What is alcohol abuse?
Alcohol abuse is a disease characterized by the over use and abuse of alcohol so-as to negatively effect a person’s life. Despite the negative consequences of alcohol abuse, people who suffer from this disorder are unable to stop drinking.
Effects of alcoholism may include physical, mental, psychological, and social issues, including domestic abuse, domestic violence, loss of income, inability to keep a job, stress, or even damage to an unborn baby.
History of Abuse
Alcohol is so intertwined in American culture that the word “drinking” alone connotes alcohol consumption. Prohibition, the most wide-sweeping effort ever made to eradicate alcohol from the American landscape, became law after the ratification of the 18th Amendment on January 29, 1919. However, the criminalization of alcohol distribution and consumption only led to the proliferation of bootlegging (unlawful manufacturing), speakeasies (clubs of ill repute), smuggling alcohol across state lines, and the production of homebrews (“moonshine”). Prohibition also had the unintended consequence of leading to an increase of power among crime syndicates. Notably, gangster Al Capone reportedly earned $60 million per year from illegal bootleg and speakeasy operations.
Prohibition was not working, and the Great Depression only exacerbated matters. In 1933, Congress passed the 21st Amendment to appeal the 18th Amendment. Alcohol distribution and consumption were again legal, which helped to stimulate the depressed economy. Although Prohibition was retired to history as a “failed experiment,” its enactment demonstrates how alcohol has long been considered a threat to public health. The repeal of Prohibition is also instructive because it showed that alcohol use had a far greater grip on the American way of life than legal authorities had conceived. It would appear from the “failed experiment” that alcohol cannot simply be expunged from American life. For this reason, public education is necessary to prevent alcohol misuse, and rehab centers must continue to treat cases of abuse.
In light of the fact that alcohol consumption appears to be here to stay, moderation of use is critical. This temperance approach is reflected in the “Drink Responsibly” message found in different alcohol advertisements. But a survey found that the Drink Responsibly Campaign does not appear to be optimally designed to actually carry out this important public health message. Studies of advertisements with the “Drink Responsibly” message have revealed the following:
- A study from The Bloomberg School of Public Health reviewed ads run in US magazines from 2008 to 2010 and found that 87 percent did not offer any guidance as to what drinking “responsibly” means.
- A survey conducted by Alcohol Justice, a watchdog non-profit, analyzed alcohol ads from 41 magazines and found that the font used was usually small and placed along the edge of the copy so as to make the message nearly invisible.
- Some manufacturers added their company name into the message, such as “Drink Heineken Responsibly.”
- Some ads did not include “Drink Responsibly” as a standalone message; the message appeared in a block of ad copy, preceded by words such as “party,” “drink,” and “celebrate.”
Both the “failed experiment” and the “Drink Responsibly” campaign demonstrate that alcohol distribution and consumption are big business in America. Although it is legal to manufacture and consume alcohol, alcohol is a drug. The legal status and aggressive marketing of this drug have no doubt contributed considerably to alcohol abuse and alcoholism. While alcohol abuse is never advisable, it is understandable how the media may encourage drinking. The key is to understand the extent of alcohol abuse in America, warning signs, and ways to get help when necessary.
Statistics on alcohol use
The 2013 National Survey on Drug Use and Health (NSDUH), sponsored by the Substance Abuse and Mental Health Services Administration, is one of the most current and reliable sources of information on alcohol and other drug consumption patterns and trends in the US. In addition to Christmas being one of the heaviest times of drinking, the 2013 NSDUH included the following findings on alcohol:
- 2 percent of Americans in the 12 or older age group self-reported that they were current alcohol drinkers
- 5 million Americans in the 12 or older age group were considered “heavy drinkers, ” defined as binge drinking at least five days in the last 30 days
- 1 million Americans aged 12 or older were “binge alcohol users” in the past month, defined as consuming five or more drinks on the same day, at least one time, in the 30 days prior to the survey
- 7 million underage Americans, aged 12 to 20, were current drinkers, including 1.4 million heavy drinkers and 5.4 million binge drinkers
These statistics reflect alcohol use, but it is less clear from the study how many Americans would be considered to suffer from alcohol use disorder (alcoholism). A chronic condition, alcohol use disorder occurs with the continuous use of alcohol, which leads to compulsive use and, in some cases, physical dependence (i.e., the body builds a tolerance to alcohol and discontinuing use triggers withdrawal symptoms).
Alcohol use disorder
Alcohol use disorder is distinguished from alcohol abuse, in part, based on the person’s ability to limit their consumption. A person suffering from alcohol abuse will more easily be able to self-regulate and limit the level of consumption. The diagnosis is usually reserved for those who abuse alcohol so persistently that they become disabled. In these cases, cravings for alcohol often make it difficult for the person to focus their attention on anything but drinking.
According to the National Institute on Alcohol Abuse and Alcoholism, in 2012, there were 17 million Americans aged 18 and older (7.2 percent of this population) who had an alcohol use disorder. The gender makeup breaks down to 11.2 million men (9.9 percent of the population in this age group) and 5.7 million women (4.6 percent of the population in this age group). These statistics do not indicate whether these Americans have received a formal diagnosis, but on review of their usage, they would be considered to suffer from an alcohol use disorder.
The 2013 NSDUH provides insight into how many Americans require treatment for alcohol abuse and actually seek treatment. The survey made the following related findings:
- About 22.7 million Americans in the 12 or older age group needed treatment for an illicit drug or alcohol use problem (8.6 percent of this population).
- Of the 22.7 million Americans in need of treatment, 2.5 million received treatment at a formal rehab facility dedicated to alcohol and other drug treatment.
