Alcohol use disorder: When is drinking a problem?

Over the past few months, a conversation about alcohol use has been center stage in the national news. Stories about underage drinking, blacking out, and harmful behavior associated with alcohol use are quite common in many families around the world. The rise of the opioid epidemic in the US has rightly caught our attention, but overshadowed a much more common problem. In the United States, from 2006 to 2010 alcohol-associated deaths accounted for 88,000 deaths annually, or almost 10% of all US deaths.

While many people are becoming aware that medication assisted therapy can help treat opioid use disorder, very few know that medication and counseling can significantly reduce alcohol use compared with trying to cut back on your own.

What is an alcohol problem, anyway?

In the US, 6.6% of adult population reported heavy alcohol use, and one in four people reported at least one episode of binge drinking. Binge drinking is defined as four or more drinks in a day for a woman and five or more drinks in a day for a man. I bet you probably know someone who binge drinks — if not daily, then at least on weekends.

Alcohol use disorder (AUD) and other substance use problems are considered diseases like any other, but are stigmatized as moral failure by many. The cause of AUD is a complex interaction between genes and environment, with a strong association with other health problems. In one study, 77% of the individuals with AUD carried another medical problem, either cancer, liver disease, pancreatitis, or other psychiatric diseases such as depression, anxiety, bipolar disorder, or schizophrenia. A history of trauma, physical, verbal, and sexual abuse is also highly prevalent in this population. Even though genetics play an important role, exposure to specific life events and situations can significantly increase one’s vulnerability to seek comfort and reward using alcoholic beverages.

Recognizing alcohol use disorder

The awareness that alcohol use may be causing a problem does not come so easily. Drinking is socially accepted in most places, and is frequently used as a social lubricant. I rarely see a patient coming forward on his or her own to talk about drinking behavior. The conversation is usually triggered by friends and family members who urge their loved ones to seek help, as many do not see their alcohol use as a problem. If you are unsure if you or someone you love may have a problem using alcohol, I would recommend asking one question: how many times in the past year have you had five (for men) or four (for women) or more drinks in a day? A response equal to or greater than “once” identifies, on average, eight out of 10 people with AUD. A positive answer should trigger a more thorough evaluation in a doctor’s office, or least stimulate a reflection about one’s drinking behavior.

Treating alcohol use disorder

As with many other chronic diseases, AUD treatment is not as straightforward as taking antibiotics for pneumonia. However, it may surprise you that there are several medications that can help patients deal with cravings and reduce drinking. Naltrexone, acamprosate, and disulfiram are among the current FDA-approved drugs to treat AUD. Other drugs that are used off-label to treat AUD include nalmefene, baclofen, gabapentin, and topiramate. Individual and group therapy may also help reduce binge drinking and increase abstinence.

For some people, drinking at night or on the weekend may feel like the only source of relaxation and comfort. It is not uncommon for people who suffer from anxiety and depression to drink to alleviate their feelings and emotions. The treatment of these psychiatric disorders may also help reduce the frequency and amount of drinking. Nonetheless, it may be hard to keep the motivation going. Relapses are a common part of the disease, and successfully overcoming AUD often depends on stability at work, adequate housing, hope for the future, and support from family, friends, and the health system.

Don’t be afraid to seek professional help if alcohol use defines who you are and is affecting your life and relationships. We now have several approaches that may lead to healing and recovery. A simple conversation with your doctor about whether or not you have a problem with alcohol use could be the first step toward a healthier and more fulfilling life.

Sources

Diagnosis and Pharmacotherapy of Alcohol Use Disorder: A Review, JAMA, August 2018.

Related Information: Alcohol Use and Abuse

Comments:

  1. KBI

    What constitutes ” a drink” in terms of actual alcohol content? I have a relative who fills a regular drinking glass anywhere from half to three quarters full of gin or vodka, mixes in some club soda and calls that “a drink”. I’m thinking it may actually be 3 drinks? Am I correct?

  2. Loni

    Drugs to ease drug use is always perplexing to me.

  3. Susana Neto

    I found this article very informative to me, and I am thankful for this extra information. Unfortunately I have some relatives with chronic drinking problems, and I am familiar with the behavior when it relates to a heavy and serious drinking addiction. But I have more difficulty in identifying, and doubts in considering (or not) a drinking problem when someone drinks, let’s say 2 or 3 beers in a day for 3 or 4 days during the week + a glass of wine at dinner every day + and eventually another drink (like gin & tonic) once in a while during the week too. For me it seems to be a lot of drinking, but some persons I know have this pattern, and they consider it not a problem…and of course these people never get drunk. Should I worry, and insist with these friends or not? Thank you for any advice. Susana

    • Marcelo Campos

      Hi Susana, a recent research shows that alcohol can be harmful even in smaller amounts. The current recommendations is up to 1 drink a day for women and 2 drinks a day for men. Denial is common with this disease and other substance use disorders. What we cannot deny is the association of alcohol use with cancer, psychiatric, liver and neurologic diseases.

  4. Noreen Albright

    I would say to ask a different question. Have you ever been arrested or kicked out of an establishment due to drinking? Then recommend they go to AA. Also, do you have relatives who have drinking problems, lost a license, crashed or blacked out due to alcohol. Some people can’t even drink one drink!!!! I’ve met people like this, at least three who get crazy after just one! They should avoid it entirely. If you are hiding any alcohol in your home, drinking alone or not knowing how you got home, you have a serious problem and need to join AA before alcohol destroys you,your familiy and your health. It’s a serious problem that many deal with and you need supportive sponsors, family and friends. Celebrate your sobriety and good luck to all.

