What is Alcohol Use Disorder?
Alcohol is the most widely used substance in the U.S., with 84% of adults admitting to having consumed it at some point in their lives, according to a 2022 survey. People’s relationship with alcohol can range from low-risk consumption to developing a serious condition known as Alcohol Use Disorder (AUD). In-between, there’s a category called risky drinking, which includes heavy and binge drinking.
AUD is a long-term illness that can have severe medical, social, and psychological effects on the person suffering from it. AUD also significantly burdens the healthcare system, leading to more than 200,000 hospital admissions and 7.4% of emergency room visits every year. About 29.5 million people over the age of 12 in the U.S. have AUD. Unfortunately, only a small proportion — 7.6% — receive treatment.
This major gap in treatment allows doctors to identify a common medical condition with harmful health and social consequences.
What Causes Alcohol Use Disorder?
The precise cause of alcohol use disorder is still a mystery, but it’s believed to be influenced by a mix of different factors. Studies with twins and adopted children have shown that about half of the risk of developing the disorder comes from genetic factors, while the other half is due to environmental influences.
Changes in the brain and in how genes are turned on and off – also referred to as neurobiological and epigenetic adaptations – are thought to contribute to alcohol use disorder. However, more research is needed to fully understand these factors.
Risk Factors and Frequency for Alcohol Use Disorder
Alcohol use is widespread in the United States, as suggested by the 2022 National Survey on Drug Use and Health. Most adults have consumed alcohol in the past year. However, the use of alcohol sometimes leads to risky behaviors, such as binge drinking and heavy alcohol use. Furthermore, a large number of people-over 29 million as of 2022-have been diagnosed with Alcohol Use Disorder (AUD), making it the most common substance use disorder according to the Substance Abuse and Mental Health Administration.
- Alcohol is the most frequently used substance in the United States.
- 67.4% of people aged 18 and above reported drinking alcohol in the past year.
- 23.5% of adults reported binge drinking in the past month.
- 6.3% reported heavy alcohol use.
- There are about 29.5 million people aged 12 and older who are estimated to have Alcohol Use Disorder as of 2022.
- As of 2019, Alcohol Use Disorder is the most commonly diagnosed substance use disorder.
Signs and Symptoms of Alcohol Use Disorder
The United States Preventive Services Task Force suggests that doctors should check their adult patients for unhealthy alcohol use during regular check-ups. They can do this through either a single question screening or a three-question test known as the Alcohol Use Disorders Identification Test-Consumption. If the patient’s quiz results seem worrisome, the doctor should then evaluate for potential Alcohol Use Disorder (AUD) using the guidelines from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).
The diagnosis of AUD depends on the DSM-V criteria. These criteria, learned from the patient’s history and other sources, mainly focuses on how alcohol is affecting the patient’s life, health, daily activities, and drinking control. The diagnosis takes into account whether a patient experiences withdrawal symptoms when they stop drinking alcohol, and whether they need more and more alcohol to achieve the same effect.
Diagnosis of AUD mostly relies on a person’s history, but blood tests can be helpful in certain scenarios. They can test the blood alcohol level to check for recent intoxication, and other tests can detect alcohol use from the past few days to even a few weeks. However, these tests might give false-positive results. Another test, called PeTH, can highlight alcohol use from three weeks prior.
- Regular screening of adults for unhealthy alcohol use
- Use of the Alcohol Use Disorders Identification Test-Consumption for screening
- Evaluation for potential AUD using DSM-V criteria if screening results are positive
- Diagnosis of AUD based on the impact of alcohol on the patient’s life and health condition
- Use of blood alcohol level tests to check for recent intoxication
- Use of serum ethyl glucuronide and carbohydrate deficient-transferrin to detect alcohol use in the past few days or weeks
- Use of PeTH test to detect alcohol use from three weeks prior
Testing for Alcohol Use Disorder
Doctors need to routinely check for the prolonged effects of alcohol usage, as this habit could lead to negative impacts across different areas of the body and induce or exacerbate many health conditions.
For the digestive system, alcohol may cause damage to your liver to a point where stopping alcohol consumption won’t help. This can be detected by liver tests yielding higher levels of certain enzymes (alanine aminotransferase and aspartate aminotransferase as well as gamma-glutamyl transferase). Alcohol can also lead to alcohol-related liver inflammation and present with symptoms like yellowing of skin and eyes, fever, accumulation of fluid in the abdomen, and high white blood cell count. One could also develop symptoms like red-growing spots, red palms, and fluid in the abdomen, usually seen with alcohol-induced severe liver disease. Furthermore, alcohol can cause both severe or persistent pancreatic inflammation and dehydration ability. Lastly, alcohol can contribute to the development of gut inflammation and acid reflux.
With regards to the blood system, alcohol can slow down the production of blood cells causing low white blood cells count, platelets count, and anemia. It may also lead to an enlarged red blood cells due to deficiencies in B12 and folate.
In the case of brain and nervous systems, long-term use of alcohol may lead to deficiency in thiamine that can cause a type of memory disorder. It can also lead to damage to your nerves, impacting sensation in hands and feet. It can also affect your ability to walk. Plus, it can make various mental health disorders worse, such as depression, as well as increase the risk of stroke and dementia.
In terms of heart health, alcohol can trigger irregular heartbeat events and speed up heart disease development, along with leading to heart muscle stretching and drooping. Both alcohol use and withdrawal can make high blood pressure worse.
