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Alcohol Addiction and Treatment Options
Alcohol abuse is a widespread problem with more than half of people 12 and older drinking alcohol in the month prior to the survey and 17 million people in the U.S. being heavy alcohol users.1 Some things to know about alcohol abuse include the following:
- While the initial effects of alcohol include euphoria and increased sociability, later effects include loss of coordination, depressed mood, poor judgment, and memory problems.6
- Long-term alcohol abuse can lead to many ill effects on the person’s mental and physical health including liver disease, depression, and even cancer.11,12
- Professional treatment is often required for individuals struggling with alcoholism.
Alcohol is legal, ever-present, and largely socially acceptable, so it’s no surprise that it is widely used (and abused).
According to a 2015 survey from the Substance Abuse and Mental Health Services Administration (SAMHSA), more than 138 million people said they used alcohol in the previous month—that’s over half of the population 12 years and older.1
In the same survey, 67 million people reported binge drinking, while 17 million reported “heavy” alcohol use (having 5 or more “binges” in a month) during the same time span.1
When moderation takes a backseat, serious harm can ensue.
Alcohol is commonly used in moderation, but when moderation takes a backseat, serious harm can ensue, and with time, alcohol addiction may develop.
In 2015, an estimated 15 million adults in the U.S. had an alcohol use disorder (AUD), but only about 8% of them received care in a specialized treatment facility.2 This treatment gap leaves many without the professional assistance needed to safely detox and address their addictions.
How Does Alcohol Affect the Body?
Alcohol produces a range of effects, and the speed at which they manifest will be influenced by:
- The alcohol content – beer, wine, liquor, and malt liquor have different proofs, or alcohol percentages by volume.
- The quantity consumed.
- The speed at which is it consumed.
People might feel a surge of happiness or excitement when they begin drinking, but alcohol is, in fact, a depressant.3,4 This fact can be seen in alcohol’s ability to make someone feel drowsy, inattentive, and uncoordinated.3,4
Understanding Blood Alcohol Content (BAC)
BAC, or blood alcohol content, is a percentage measurement that can be used to indicate how much influence alcohol has on an individual’s body. As BAC increases, the effects of alcohol become more noticeable and more serious:3
BAC from 0.0%-0.05%—Mild impairment
o Pleasurable effects such as feelings of relaxation and happiness
o Mild issues with speech, attention, coordination, and memory
BAC from 0.06%-0.15%—Moderate impairment
o Risk of aggression
o Severe impairment of driving skills
o Risk of injury to self or others
o Further speech impairment
o Reduced attention
BAC from 0.16%-0.3%—Severe impairment
o Very poor judgment and decision-making skills
o Dangerous impairment of driving skills
o Significant problems with speech
o Inability to pay attention
o Failing motor coordination
o Slowed reaction time
o Amnesia and blackouts
o Loss of consciousness
BAC from 0.31%-0.45%—Life-threatening impairment
o Serious risk of alcohol poisoning
o Loss of consciousness
o Slowed, stopped, or irregular breathing
o Erratic heart rhythm
o Seizures from dehydration or low blood sugar
o Brain damage
BAC can rise quickly. Women that have just 4 drinks over 2 hours can reach the legal limit of 0.08%.3 Many drinkers may not realize that their BAC can continue to climb even after the final drink, as the stomach and intestine continue releasing the alcohol into the bloodstream.3
What Counts as One Drink?
Each drink increases your BAC, so it is essential to know what counts as one drink. Most likely, it’s less than you think. One serving of alcohol depends on the type of drink consumed and the alcohol content of that specific beverage. Examples of one serving include:3
- 12 fl oz of beer (? 5% alcohol).
- 8-9 fl oz of malt liquor (? 7% alcohol).
- 5 fl oz of wine (? 12% alcohol).
- 1.5 fl oz of liquor (? 40% alcohol).
Keep in mind, the drink you pour for yourself or get out at a bar or restaurant is likely to be larger than the servings listed above. For example, the glass of red wine you order with dinner may actually be large enough to count as two drinks. So if you have 2 of these glasses, you may, in fact, have had 4 drinks—and those 2 glasses may have put you at or over the legal BAC limit.
