Alcohol Use Disorder
Alcohol Use Disorder (AUD) is a chronic relapsing brain condition characterized by an impaired ability to stop or control drinking despite adverse social, occupational, or health consequences. It’s a prevalent, detrimental, and often misunderstood disease that affects millions of people worldwide. AUD is a relatively recent terminology introduced by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), replacing the term “alcoholism.”
AUD is a progressive disease, meaning symptoms usually worsen over time with continued drinking. Chronic, heavy drinking may lead to critical health conditions such as liver disease, cardiovascular disease, and various forms of cancer. The fatality risk associated with AUD is high; however, it’s also important to note that the course of the disorder varies widely from person to person, influenced by factors like genetics, environment, and individual physiology.
The primary aspects include:
- Loss of Control
Inability to limit alcohol consumption despite the desire and attempts to do so. - Preoccupation with Alcohol
Overemphasis on the acquisition, consumption, and recovery from alcohol’s effects, causing other life activities to be neglected. - Negative Emotions
Presence of anxiety, restlessness, and other negative emotional states when not consuming alcohol. - Tolerance and Dependence
Needing increasing amounts of alcohol to achieve the desired effects, and/or experiencing withdrawal symptoms without alcohol.
Signs and Symptoms
The signs and symptoms of AUD can vary depending on several factors, including the severity of the disorder, the frequency of alcohol consumption, and the individual’s overall health status. Here are some key signs and symptoms that may indicate the presence of AUD:
Physical
- Increased tolerance to alcohol, i.e., the need for more alcohol to feel its effects
- Withdrawal symptoms when not drinking, such as trembling, nausea, sweating, or insomnia
- Neglect of personal appearance and hygiene
- Sudden or unexplained weight loss or gain
- Redness of the face or broken capillaries on the skin
- Frequent injuries or accidents associated with drinking
Behavioral
- Drinking in larger amounts or over a longer period than was intended
- Persistent desire or unsuccessful efforts to cut down or control alcohol use
- A great deal of time spent in activities necessary to obtain alcohol, consume alcohol, or recover from its effects
- Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
- Giving up or reducing social, occupational, or recreational activities because of alcohol use
Psychological
- Craving, or a strong desire or urge to drink alcohol
- Continued alcohol use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol
- Experiencing withdrawal symptoms—such as anxiety, irritability, fatigue, nausea/vomiting, hand tremors or seizures, hallucinations, confusion, or insomnia—when attempting to cut back or quit drinking
- Experiencing memory problems, including blackouts or memory loss
Recognizing these signs and symptoms in oneself or a loved one can be the first step towards addressing the problem. Early intervention can lead to better outcomes in managing AUD, reducing its adverse effects on health, relationships, and overall quality of life. However, diagnosing AUD should be made by a healthcare professional based on a thorough evaluation of the individual’s symptoms, history, and condition.
Brain Disease
It’s crucial to emphasize that AUD is not just a physical dependency on alcohol; it is a disease of the brain. Long-term excessive alcohol consumption can cause significant alterations in brain structure and function. Key points include:
- Changes in Neurotransmitters
Alcohol alters the balance of neurotransmitters such as dopamine and gamma-Aminobutyric acid (GABA), affecting mood, energy levels, and other aspects of mental health. - Impairment of Brain Regions
The prefrontal cortex and the limbic system, responsible for decision-making and emotional regulation, are particularly affected, leading to impaired judgement and increased impulsivity. - Neuroadaptation and Neurotoxicity
The brain attempts to compensate for alcohol’s depressant effects, leading to “neuroadaptation.” Chronic exposure can also lead to “neurotoxicity,” causing brain damage and cognitive impairments.