What is Alcohol Use Disorder? A Clinical Psychology Podcast Episode.
What is Alcohol Use Disorder? A Clinical Psychology Podcast Episode.
A lot of people think that they understand what alcoholism or alcohol use disorder is, but they don't. I often hear people joking that their friends and family members are alcoholics because they like to drink. Yet alcohol use disorder is a little more complex than that, and it can ruin lives, destroy relationships and lead to severe physical and mental health consequences. Therefore, in this clinical psychology podcast episode, you'll learn what is alcoholism or alcohol use disorder, what are the causes and symptoms and how is alcohol use disorder treated. If you enjoy learning about addiction, mental health and alcoholism, then this will be a great episode for you.
Today's psychology podcast episode has been sponsored by Biological Psychology. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
What is Alcohol Use Disorder?
Alcoholism or Alcohol Use Disorder is a problematic pattern of alcohol use that leads to significant disorder or impairment. As well as it's the significant amount that we need to focus on because the majority of people use alcohol as a way to celebrate, socialise and relax at home or out with friends and family. For example, in a few days’ time, we're having a large BBQ for my dad's 60th birthday with our friends and family members. I don't drink but I know other people will and that's okay because alcohol is a great way to relax and socialize with friends.
However, alcohol becomes problematic when someone drinks in excess or they drink as a way to avoid problems or stressors in their life despite the physiological as well as psychological risks that excess alcohol poses. I'm reminding us of this point because someone drinking "a lot" doesn't mean they're an alcoholic or they have alcohol use disorder.
In my life, I've heard a lot of people use the term "alcoholic" without fully understanding what it means. And I'm not innocent of this mistake. When I was younger and before I better understood the devastating impact of alcoholism, I also made jokes about people being alcoholics.
As a result, the amount of alcohol consumed isn't a good indicator of whether someone has alcohol use disorder or not, because alcohol use does vary greatly between people. Instead, it can be a lot more useful to identify general patterns of behaviour to see if the alcohol use is reducing their ability to function and if it's creating difficulties for the person. For example, alcohol use can be problematic if it creates interpersonal difficulties between friends and family members, or it leads to a person reducing their social activities. Like someone might be too drunk and hungover to go out with their friends, or they no longer want to spend time with their family members at a specific event that they used to go to, because it doesn't serve alcohol. As well as a sign of problematic alcohol use is when drinking interferes with their school, work or home life.
For instance, when considering someone's relationship with alcohol, it's important to bear in mind their family history, age and how often or how much they drink. Such as, if someone drinks a lot of alcohol regularly then that could be a sign of alcoholism, but if someone drinks a lot once a year, then that probably isn't a sign of problematic alcohol use.
In addition, alcohol abuse isn't limited to a certain age, race or gender. Since in the United States, nearly 14 million people have a problematic relationship with alcohol use with men being more likely than women to have an alcohol problem. Also, difficulties with alcohol tend to be highest in young adults aged between 18 and 29 and lowest in people aged 65 and over. As well as one of the biggest problems with assessing and diagnosing alcohol use disorder is that when working with young adults, their lifestyle that often includes excessive drinking, can make it difficult to see when someone truly has a disorder and not.
In my opinion, this reminds me of a very short podcast episode I listened to this morning about alcohol use and being reflective or mindful about your relationship. For example, as a young adult, I decided that I didn't want to drink because it used to be cheaper (even though everything is so expensive now I doubt it makes much difference), I wanted to protect my health and I don't like what alcohol does to people. Also, I value my productivity and doing things too much so I don't want to have to deal with the negative consequences of alcohol consumption the next day when I could be doing something else.
I'm not writing down my thoughts and feelings on alcohol to convince others to give up alcohol because if you want to drink then more power to you. It's a personal choice, but as a young adult, I am generally thought of as weird or boring because I don't drink. It is such a normal part of youth culture to drink, to club and to get so drunk that deviating from that expectation comes with social risks and social judgment.
Finally, according to the United States' Department of Health and Human Services as well as their Department of Agriculture Dietary Guidelines, they determine that moderate drinking is up to one drink per day for women and up to two drinks per day for men.