Dangers of Using Alcohol with Other Drugs
Significant danger may result from mixing alcohol with illicit drugs, prescription medications, over-the-counter products, or even herbal remedies.4 Mixing alcohol with other drugs may result in serious complications in 3 ways:4,5
- Increasing BAC. Some medications, like cough syrups and laxatives, contain alcohol. By drinking alcohol and using these medications, the individual is increasing their BAC and increasing the risk of harm.
- Boosting the effects. Opioids (pain medications and heroin), sleeping pills, and drugs used to manage anxiety can make people feel drowsy and slow their breathing. Alcohol can trigger the same effects, and when taken together, the combination can result in severe breathing problems and overdose.
- Masking the effects. Stimulant substances like cocaine or prescription medications used to treat attention-deficit/hyperactivity disorder (ADHD) can make it harder to perceive the intoxicating effects of alcohol, which could result in the individual drinking far more than intended and potentially experiencing alcohol poisoning.
Sometimes the user may combine substances without any awareness of the potential interactions and risks. But other times, a user will intentionally drink alcohol while taking other drugs in order to intensify or modify the effects and/or attain a “better” high.5 In either case, combining alcohol and other drugs can be extremely dangerous and result in effects such as:3,4
- Nausea with vomiting.
- Strong headaches.
- Drowsiness and extreme sedation.
- Sudden fainting.
- Complete loss of coordination.
The Problem with Binge Drinking
As mentioned, almost 67 million people in the U.S. reported binge drinking in the last month, which is about 25% of people 12 and older.1 Binge drinking means consuming a large amount of alcohol in a short amount of time at least one time in the last month. For women, binge drinking is defined as having 4 drinks in 2 hours or less. For men, it is having 5 drinks in 2 hours or less.2 People that binge drink 5 or more days in a month are classified as heavy drinkers.2
Consuming a large amount of alcohol in a short period can push the BAC to severe or life-threatening impairment and may easily lead to alcohol poisoning, signs of which include:3
- Profound confusion.
- Significantly slowed breathing.
- Pale skin or cyanosis (bluish tint to skin).
Binge drinking is possible in any age group, but per the Substance Abuse and Mental Health Services Administration, binge drinking is a major concern for drinkers between 18 and 25 years old.1 Binge drinking is an ongoing problem on college campuses, resulting in issues such as:2
- Poor academic performance.
- Accidental injuries.
- Vehicle collisions.
- Increased rates of sexual and physical assault.
Another problem with binge and heavy drinking is the increased likelihood of developing an alcohol use disorder (AUD). Low-risk alcohol consumption is associated with a very small likelihood of AUD:2 Specifically, women that have 3 or fewer drinks in a day and no more than 7 drinks per week and men that have 4 or fewer drinks in a day and no more than 14 drinks per week have only a 2% chance of developing an AUD.2
The main indication that a person has an AUD is if alcohol is causing major distress in their life yet they are unable to stop drinking.2 Learn more about the signs of an alcohol addiction below.
How Can I Tell if Someone Is an Alcoholic?
Determining whether you or someone you love may have a problem with alcohol can be challenging because alcohol consumption is so normalized. In fact, you may have even heard of some of the touted benefits of moderate consumption of alcohol, such as:2
- Decreased rates of heart disease.
- Lowered risk of ischemic strokes.
- Decreased risk of diabetes.
The key here is moderate (low-risk) drinking. This type of consumption may be safe and may have some benefits, but heavy or binge drinking is extremely problematic—even when some time passes between episodes. Any binge drinking is associated with a higher risk of developing an AUD, and so is high weekly consumption of alcohol.2
Remember, men drinking more than 14 servings and women drinking more than 7 servings in a week are at high risk of an AUD, regardless of whether they engage in binge drinking episodes.2
Any binge drinking is associated with a higher risk of developing an AUD, and so is high weekly consumption of alcohol.
If you’re worried that your or your loved one’s drinking is problematic, check for the following signs of an AUD:6
- Drinking more alcohol or drinking for longer than originally intended.
- Making multiple attempts to cut back or quit drinking without success.
- Expending a lot of time and energy in buying and drinking alcohol, as well as recovering from hangovers.
- Having strong urges to drink when sober.
- Consistently drinking despite the strong likelihood of bad outcomes.
- Giving up social or recreational activities in order to drink.
