Alcohol use disorder is a pattern of alcohol use which involves heavy or frequent alcohol drinking even when it causes problems, emotional distress or physical harm. In AUD, the person has problems controlling their drinking, being preoccupied with alcohol or continuing to use alcohol even when it causes problems. It has withdrawal symptoms when one rapidly decreases or stops drinking as well as develops tolerance which involves having to drink more to get the same effect.

DSM-V defines alcohol use disorder as a maladaptive pattern of alcohol consumption that includes:

1. Consumed more alcohol or spent more time drinking than intended.
2. Wants to limit or halt alcohol use, but hasn’t succeeded.
3. Spends an inordinate duration drinking, being ill, and undergoing the after effects of alcohol use.
4. Have strong cravings for alcohol.
5. Consuming alcohol or becoming ill because of it has kept the person from properly attending to household duties and children, or resulted in difficulties performing on the job or at school.
6. Has continued drinking in spite of it causing problems with family and loved ones.
7. Has discontinued or is only sporadically involved with things that were once enjoyable or important to be able to drink.
8. Has repeatedly been in situations during the consumption of alcohol that has increased the chance of being injured (using machinery, driving).
9. Even though a person feels sad or distressed, or it affects an already existing health problem, the person continues to drink. Or, after episodes of forgetting or going blank about the events during drinking, the individual continues to use alcohol.
10. Has to increase drinking to get the results he wants. (The usual amount of alcohol provides little results.)
11. When the alcohol wears off, it causes symptoms like insomnia, difficulty staying asleep, aggravation, nervousness, sadness, stomach upset and nausea, and/or perspiring. Or, the person felt items were there, but they are actually not.

Degrees of AUD

1. Mild AUD Diagnosis:
   The presence of two symptoms in the criteria signifies mild AUD.
2. Moderate AUD Diagnosis:
   When an individual has four to five criteria, the AUD diagnosis is considered moderate.
3. Severe AUD Diagnosis:
   Individuals who have six or more of the criteria are diagnosed with severe AUD

What happens when you drink alcohol?

Alcohol contains ethanol which has various effects in the body. Ethanol reduces activity of various inhibitory and excitatory neurotransmitter pathways. It increases GABA (gama amino butyric acid) inhibition. It activates opioid receptors which induces release of endorphins that help release dopamine and serotonin. It also blocks glutamate which is an excitatory neurotransmitter.

The combined effect of these lead to produce pleasant or rewarding feeling like euphoria which makes it more likely for the person to drink again.

Blood Alcohol Content (BAC)

0.0% to 0.05%:  makes one feel relaxed and happy. It may lead to slurred speech, difficulty with coordination and breathing.

0.06% to 0.15%:  more impairment in speech, attention, coordination and memory. There is an increase in aggression and violence.

0.16% to 0.30%: alcohol poisoning which causes vomiting, black outs or loss of consciousness.

Above 0.31%: severely suppressed breathing and death.

Symptoms

Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms one experiences, which may be:

• Being unable to limit the amount of alcohol you drink
• Wanting to cut down on how much you drink or making unsuccessful attempts to do so
• Spending a lot of time drinking, getting alcohol or recovering from alcohol use

• Feeling a strong craving or urge to drink alcohol
• Failing to fulfill major obligations at work, school or home due to repeated alcohol use
• Continuing to drink alcohol even though you know it’s causing physical, social, work or relationship problems
• Giving up or reducing social and work activities and hobbies to use alcohol
• Using alcohol in situations where it’s not safe, such as when driving or swimming
• Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount
• Experiencing withdrawal symptoms — such as nausea, sweating and shaking — when you don’t drink, or drinking to avoid these symptoms
• Ability to function at work or in social situations.

Causes

Genetic, psychological (low self-esteem, impulsiveness), and environmental factors can impact how drinking alcohol affects one’s body and behavior.

Treatment

AUD treatment may include individual or group counseling or a combination of both, an outpatient program, or a residential, inpatient stay. Treatments may include the following:

1.      Medications

Medicines approved by the Food and Drug Administration (FDA) to treat alcohol dependence include disulfiram, oral naltrexone, extended-release naltrexone, and acamprosate. Positive results are found when medications are combined with behavioral treatment.

2.      Behavioral Therapies

Behavioral therapies are especially effective in encouraging self-change—or the ability of some people to quit drinking on their own. These approaches use goal setting, self-monitoring of drinking, analysis of drinking situations, and learning alternate coping skills. Couples and family therapies analyze drinking behaviors and aim to improve relationship factors, such as improving communication, avoiding conflicts, and learning to solve problems that might lead to drinking.

1.      Mutual-help Groups (MHGs)

MHGs are groups of two or more people who share a problem and come together to provide problem-specific help and support to one another. It is flexible and responsive. People can attend MHGs as frequently and for as long as they want without insurance and without divulging personal information. Often, people can attend MHGs at convenient times, like evenings and weekends, when they are at higher risk of a relapse to drinking. MHGs also are more cost effective than formal treatment.

Reference

Alcohol use disorder – Symptoms and causes. Mayo Clinic. (2022). Retrieved 1 August 2022, from https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243.

Alcoholism – causes, symptoms, diagnosis, treatment, pathology. Youtube.com. (2017). Retrieved 2 August 2022, from https://www.youtube.com/watch?v=e5DxD6Tuxxw.

Alcohol Alert Number 81. Pubs.niaaa.nih.gov. Retrieved 2 August 2022, from https://pubs.niaaa.nih.gov/publications/aa81/aa81.htm.

KM, L. (2017). Alcohol use disorder: Criteria, symptoms, treatment. Thriveworks. Retrieved 2 August 2022, from https://thriveworks.com/blog/alcohol-use-disorder/#:~:text=Alcohol%20Use%20Disorder%20Criteria%2C%20According,the%20aftereffects%20of%20alcohol%20use.