Why is Alcohol Use Disorder Serious?
The main reason why alcohol use disorder is so serious is because it can lead to some horrific health consequences. For example, people with alcohol use disorder are more likely to get cancer, even more so liver, colon, larynx and oesophagus cancer. A person with alcoholism is also more likely to experience erectile dysfunction, high blood pressure and nutritional deficiencies.
In addition, people with alcohol use disorder are more likely to have acute or chronic pancreatitis, this is an inflammatory disease of the pancreas, cirrhosis of the liver is also common and this is the fibrotic changes in the liver, as well as alcohol-related dementia.
Some other health consequences of alcohol use disorder are alcoholic neuropathy. These are degenerative changes in the nervous system that affect the nerves responsible for movement as well as sensations. Also, alcoholic cardiomyopathy, Fetal alcohol syndrome in the children of women who drink during pregnancy, and Wernicke-Korsakoff syndrome or Wernicke’s encephalopathy are some other consequences of alcoholism. This is a syndrome of the central nervous system that results in a person experiencing loss of vision, loss of balance and confusion.
All of that sounds horrific.
It’s these horrific health consequences of alcohol use disorder that make it so important that we research it, understand it and treat it. By learning about the causes and treatment options for the condition, we can hopefully prevent some of this happening as well as we can prevent alcohol use disorder taking root in an individual before they experience these awful health consequences. That’s the hope at least.
What is Alcohol Withdrawal?
On the flip side, you have alcohol withdrawal. This is a serious condition that can become life-threatening if it isn’t treated. Since when a person who’s been drinking heavily suddenly reduces or stops their alcohol intake, this leads to a wide range of symptoms, because the body is so used to being dependent on alcohol to function. When you cut off alcohol, the body doesn’t know how to function.
The symptoms of alcohol withdrawal include anxiety, depression, seizures, hallucinations, irritability, fatigue, sweating, insomnia, hand tremors and rapid heart rate. These symptoms tend to develop within several hours or a few hours after a person dramatically reduces their alcohol intake. This is one of the reasons why a person with alcohol use disorder should consult a medical professional and collaborate on a course of action, so reducing their alcohol intake can be done safely.
What Causes Alcohol Use Disorder?
This is the main reason why I'm interested in learning more about this type of disorder, because if we understand what causes alcohol use disorder, or at least the factors that increase someone's risk of developing the condition, then we can actually target the root causes in society. This is something that I'm interested in thinking about because I'm a part of a local political party and we're interested in creating policies that will reduce gambling, drug and alcohol addiction in our local authority.
We can't create these policies though unless we understand the actual causes, so let's explore the topic now.
Therefore, like a lot of mental health conditions, the exact cause of alcohol use disorder isn’t fully understood or known, but we do understand the factors that can contribute to the development as well as maintenance of the condition. For example, alcohol abuse tends to run in families because alcohol use disorder is three to four times higher in close relatives of alcoholics, and the closer a person’s genetics are to the alcoholic’s the more likely they are to develop alcohol use disorder themselves.
Another potential cause is that alcohol is an addictive substance in its own right so it is very good at hijacking the brain’s reward system so even though, it is a depressant, it creates a buzz that people perceive as pleasurable. Also, there are individual differences because drinking alcohol impacts a person’s mental and physical health differently so some people can drink alcohol without developing alcohol use disorder, but others do. As well as excessive alcohol usage leads to changes in the chemical makeup of the brain and this can contribute to someone becoming addicted to alcohol.
Penultimately, some environmental factors that can increase the likelihood of someone developing alcohol use disorder is the availability of alcohol, substance abuse in peers and cultural attitudes towards drinking.
Finally, a person’s risk of developing alcohol use disorder increases if the person uses alcohol to numb themselves to problems in their lives or as a maladaptive way to cope with mood, fears or anxiety difficulties. Impulsivity is linked to alcohol abuse as well.