- Increased fighting/strained communication with friends, family members, or coworkers.
- Failing to perform normal work, home, or school responsibilities.
- Drinking even when doing so has led to physical or mental health problems and is likely to make them worse.
- Developing a tolerance (the need to drink larger amounts to get drunk).
- Experiencing withdrawal (uncomfortable or dangerous symptoms that arise when not drinking).
Having two or more of these signs generally indicates the individual may have an AUD.6 An AUD is further classified as mild, moderate, and severe. So while you or someone you care about might only have two of the symptoms above, an AUD may still be present but in the beginning stages. Always seek a professional evaluation if you think there’s a problem, even if you think it may not be particularly severe (yet). Getting help while the problem is in its initial stages can increase the likelihood of successful long-term recovery.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) offers a variety of alcohol screening tests to assess whether someone’s alcohol use is problematic.7 The CAGE, T-ACE, and AUDIT are self-evaluation tools to quickly investigate how alcohol impacts your life and the life of your loved ones.7 For example, the CAGE looks at whether you:7
- Feel you should Cut down your drinking.
- Have felt Annoyed by criticisms of your drinking.
- Have felt Guilt about your drinking.
- Need to use alcohol as an “Eye-opener” early in the morning.
Alcohol Dependence and Withdrawal
The progression from recreational drinking to alcohol dependence and addiction is complex. Before alcohol is consumed, chemicals called neurotransmitters function in balance. Alcohol disrupts this balance, causing euphoria as well as the negative effects of intoxication.8
These adjustments are mild at first, but as use continues, the brain will adapt more significantly to find balance. The adaptations will produce a higher tolerance for alcohol and make each drink less effective.8 The individual will have to keep drinking more and more to counter their increased tolerance, significantly increasing their risk of dangerous consequences and alcohol poisoning.
Continued drinking over time, especially with increasing doses, may eventually lead to physical dependence, a phenomenon in which the body needs alcohol simply to feel well enough to function. Once a user is dependent, the person will need to have alcohol in their system to avoid withdrawal, which has the potential to cause dangerous medical complications.
Alcohol withdrawal symptoms include:9
- Excessive perspiration.
- Shaky hands.
- Higher heart rate and blood pressure.
- Inability to sleep.
- Nausea, vomiting, and diarrhea.
People with more severe alcohol withdrawal symptoms may experience:9
- Intense changes in body temperature and blood pressure.
- Extreme agitation.
Symptoms of alcohol withdrawal can begin anywhere from 6 to 24 hours after last use and continue for up to 10 days.9 The most severe, dangerous symptoms commonly appear between 36 and 72 hours after the last drink.8
Problems stemming from alcohol withdrawal can continue beyond this acute stage. Protracted withdrawal (sometimes called “post-acute withdrawal syndrome,” or PAWS) represents symptoms that persist past the initial acute period of withdrawal.10 Protracted withdrawal can last for months or sometimes years after alcohol use ends. PAWS symptoms may include:10
- Mood changes.
- Poor concentration and attention.
- Trouble thinking clearly.
- Lack of sexual interest.
- Unexplained pain.
- Sleep problems:
o Trouble falling asleep.
o Poor quality of sleep.
o Sleep apnea.
Long-Term Effects of Alcohol Abuse
The more someone consumes alcohol, the more at risk of serious symptoms they are, not only in the short term but in the long term as well. The consequences of enduring alcohol abuse may show up in many ways:11,12
o Learning problems
o Problems with coordination
o Memory issues
o Increased mental health concerns including depression and anxiety
o Irregular heart rhythm
o Increased blood pressure
o Fatty liver
o Pancreatitis, a painful and dangerous inflammation that interferes with digestion and can be fatal
- Immune system:
o Decreased ability to fight infections and diseases
Long-term alcohol use is also associated with an increased risk of developing several types of cancer, including:11,12
Of course, the impact of alcohol addiction doesn’t rest solely on the physical and mental health of the user—it extends into every area of their life. People suffering from an addiction to alcohol often experience:
- Worsening relationships with loved ones.
- Financial issues, often stemming from unemployment and/or spending an exorbitant amount of money obtaining alcohol.
- Legal troubles, e.g., from citations given for driving under the influence.
- Difficulty completing their normal daily activities/responsibilities.
