Alcohol Addiction – The Ultimate Guide

Alcohol addiction is a complicated issue that can be well hidden, making it challenging to identify. Regardless, the habit can get conquered with the right treatment and complete life-long abstinence.

If you’re concerned about your alcohol use, or someone else’s, this article discusses the problem in-depth to give you a good general understanding of the condition.

Get to know more about the causes, signs and effects, detox and withdrawal, and treatment options. Understand how you can help an alcoholic as well.

Vital to note, though, is that there’s no one-size-fits-all symptoms or solutions. For complete recovery, each case must get assessed and treated individually.

Also known as alcohol use disorder, or AUD and commonly called alcoholism, no one needs to suffer for the rest of their life if they choose not to.

What is alcohol addiction?

Alcohol addiction can be defined as a chronic disease that leads to habitual and excessive alcohol use despite adverse consequences.

As with all addictions, it involves a pattern of use that the addict struggles to control. They become preoccupied with alcohol and ensuring that they have enough available. Whether they drink at home or socially, access to alcohol is a prime priority, often taking precedence over responsibilities and relationships.

Despite obvious problems caused by their drinking, the addict will continue. Whether it’s home, work, school or health concerns, they will minimize the impact of alcohol, often shifting blame to divert attention from their drinking. As a result, they can become dishonest or secretive about their drinking and its consequences.

Over time, addicts will have to drink more to get the same effect and get withdrawal symptoms when they try to limit intake or stop. The inability to handle withdrawal and consequent fear of it can push an addict deeper because they start drinking more to ward off symptoms.

Heavy alcohol use, binge drinking and high-intensity drinking don’t necessarily constitute alcohol addiction; however, they make people more prone to it. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the three categories are defined by use –

Heavy alcohol use: binge drinking on five or more days in a month

Binge drinking: consuming five or more servings of an alcoholic drink for men and four or more for women in one sitting or within two to three hours

High-intensity drinking: consuming twice or more the gender-specific threshold for binge drinking, which is ten or more alcoholic drinks for men and eight more for women

Key alcohol addiction statistics

Because alcohol addiction is a secretive disease, reliable statistics rely mostly on reports from hospital emergency rooms, medical professionals, addiction treatment centers and mental health practitioners. Both addicts and families tend to downplay the problem for fear of condemnation and stigmatization and might prefer to put addiction down to heavy alcohol use or binge drinking.

In 2019 National Survey on Drug Use and Healthy (NSDUH) released the following statistic related to alcohol addiction in the USA –

14.5 million people older than 12 years had alcohol addiction (5.3% of this age group)
414 000 adolescents between 12 and 17 had alcohol addiction (1.7% of this age group)
7.2% of people older than 12 received some treatment in 2019
6.4 % of adolescents 12 received some treatment in 2019
Less than 4% of people were prescribed medication approved by the US Food and Drug Administration (FDA) to treat their condition
People are more likely to seek help for an alcohol-related medical problem rather than for their alcohol addiction
4.2 million people between 12 and 20 reported binge drinking in 2019 (11.1% of this age group)
825 000 people between 12 and 20 reported heavy alcohol use in 2019 (2.2% of this age group)
25.8% of people older than 18 reported engaging in binge drinking in 2019
6.3% of people older than 18 reported engaging in heavy alcohol use in 2019
9.5% of pregnant women between 15 and 44 used alcohol in 2019

The National Institute on Alcohol Abuse and Alcoholism reports –

95 000 people in the US die annually from alcohol-related causes
5.3% of global deaths were attributable to alcohol consumption in 2016
Alcohol misuse was the 7th leading risk factor for premature death and disability in the world in 2016
14% of total deaths globally among people between 20 and 39 were attributable to alcohol
1 to 5% of first-graders from a sample of 6 000 in the US have fetal alcohol spectrum disorders

What causes alcohol addiction?

Many factors contribute to alcohol addiction. These include genetics, mental health issues, social conditions and environmental factors.

Drinking high amounts of alcohol regularly changes the normal functioning of the brain. Particularly the areas of judgement, pleasure and behavior control. It also depresses the central nervous system. Subsequently, it leads to false feel-good feelings that need to be fed in higher amounts to get the same results.