The last risk factor is of particular interest to me because this stresses the importance of developing good mental health support. Since if an area, like a deprived area, doesn’t have good access to mental health support, if people cannot figure out ways to cope and improve their situation and if their mental health gets more severe, then they might turn to alcohol as a coping mechanism. In my experience, humans are wired to survive however they can, and alcohol is a method. It is not a good method, but to the individual, it is better than nothing. Therefore, this is one reason why investing in mental health and ensuring that deprived areas have access to mental health support is so important. It can help to reduce the rates of alcohol use disorder as people don’t need to turn to alcohol to cope with life’s stressors.
A final aspect for this section that I want to comment on is the availability of alcohol. All the research shows that alcohol is the world’s most damaging drug because it is so common, it wrecks our physical and mental health and yet it isn’t classed as dangerous. People die because of drunk driving, people get injured because they get into drunken fights and so on. This places immense stress on public health services, but it isn’t classed as a dangerous drug. You can get alcohol anywhere in the United Kingdom and most of the Western world. You can get it from family members, supermarkets, corner shops and restaurants. It’s very hard to escape alcohol despite the damage that it does to us. Whilst I don’t really have a point, I just wanted to mention that it is a little weird that research consistently highlights the sheer damage that alcohol does to society, our relationships and our physical and mental health and yet it is perfectly legal.
It doesn’t make sense.
What are the Symptoms of Alcohol Use Disorder?
Moving on to our next section, the interesting thing about the symptoms of alcohol use disorder is that the majority of the symptoms are identical to the symptoms of any other addictive disorder. It is just that alcohol is the specific addictive substance in this case. Therefore, for someone to be diagnosed with alcohol use disorder then according to the DSM-5, a person’s drinking behaviour needs to result in clinically significant distress or impairment in daily functioning. We judge this impaired functioning by seeing if the client has two or more of the following experiences within a 12-month period.
The client has a strong desire or urge to drink alcohol, they spend a lot of time getting alcohol, drinking it or recovering from its effect, or they drink more than intended or they drink alcohol for a longer time than intended.
In addition, the client with alcohol use disorder would continuously want or attempt to unsuccessfully cut down or stop their drinking, they would continue to drink despite the harm it does to their relationship with friends and family members, as well as the person prioritises drinking by cutting back or stopping other important activities.
Additionally, a person with alcohol use disorder might have withdrawal symptoms if they stop drinking so they might drink to relieve or avoid these symptoms. Also, they might need much more alcohol than was once needed to get the same desired effect (also known as tolerance) or when they drink the same amount, they don’t experience the same effect. As well as they drink in situations where it is physically dangerous to drink.
A final symptom of alcoholism is a person continues to drink even when they have one or more persistent psychological or physical difficulties that drinking has caused or has made worse.
Finally for this section, a person can be diagnosed with mild alcohol use disorder if two or three of the above symptoms are present. They’ll be diagnosed with a moderate case if four or five of the above symptoms are present, as well as a person will be diagnosed with a severe case of alcohol use disorder if six or more of these symptoms are present.
How is Alcohol Use Disorder Treated?
I’m sure all of us have heard of treatment programmes like the 12-step program for alcoholism, but there is more to treatment of alcohol use disorder than that. We’ll explore these other options in the next few sections. Yet first of all, I want to be clear by saying that treatment for alcohol use disorder can work for a lot of people, but at the end of the day, alcoholism is still a chronic condition. This means that there are varying levels of success for different people as some programmes will work for some, but not others. Some people will stay sober and other people will have to battle with sobriety for years, if not decades, as they relapse and try to get sober again.
The most important thing to remember is that the longer a person can abstain from alcohol, the more likely it is that they will be able to maintain their sobriety.
Also, whilst the majority of these treatment options in the next few sections are effective for alcohol use disorder, they are more commonly used for people who experience alcohol abuse and have a problematic relationship with alcohol.
What is Detoxification?
When a person’s drinking behaviour is problematic because they’re experiencing withdrawal symptoms or they’re significantly intoxicated then the person might need to start off with detoxification to start the treatment process. Detoxification is done in a controlled and supervised setting that uses medications to relieve symptoms. Typically, this takes about four to seven days and during this time, the person undergoes other medical examinations to check for other problems. Such as liver problems or blood-clotting. They’re given a balanced diet with vitamin supplements too.