Impact on Reproductive Health and Pregnancy
Alcohol has the potential to have serious consequences for a woman’s reproductive health. Consider that:13
- 50% of women of child-bearing age drink alcohol (with about 1 in 5 binge drinking).
- Heavy drinking can interfere with a woman’s normal menstrual cycle and may cause fertility problems.
- Women that drink alcohol in binges are more likely to have more sexual partners and less likely to use birth control, which increases the risk of sexually transmitted diseases (STDs) as well as unintended pregnancy.
Drinking alcohol is a special concern for women that are or may become pregnant. Use of alcohol during pregnancy leads to lasting issues for the mother and the baby. If a woman is drinking, having sex, and not using birth control, she may get pregnant and unknowingly expose her baby to the harmful effects of alcohol.
Most women do not know that they are pregnant until they are 4-6 weeks into their pregnancies.14 Alcohol exposure, even during these early weeks, can have a negative impact on the developing fetus. It is important to remember that there is no safe level of alcohol use during pregnancy.14
Unfortunately, about 10% of pregnant women drink during their pregnancies.13 In-utero alcohol exposure can have devastating consequences, including:13-15
- Premature delivery.
- Sudden Infant Death Syndrome (SIDS).
o Children that are exposed to alcohol in the womb have a greater chance of death from SIDS, especially if their mother binge drank during her first trimester.
Drinking while pregnant can also cause the child to have fetal alcohol spectrum disorders (FASD).13,14 Fetal alcohol syndrome (FAS) is the most severe type of FASD.
Fetal alcohol syndrome can lead to permanent problems like:13,14
- Low birth weight.
- Slow growth.
- Heart, kidney, and other organ problems.
- Brain damage leading to:
o Learning, intellectual disabilities, and low IQ.
o Poor attention and concentration.
o Poor social skills.
o Impaired judgment.
As children with FAS grow into teens and adults, they are more likely to struggle with:14
- School and work.
- Living alone.
- Making friends.
- Mental illness.
- Substance abuse.
- Increased legal issues.
Getting Treatment for Alcoholism
Alcohol addiction most often requires professional treatment, especially because quitting “cold turkey” has the potential to be fatal. Withdrawal is sometimes associated with severe health developments such as grand mal seizures and delirium tremens (DTs).15
It is not safe to “go it alone” when attempting to quit or significantly decrease your alcohol use. The best course of action is to contact a professional, such as your primary care doctor, or an addiction treatment program.
It is not safe to “go it alone” when attempting to quit. Because the withdrawal syndrome associated with alcohol dependence is so severe, treatment should begin with some form of supervised medical detoxification.15
This will help to ensure that you stay safe and your symptoms are well managed.16 To mitigate the risks of severe alcohol withdrawal, a closely supervised, medical detox will take place in a hospital or other inpatient setting and, when needed, will incorporate the use of certain medications to ease discomfort and prevent dangerous complications, such as seizure.
Medications used in alcohol withdrawal include:16
- Benzodiazepines. This group of medications that includes drugs like diazepam (Valium) helps to alleviate symptoms and prevent withdrawal from becoming life-threatening.
- Barbiturates. While most barbiturates have fallen out of favor because of potential dangers and abuse potential, phenobarbital can help to mitigate serious withdrawal symptoms when used under close medical supervision.
- Anticonvulsants. In some instances, medications like carbamazepine may be as helpful as benzodiazepines for mild or moderate withdrawal.
- Antipsychotics. Drugs like haloperidol may be used to treat hallucinations, delusions, and extreme agitation, if present during withdrawal.
Other medications and over-the-counter drugs can be used to manage related symptoms like headaches and diahrrea.16
Detox is a crucial stage of treatment. However, people that only undergo detoxification and don’t continue with further treatment may quickly return to drinking, as they have not addressed the behavior, only the physiological dependence.
Without treatment that includes therapy to work through the issues that lead you to drink, your treatment will be incomplete.
Once your body is safely cleared of alcohol, you can move on to one or more of the following programs:15,16
- Residential rehabilitation. These treatment programs are highly structured with 24-hour supervision from professional staff as you live in the center. Round-the-clock support combined with limited outside contact can help to prevent relapse, as you will be able to focus on your recovery without facing the triggers of your daily environment. Residential facilities offer many benefits, including therapy, medication management, employment training, and additional comprehensive services. The duration of stay could be as little as a few weeks to as long as a year, based on your needs and ability to cover the cost of continuing treatment.
