ALCOHOLISM
Overview

Alcohol, also known as ethanol or ethyl alcohol, is one of the most popular psychoactive and addicting substances worldwide. Addiction to alcohol, commonly known as “alcoholism,” remains a serious problem in the United States. The National Institute on Alcohol Abuse and Alcoholism reported that 6.2% of Americans aged 21 and over had an alcohol use problem in 2015. Medically, alcoholism is referred to as “alcohol use disorder.”

Alcohol also goes under the names “booze,” “brew,” and “juice.”

How Alcohol Works in the Brain

Alcohol is a central nervous depressant that slows down the ability to react and induces a calming effect. It is believed to exert its effects by increasing the activity of a GABA (gamma-Aminobutyric acid), our body’s natural “slow chemical.” By enhancing the effect of GABA, users feel a sense of relaxation and lowered inhibitions. This mechanism is similar to benzodiazepines such as Xanax and Valium, an addicting class of central nervous system depressants.

Why is Alcohol Addicting?

In addition to finding the relaxing effects addicting, alcohol may also play a role in the brain’s reward pathway. The reward pathway is a primitive system in our brain that “rewards” us for performing activities essential to survival such as eating, drinking and procreating. When this system is activated, it causes a pleasurable feeling that drives us to repeat the behavior. Since alcohol stimulates this system, it essentially tricks our brain into rewarding us for drinking it.

Not all people that drink alcohol become addicted to it. Some can drink moderately without becoming addicted while others can become addicted soon after being introduced to it.

Research has shown that some people have a genetic predisposition towards alcohol use disorder. Combined with ease of access and lack of a support system, many people can easily spiral down the path of addiction.

Short Term Effects of Alcohol
  • Slurred speech – If someone has had too much to drink, they nearly always have slurred speech and may not be able to enunciate words clearly.
  • Drowsiness – Alcohol can make a user feel tired and drowsy. Excessive drinking can even cause the user to become unconscious
  • Nausea – In many ways the body treats alcohol as a poison, in fact some byproducts of alcohol metabolism are indeed toxic.4 Like any poison, the body will attempt to remove it by vomiting.
  • Impaired Coordination – Because alcohol slows down the body, the ability to coordinate muscle movements is impaired.
  • Slow Reaction Time – Alcohol can slow down the time it takes to react, making performing activities such as driving incredibly dangerous.
  • Amnesia - Alcohol impairs the ability to form memories will under the influence, often known as “blacking out.”
Alcohol Poisoning

Alcohol overdose, more commonly known as “alcohol poisoning,” occurs when a dangerously large amount of alcohol is consumed. People suffering from alcohol poisoning may exhibit the following signs and symptoms

  • Respiratory depression (slow breathing)
  • Seizures
  • Blue-tinged skin
  • Unconsciousness
  • Coma

Alcohol poisoning can be deadly, particularly when other drugs are involved such as benzodiazepines or opioids.

What Exactly Makes Someone an “Alcoholic?”

Alcohol use disorder, commonly referred to as “alcoholism,” is a disorder characterized by excessive alcohol consumption. If alcohol is completely legal for those over the age of 21 and many can drink moderately with no health concerns, what exactly counts as alcoholism and what classifies someone as an “alcoholic?”

The Diagnostic and Statistical Manual of Mental Disorders, the most authoritative tool for diagnosis of mental disorders, has developed a set of criteria in the form of a questionnaire. An individual meeting at least 2 of the 11 criteria in the same 12-month period receives a diagnosis of “alcohol use disorder.” Select criteria for diagnosis is listed below (not all criteria is listed)

  • 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 aftereffects?
  • 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 job troubles? Or school problems?
  • Continued to drink even though it was causing trouble with your family or friends?
Signs of Alcohol Use Disorder

In general, the following signs may indicate that someone has an alcohol use disorder:

  • Biological – Some people’s brains are simply wired in a way that predisposes them to addiction; these individuals have a much more difficult time resisting urges to drink.
  • Genetic – A family history of alcoholism may put an individual at greater risk of developing it themselves.
  • Social – Because drinking is a common, accepted, and sometimes even encouraged aspect of socialization, many people find themselves surrounded by those who engage in unsafe alcohol consumption, even at a young age.
Alcohol Withdrawal

Individuals with a drinking problem will often drink larger amounts to overcome the tolerance built up over time. This leads to dependence, where the individual needs to drink in order to function normally. Someone dependent on alcohol will suffer serious withdrawal symptoms if they do not drink, some of which can be life-threatening.

Some symptoms of alcohol withdrawal are listed below

  • Anxiety
  • Insomnia
  • Depression
  • Fatigue
  • Uncontrollable shaking (known as “delirium tremens,” or “DT’s”)
  • Rapid heart rate
  • Seizures
Alcohol Detox

When someone with an alcohol use disorder decides to stop drinking, the first priority is ensuring safe discontinuation of alcohol. Since sudden discontinuation, also called “cold turkey,” can cause life-threatening seizures. It is important that heavy drinkers see a medical professional during the initial detox period.

Control of initial withdrawal symptoms may involve the use of the benzodiazepine Valium (diazepam) or Librium (chlordiazepoxide) to prevent or control seizures and anxiety, as well as sleep aids to help insomnia.

Controlling withdrawal symptoms during the detox period is not the same as treating alcohol use disorder itself, which is a far more complex substance abuse disorder.

 

Drug Treatments for Alcohol Use Disorder Treatment
  • Antabuse - The drug Antabuse (disulfiram) creates an artificial sensitivity to alcohol. If someone drinks alcohol while taking Antabuse, they will immediately suffer symptoms similar to an extreme hangover such as vomiting, nausea, headache and fast heart rate. In most cases these effects would be unwelcome, however in this case they are designed to be felt in order to deter drinking.
  • Vivitrol – Vivitrol is a drug containing the opioid-antagonist naltrexone. It is injected into the muscle where it stays and releases the drug slowly over four weeks. While it is not known exactly how Vivitrol works for alcohol dependence, it appears to reduce cravings.
  • Campral – Campral is the brand name of the drug acamprosate. It is believed to work by stabilizing chemical signaling in the brain that would normally be disrupted by alcohol withdrawal9 It is only effective as a supportive therapy to psychosocial support such as counseling and group therapy.
Behavioral Treatment for Alcohol Use Disorder

Most treatment programs involve the use of counseling sessions to focus on the behavioral modifications necessary to treat alcohol use disorder. Some treatment programs may feature group counseling sessions, where people recovering from alcoholism can discuss their problems and progress in a support group atmosphere.

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