Don't Take Alcoholism Lightly; It's a Chronic Brain Disease

Alcohol use disorder (AUD) is a substance use disease that can affect every aspect of life and severely impact physical health and personal safety. According to 2019 estimates, 14.5 million Americans live with this common disorder.

Despite the prevalence, only about 7 percent of people who meet the criteria for AUD receive treatment.

Studies indicate the consumption of alcohol increases subjective sexual desire and the likelihood of risky behavior, but also lowers physiological arousal in women. For women dependent on alcohol, the most common forms of sexual dysfunction include dyspareunia (painful intercourse), an increase in genitourinary issues and low vaginal lubrication.

For men, the risk of long-term erectile dysfunction (ED) has been linked to heavy alcohol use. A study from 2007 indicated that 72 percent of the alcohol-dependent subjects had one or more sexual dysfunctions, the most common of which were ED, premature ejaculation and low desire. Alcohol can reduce the production of testosterone.

"Alcohol use disorder is defined by compulsive, continued use despite harm and functional impairment," said Bruce Bassi, M.D., an addiction psychiatrist and medical director and founder of TelepsychHealth, based in Jacksonville, Florida.

Alcohol use disorder has whole system effects and is characterized as a chronic brain disease causing lasting changes in several regions of the brain, impacting decision-making and cognitive function. If untreated, alcohol use disorder can lead to an increased risk of cancer, heart problems, liver disease and even death. A range of symptoms afflict each stage of AUD, but treatments are available.

Common symptoms of AUD

In past editions, the Diagnostic and Statistical Manual of Mental Disorders—the authoritative guide for diagnosing mental disorders—had two diagnoses for alcohol abuse: alcohol use and alcohol dependence. In the most current edition, the fifth edition (DSM-5), these two diagnoses are grouped together as part of one diagnosis, alcohol use disorder, with 11 criteria defined.

You don't need to meet all 11 criteria to have AUD. But as the number of criteria checked increases, so does the severity of AUD, which ranges from mild to moderate to severe; health complications increase alongside stages of AUD.

"An individual usually has had repeated failures to cut back or stop," Bassi said.

One of the criteria in the DSM-5 is a person having the awareness of a problem but an inability to stop it. In this scenario, you're aware alcohol is affecting your life and know continued drinking is not good for you, but you continue the behavior.

Alcohol use disorder significantly interrupts everyday life.

"Alcohol use leads to difficulties in fulfilling major obligations at work, school or home," Bassi noted. "An individual may give up social activities, work activities or hobbies in order to use alcohol."

It's often the case that people with AUD develop a tolerance for alcohol and need to consume more to get the same effect they used to get with less. Cravings become a big part of life with alcohol use disorder to the point that sufferers may forgo social activities that don't include alcohol. Additionally, people may carry out dangerous activities while drinking, such as operating a vehicle.

Another important sign of alcohol use disorder is withdrawal, which can best be characterized as feeling the effects when you stop drinking, such as headaches, shaking, gastrointestinal symptoms, anxiety, rapid heart rate and, potentially, seizures.

Aside from the DSM-5, a medical provider might use the CAGE questionnaire as a preliminary screening tool; that is, the questions do not diagnose the disorder but could indicate whether a problem may exist. The four questions are:

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?

According to American Addiction Centers, answering "yes" to two or more questions is clinically significant.

Risks and causes of AUD

Bassi said there's no single risk factor that researchers have been able to point to as a definitive cause of alcohol use disorder.

"The risks for developing an alcohol use problem are multifactorial," he said.

A mix of genetics, environmental factors, social factors or the existence of other mental health disorders can each impact the risk of developing AUD.

"Alcohol use disorder is partially genetic," Bassi said. "There are heritable components to alcohol use, and social and cultural experiences may have served to normalize heavy alcohol use."

Alcohol use disorder can run in families, which is sometimes referred to as having the "alcoholism gene."

"Having a mental health condition, such as bipolar, depression or PTSD [post-traumatic stress disorder], can also raise one's risk for developing a problem with alcohol," Bassi added.

Research substantiates that some mental illness symptoms, such as impulsivity, negative emotion associated with depression, and low self-esteem, can increase vulnerability to developing AUD.

Research has demonstrated that early childhood trauma or life stress could be an antecedent for developing alcohol use disorder, too. One relationship between the two is that early life stress produces long-standing changes in the stress and reward systems of the brain, making an individual more vulnerable to developing AUD.

Alcohol use disorder can affect anyone, regardless of race, class or gender. Social factors, such as increased drinking at work functions, college or another environment where the behavior is widespread and normalized, may also play a prominent role in someone's likelihood to develop AUD.

Treatment for AUD

It's never too late to receive care if you suspect you have alcohol dependency, but receiving treatment is paramount. Bassi explained that treatment for AUD depends on how alcohol use is impacting your life.

"If one is actively drinking, then it would be wise to be evaluated by a physician for risk factors for harmful withdrawal, which can lead to death," he said.

Various treatment options exist, including social support, therapy, outpatient and inpatient rehabilitation options, and medication.

"Once outside of the acute window of withdrawal, treatment typically consists of a combination of therapy, support and medications," Bassi explained. "Therapy can be both individual and group, and there are many free groups that have much data to support their efficacy. Support includes family therapy and obtaining a sponsor and a sober community to promote self-efficacy."

Medication can also help.

"There are various medications that are both FDA-approved and non-FDA-approved that are often used to help reduce cravings and are scientifically proven to reduce relapse rates," he added.

Most people benefit from some form of treatment for alcohol use disorder. If someone you know is considering treatment, receiving an evaluation from a healthcare provider is a good start and highly recommended. A mental health provider or your regular doctor can help you determine which treatment option is best.