Can you imagine a party, wedding or any kind of celebration without some form of alcohol? Alcohol is even often a part of religious rites and practices. With the pervasive use of alcohol in American culture, it can be confusing to tell where the “line” is between moderate alcohol use and alcohol misuse – also called alcoholism.
First, what is alcohol and how does it work? Alcohol is a Central Nervous System (CNS) depressant. Like most substances, it changes the levels of certain chemicals in the brain called neurotransmitters. These chemicals can be either inhibitory, meaning they slow down (depress) the brain’s activity levels, or excitatory, meaning they speed things up. Alcohol works by increasing the inhibitory chemicals in the brain (i.e. GABA) and decreasing excitatory chemicals (i.e. glutamate). It also creates a chemical called dopamine, which is linked to the brain’s reward system, creating a feeling of pleasure and euphoria. So, alcohol simultaneously creates depression and tricks the brain into thinking it feels really good.
Signs and effects of alcohol use include:
- Euphoria or feeling good
- Mood changes
- Drowsiness or sluggishness
- Lapses in memory
- Reduced inhibitions
- Impulsive or destructive behavior
- Reduced attention span
- Slurred speech
- Coordination problems/unsteady gait
- Loss of control over volume of speech
- Flushed appearance
- Anger or aggression
- Changes in sleep patterns
When alcohol is used in high doses, effects can also include:
- Blackouts – lacking complete memory for a period of time
- Loss of consciousness
- Dizziness or vertigo
- Alcohol poisoning – a medical emergency.
So, what is moderate drinking? It is not always helpful to compare oneself to friends or family, because what someone might consider “normal” drinking likely will depend on how much the people around them are drinking. It is much more helpful to think about what research has shown to be low risk. According to the National Institute of Health, moderate drinking for all women and men over the age of 65 is no more than 3 drinks in a day and no more than 7 in a week. Moderate drinking for men under the age of 65 is no more than 4 drinks in a day and no more than 14 in a week. One drink is equal to:
- 1.5 ounces of liquor
- 5 ounces of wine
- 12 ounces of beer
When these moderate drinking levels are exceeded on a regular basis, it is called alcohol abuse or alcohol misuse. There are two different types of alcohol abuse: binge drinking and heavy drinking. Binge drinking is defined as the consumption of large amounts of alcohol in a short period of time, while heavy drinking is defined as continuous use of unhealthy amounts of alcohol. Both types of high risk drinking can eventually develop into an addiction to alcohol, causing significant problems with social life, family, health, finances and other issues.
Alcohol Abuse and Addiction (Alcoholism)
So how do you know you have crossed that line from high risk drinking into alcoholism? Addictive use of any substance, including alcohol, has three components. The first is continued use despite negative consequences of drinking (family problems, health issues, finances, work performance, etc.). Second, one begins to experience cravings, defined as a strong desire to drink. Finally, for someone with an alcohol addiction, alcohol will preoccupy their thoughts; thoughts of when they will be able to drink next, thoughts of how they will get it and thoughts of how they will recover from their hangover or cure withdrawal.
If you are wondering whether you or a loved one is struggling with alcoholism, the best thing you can do is seek professional advice. This article does not substitute an assessment by a professional. The following are some signs of addiction:
- A strong desire to drink (cravings)
- Once you start drinking, you drink more and more and have a hard time stopping
- Drinking alcohol and managing hangovers or withdrawal, start to replace other important things in life (family time, work, hobbies, etc)
- Trying to hide alcohol or drinking from others
- Minimizing or lying about your alcohol use
- People, including loved ones, say that you drink too much
- Feeling defensive when people ask or confront you about your drinking
- Becoming very moody, depressed, anxious or angry when drinking
- Using alcohol to cope with emotions or stress
- Feeling you “need” to have a drink to be social, sleep, relax, etc.
- Continuing to drink despite negative consequences of drinking – financial problems due to the cost of alcohol, family conflict, legal issues like DUI’s, interference with work ethic/performance, etc.
- Continuing to drink despite medical issues – pancreatitis, liver problems, digestive issues, etc.
