Demon in a Bottle: Alcohol Use Disorder

Alcohol use disorder (AUD) is a chronic condition that impacts a person's ability to function in day-to-day life because of a dependency on alcohol consumption. AUD puts health and safety at risk, and is a common disorder affecting an estimated 14.5 million Americans, based on numbers reported in 2019.

Studies indicate that the consumption of alcohol increases subjective sexual desire and the likelihood of risky behavior, but it 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 also reduce the production of testosterone.

Alcohol use disorder is also associated with a variety of other health problems, such as depression, liver disease and heart disease.

What is AUD?

"AUD is a serious medical condition that is actually considered a brain disorder," said Ravi Chandiramani, N.M.D., a naturopathic doctor at Soul Surgery, an integrative medicine addiction center in Scottsdale, Arizona. "It is often characterized by an impaired ability to stop or control the use of alcohol despite the fact that it causes harm to one's life."

Alcohol use disorder impacts several regions of the brain—such as the midbrain, the limbic system, the prefrontal cortex and the amygdala—which govern emotions, stress, sleep and the execution of motivated behaviors.

It also causes a variety of short- and long-term effects. Short-term effects include impairment, memory loss, hangovers and blacking out. Long-term health outcomes associated with AUD include stomach ailments, liver damage, brain damage and long-term memory loss, heart problems and cancer.

The disorder may also increase the risk of entering dangerous situations by impairing healthy decision-making. AUD can also worsen mental health problems such as depression and anxiety, and can impact all aspects of life, from work and personal relationships to finances.

Statistics published in 2022 by the National Institute on Alcohol Abuse and Alcoholism indicated that a majority of adults in the United States—85.6 percent—report consuming alcohol at some point in their lives.

But when does alcohol use become a problem?

Alcohol use disorder is diagnosed by meeting at least two of 11 criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), where AUD is described as "a problematic pattern of alcohol use leading to clinically significant impairment or distress." AUD can begin at any age and range in severity from mild to moderate to severe. The presence of two to three criteria indicates mild AUD; as the criteria count increases, so does the severity of AUD.

The condition also has several stages: at-risk, early, mid-stage and end-stage. Alcohol use disorder can accelerate quickly, depending on the individual, as folks in the at-risk stage may begin developing a tolerance for alcohol or drinking socially.

In the early stage of alcohol use disorder, thoughts about alcohol progress and the individual might experience blackouts. During mid-stage, AUD is out of control and causes issues in day-to-day life, and organ damage shows on tests and scans. End-stage AUD includes drinking as the primary focus of someone's life, complications from organ damage and impending fatality.

AUD versus alcoholism

While some people may conflate the terms alcoholism and AUD, they are not interchangeable, primarily for diagnostic reasons.

Essentially, alcoholism and AUD are one and the same, Chandiramani explained. They share a lot of similar symptoms, such as a lack of control around alcohol consumption.

"AUD is a medical diagnosis while alcoholism is not," Chandiramani said. "AUD can be classified as mild, moderate or severe. There is no difference between AUD and alcoholism. Alcohol use disorder encompasses what people refer to as alcoholism. Alcoholism is a colloquial term and not a medical diagnosis."

Essentially, AUD is in the DSM-5, whereas alcoholism is not.

The terms "alcoholic" and "alcoholism" commonly come from Alcoholics Anonymous, a 12-step program dedicated to recovering from alcohol use.

The sexual side effects of AUD

The impact of AUD on sexual function is wide-ranging.

"Alcohol can act as both a stimulant and a depressant depending on the situation," Chandiramani explained. "For both men and women who have AUD, it's very common to experience sexual arousal disorders which can seriously affect a person's ability to perform in bed and enjoy sex."

The nature of alcohol use disorder can influence someone's desire for sex.

"By the time a person is diagnosed with AUD, they have often lost interest in passions they have previously had, including sexual desire, because their sole focus and passion is now drinking," Chandiramani noted.

Alcohol also impacts performance and pleasure.

"At the most basic level, medical literature describes sexual side effects in men, including decreased sexual desire, sexual aversion, erectile dysfunction, difficulty achieving orgasm and premature ejaculation," he continued. "In women, the literature describes a lack of sexual interest, decreased sexual arousal and inability to achieve orgasm."

A 2021 meta-analysis indicated a significant association between regular alcohol use and ED. While there are fewer studies on female sexuality and alcohol use, some suggest it could negatively influence vaginal lubrication and overall function.

Excessive alcohol use can also decrease female fertility by causing menstrual irregularities and, sometimes, the absence of ovulation. Alcohol use disorder in men can also impact fertility, and studies link heavy alcohol consumption with decreased sperm and testosterone production. Heavy alcohol use before and during pregnancy may result in varying birth complications, including miscarriage, stillbirth and preterm births.

Facts and studies about AUD

Alcohol use disorder is significantly prevalent in higher-income countries and considered one of the most common psychiatric disorders. Despite the prevalence, only about 7 percent of people who meet the criteria for AUD receive treatment of any kind. The stigma associated with AUD might play a role in treatment rates. Similarly, insufficient screening in primary healthcare may influence treatment.

Alcohol use is a major contributor to preventable deaths, and it's reported that 95,000 Americans die from alcohol-related causes every year.

Throughout the course of the COVID-19 pandemic, it's estimated that excessive drinking rates increased by 21 percent. Using data from a national survey, scientists estimated that a one-year increase in alcohol consumption will lead to a surge of 8,000 additional deaths from alcohol-related liver disease, 18,700 cases of liver failure and 1,000 cases of liver cancer by 2040.

Though alcohol use disorder impacts all aspects of day-to-day living and brain function, recovery is attainable.

"It is possible to achieve and maintain recovery after an AUD diagnosis through evidence-based treatment," Chandiramani said.