- Outpatient treatment. Less intensive than residential treatment, outpatient programs allow you to live at home while you work and maintain your other responsibilities. You will attend a scheduled amount of daily, weekly, or monthly treatment at the facility and return home. More intensive forms of outpatient treatment include:
o Partial hospitalization programs (PHPs). Called day treatment, these programs last for about 6 hours per day 5 days per week and include a combination of group and individual sessions.
o Intensive outpatient programs (IOPs). A step down from PHPs, IOPs offer 2 or 3 sessions per week with between 6 and 9 hours of total treatment.
A person attempting to recover from alcohol abuse may progress through multiple treatment types by beginning with detox and subsequently moving to a residential program. Once that is complete, outpatient treatment can be a next step. In some cases, an IOP or PHP may be the primary course of rehab, with another less intensive form of outpatient treatment potentially being a step-down treatment.
When it comes to addiction recovery, there is not one treatment type or course of treatment that works for everyone.15 Instead, there needs to be a focus on meeting the specific needs of the individual and treating the entire person, not just the addiction. This includes making sure that their mental health and social needs are addressed.
Medication-Assisted Treatment for Alcohol Addiction
Treatment for alcoholism may include medication to help recovering individuals stay sober. Medication-assisted treatment (MAT) for alcohol addiction involves medications combined with behavioral therapy.15
MAT options for individuals in recovery from alcohol include:15
- Acamprosate (Campral)—helps treat alcohol dependence and may lessen PAWS symptoms, such as insomnia and anxiety.
- Disulfiram (Antabuse)—produces an unpleasant physical reaction if alcohol is consumed to discourage drinking.
- Naltrexone—blocks opioid receptors to remove the pleasurable feelings of alcohol and lessen cravings.
What is Aftercare?
Aftercare refers to continuing treatment that takes place after an initial round of rehabilitation and helps to recover individuals to prevent relapse. For example, engaging in standard outpatient care that involves weekly or monthly appointments with a therapist can continue for years into recovery.16
Other options for finding continued support in recovery include:15,17
- Support groups. 12-step groups like AA have a long history of success for those in recovery from alcohol addiction. These groups help by fostering a sense of community built around sobriety. For those uncomfortable with the spiritual aspect of 12-step groups, there are other secular programs, such as SMART Recovery, that offer the same level of support in helping people find and maintain sobriety but without the idea of a “higher power.”
- Sober living houses. Sometimes called the “social model,” sober living homes are residences for people living in recovery. These individuals live together and share household responsibilities while working and attending professional treatment. Housemates are responsible for helping themselves and others meet the expectations of the home.
Like other chronic conditions, alcohol recovery is a lifelong process. Shorter courses of treatment are associated with a higher risk of relapse, so committing to a longer-term program and making efforts to find support—whether in a sober living home, outpatient program, or a support group—can you help you find freedom from alcohol.15
- Substance Abuse and Mental Health Services Administration. (2016). Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health.
- National Institute on Alcohol Abuse and Alcoholism. (2017). Alcohol Facts and Statistics.
- National Institute on Alcohol Abuse and Alcoholism. (2015). Alcohol Overdose: The Dangers of Drinking Too Much.
- National Institute on Alcohol Abuse and Alcoholism. (2014). Harmful Interactions.
- University of Michigan: University Health Service. (n.d.). The Effects of Mixing Alcohol with Other Drugs.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- National Institute on Alcohol Abuse and Alcoholism. (n.d.). Screening Tests.
- (2016). Withdrawal Syndromes.
- World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Setting.
- Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
- Centers for Disease Control and Prevention. (2016). Fact Sheets: Alcohol Use and Your Health.
- National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol’s Effects on the Body.
- Centers for Disease Control and Prevention. (2016). Fact Sheets – Excessive Alcohol Use and Risks to Women’s Health.
- Centers for Disease Control and Prevention. (2016). Alcohol and Pregnancy.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
- Massachusetts Executive Office of Health and Human Services. (2016). Substance Abuse Services Descriptions.