Once the brain’s programming gets altered, it becomes more difficult for people to stop because they crave the effects and go through withdrawal if they stop. That’s how alcohol addiction manifests at a physical level.

Genetic link

In the years that I’ve been working with addicts, I’ve noticed definite addictive patterns within families, and the American Medical Association (AMA) concurs. Often alcoholics (as they’re referred to in the rooms) share stories of family members with similar problems while others abstain entirely or have the odd social drink. A family having alcoholics and tee-totals in the same bloodline, raised under the same roof, indicates that alcohol must affect people differently.

Many of them are raging alcoholics who suffer severely as they try to get a grip on their condition. And it’s only with a dedicated commitment to their sobriety and support from family and friends that they succeed. These cases, to me, demonstrate a genetic predisposition.

Sadly, support is often not there for alcoholics who come from families with a history of alcoholism for two reasons. Firstly, they can get branded early on as being “the same as…” leading to rejection and judgement. Secondly, they return to family who don’t want to get help for themselves and therefore drag them back into the problem.

The American Academy of Child & Adolescent Psychiatry estimates that one in five adult Americans has lived with an alcoholic relative while growing up. Furthermore, children of alcoholics are four times more likely than other children to become an alcoholic themselves.

Mental health

Mental health is another contributing factor simply because alcohol is a relaxant and central nervous system depressant that’s readily available, cheap and socially acceptable. People medicate anxiety and depression with it while not realizing it’s a highly addictive substance.

According to the AMA, about 37% of people who abuse alcohol have at least one serious mental illness.

In general, mental illness and mental health are still poorly understood in society and regularly dismissed as “being difficult”. Without professional support and education of their condition, it’s easy to see how self-medication with alcohol becomes an option for many.

Even for people on mental health treatment who struggle to cope, alcohol can become a problem because of its initial effects of relaxation and pleasure. Well known as a social lubricant, people with social disorders often use alcohol at the outset to mix with others or to cope with social contact at work.

Socio-economic factors

Social conditions and environmental factors also play a significant role. When children grow up surrounded by alcohol use, it becomes the norm. Parents either don’t notice their child’s alcohol consumption, or they ignore it.

Overindulgence on alcohol knows no social bounds and occurs widely across general society.

Whether it’s partying or a drink after work, it impacts families. Just go on social media and see how popular the #WineMom culture is worldwide. Wine moms need a drink to relax after a hectic day of childcare, but it runs much deeper.

Even one or two drinks impacts the attention we can give to our family. As parents reach for a bottle, whether it’s a bottle of plonk or from the top shelf, children start getting in the way. Either they get ushered to bed early or put themselves to sleep. Either way, they miss out on the vital attention they need from their parents.

Lack of parental support leaves children anxious, lonely or over-reliant on each other and lacking self-esteem or self-worth. As a result, they become prone to mental health issues that can lead to self-medication with alcohol which they see as normal.

Unfortunately, poverty and alcohol often go hand in hand. Alcohol might not be the cause of poverty, but for many, it’s a means to escape the biting pain and suffering it brings. Alcoholic parents can’t take proper care of their family or provide for them financially or emotionally.

Since poverty leads to people living in small and usually crowded places, people are defenseless to abuse inside and outside the home. Children are particularly vulnerable. Mental health problems abound, and the go-to substance is alcohol.

Socio-economic deprivation creates helplessness at every level of wellbeing, leaving many feeling hopeless and lacking the will to change their circumstances. Without outside support, they become susceptible to alcohol addiction and repeating the cycle of alcoholism and poverty.

Other risk factors

Apart from the potential causes mentioned previously, there are other risk factors. These include –

Drinking from an early age: the younger a person is when they start regular drinking, the more likely they are to develop an alcohol addiction. Young minds are still developing and learning coping skills for more mature life experiences. Dulling life skills with alcohol can lead to using alcohol as a coping mechanism throughout life.

Continued drinking over time: ongoing drinking becomes a habit that eventually changes neural pathways and our perceptions of life and ourselves. Regular binge drinking can have the same effect leading to alcohol addiction.