Afterwards, the person should enter an alcohol rehabilitation or recovery programme to support the person in maintaining their abstinence from alcohol. These programmes normally provide people with medical care, nursing, counselling as well as psychological support.
Another key part of the therapy is providing the person with education about alcohol use disorder and its effects, and a lot of the people employed by these programmes have recovered from alcoholism themselves.
Furthermore, within these programmes, which can be inpatient or outpatient, it’s important to consider what mental health conditions can coexist with the alcohol use disorder. Since the depression, anxiety or other condition might be maintaining the alcoholism and vice versa. If you want to treat the alcoholism, you have to treat the other conditions too.
What is Alcoholics Anonymous?
Alcoholics Anonymous is another treatment option for alcohol use disorder because this is an effective mutual-help programme that allows people to support each other, share their stories and learn from each other. Even though people typically find that AA is most effective when used with another treatment option alongside like medication or psychological therapy.
What are Harm Reduction Approaches?
If you’re like me then you might have thought that the 12-step programme was all there really was to treat alcohol use disorder and it was a type of harm reduction approach. Instead the two are very different. Since the 12-step programme sees abstinence as the cure for alcoholism whereas a harm reduction approach focuses on being more individualised. This means that the treatment programme is tailored to the individual’s needs and situation instead of simply following the exact same 12-steps as everyone else just because the person has alcohol use disorder.
Furthermore, abstinence isn’t the end goal for harm reduction approaches. Instead the aim is to reduce the consequences of alcohol use so someone doesn’t need to give it up entirely to stop the negative impact that it has on their lives. As well as harm reduction approaches are nothing new because public health often relies on these approaches. For example, giving out free condoms to reduce the risk of sexually transmitted infections, safe injection sites for people with drug addictions as well as needle exchanges.
The reason why I’m writing about harm reduction approaches on a psychology podcast is because psychotherapy is often used in a harm reduction approach, and this is where it gets interesting for me to reflect on. If we think about it, this is immensely skilled work, even more so considering how skilled clinical psychology naturally is. In a harm reduction approach, we would need to focus on reducing the harm that alcohol does to an individual, their family and their social network, whilst not saying that the client has to give alcohol up entirely. That is interesting because we would have to work with a client to give them the tools and techniques so they can develop a satisfying, healthy and adaptive relationship with a substance that has damaged their life for so long.
It’s interesting to think about how difficult that must be at times, and I really admire mental health professionals who can do this.
How is Medication Used to Treat Alcohol Use Disorder?
In addition to more behavioural treatments for alcohol use disorder, at the time of writing, there are three types of oral medication that can be used to treat the condition. These are Antabuse (disulfiram), Campral (acamprosate) as well as Depade or ReVia (Naltrexone). These medications are used because they help people to avoid relapse into heavy drinking, they help a person to achieve abstinence and they reduce a person’s dependency on alcohol.
The different types of medication work in different ways. For example, acamprosate is one of those drugs where we know it works but we aren’t too sure how. Therefore, it is believed that acamprosate works by reducing symptoms of alcohol use disorder that manifest after a period of abstinence, like insomnia or anxiety. Whereas naltrexone works by reducing cravings for alcohol after a person has given up. Finally, disulfiram works by making a person feel sick if they drink alcohol.
If oral medication doesn’t work, then people with alcohol use disorder can receive naltrexone in an injectable and long-acting form as well. Also, other medication is available if a person experiences alcohol withdrawal as we learnt about earlier.
Personally, this section is more in this podcast episode to make sure that we’re all aware of it, because this medical side of alcohol use disorder isn’t really something psychologists would be involved in too much.
What is Abstinence in the Treatment of Alcohol Use Disorder?
The final treatment for alcohol use disorder I want us to look at is abstinence and this is the treatment option that is strongly recommended for people who have tried to cut down but couldn’t stay within their set limits, they’ve been diagnosed with alcohol use disorder, they have a mental or physical health condition that is made worse or caused by drinking, they’re pregnant or they’re taking medication that interacts with alcohol.
Clinical Psychology Conclusion
As a non-drinker, this was always going to be an interesting episode because I don’t like what alcohol does to the body, how it makes others act and I’ve seen how destructive it can be in friendships and other relationships. Therefore, it was really interesting to learn about alcohol use disorder because now, we understand what it actually is instead of the myths and misconceptions, we know the symptoms, causes and most importantly, that there are effective treatments.
