For many, beer, wine, and spirits conjure up thoughts of social gatherings and tipsy fun. But alcohol is a nervous system depressant and easily alters behavior, culminating in some cases in the emotional pain and physical disintegration of alcohol addiction , colloquially known as alcoholism.
Signs, Symptoms, and Diagnosis of Alcoholism
Alcoholism most often refers to alcohol use disorder—a problematic pattern of drinking that leads to impairment or distress—which can be characterized as mild, moderate, or severe based on the number of symptoms a patient has, such as failing to fulfill obligations or developing a tolerance.
Mild is classified as two to three symptoms, moderate is classified as four to five symptoms, and severe is classified as six or more symptoms, according to the DSM-5 .
Alcohol use disorder is a problematic pattern of alcohol use that leads to distress in one’s daily life, according to the DSM-5. The symptoms that can lead to a diagnosis include drinking more alcohol than intended, failing to cut back on alcohol use, devoting substantial time and effort to drinking and recovering from drinking, strong cravings for alcohol, failing to fulfill obligations at work, school, or home, disengaging from relationships and activities, and developing tolerance or withdrawal, among others.
Experiencing at least two symptoms throughout the course of a year merits a diagnosis, from mild to moderate to severe.
Causes and Risk Factors of Alcoholism
Like all addictions, alcohol use disorder is linked to a complex combination of biological, social, and psychological factors. Research highlights a genetic component to the disorder, as about half of one's predisposition to alcoholism can be attributed to genetic makeup. People may turn to alcohol as a way to cope with trauma or other, often unrecognized psychological disorders. Socially, alcoholism may be tied to family dysfunction or a culture of drinking.
Before it becomes problematic, why do people turn to alcohol in the first place? A number of factors can motivate people to drink. One is simply its rewarding consequences, such as having fun or escaping social anxiety . Having an impulsive personality plays into the decision to seek rewards despite negative repercussions. Another factor is stress , because alcohol can alleviate distressing emotions. Social norms, such as drinking during a happy hour or on a college campus, and positive experiences with alcohol in the past (as opposed to getting nauseous or flushed) play a role as well.
The chance of developing any health problem is related to the genetic code we are born with. Just like some people have a greater risk of developing cardiovascular disease or cancer, others have a greater risk of developing an alcohol use disorder.
Someone with a family history of alcohol problems, someone prone to anxiety or depression , someone who is highly impulsive and takes risks, and someone who needs more alcohol than average to experience its effects has a higher likelihood of developing the disorder.
The Effects of Alcohol
Alcohol is a powerful substance, with the capacity for positive experiences, such as bursts of creativity and fun, as well as harmful repercussions, such as addiction and health problems. Becoming dependent on alcohol can lead to challenges for both the mind and the body.
Heavy drinking can fuel changes in the brain —and about half of the people who meet the criteria for alcoholism show problems with thinking or memory , research suggests. The ability to plan ahead, learn and hold information (like a phone number or shopping list), withhold responses as needed, and work with spatial information (such as using a map) can be affected. Brain structures can shift as well, particularly in the frontal lobes, which are key for planning, making decisions, and regulating emotions. But many people in recovery show improvements in memory and concentration , even within the first month of sobriety.
The idea that altered forms of consciousness such as mania or alcohol can enhance creativity is a popular belief. And it turns out there’s some evidence for that idea. Researchers found that participants who had a few drinks were better and faster at creative problem solving than their sober counterparts. The reason may be that alcohol tamps down working memory and therefore sparks people to think outside the box.
As anyone who has had even a glass of wine can attest, alcohol can have a noticeable influence on mood. Drinking releases endorphins which can lead people to feel happy, energized, and excited. But alcohol is also classified as a depressant and can cause fatigue, restlessness, and depression. It may shift from stimulant to sedative in line with whether blood alcohol content is rising or falling. Given the power of alcohol on the brain, people who drink heavily may come to rely on it to regulate their mood.
Treatment and Recovery for Alcoholism
In some cases, the first step in treating alcohol use disorder is detoxification—experiencing withdrawal in a safe setting with medical professionals. Following withdrawal, there are many paths to recovery.
Some people are able to stop drinking on their own. There are many organized programs that provide the support of peers, usually through frequent meetings. Alcoholics Anonymous is one example; it offers a structured 12-step path toward recovery with a community of support from those who have dealt with similar challenges.
Cognitive behavioral therapy is another path, available in person or online. Non-abstinence-based recovery models—such as Moderation Management —advocate for reducing one's alcohol consumption rather than abstaining completely.
The biggest barrier to therapy of any kind that patients may face is shame and stigma ; most programs address such concerns directly.
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