Past trauma: a history of traumatic experiences, whether emotional or otherwise, can be a precursor for alcohol abuse. Victims of abuse are often left with low self-esteem and a lack of self-confidence. Alcohol gives them “courage” to face the world.

Social circle: mixing in a circle of heavy drinkers or having a partner who drinks a lot increases alcohol addiction risk. In these circumstances, drinking is normalized and not joining in can mean rejection. To gain acceptance, a person can fall into continued drinking that escalates.

Bariatric surgery: research conducted by the American Society for Metabolic and Bariatric Surgery found that around 11% of 2 000 people who had gastric bypass surgery developed drinking problems by the second year after the operation.

Signs that you have an alcohol addiction

In general, if you think you have an alcohol addiction, you likely do. Alcohol is so entrenched in daily life that most people will vehemently deny having an issue. Only when it starts to impact our lives and wellbeing negatively do thoughts about addiction begin to stir.

A serving of an alcoholic drink is –

1.5 oz. of 80 proof distilled spirits (40% alcohol content)
2 to 3 oz. of aperitif, cordial of liqueur
3 to 4 oz. of fortified wine port, sherry, etc.)
5 oz. of wine
8 to 9 oz. of malt liquor
12 oz. of beer

Establishments regularly over-serve alcohol by using big glasses and mugs, and when we’re drinking socially, servings seldom get measured. So serving control requires your focused attention.

Alcohol addiction isn’t only about the amount you drink, but also how often you drink, how it impacts your life and what happens if you try to cut down or stop.

You have an alcohol addiction if you have three or more of the following symptoms: the more you have, the more severe your problem. Self-honesty is crucial when asking yourself if you –

Have previously tried to cut down or stop but couldn’t
Experience withdrawal symptoms if you go without alcohol
Want to limit your drinking but end up drinking more
Think about alcohol most of the time
Spend most of your time drinking, being drunk or feeling hungover
Are having problems at home, work or school as a result of your drinking
Continue drinking even though you can see the problems around you
Carry on drinking even though you can see physical symptoms of alcohol abuse
Calculate alcohol as an essential expense in your monthly budget
Prioritize buying alcohol above paying rent or buying food
Give up healthy activities you enjoy in favor of drinking
Feel guilty and even ashamed about your drinking
Have placed yourself in risky situations because of your drinking
Wake up with no memory of what happened while you were drinking
Are aware that your drinking has increased to get the same effect

Effects

Even in mild cases, alcohol addiction will have some adverse effect in the long-term. Frequently addicts start drinking to cope with challenges, but the longer they drink, the fewer coping skills they have. This quickly progresses into a negative cycle of facing a problem, not handling it and turning to alcohol to numb the situation.

This cycle includes issues created by drinking itself. Growing awareness of physical and mental health concerns and relationship problems often results in increased alcohol consumption rather than facing matters. About 30 to 50 % of people who drink too much develop dysthymia or chronic depression.

Short-term effects include –

Mood swings
Uncharacteristic behavior
Block outs
Short-term memory loss
Regular hangovers

Long-term effects include –

Gastrointestinal complications
Cardiac problems
High blood pressure
Kidney failure
Alcohol-related dementia
Permanent memory loss
Cirrhosis of the liver
Pancreatitis

Besides placing their health at risk, addicts can partake in risky behavior that poses a threat to their health and safety as well as their life, such as –

Drink driving
Physical violence
Unprotected sex
Suicidal thoughts
Swimming while drunk
Walking on busy roads while drunk

Understanding alcohol withdrawal

Withdrawal from alcohol usually starts within a few hours after the last drink. However, since there are so many factors contributing to detox, the length and severity differ from person to person.

Heavy drinkers and those drinking for a long time are inclined to experience more severe symptoms. Underlying health conditions are another issue that can cause serious complications.

According to the National Library of Medicine, alcohol withdrawal typically occurs within 8 hours after the last drink but can happen days later. Symptoms generally peak by 24 to 72 hours but can go on for weeks.

Under normal circumstances, excluding underlying health conditions, the withdrawal timeline has three stages –

1. Stage 1: lasts for between 6 to 12 hours and includes anxiety, headaches, insomnia, shaking, loss of appetite, nausea, stomach ache and vomiting

2. Stage 2: lasts for 12 to 48 hours and symptoms escalate to include hallucinations and even seizures

3. Stage 3: lasts for a further 48 to 72 hours and expands to potentially include confusion, fever, high blood pressure, increased heart rate and sweating. Rarely delirium tremens can set, which can lead to death.

