Alcohol use disorder is a broad category that includes many alcohol problems. Alcohol addiction and dependence, both found in the category of alcohol use disorder, affect around 16 million American adults, according to the National Institute on Alcohol Abuse and Alcoholism.1 Half of Americans have a close family member with an alcohol use disorder, which takes a major toll on the health of the family. Alcohol use disorder reduces your sense of wellbeing and creates numerous problems in your life.
Recovery from alcohol use disorder is a process of restoring life and finding internal motivations for quitting drinking. Asking for help is often one of the hardest parts of recovery, but it’s the first step towards reclaiming life from alcohol.
How is AUD Defined?
Alcohol abuse, addiction, and dependence are diagnosed under the umbrella term “alcohol use disorder” or AUD. The diagnosis is characterized as mild, moderate or severe, depending on how many of the diagnostic criteria are met. While all found under the umbrella of alcohol use disorder, alcohol abuse, addiction and dependence are not the same things, although these terms are often used interchangeably. Understanding the differences is important for understanding alcohol use disorder treatment and recovery.
Alcohol abuse is defined as using alcohol in a way that causes negative consequences in life. Alcohol abuse can lead to relationship problems, legal troubles, financial issues, or physical and mental health conditions. According to the Centers for Disease Control (CDC), binge drinking is a form of alcohol use disorder. Binge drinking is the most common, most costly and deadliest form of alcohol abuse in the U.S. Binge drinking occurs when enough alcohol is drank over the course of two hours to bring the blood alcohol concentration to .08 percent or higher. For men, this typically occurs with five drinks. For women, it typically occurs with four drinks.
According to the CDC, one in six U.S. adults binge drink, and therefore, an alcohol use disorder. Although binge drinking is most common among people aged 18 to 34 years, more than half of the 17 billion binge drinkers are people aged 35 years and older.
Binge drinking leads to serious problems, including unintentional injuries, alcohol poisoning, violence, sexually transmitted diseases, unintended pregnancies, chronic diseases, and cognitive problems. Most people who binge drink are not addicted to or dependent on alcohol.
Around 15 percent of people who abuse alcohol will develop an addiction, classifying them as having an alcohol use disorder. People with an alcohol addiction drink compulsively, even though the drinking causes serious relationship, legal, financial or health problems. Once addiction develops, it’s difficult to stop drinking independently.
Addiction develops as the brain changes in response to heavy alcohol abuse by the person with alcohol use disorder. Alcohol acts on the dopamine system in the brain. Dopamine is a neurotransmitter that’s responsible for feelings of pleasure. It also plays an important role in the memory, learning, motivation, and reward centers of the brain. Heavy alcohol abuse produces elevated dopamine levels. This leads to a rewiring of motivation, learning and memory centers of the brain. As a result of this rewiring, drinking becomes compulsive and driven by intense cravings.
Whether alcohol use disorder addiction develops depends on several factors. A history of trauma, mental illness, chronic stress, and a family history of addiction are risk factors that may increase the chances of alcohol addiction. An alcohol use disorder addiction is widely considered to be a chronic and relapsing disease of the brain. As a chronic disease, alcohol use disorder addiction can be sent into remission with treatment. If someone drinks again after a period of remission, the brain can quickly revert and lead to compulsive drinking.
Dependence is a physical need for alcohol. It’s characterized by withdrawal symptoms that occur when drinking suddenly stops. Alcohol use disorder dependence, like addiction, results from changes in the structures and functions of the brain, caused by heavy alcohol abuse.
When alcohol is first consumed, it elevates the activity of the neurotransmitter GABA, which produces feelings of relaxation and calm. At the same time, it suppresses the activity of glutamate, which is responsible for feelings of excitability. With heavy alcohol abuse, the brain attempts to maintain normal neurotransmitter function. It does this by suppressing GABA and increasing glutamate activity in an attempt to compensate for the effects of the alcohol. This produces tolerance, which means that more is consumed to get the previous effects.
As more alcohol is consumed, the brain continues to compensate. At some point, brain function may shift so that it now operates more comfortably when alcohol is in the blood. Then, when drinking stops suddenly, normal brain function quickly rebounds. GABA, which was suppressed, now floods the brain. Glutamate, which was increased, is now suppressed. This sudden change in the function of these and other neurotransmitters causes physical withdrawal symptoms.
Get Help to Recover
Overcoming an alcohol use disorder isn’t easy, but treatment helps develop the mindset, skills, strategies and techniques needed for long-term success. Treatment helps to transform life on all fronts, including helping to repair damaged relationships, find purpose and meaning in life without needing alcohol to relax and have fun.
The first step to recovery is seeking help when you feel helpless against alcohol. The treatment works for most people who fully participate in their treatment plan, and it can help you overcome an alcohol use disorder, too.