It is these treatments that give friends, families and individuals hope for a better future. A future where they can have a relationship, they can go out for nice family events and they don’t need to be scared of what state their loved one will be in. They can return to how they used to be without alcohol, or they can undergo some kind of growth so they’re even better than they were before alcohol use disorder took over their life.
Treatment and mental health professionals are what make this possible.
As a little reminder to end this episode, alcoholism or Alcohol Use Disorder is a problematic pattern of alcohol use that leads to significant disorder or impairment. As well as it's the significant amount that we need to focus on because the majority of people use alcohol as a way to celebrate, socialise and relax at home or out with friends and family. However, alcohol becomes problematic when someone drinks in excess or they drink as a way to avoid problems or stressors in their life despite the physiological as well as psychological risks that excess alcohol poses.
I hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Biological Psychology. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.
Have a great day.
Clinical Psychology References and Further Reading
Adams, C., Conigrave, J. H., Lewohl, J., Haber, P., & Morley, K. C. (2020). Alcohol use disorder and circulating cytokines: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 89, 501-512.
Flores-Bonilla, A., & Richardson, H. N. (2020). Sex differences in the neurobiology of alcohol use disorder. Alcohol research: current reviews, 40(2), 04.
Guinle, M. I. B., & Sinha, R. (2020). The role of stress, trauma, and negative affect in alcohol misuse and alcohol use disorder in women. Alcohol research: current reviews, 40(2), 05.
https://www.psychologytoday.com/us/conditions/alcohol-use-disorder
Jacob, L., Smith, L., Armstrong, N. C., Yakkundi, A., Barnett, Y., Butler, L., ... & Tully, M. A. (2021). Alcohol use and mental health during COVID-19 lockdown: A cross-sectional study in a sample of UK adults. Drug and alcohol dependence, 219, 108488.
Koob, G. F., & Colrain, I. M. (2020). Alcohol use disorder and sleep disturbances: a feed-forward allostatic framework. Neuropsychopharmacology, 45(1), 141-165.
Kranzler, H. R. (2023). Overview of alcohol use disorder. American Journal of Psychiatry, 180(8), 565-572.
Milani, R. M., & Perrino, L. (2021). Alcohol and mental health: Co-occurring alcohol use and mental health disorders. In The handbook of alcohol use (pp. 81-106). Academic Press.
Puddephatt, J. A., Irizar, P., Jones, A., Gage, S. H., & Goodwin, L. (2022). Associations of common mental disorder with alcohol use in the adult general population: a systematic review and meta‐analysis. Addiction, 117(6), 1543-1572.
Tsermpini, E. E., Plemenitaš Ilješ, A., & Dolžan, V. (2022). Alcohol-induced oxidative stress and the role of antioxidants in alcohol use disorder: a systematic review. Antioxidants, 11(7), 1374.
Yang, W., Singla, R., Maheshwari, O., Fontaine, C. J., & Gil-Mohapel, J. (2022). Alcohol use disorder: neurobiology and therapeutics. Biomedicines, 10(5), 1192.
Zhifeng, C. (2020, November). Analysis of the Causes, Effects and Treatments of Alcohol Use Disorder. In 2020 International Conference on Public Health and Data Science (ICPHDS) (pp. 342-346). IEEE.
Zhou, H., Kember, R. L., Deak, J. D., Xu, H., Toikumo, S., Yuan, K., ... & Gelernter, J. (2023). Multi-ancestry study of the genetics of problematic alcohol use in over 1 million individuals. Nature Medicine, 29(12), 3184-3192.
I truly hope that you’ve enjoyed this blog post and if you feel like supporting the blog on an ongoing basis and get lots of rewards, then please head to my Patreon page.
However, if want to show one-time support and appreciation, the place to do that is PayPal. If you do that, please include your email address in the notes section, so I can say thank you.
Which I am going to say right now. Thank you!
Click https://www.buymeacoffee.com/connorwhiteley for a one-time bit of support.
Comments