What is delirium tremens?

Commonly referred to as DTs, delirium tremens is an extreme symptom of alcohol withdrawal that can be fatal in less than 5% of cases. Not everyone will experience DTs, but if symptoms manifest, immediate medical attention is essential, and hospitalization is usually required. Untreated DTs are more likely to cause death.

Symptoms occur from 48 hours to 10 days after the last drink and last between five and seven days. Symptoms are similar to stages 2 and 3 withdrawal but will be severe and can include auditory disturbances and agitation.

Chronic alcohol abuse, a history of seizures, underlying medical conditions and having had DTs previously make people high risk.

What causes withdrawal?

When alcohol is present in the body, the brain’s neurotransmitters get severely suppressed. Regular drinking and consuming alcohol in large amounts eventually causes chemical changes in the brain as it adjusts to cope. This also affects the nervous system, which becomes depressed.

The initial effects of alcohol on the brain is to slow it down. As a result, the way nerves send messages back and forth changes as well. When alcohol is very often present in the body, it has to make adaptions to keep the brain and nervous system awake and functioning.

Regard these adaptations as semi-permanent; the body needs the presence of alcohol to function “normally”. The sudden absence of alcohol throws the brain and central nervous system out of balance. Surges of glutamate, in particular, cause adverse effects throughout the body and brain.

Glutamate is a potent excitatory neurotransmitter released by nerve cells. It’s responsible for sending signals between nerve cells and is essential for learning and memory. Alcohol interferes with the healthy functioning of glutamate.

Is detox at home a good idea?

People often mistakenly think that going through alcohol withdrawal is safe to do at home and that it’s different from drug withdrawal. Reality can be very different, especially with alcohol addiction!

Home-detox can be so harrowing for some that it causes them to start drinking again and fear ever trying to dry out again. Mild withdrawal is unpleasant, moderate withdrawal excruciating and challenging and severe withdrawal can be deadly.

Prepare ahead if you want to try detoxing at home and make sure that you have the support of people within the family. Here are a few factors to ensure your safety and safeguard your health and wellbeing –

Remove all alcohol from your home and get those living with you not to expose you to alcohol use
Make time for detox by clearing your schedule of all responsibilities for about a week
Maintain a balanced diet and get all the vitamins and minerals necessary for a healthy recovery
Drink plenty of water to stave off dehydration
Tell people what you’re doing, especially if you live alone, so they can check up on you and be available if you need help
Prepare yourself mentally to go through a very challenging time

Although a balanced diet might seem like the last thing you need when detoxing, its vital to maintain physical strength and boost your immune system. Fresh fruit and vegetables and low-fat protein like white fish and skinless chicken will digest quickly.

Hydration is vital during detox, so make it a priority. Many people crave something sweet during detox, and although fruits contain sugar, eating too much might not be possible. Having candy available can help.

How to treat alcohol addiction

While home-detox is possible, it’s essential to know that it won’t cure alcohol addiction. Besides potential bodily harm caused by too much alcohol, such as liver, kidney, digestive and heart disease, mental health is also a factor that needs to get addressed separately.

A doctor must treat physical conditions because they can be chronic, meaning they’ll worsen without treatment. Drying out also won’t stop future cravings or help with anxiety and depression that linger long after withdrawal.

Have you ever heard of the term “dry drunk”. It’s a common term used in the rooms to describe someone who’s stopped drinking but still behaves like an alcoholic. One of the prime life skills lost in addiction is our ability to cope with everyday life challenges.

Staying sober in the long term requires a healthy body and mind, and working on recovery after detox must become a committed and ongoing practice. So if you prefer to detox at home, know that it’s only the beginning, and you will need considerable support and have to make a concerted effort to maintain sobriety.

Treatment centers take care of all your needs by ensuring safe withdrawal, monitoring your progress, providing counselling and devising a long-term recovery plan that suits your needs. Inpatient and outpatient treatment is available.

