Alcoholism is a global epidemic that’s often swept under the rug. Alcohol use is glamorized in advertisements and films, both at fabulous college parties with binge-drinking contests and as a normal part of meals.

It’s a well-accepted social lubricant and is seen as the ultimate tool to unwind after a stressful day.

When is it Time to Seek Help for Alcohol Dependence?  

But, as one 2021 British article argues, if alcohol was invented today, it would be classified as a class A (in the United States, Schedule I) drug, meaning it has no benefit and a high risk for abuse, addiction, and death. 

In the US, alcohol caused 28% of driving fatalities, but that was less than 11% of the roughly 95,000 total alcohol fatalities in 2019. That means almost 90% died of other alcohol-related causes. Alcohol-related issues cost the country around $249 billion per year, but that monetary cost is nothing compared to the cost in loss of life and quality of life by addicts and their families.

Alcoholism is a destructive force that breaks families apart, causes financial difficulties due to its cost or interference with work, and leads to serious health problems. But the most challenging part is that very often, those with an alcohol use disorder (AUD) won’t even admit that they have a dependency. If they do recognize it, they often deny that their drinking habits are causing any problems in their life.

The dire, long-term health effects of excessive alcohol consumption may include:

• Hypertension
• Heart disease
• Brain aneurysm
• Liver disease
• Various cancers
• A weakened immune system
• Dementia, memory problems, and other cognitive impairments
• Depression, anxiety, and other mental health issues.

How Much is Too Much?

Some studies have long said that small amounts of alcohol are not harmful and may even be beneficial. A 2018 global study, however, found that all alcohol consumption is harmful. Any benefits (heart health) are offset by deficits (increased cancer risk). 

The risks seem lower but not nonexistent with moderate drinking: no more than two drinks per day for men, one for women. A heavy-drinking level is more than four drinks per day or 14 per week for men, three and seven for women. Binge drinking is five or more drinks within two hours for men, four or more for women, in the previous month.  

The size of the drink matters and varies for different alcoholic beverages because some have higher alcohol content. A standard drink is:

• 12 ounces of beer (one standard bottle)
• 5 ounces of wine (about one-fifth of a bottle) or 150 ml
• 1.5 ounces of distilled spirits (a single shot).

Not all heavy drinkers or binge drinks are alcoholics (an extreme level of AUD), and not all alcoholics are heavy drinkers. Neither are binge drinkers, who may only rarely drink so heavily. What characterizes someone with a severe AUD is dependence.

Signs that someone has an alcohol use disorder include:

• They crave alcohol almost all of the time
• They can’t control how often, how long, or how much they drink.
• They prioritize drinking over all other responsibilities (job, family, friends, health).
• They need to drink more to feel the same effect because they have built up a tolerance to alcohol
• They drink to avoid withdrawal symptoms (anxiety, depression, mood swings, nausea/vomiting, rapid heart rate, excessive sweating, hand tremors)
• They drink in unsafe situations (just before driving, swimming, operating heavy machinery)

If someone shows these signs and can’t stop drinking on their own, it is time to seek help.

What help is available?

Once someone realizes they have an alcohol use disorder and want to stop, the first step is detoxification: to stop using alcohol until they complete physical withdrawal. In severe, long-term cases of AUD, sudden and complete detox (also known as cold turkey) can be life-threatening, so a gradual taper or medical supervision is advised. 

An alternative is to first join a peer fellowship made up of other people with AUD, such as  SMART Recovery. Others join after completing rehab treatment. 

The next step is often professional alcohol rehab treatment, either inpatient or outpatient. With outpatient treatment, individuals with AUD visit the clinic, office, or treatment center for therapy, education, and medical care. With inpatient treatment, the individual lives, eats and sleeps at the rehab center while receiving treatment. 

Most rehabs use multiple treatments. One of the most common is cognitive-behavioral therapy (CBT), a form of psychotherapy that helps shift negative thought patterns and teaches coping skills to offset the pattern of addiction. 

CBT is often paired with medication-assisted treatments (MAT), the use of non-addictive drugs to assist alcohol recovery, including:

• Acamprosate: Reduces alcohol cravings, helps restore the brain to normal
• Disulfiram: Causes unpleasant, withdrawal-type side effects if alcohol is consumed
• Naltrexone: Reduces the craving for and blocks the pleasurable effects of alcohol. This is most effective for people whose goal is to control or limit their drinking, not abstain entirely. Taken an hour before drinking, as in the Sinclair Method for Alcoholism, individuals learn to drink less because there is less reward. 

Mental health issues frequently co-occur with alcohol dependencies. Treatment for alcohol use disorders should always begin by looking for such a dual diagnosis. Alcohol abuse may have started in an attempt to medicate for these mental health symptoms. Without equal co-treatment, both conditions may persist. 

When You Love Someone with AUD

AUD can be as hard or harder on those who love someone with AUD. You come in second place to alcohol. You’re constantly negotiating with them to limit or stop their drinking. This often causes stress, self-esteem issues, anxiety, and depression. 

Self-care is essential. You can’t be there for them or anyone if you don’t take care of yourself. You need to build a support system for yourself. Create a network of sober friends. Join a peer fellowship for the families and loved ones of alcoholics, such as Al-Anon, SMART Family and Friends, or Adult Children of Alcoholics. If you feel that you are slipping into depression or experiencing anxiety, seek professional support. 

Managing your loved one’s illness is not your responsibility, but if you try, it is essential to be patient and supportive. Take note of improvements, and encourage them to pick themselves up when they fall and keep going.

Recovery from AUD is an ongoing process. Relapses are common—an average of five attempts before recovery, although 50% manage it in two—so persistence is essential. Professional support and continuous therapy will lead you through this challenging time, and a commitment to overcome the addiction will prevail.

Sources

• theguardian.com – Time to face the truth: there’s no glamour at the bottom of a glass
• niaaa.nih.gov – Alcohol Facts and Statistics
• cdc.gov – Alcohol Use and Your Health
• npr.org – No Amount Of Alcohol Is Good For Your Health, Global Study Says 
• niaaa.nih.gov – Drinking Levels Defined
• mayoclinic.org – Alcohol use disorder
• niaaa.nih.gov – Treatment for Alcohol Problems: Finding and Getting Help
• medlineplus.gov – Alcohol withdrawal
• smartrecovery.org – SMART Recovery

• frontiersin.org – Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy
• samhsa.gov – Medication-Assisted Treatment (MAT)
• nami.org – Acamprosate (Campral) 
• medlineplus.gov – Disulfiram
• samhsa.gov – Naltrexone
• academic.oup.com – Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism
• sinclairmethod.org – One Little Pill
• sinclairmethod.org – What is the Sinclair Method?
• al-anon.org – Al-Anon, 
• smartrecovery.org – SMART Recovery Family and Friends
• adultchildren.org – Adult Children of Alcoholics 
• ncbi.nlm.nih.gov – How Many Recovery Attempts Does it Take to Successfully Resolve an Alcohol or Drug Problem? Estimates and Correlates From a National Study of Recovering U.S. Adults