  5. kim j masters

    AUD can be determined by asking is there is ‘use’ despite trouble and enabling, having someone support the use by suppling the etoh or covering up the effects. Trouble is arrests, domestic disputes, job disputes, and risky behaviors

  6. Roger Sramek

    Surprised you did not mention AA as an option. I have friends who have been sober for years – and have helped others – via AA.

    • JAS

      AA does not appeal to many people because of its basic tenet of reliance on a higher authority.

    • NFC

      AA has a poor track record — some studies suggest that something like 5-10% of people are able to stick with “the program” after a year.

      AA is also not a science- or evidence-based program. It is more of a “faith-based” program, both in the sense of its connection to religious belief and its essentially theological commitment to a program that was made up over 80 years ago. It can also be cultish.

      For people AA works for, great. But it comes with a lot of baggage.

  7. Bruce Gillett

    Masking pain with alcohol or other drugs is very temporary and for me actually leads to more pain. It is the avenue of lies and miss truths to oneself. Breathing in these dark feelings and accepting them, then breathing out hope, light, happiness has become my armor and mantra. The truth within is the knowledge that this path of relief through alcohol will lead to death. My battle is with these unfortunate demons. The current events of the world, social media, and instant information from all sources feed these demons. So I must evaluate the power of this knowledge. It is just as dangerous as the drugs. I find myself becoming more disenchanted with the human specie and their endless need for acceptance, control, money and power. So Inwardly I must find humor and laugh at this very ugly behavior. And in this humor I smile and unfortunately keep my distance. Drugs are the masking. Feelings continue as long as I breath and like a cycle, they too will pass. And that is the hardest challenge I have ever confronted. Breathe wait and live.

    • Noreen Albright

      Thank you Bruce. Well written, insightful with the emotions, pain and self knowledge but also with solutions of breathing and accepting emotions and switching it up to good thoughts/feelings. There is always a ying and a yang so don’t just focus on one and why not the good ones? Focusing on the good here and sobering up.

    • Debbie

      Very inspiring. Thank you.

  8. Linda Gann

    I appreciate this article and the approach that something other than abstinence is effective in treating AUD.

  9. kim j masters

    The simple way to determine if etoh is an issue is by definition:
    The definition of aud is use despite trouble plus enabling , which is having someone helping you to use. There are 2 types of enabling, positive like the parent who buys etoh so their teens will drink T home, and negative enabling, which is cleaning up and hiding someone’s use from others.
    Use despite trouble means that drinking causes trouble like argum nets, DUIs , job loss, risky behavior etc.
    Everyone who has use despite trouble has an enabler.

  10. Jason A

    Surprised at not one mention of Alcoholics Anonymous in this article. The organization has been keeping millions of alcoholics sober for decades, worldwide. Even many who relapse return to AA and lead full lives as productive members of society.

    • Noreen Albright

      True. It was wrong not to mention them. They have been in the trenches for years and helping so many unfortunate, despairing souls. They helped 4 of my relatives get sober. One relapse but no drugs to mask. Learn to live your life without alcohol and controlling environment and people you’re around / situations so the temptation is not there.

      • KB

        I could not agree more with the comments expressed by Roger, Noreen, and Jason A. I have many friends and family who have been able to recover using the principles found in AA. FWIW, If you think you have an issue with alcohol, I would at least check out a meeting or two before discounting it.

      • Marcelo Campos, MD

        The article mentions individual and group therapy as ways to treat patients with AUD. AA is one of these modalities. AUD is a chronic disease just like hypertension and diabetes. Medications don’t mask the problem. They are tools patients can use to help reduce alcohol consumption or achieve full sobriety.

  11. roberto md

    brazil power . thanks dr marcelo dear collegue

  12. Owebeyi James

    I am so thankful to the author of the article and those specialists who have assisted to compile the research.
    However it is very challenging that very few people will have access to the article and bather to read it,and tell friends especially my African friends. while 10% of death in the US was due to scourge of alcohol as in the article it is more and more that that in Africa and worst in Uganda.
    The worst challenge is that there is no law regulating the use of alcohol in most African countries, even the fewer laws have not been enforced. I can say this because the Enguli Act of Uganda is one of the unknown, and unfunctional law in Uganda yet it is the only one on alcohol related cases.
    I don’t know whether the writer tried to look at the impacts of AUD in relation to HIV/AIDS and domestic violence. here most cases of domestic violence are closely related to alcohol, again it is obvious t that many people lose self control when drunk and can easily give up to in protected sex,to contract HIV,alcohol easily weakens the immune system of an HIV victim.
    I think there should put stringent laws to regulate on the use of alcohol.

    • Bobby N.

      Laws only matter to people who care to obey them. More laws do not solve a problem. People need reasons to change behavior, and the first reason is self love…. understanding that abusive drinking is slow suicide. If one does not care about himself, by extension, does not truly care about anyone else. Sometimes it requires many other people pointing out the behavior problems that follow drinking episodes to help someone understand that the behavior needs to change. Keep in mind that you can only make decisions for yourself, not for someone else.

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