While alcoholism clearly has a negative effect on any individual who struggles with it, there is still much debate in regards to whether or not alcoholism is a lifestyle choice or a disease. This is problematic, as those who consider alcoholism to be a lifestyle choice feel that every alcoholic could simply decide to stop drinking and that would be the end of it. However, alcoholism, along with any substance abuse disorder or addiction, is more complicated than that.
If a friend or family member is struggling with alcoholism, the following information may give you insight as to how to help the individual in question while also giving you tips on ways to find support for yourself during this time.
Alcoholism is a Disease
The National Institute on Alcohol Abuse and Alcoholism describes alcoholism (or what is medically referred to as Alcohol Use Disorder) as “a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.”
What does that mean?
The two key words here are chronic and relapsing:
- Chronic means a disease that lasts over long periods of time and can be controlled with treatment.
- Relapsing means the alcoholic may go through multiple cycles of treatment, abstinence, and relapse throughout their life.
By classifying alcoholism as a chronic relapsing brain disease, medical professionals and addiction specialists can relate alcoholism to other chronic diseases such as diabetes or asthma. Just like a diabetic or asthmatic can have periods of time with and without symptoms of their disease, an alcoholic can experience this wax and wane of symptoms, as well.
Why is this important?
When alcoholism is classified as a chronic relapsing disease, it negates the idea that every alcoholic is of poor moral character, is capable of stopping drinking without treatment, or that relapse means complete failure. This is vastly important because it helps take away the shame of alcoholism that deters many alcoholics from reaching out for help in the first place. This approach can also help alcoholics who are seeking treatment. Those who enter treatment with the mindset that they are struggling with a disease recognize they are going to treatment to learn how to manage their symptoms and that setbacks are not a sign of failure or mean treatment is working.
How is alcoholism diagnosed?
If a friend or family member who is struggling with alcoholism were taken to a doctor, the doctor would not give them a diagnosis of ‘alcoholism.’ This is because, in the medical world, what most people call alcoholism is referred to as Alcohol Use Disorder or AUD. An individual is determined to have an AUD when they meet certain criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Depending on the number of criteria met, an individual may be diagnosed as having a mild, moderate, or severe AUD.
Although a medical professional should always be consulted to make a formal diagnosis, there are certain questions you can ask to help determine if your loved one has an AUD.
In the past year, has your loved one:
- Experienced times where they ended up drinking more alcohol than intended?
- Tried to cut down or stop drinking but did not succeed?
- Spent a lot of time drinking or being sick due to the aftereffects of drinking?
- Experienced cravings for alcohol or a strong urge to drink?
- Needed alcohol to feel ‘normal’?
- Had problems at work, school, or with family life due to drinking?
- Missed school or work due to drinking or the aftereffects of drinking?
- Given up hobbies, activities they once enjoyed, or time with family in order to drink?
- Put themselves in a dangerous situation while drinking such as driving under the influence or having unsafe sex?
- Continued to drink despite the development of health problems due to alcohol consumption?
- Continued to drink even if alcohol has contributed to money troubles, legal issues, or family conflict?
- Needed to drink more alcohol to get the same desired effects?
- Suffered from alcohol withdrawal symptoms, such as shakiness, irritability, anxiety, depression, nausea, vomiting, or sweating when he stops drinking?
If you can answer ‘yes’ to one or more of these questions, your loved one’s drinking may be a cause for concern and would be best evaluated by a medical professional for a formal diagnosis.
How does alcoholism develop?
Everyone’s brains and bodies are built differently, so at that this time, even though scientists and medical professionals believe some people are genetically predisposed to alcoholism, they do not know for certain why certain individuals develop alcoholism while others do not. However, most alcoholism develops over time and may follow this type of staged continuum:
1) Stage One: Experimental Use
Alcoholism doesn’t happen overnight. In fact, the first stage of alcoholism typically begins with experimentation. People in this stage may start experimenting with drinking in specific situations, such as college kids at a party or adults having a drink after work. This experimentation may stem from general curiousity about alcohol to feeling pressured to drink because friends are doing it.
Drinking in this stage is typically considered social, fun, or as a way to unwind. The individual is not dependent on alcohol to function and does not experience cravings. People in this stage may even engage in binge drinking on occasion, but still may not be alcohol dependent.
2) Stage Two: Regular Alcohol Use
The next stage of alcoholism begins when alcohol consumption becomes more frequent. Individuals may find that their drinking begins to follow a predictable pattern, such as drinking every weekend or consistently reaching for alcohol under certain circumstances, like when they’re stressed or lonely. These individuals may start to develop an emotional attachment to drinking. This more an individual turns to alcohol to “feel good”, the more at risk they are of developing an alcohol use disorder.
3) Stage Three: Problematic Alcohol Abuse
The third stage of alcoholism begins when individuals start to lose control over their alcohol consumption and/or when drinking begins to take a negative toll on their life.
In the stage of alcoholism, individuals may or may not be physically dependent on alcohol. In other words, they may or may not experience symptoms of withdrawal when they stop drinking. However, individuals in this stage of alcoholism typically have a high emotional attachment to drinking, meaning they may feel they need it “to have a good time” or to relax. People who continue to drink in spite of the negative effects that alcohol has on their life are more likely to transition to the next stage of alcoholism: severe alcohol abuse and dependence.