As for cancer risk, long-term use of alcohol can increase your risk of cancers such as those affecting the breast, esophagus, mouth, throat, liver, colon, stomach, and pancreas.
In the hormone system, alcohol can negatively impact bone health leading to osteoporosis and can also contribute to low thyroid function.
For respiratory health, alcohol not only worsens sleep apnea in those already diagnosed but also increases the overall likelihood of developing sleep apnea. It is also associated with an increased likelihood of lung-related infections like pneumonia.
Lastly, in the immune system, alcohol can degrade the function of B and T cells, making you more susceptible to both bacterial and viral infections.
Treatment Options for Alcohol Use Disorder
The goal of treating Alcohol Use Disorder (AUD) is to either reduce the amount of alcohol consumed or to stop drinking completely. This often involves medication, sometimes combined with behavioral therapies. There are three medications approved by the US Food and Drug Administration (FDA) for treating AUD:
Naltrexone is a medication that makes drinking alcohol less pleasurable, decreasing the desire to drink. It can be taken orally every day or given as a monthly injection in a clinic. It helps to reduce the number of days people drink and the amount of alcohol they consume. However, it is not suitable for everyone. It should not be used by people taking certain pain medications or those with a severe liver disease, unless under strict supervision from a liver specialist.
Acamprosate is another effective medicine for AUD, but it must be taken two times, three times a day, which can be hard for patients to stick with. The specific way acamprosate works is not fully understood, but it likely affects a particular set of brain receptors. It’s generally started after someone has stopped drinking alcohol. It should not be used by people with severe kidney problems.
Disulfiram is a slightly different medication that causes an uncomfortable reaction when alcohol is consumed, such as flushing, nausea, vomiting, and heart palpitations. As this reaction can put stress on the heart, disulfiram should not be used by people with heart disease. It also requires regular liver checks after starting, as it can sometimes cause liver disease. Its use is therefore also not recommended in people with an already impaired liver. It’s most effective for those who have someone to help ensure they take the medication.
Other medications, such as gabapentin, topiramate, or baclofen, may also be used in treating AUD, although they are not approved by the FDA for this use, and their effectiveness is less strongly supported.
Behavioral treatment options are also available and can be beneficial. They can take place in various settings, including inpatient facilities, outpatient individual therapy, or group therapy sessions. It’s important that these are not used instead of medication, but alongside it. Some examples of available group options are Alcoholics Anonymous or SMART Recovery.
What else can Alcohol Use Disorder be?
When a person is consuming alcohol in an unhealthy way, it might be a sign of certain mental health conditions. Doctors should check for these possible conditions:
- Posttraumatic Stress Disorder (a condition caused by experiencing a traumatic event)
- Bipolar Disorder (a condition that involves shifts in mood, energy and activity levels)
- Panic Disorder (a condition causing unexpected and repeated episodes of intense fear)
- Anxiety Disorder (a condition that causes excessive, uncontrollable worry)
- Dysthymic Disorder (a low-grade, chronic depression)
- Major Depression (a disorder characterized by a persistent feeling of sadness or a lack of interest in outside stimuli)
- Insomnia (Inability to sleep or frequent wakeups during the night)
It’s crucial for health professionals to look for signs of these conditions in patients who are having problems with alcohol.
What to expect with Alcohol Use Disorder
AUD, or Alcohol Use Disorder, is a long-term condition with outcomes that can vary widely. For some, the disorder may show a pattern of recurring symptoms that then disappear, or relapsing and remitting. Other people manage to avoid alcohol without joining a formal treatment program. However, people who also struggle with mental health disorders or use of other substances are more likely to experience a relapse.
Possible Complications When Diagnosed with Alcohol Use Disorder
Alcohol use disorder, or excessive consumption of alcohol, can lead to many complications. These can include:
- Accidents like falls and car crashes
- Intentional injuries
- Different types of cancer such as mouth, throat, esophagus, stomach, breast, colorectal, liver and pancreatic
- Gum disease
- Nutrient deficiencies
- Gastroesophageal reflux disease
- Inflammation of the stomach lining
- Mallory-Weiss syndrome, which is tearing of the lower end of the esophagus
- Delayed stomach emptying
- Liver cirrhosis
- Severe inflammation of the pancreas
- Pancreatic insufficiency
- Bleeding in the upper gastrointestinal tract
- Stroke
- Coronary artery disease
- Irregular heart rhythm
- Heart weakening
- High blood pressure
- Weakening of the immune system
- Sleeping disorders
- Inhalation of foreign substances
- Bacterial pneumonia
- Malabsorption of nutrients
- Sexually transmitted diseases
- Wernicke-Korsakoff syndrome (Alcohol-related brain disorder)
- Peripheral nerve damage
- Dementia
- Underactive thyroid
- Thinning of bones
- Megaloblastic and sideroblastic anemia
- Reduction of platelets in blood
- Sudden heavy drinking leading to inflammation of the liver
Preventing Alcohol Use Disorder
Here are the crucial points that patients and their families need to learn:
Firstly, it’s important to understand that Alcohol Use Disorder (AUD) is a long term health condition, but there are proven treatments available. Secondly, patients should work with their healthcare providers to create a treatment plan. This plan might involve medication and behavioral therapy.
The goals of treatment could be either not drinking alcohol at all or simply reducing the amount drunk. Finally, patients should be taught about how alcohol negatively affects different parts of the body.