- Black outs
- Needing to drink more to get the same affect (increased tolerance)
- Feeling ill if you haven’t had a drink (withdrawal)
- Needing a drink first thing in the morning to steady yourself
- Feeling guilty or ashamed of your drinking
- Having had unsuccessful attempts to cut down or control your drinking (taper, ration out, switch to beer instead of liquor, etc.).
- Mixing alcohol with prescription medications like benzodiazapines (anti-anxiety), sleeping pills like Ambien, or opioids; these can be very dangerous combinations.
If one or more of these applies to you or your loved one, you could be dealing with alcoholism. It is important to speak to a professional who can assess the situation and give you treatment options.
As an alcohol addiction progresses, two things happen: tolerance and withdrawal. When tolerance is developed, you need to drink more and more in order to achieve the same effect. Withdrawal happens when the body has gotten so used to taking in alcohol that it actually becomes dysregulated without it. People going through withdrawal often describe it as “needing” to have a drink in order to function. Symptoms of alcohol withdrawal can begin to occur around 6 hours after the last drink. These symptoms tend to get worse before they get better, lasting anywhere between 5-7 days. After the initial acute withdrawal phase, some milder symptoms – like difficulty sleeping, or a slight tremor – can persist for weeks, a syndrome called Post-Acute Withdrawal. Experiencing alcohol withdrawal means that a person is alcohol dependent, a severe and clear sign of alcoholism.
Symptoms of alcohol withdrawal include:
- Tremors or shaky hands, that could affect handwriting
- Difficulty sleeping (insomnia)
- High blood pressure
- Increased heart rate
Alcohol withdrawal can be life threatening if it is done without any medical assistance. Vomiting and diarrhea can cause dehydration. Additionally, there are other potentially life threatening complications including seizures and delirium tremens (DTs). DTs occur in about 5% of people with alcohol withdrawal, and symptoms include hallucinations (seeing, hearing, or feeling things that aren’t there), delusions (false beliefs), fever, confusion, sweating, high blood pressure and high pulse (racing heart). If you believe that you or someone you know is experiencing complications from alcohol withdrawal, please immediately call 9-1-1 as these are medical emergencies.
Alcohol Detox and Rehabilitation
Alcohol withdrawal is one of the few withdrawals that can be life threatening if done without medical assistance. If you are experiencing symptoms of withdrawal when you stop drinking, a medically assisted detox can make the process safer and more comfortable. A medically assisted detox involves a taper. This means that a medication is given in lower and lower doses, until the body gets used to being without alcohol. Usually a class of anti-anxiety medication called a benzodiazepine (i.e. Librium®) is prescribed for this taper. A detox will never be symptom-free, but withdrawal symptoms will be much more manageable. Medications can also be prescribed that target certain symptoms of withdrawal, including nausea (i.e. Phenergan (TM)), sleep (i.e. Trazodone) and blood pressure (i.e. clonidine). During alcohol detox, natural remedies can also help. For instance, it is important to rest, avoid physical exertion, avoid caffeine and hydrate with water or other electrolyte-rich liquids like sports drinks. These natural remedies help protect the heart and body from any additional damage.
Detox is just the beginning of recovery. Residential alcohol rehabilitation offers much more than medication and comfort. It allows a person to get away from their home environment and to have some time to heal. In addition, a good residential alcohol rehabilitation program will provide coping skills to help manage cravings and emotions. A rehab can also help you to build social support, start to deal with family issues that could be getting in the way and create a plan for when you leave that will support your goals and ongoing sobriety. Often, this involves continued treatment at an outpatient level and finding a 12 Step or non-12 Step community group that can offer ongoing support.
If you or a loved one is struggling with an alcohol addiction, there is hope. AToN Center’s alcohol treatment program can help and a professional can assist you in deciding whether residential treatment and detox are right for you or your loved one.
- Venezuela, C. F. (1997). Alcohol and Neurotransmitter Interactions. Alcohol Health & Research World, 21(2): 144-148.
- National Institute on Alcohol Abuse and Alcoholism (NIH).
- National Institute Health: Alcohol Consumption
- Centers for Disease Control and Prevention (CDC)