Alcohol Use Disorders

Alcoholism is a neurologically-based brain disease that develops after repeated ingestion of alcoholic beverages.  Once established, it is often a chronic condition that causes significant impairment in occupational, social, and health functioning.

A new CDC study concluded that  “excessive alcohol use in the US rose to almost a quarter of a trillion dollars in 2010” and that it was “draining the economy.”

What Causes Alcoholism?

  • There is a significant genetic contribution to the development of alcoholism, with heritability estimates around 50 to 60%, considered a moderate to strong effect. (The heritability of alcohol use disorders: a meta-analysis of twin and adoption studies).
  • If you have a biological parent or sibling with alcoholism, you have a two to four times higher risk of becoming an alcoholic than someone without a first-degree relative who is an alcoholic.
  • For adoptees, the rates of alcoholism are significantly higher in those who have a biological parent with alcoholism than those with a negative family history.  This family risk was shown to be higher for males than females.
  • In twin studies, identical twins have more similar risks for developing alcoholism than fraternal twins.
  • Research in numerous countries has demonstrated that males have an overall higher risk for developing alcoholism than females.
  • All studies have shown that relatives of female alcoholics have about a 40 percent greater risk of developing alcoholism than relatives of male alcoholics.

Signs of Alcoholism

The Diagnostic and Statistical Manual (DSM) is the classification system published by the American Psychiatric Association.  In 2013, the 5th edition was released.  It eliminated the terms Alcohol Abuse and Alcohol Dependence, and it created the broad category of Alcohol Use Disorders (AUD).  In order to meet the criteria for an AUD, a person must have at least two of the following symptoms:

  1. Alcohol is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  4. Craving, or a strong desire or urge to use alcohol.
  5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  8. Recurrent alcohol use in situations in which it is physically hazardous.
  9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
  10. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect b) A markedly diminished effect with continued use of the same amount of alcohol.
  11. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol (refer to criteria A and B of the criteria set for alcohol withdrawal) b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

The presence of at least 2 of these symptoms indicates an alcohol use disorder (AUD). The severity of an AUD is either mild, moderate, or severe, depending on the number of symptoms.

Mild: The presence of 2 to 3 symptoms.
Moderate: The presence of 4 to 5 symptoms.
Severe: The presence of 6 or more symptoms.