Even if you have a mild alcohol addiction, it can be better to opt for guided treatment from the get-go because there are so many considerations. Just thinking of all that must get well-thought-out can be overwhelming for someone thinking of detox, triggering fear and anxiety that can cause a change of heart.

People without a supportive family environment should consider inpatient treatment so that all family pressures get removed. During treatment, you will have access to a doctor and trained drug therapists to guide you through the early days of recovery when you’ll be very fragile on all levels.

By the time you leave the center, you’ll be on treatment for health conditions, equipped with coping skills, have a plan for going forward and access to support.

What to expect

If a treatment center doesn’t appeal to you, you can also approach your local doctor. Knowing your physical health status can mean the difference between a safe detox and ending up in a hospital. No matter what support you get, the early stages of treatment are similar.

Interview

Be willing to answer some very personal questions with honesty. Downplaying your drinking will only hamper your recovery and impact withdrawal if you say you drink less than you actually do.

Also, disclose physical symptoms related to, and unrelated to, alcohol. If you have a chronic condition, inpatient treatment or hospitalization might be recommended.

Prepare for detox

You’ll get guided on what to expect and given meds to help you through withdrawal. As an outpatient, you’ll get a prescription and an eating plan. All meds and dietary requirements get provided to inpatients, so they don’t need any prep other than assigning responsibilities while they’re away.

After detox

Inpatients will likely stay in the treatment center after withdrawal for ongoing treatment that includes regular sessions with a therapist, medical care, intro to support groups and often occupational therapy.

These services are also made available to outpatients. If you’re under the treatment of a doctor, they’ll refer you to a psychologist or psychiatrist and recommend support groups. Expect to have regular physical checkups for at least six months and longer if you have chronic conditions.

Maintenance

On leaving in or outpatient treatment, you’ll be equipped to continue your recovery. Depending on the severity of alcohol addiction and social circumstances, some people opt for halfway house treatment that can last for up to a year. Halfway houses (also known as sober-living houses) run active rehabilitation programs that help addicts reintegrate safely into society. Paid employment is encouraged, but free time is mostly spent onsite.

Those reentering their previous lifestyle are strongly encouraged to avoid situations where they previously used alcohol. We can avoid triggering situations by having regular therapy, attending support group meetings, and service to others.

Many addicts attain long-term sobriety by following these simple steps, taking care of their physical health and finding a spiritual foundation.

How to help someone with alcohol addiction

Helping someone with an alcohol addiction can get tricky because they’re likely to resist unsolicited efforts. Often people don’t understand alcohol addiction and, therefore, don’t comprehend the depth of the problem or its effects on the addict.

No one can “get over it” or pull themselves right. Both detox and recovery take preparation, planning and sustained long-term effort. That said, though, with the proper support and personal effort, long-term recovery is possible.

If you want to help an addict, you must be prepared to support them in the long-run. It’s not just a matter of getting them into a treatment center or through withdrawal. In early recovery, all addicts are incredibly fragile, and any hint of rejection or pressure can drive them back to drink.

Crucial to accept is that no one can be forced into recovery or do it for them, no matter how much you love them.

Obviously, the easiest solution is when the addict approaches you for help, but denial plays a huge role in addiction. Addicts often can’t imagine life without alcohol because it’s become the core of their existence, no matter the negative consequences.

There are options, however, that you can take if the addict is in denial.

Tough love

Tough love is mostly misunderstood. It’s not rejection, shaming and humiliating an addict into agreeing to address their problem. Instead, it’s about setting healthy boundaries and encouraging self-responsibility.

Let’s say you, as an adult, live with an adult alcohol addict. Adults in the home should share responsibilities and contribute financially to the family. What usually happens is that as the drinking progresses, the addict spends less time helping in the house and more and more of their income goes to alcohol.

In this case, you must set boundaries with consequences. For example, make a list of things they must do around the house and set a minimum income to live there. Also include a reasonable timeframe, like “within the next month I want you to…”

Consequences must be clear and rational. You might want to tell them that you’ll help them find another place to stay if it doesn’t happen. But before you set the boundary, be willing to live by the costs. Empty threat will only open you up to further manipulation.

If the addict is financially reliant on you, you can opt to cut off alcohol and entertainment funds.

