” and has outlined 11 criteria for AUD.
Stages of Alcoholism
There are three main stages of alcoholism: Early, middle, and end (or late). Some addiction experts include a fourth “pre-alcoholic” stage to describe the alcohol abuse that precedes the development of AUD.
Stage 1: Early Stage Alcoholism
Early-stage alcoholism is characterized by increasing alcohol use and the development of tolerance, but without necessarily drinking so much that it becomes obviously problematic. However, it is important to understand that excessive consumption leads to alcohol dependence, meaning that the brain is dependent on alcohol in order to function without experiencing debilitating withdrawal symptoms. People in early-stage alcoholism have developed some degree of tolerance and dependence, but they can function normally without alcohol.
Signs of early-stage AUD include:
Drinking more frequently than normal
Drinking to manage stress, boredom or loneliness
Preferring social activities that include alcohol
Creating reasons to use alcohol
Stage 2: Middle-Stage Alcoholism
People in middle-stage alcoholism require alcohol in order to function normally. Chronic excessive alcohol use is associated with the development of a physical dependence on alcohol. Middle stage alcoholics need alcohol to feel normal and, if they don’t drink, they will experience uncomfortable withdrawal symptoms like trembling, nausea, sweating, and irritability.
Signs of middle stage AUD include:
Drinking habitually in non-social settings
Loss of interest in alcohol-free social activities
Strained relationships with friends and loved ones
Withdrawal symptoms set in when alcohol isn’t being consumed
Stage 3: End-Stage Alcoholism
People who reach end-stage alcoholism are physically dependent on alcohol. Drinking is not an option but a requirement. End-stage alcoholics have a high risk for serious, even life-threatening diseases like alcoholic liver disease and cardiovascular disease.
People with end-stage alcoholism cannot safely quit drinking on their own. Chronic heavy alcohol use causes substantial changes in brain chemistry, most notably by increasing levels of the inhibitory neurotransmitter GABA and reducing the effectiveness of the excitatory neurotransmitter NMDA. The combined effect of these changes reduces overall brain activity. If someone in end-stage alcoholism abruptly quits drinking, GABA and NMDA levels quickly return to normal, effectively removing the “brake” on activity in brain cells. The result is cellular hyperexcitability, which can cause seizures, delirium tremens or heart attack.
Signs of late-stage AUD include
Malnutrition
Cognitive decline
Erratic behavior
Financial and/or legal troubles
Serious health problems
Signs & Symptoms
There are some common signs of alcoholism that can help people determine whether they or someone they love is at risk for developing an AUD, including:
Loss of interest in hobbies or activities
Avoiding social events that don’t serve alcohol
Drinking alone
Drinking during the day
Hiding alcohol use
Drinking and driving
Symptoms of alcoholism are experienced by the person who has developed alcohol dependence, and often includes:
Being unable to cut down or stop drinking
Preoccupation with alcohol
Drinking despite negative health and/or social consequences
Requiring large amounts of alcohol to achieve the desired effect
Drinking to prevent withdrawal
Withdrawal & Detox Process
Anyone who wants to quit drinking should make an appointment with an addiction specialist who can help them make a plan. Alcohol withdrawal symptoms can be dangerous and may require medical intervention, so alcohol detoxification should be done under professional supervision.
Alcohol Withdrawal Symptoms
Even people with early-stage AUD may experience the following withdrawal symptoms when they aren’t drinking:
Headache
Irritability
Anxiety
Cravings
Insomnia
Restlessness
Withdrawal symptoms that are associated with middle and end-stage AUD include:
Pronounced tremors
Profuse sweating
Low-grade fever
Nausea/vomiting
Diarrhea
Rapid breathing and heart rate
Psychomotor agitation (repetitive, purposeless motions)
Increased anxiety and emotional stress
Severe alcohol withdrawal may include additional symptoms that can be life-threatening without medical intervention. Dangerous symptoms of alcohol withdrawal include:
Respiratory depression
Seizures
Delirium tremens (hallucinations, delirium, confusion, loss of touch with reality)
Heart attack
Alcohol Withdrawal Timeline
Early, middle and end-stage alcohol withdrawal have slightly different timelines, and the duration can vary to some degree between individuals. Symptom onset generally occurs 6-8 hours after the last drink. Mild and moderate withdrawal symptom severity peaks around 72 hours after the last drink and often resolve within about one week. Severe AUD withdrawal can take several weeks to fully resolve.
Post-acute withdrawal syndrome (PAWS) is a frustrating phenomenon that affects a minority of people who successfully completed detox and acute withdrawal. PAWS is characterized by persistent withdrawal symptoms that fluctuate in intensity and may last for weeks, months, or, in extreme cases, years after quitting drinking.
Treatment Options
Overcoming alcohol use disorders can be challenging, but there are several treatment options. Importantly, anyone who wants to quit drinking should seek a consultation with an addiction specialist. Comprehensive AUD treatment often involves medical detox, residential rehab, outpatient rehab, and aftercare:
Medical detox: In some cases, alcohol withdrawal can be very dangerous. Medical detox provides 24/7 supervision by medical professionals who can intervene in the case of complications, and medications that can reduce withdrawal symptom severity may be prescribed
Residential rehab: Following medical detox, most people transition into a residential (inpatient) rehab program. Residential rehab provides a safe environment and evidence-based treatments like cognitive behavioral therapy to help people overcome addiction and learn how to manage stress, triggers, and temptation
Outpatient rehab: People in early-stage AUD might start their recovery process in an intensive outpatient program, while others will move into outpatient treatment after successfully completing a residential program. Outpatient rehab options range from intensive programs that require a substantial time commitment to weekly therapy sessions
Aftercare: For many people, aftercare programs are an important component in long-term recovery from AUD. Aftercare programs vary quite a bit, but the goal is the same: Provide people in recovery with resources and support as they reorient to a sober lifestyle
Relapse rates are high among people with AUD, but there is evidence that professional inpatient treatment programs reduce relapse rates, especially for people with end-stage alcoholism.
Pharmacological Approaches to AUD Treatment
Alcohol use disorder, like other types of addiction, is a disease that is caused by significant structural and chemical changes in the brain. Pharmacological treatments may help restore normal brain function and minimize the risk of alcohol relapse. There are currently three FDA-approved medications for AUD treatment:
Disulfiram: Disulfiram affects how alcohol is metabolized. When someone taking disulfiram drinks alcohol, they experience very unpleasant side effects, including vomiting, headache, and increased heart rate. The goal of this drug is to prevent people in recovery from using alcohol
Acamprosate: Although the exact mechanism is unclear, acamprosate is thought to normalize some of the brain signaling pathways that are dysregulated in AUD. Acamprosate reduces cravings and the desire to use alcohol
Naltrexone: Like acamprosate, naltrexone reduces alcohol cravings. Naltrexone inhibits activity in the endogenous opioid system, which is a key driver of addiction
Medical Disclaimer:
This article aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.
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