Alcohol Use Disorder (AUD)

Alcohol consumption is quite common among people of all socio-economic status. Alcohol is known to cause addiction though everyone who consumes alcohol will not be addicted.

AUD can occur in form of alcohol abuse or addiction. Alcohol abuse and addiction are not the same.  

Alcohol addiction is a psychological dependence on alcohol that involves continued, compulsive drinking despite its adverse consequences. People addicted to alcohol are also physically dependent on it and experience severe, life threatening withdrawal symptoms upon quitting.    

Alcohol abuse does not necessarily denotes addition to alcohol. Alcohol abuse is typically seen as heavy drinking who continue drinking regardless of its outcome. Alcohol abuser may drink only once a week. However, when abuser drinks, he puts himself into risky situation such as alcohol poisoning. Alcohol abuser may not drink on a consistent basis. The person is not physically dependent but have a serious problem. Alcohol abuse may put a person into social or legal problems.

Another common problem is binge drinking. It is drinking about 5 or more drinks for men and 4 or more drinks for women in two hours. 

Certain abusers may eventually become addicted to alcohol.   

The National Institute of Alcohol Abuse and Alcoholism defines One standard drink as any one of the followings:

  • 12 ounces (355 ml) of regular beer (5% alcohol)
  • 5 ounces (148 ml) of wine (12% alcohol)
  • 1.5 ounces (44 ml) of hard liquor (40% alcohol)

Causes:

There are multiple factors that contribute to alcohol consumption. It include genetic, psychological and environmental components for this behaviour. Continued drinking or heavy alcohol intake affects the body and behaviour including areas in the brain associated with pleasure, judgement and control of mood. Ultimately this may lead to craving of alcohol to restore good feelings, positive emotions and reduce negative thoughts.     

Symptoms & Signs:

The symptoms in person with AUD are not consistent or uniform. The symptoms may vary based severity of the case i.e. mild, moderate or severe. The following symptoms indicate a problem.

  1. Neglecting personal/family responsibilities
  2. Declining professional or academic performance
  3. Depression
  4. Family conflicts
  5. Preoccupied with drinking
  6. Failed attempt to control drinking
  7. Needing increasing amount of alcohol for its effect
  8. In short term heavy drinking can be dangerous to cause vomiting, headaches, slurred speech, slowing of reflexes, impaired judgment, insomnia, memory loss, breathing problems, coma and death.
  9. Long term consequences of alcohol abuse could be esophageal, throat, liver and breast cancer.
  10. Risk of heart diseases like damage to heart muscles (cardiomyopathy) 
  11. High blood pressure
  12. Brain damage
  13. Liver disease
  14. Pancreatitis
  15. Peptic ulcer
  16. Deficiency of vitamin B1 (thiamine)
  17. Vehicle accidents
  18. Multiple drug interactions
  19. Homicide
  20. Suicide
  21. Drowning

Alcohol abuse may damage relationships with loves one because of anger, violence, neglect and abuse.

Pregnant women have risk of miscarriage. The baby is more likely to have fetal alcohol syndrome and higher chance of dying from SIDS (sudden infant death syndrome).

AUD can include periods of alcohol intoxication and symptoms of withdrawal.

Alcohol intoxication:

It is due to high quantity of alcohol in the blood. It causes behavioural problems and mental changes. It is characterized by inappropriate behaviour, unstable mood, poor coordination and impaired judgement. There could periods of “blackouts” where person do not remember events. A very high level of alcohol may lead to coma and death.

Alcohol Withdrawal:

Someone with alcohol dependence or addiction who stops drinking may have following withdrawal symptoms within few hours to 4-5 days:

  1. Nausea
  2. Severe Vomiting
  3. Shaking
  4. Sweating
  5. Irritability
  6. Loss of sleep
  7. Anxiety
  8. Seizures
  9. Hallucinations
  10. Fever

Alcohol withdrawal can be a medical emergency.

Risk Factors:

Alcohol consumption may begin at adolescence and may lead to AUD in 20s and 30s, though it can start at any age.

  1. Regular alcohol consumption for extended period or binge drinking.
  2. Early age
  3. Family history of alcoholism
  4. Mental problems like depression, anxiety etc.
  5. Emotional trauma
  6. Bariatric surgery
  7. Social & cultural influences like social media, alcoholic friends & parents, symbol of glamour

Complications:

The complications of AUD include problems related to safety, social stigma and physical & mental illnesses. The following complications are often seen in person with AUD.

  1. Motor vehicle accidents
  2. Relationship problems
  3. Violent crimes
  4. Problems with employment or finances
  5. Other substance abuse
  6. Unprotected sexual behaviour thus diseases like HIV, Hepatitis
  7. Suicidal risk
  8. Alcoholic liver disease culminating into irreversible liver cirrhosis and failure
  9. Acute or chronic gastritis including ulcers.
  10. Heart failure
  11. Stroke
  12. High risk of hypoglycaemia in patients with diabetes.
  13. Sexual dysfunction like erectile dysfunction, menstrual irregularities
  14. Eye problems due to weakness and paralysis of eye muscles.
  15. Birth defects
  16. Weakened immune system
  17. High incidence of cancers

Treatment: 

The treatment of AUD focuses on helping learn ways to control the disorder. Abstinence is often the only way to manage the disease.

Treatment involves educating people on their dependency and any problem in their life. Recovery from dependence is usually a long term process. The person should be taught on coping skills, find better ways to manage stress and develop positive inter-personal relationships.

Besides family support, psychological counselling and group therapies it has been observed that people who are involved in spiritual practices find it easier to maintain recovery. Gaining greater insight into the spiritual elements could be key factor in recovery from AUD.      

Medications:

There are few medications prescribed to reduce the symptoms of withdrawal. These are sedating medications to prevent withdrawal symptoms. Other medications can help quitting drinking by making feel sick when alcohol enters into the body or blocks the good feelings that alcohol causes, prevent heavy drinking and reduce the urge to drink.

There are injectable form of medicine given by doctor for easy recovery with consistent usage.   

Alternative Therapies: 

Few alternative approaches for the treatment as an addition to the recommended regimen may be useful for recovering from AUD.

  1. Yoga including pranayama (breathing exercises)
  2. Meditation
  3. Acupuncture 

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