4) Stage Four: Severe Alcohol Abuse and Dependence
The next stage of alcoholism begins when an individual starts to become dependent on alcohol. Dependence has three components:
Tolerance: Over time, as problem drinkers start to drink more frequently and in greater amounts, they will begin to build a tolerance to alcohol. When a tolerance is built, individuals will need to consume more and more alcohol to experience the same desired effects.
Psychological dependence: When individuals begin to experience cravings for alcohol or feel that they need to drink to feel “normal”, they have developed a psychological dependence. Individuals with a psychological dependence to alcohol will continue to drink even though they may see the damage that alcohol is having on their body, relationships, job, etc.
Physical dependence: Those who are physically dependent on alcohol experience withdrawal symptoms when they stop drinking. Withdrawal symptoms may occur as early as two hours or as late as four days after alcohol consumption has ceased. Common alcohol withdrawal symptoms include:
- Nausea or vomiting
- Irritability or agitation
- Fast heart rate
For those with severe physical dependence, alcohol withdrawal may result in dangerous withdrawal symptoms such as seizures or even death. Consequently, in this stage, most addiction professionals recommend detoxing from alcohol under medical supervision.
5) Stage Five: End-Stage Alcohol Abuse and Addiction
Addiction is what characterizes the final stage of alcoholism. In this stage, those who are addicted to alcohol no longer drink for pleasure and have no control over their alcohol consumption. At this point, it’s a compulsive behavior and the individual’s life revolves around drinking.
Can alcoholism be cured?
While recovery is possible at every stage of alcoholism, like other chronic relapsing diseases, alcoholism is not curable. No cure, however, does not mean there is no hope for long-term recovery. Like other chronic diseases, such as asthma, diabetes, or heart disease, alcoholism and its symptoms can be successfully managed with proper treatment.
How to Treat Alcoholism
As with other chronic diseases, treatment for alcoholism is centered around managing symptoms. There are many ways to do this, and it’s important to note that because every individual is different, there is not a one-size-fits-all approach to treatment. Speaking with a trusted medical professional, addiction specialist, or a recovery advisor at a treatment center may give you insight as to what type of treatment would be best for your loved one.
Some common treatment options for alcoholism include:
For many people, the first step in treating alcoholism is what is referred to as detoxification or “detox.” During this process, the individual stops all alcohol consumption (unless advised by a doctor), and gives the body time to rid itself of all alcohol in the system. During the detox period is when many people experience alcohol withdrawal symptoms. Since some alcohol withdrawal symptoms can be life-threatening, it’s important to speak with your loved one’s doctor before they stop drinking. Long-term, heavy alcohol abusers may do best by detoxing in an in-patient facility under medical supervision.
Inpatient or Outpatient Treatment
After detoxing, many alcoholics will continue treatment in an inpatient or outpatient treatment facility. Inpatient treatment facilities allow individuals to reside at the center while receiving treatment, while those in treatment in an outpatient program will live at home or in sober housing. The type of treatment that would best suit your loved one depends on several factors including the severity of their alcoholism, their needs for care, insurance coverage, and ability to be away from their family and/or place of employment. Inpatient and outpatient programs can vary greatly as to what they offer individuals in terms of treatment, but reputable treatment centers should have the following:
- Individual and Family Therapy
- Group Therapy
- Medical Supervision
- 12-Step and/or Non-12-Step Programs
- Case Management
- Continuing Recovery and Aftercare Planning
Even though, at the moment, there aren’t medications that can cure alcoholism, your loved one’s doctor may prescribe medications to help with withdrawal symptoms, alcohol cravings, and anxiety. Some medications used in the treatment of alcoholism include:
- Acamprosate: Can help restore the balance of neurotransmitters in the brain, which can help with alcohol cravings.
- Disulfiram: Doesn’t allow the body to process alcohol. Since those who consume alcohol while taking this medication will either feel sick or vomit, it can help deter alcoholics from drinking.
- Benzodiazepines: Used to treat anxiety, insomnia, and seizures, which can all be symptoms of alcohol withdrawal.
- Naltrexone: May decrease a person’s desire to drink by blocking “high” that occurs from alcohol.
When an individual completes an inpatient or outpatient treatment program, they may still require ongoing care to help manage symptoms and get support in their newfound sobriety. Most reputable treatment centers have aftercare programs, which give individuals who have completed treatment the option to engage in:
- Sober Mentoring
- Educational Programs
- Alumni Activities
- 12-Step Groups
Support for Friends and Family Members
When a friend or family member is struggling alcoholism, it can be an emotionally taxing and confusing state for all parties involved. However, even in this trying time, make an effort to be patient and compassionate with the individual as opposed to shaming them for their behavior. Remember that alcoholism is a disease and that your friend or family member may require ongoing treatment to manage their symptoms of addiction.
During this time, it’s also important to practice your own self-care. For many people, this means getting emotional support to help process and deal with the situation at hand. Just as there are several outlets of support for alcoholics in recovery, friends and family members of alcoholics also have options. If you are a friend or family member of an alcoholic and feel you would benefit from outside support, some options include:
- Al-anon: A support group for families and friends of alcoholics.
- SMART Recovery: An alternative to Al-anon that provides support to friends and family members of addicts.
- A therapist or counselor. Many reputable alcohol treatment programs even offer family therapy to help parents of addicts during the recovery process.