Avoid harsh language, unreasonable consequences and threats of violence. That will only push the person further into addiction.

Tough love aims to encourage recovery and healing; it’s certainly not abuse.

Intervention

TV series have made the concept of interventions popular, but as with all entertaining shows, there’s a margin of unreality.

In untrained hands and under the wrong circumstances, an intervention can be disastrous.

Getting a group of caring people together and then jumping the addict is nightmarish. Not only is it unfair, but it’s also an infringement on the addict’s person and can have the complete opposite effect.

It can drive them deeper into their addiction and create a lack of trust on all sides. The addict gets taken by surprise and will likely feel resentful. Everyone in the intervention comes in with expectations, and if the addict reacts adversely, they’re disappointed.

Dashed hopes can trigger anger, condemnation, unreasonable threats and even violence. Unfortunately, it’s not uncommon for addicts to bolt and take off running, often not returning home for days as they binge-drink to recover from the shock.

If you are thinking about intervention, it’s best to approach an addiction therapist to facilitate the process. Even then, go in with an open mind free of expectations.

Interventions work best for addicts who have admitted their problem but find they can’t stop drinking. Addicts in denial are more likely to have an adverse reaction.

Another option is court-ordered drug treatment, but again, consider the potential outcomes very carefully before taking action.

Treatment centers

More than 14,500 specialized addiction treatment centers in the US offer outpatient, inpatient and residential care.

Treatment centers (also known as rehabs) offer regular medical care, psychotherapy, occupational therapy and group therapy. They also have access to registered dieticians for patients who require specific eating plans. Before discharge from a program, patients get given a comprehensive recovery plan with access to outside service providers and support groups.

Usually, treatment programs are individualized to meet the specific needs of each patient. Therapy sessions take place during the day, while general group activities happen after hours. Centers aim to keep patients occupied with healthy activities that promote mental stimulation and teach practical life skills.

Alcoholics Anonymous (AA) has over 2-million members worldwide and is active in more than 175 countries. Meetings start in treatment, and patients are actively encouraged to join local support groups after discharge.

Since the start of the global Covid19 pandemic, AA has started offering online meetings to ensure member safety.

SAMHSA releases an annual directory of treatment facilities. Some offer free services for people who qualify; however, most do charge. Several medical insurance plans provide cover for the costs of treatment.

Helpful telephone numbers

In the case of an emergency or overdose, always call 911 immediately for help.

Alcoholics Anonymous: 212-870-3400
Al-Anon; 757.563.1600 (for the family of alcohol addicts)
National Suicide Prevention Lifeline: 1-800-273-8255 (24 hours a day, 365 days a year)
Poison Control Centre: 1-800-222-1222 (24 hours a day, 365 days a year)
SAMHSA: 1-800-662-4357/ 1-800-487-4889 (24 hours a day, 365 days a year info service)

Books worth reading

All books listed are available on amazon.com –

Alcohol Lied To Me – Craig Beck
Quit Drinking Without Willpower – Allen Carr
Quit Like A Woman: The radical Choice To Not Drink In A Culture Obsessed With Alcohol – Holly Whitaker
The Sober Survival Guide – Simon Chapple
The Unexpected Joy Of being Sober: Discovering A Happy, Healthy Alcohol-Free Life – Catherine Gray
This naked Mind: Control Alcohol, Find Freedom, Discover Happiness & Change Your Life – Annie Grace

Conclusion

Alcohol addiction is more common than we realize and deeply rooted in society because drinking is socially accepted and, to an extent, expected. In general, people don’t understand that alcohol is a drug.

The easy availability of alcohol makes it the drug of choice for many. The girl who’s the life of the party or the guy with all the jokes could easily be hiding behind alcohol to give them the necessary confidence they need to socialize.

While drug addiction conjures up images of deadbeats on the street corner, many alcoholics get seen as someone sociable. Alcoholics usually function and part of mainstream society.

However, behind closed doors, both they and people close to them suffer significantly as alcohol eats away at the core of healthy family dynamics and interpersonal relationships.

Proper treatment and long-term abstinence can restore mental and physical health and wellbeing, allowing families to heal, regain trust and rebuild their relationships.