- Of the 2.5 million Americans who received formal rehab treatment, 875,000 had treatment for alcohol use alone, 936,000 had treatment for unlawful drug use alone, and 547,000 had treatment for both alcohol and unlawful drug use.
- In the 12-17 age group, 1.3 million needed treatment for alcohol abuse or illicit drug abuse. Of these youth, 122,000 received treatment at a formal rehab center (i.e., 1.2 million who needed treatment did not receive it at a specialized rehab center).
Research surveys provide helpful information on the extent of the alcohol problem at a national level, which is formidable. But what about at the individual level – what are the warning signs of alcohol abuse?
Signs of alcohol abuse
A person cannot always reliability self-diagnose a substance abuse problem. Family members, loved ones, neighbors, work colleagues, school officials, and other concerned persons are often the first line of detection of alcohol abuse. It may be difficult to tell the difference being social drinking and a drinking problem requiring rehab services. Whether the user or a third party is concerned, the following is a list of the outward signs of alcohol abuse:
- Ongoing inability to meet obligations: Either due to being intoxicated or hungover, the person is unable to fulfill responsibilities related to work, family, school, and social events.
- Continued drinking despite relationship problems: An expected response would be to change the behavior, but the person continues to drink.
- Drinking in dangerous situations: The need to drink outranks reason to the point of drinking and driving, drinking in unsafe neighborhoods, mixing alcohol and other drugs, operating machinery, and other risky behaviors.
- Legal problems: This can include arrests due to fighting, domestic arguments, drunk and disorderly public conduct, and/or driving while intoxicated.
- Drinking to cope: As alcohol consumption becomes the dominant form of dealing with stressful situations, other healthy responses will likely not be learned, and the problem only deepens.
In addition, alcohol abuse can result in physical distress and damage. These signs may be more apparent to the alcohol abuser than to those around him. Such signs include but are not limited to:
- Building tolerance: This is a biological process that results in a person needing to drink more alcohol over time to achieve the effects they experienced with earlier use.
- Experiencing withdrawal: As a result of tolerance, once the body is deprived of alcohol, it will manifest side effects, including anxiety, irritability, trembling, sweating, nausea, vomiting, insomnia, and headache.
- Losing control: Despite having the intention to limit drinking, the user is not able to do so when in a real-life situation.
- Inability to stop: There is a sincere desire to stop drinking, but after different attempts, this goal cannot be achieved.
The symptoms of alcohol withdrawal bear further discussion. As elaborated in The Physician’s Guide to Helping Patients with Alcohol Problems, withdrawal symptoms can range from minor to severe. Signs of withdrawal usually occur between six to 48 hours after heavy alcohol use decreases. Most often, these symptoms intensify and then decline over a period of 24 to 48 hours. Seizures occur in up to 25 percent of withdrawal cases, and usually begin in the first 24 hours after use stops.
Delirium tremens, commonly known as DTs, is the most intense effect associated with alcohol withdrawal. DTs include extreme tremors, agitation, hallucinations, and increased heart rate. DTs arises in approximately 5 percent of persons withdrawing from alcohol. The symptoms most often appear two to four days after the last consumption of alcohol.
The symptoms of alcohol withdrawal, which can be dangerous, can be addressed during a medically supervised detox. Prescription benzodiazepines, anticonvulsant medication, and adrenergic medications may be used to increase the safety and comfort of the withdrawal process.
Again, it may be difficult to self-diagnose an alcohol abuse problem. Depending on the severity of the problem, the best advice may be to enter a rehab facility, which will provide a proper diagnostics interview at admission. The results of the diagnostic findings will be directly incorporated into the prescribed treatment plan.
Short of a rehab admission, a person who is concerned about her drinking can seek a consultation with a credentialed addiction counselor. For those who would like more information, the National Council on Alcoholism and Drug Dependence provides a self-test or you may take of our CAGE assessment.
Most often, family members and other loved ones play an instrumental role in leading a substance abuser to rehab. It may not be an easy, simple, or straightforward endeavor, but it is often a necessary one.
What to say
An early concern will likely be how to broach the topic of substance abuse. The Partnership offers the following guidance:
- Wait until the person is sober to talk.
- Be sober yourself at the time of the talk.
- Emphasize the love and concern motivating the talk.
- Make it a dialogue, not a lecture.
- Provide an objective account (specific instances) of why the concern has arisen.
- If it doesn’t work this time, leave the discussion open and try again later.
The goal of the conversation should be for change to occur, and change requires action to be taken. That action is getting treatment. There is no one-size-fits-all alcohol treatment model, just as there are no two stories of alcohol abuse that are exactly the same. All treatment begins with a screening, which will result in a recommendation for an appropriate course of care.
Recovery from alcohol abuse
Depending on the level of consumption and length of alcohol abuse, the recommended treatment intervention will vary in length. The more severe cases will likely require an admission to a residential rehab facility, which most often lasts a minimum of 28 days, but often longer. Outpatient programs vary in length, and they can offer comprehensive treatment, though outpatient care is not as the intensive as the around-the-clock rehab care found at residential programs. The maze of rehab options may seem difficult to navigate at first blush, but a trained addiction specialist can assist with every phase of the rehab process, from the initial screening to program completion and an aftercare plan.
At The Recovery Village, our alcohol treatment programs and staff provide evidence-based, integrated care services to help our clients achieve sobriety and wellness. Treatment is based on the individual needs of each client with the goal of long-term success. Whatever your history of substance abuse, we are here to help you reach the sober, healthy future you deserve. Call us today for more information.