A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.
Alcohol: Alcohol Use Disorder
The diagnostic criteria for a substance use disorder were previously reviewed. These criteria apply to alcohol use disorder.
Alcohol is the most widely used (and overused) drug in the United States. The majority of people who drink are able to drink in moderation. We might call these people occasional, light, or moderate drinkers. They have never met the criteria for an alcohol use disorder. However, in the United States 13% of the people age 12 and over DO meet these diagnostic criteria (APA, 2013 . In addition, about 20% of men and 10% of women drink more than the recommended moderation guidelines. The interested reader may find it helpful to review these guidelines published by NIAAA:
The identification of problematic or "risky" drinking is a complex one. This is because individual drinking patterns change over time. Moreover, many of the people in the "high risk" category do not consider themselves "alcoholic." Therefore, they falsely conclude they do not need to pay attention to their drinking (Doyle & Nowinski, 2012). Note that the DSM-5 (APA, 2013) does not use the word alcoholic. As such, it has no diagnostic meaning. Nonetheless, most people are familiar with the term "alcoholic." It is often used to describe severe cases of alcohol addiction. Risky or problematic drinking occurs long before this level of severity and most certainly does require attention.
The NIAAA moderation guidelines (referred to above) are typical. Guidelines are based on the number of drinks per day, and the total number of drinks per week. A drink equals a 12 oz. beer, or a 5 oz. glass of wine, or a 1.5 oz. shot of liquor. For men, the maximum limits are: a) no more than 4 drinks in a day, and b) no more than 14 drinks per week. For women, the maximum limits are: a) no more than 3 drinks in a day, and b) no more than 7 drinks per week. For some people moderation is extremely difficult to maintain. They end up over-drinking. These people may go on to develop an alcohol use disorder.
Most people who develop alcohol use disorders do so by their late 30s. However, an alcohol use disorder may emerge at any time during the lifespan. Genetics heavily influence whether someone develops problems with alcohol. In fact, genetics account for about 50% of the variance. If you have several relatives with severe alcohol problems, your genetic risk may be quite high (APA, 2000). Different people respond to alcohol differently. Some people require more alcohol to produce intoxication. Some of this difference seems to be genetically determined.
The repeated use of alcohol by pregnant women may lead to fetal alcohol syndrome (FAS). FAS is characterized by devastating, physical and behavioral defects in infants such as intellectual disabilities, stunted growth; limb malformation; heart problems; and delayed motor development. These defects are usually not reversible. Heavy alcohol use often leads to tolerance and withdrawal.
Alcohol withdrawal begins 4-12 hours after stopping or reducing heavy use. Symptoms of alcohol withdrawal are often extremely unpleasant. Symptoms may include sweating; tremor; insomnia; nausea/vomiting; hallucinations; agitation; anxiety; and even seizures. In severe cases, alcohol withdrawal may result in death. Consult with a physician prior to discontinuing heavy alcohol use.
Effects of Alcohol: Alcohol Intoxication
Alcohol intoxication is indicated by behavioral and psychological symptoms. This includes poor judgment and difficulty getting along with other people. Alcohol affects the cerebral cortex. This makes it difficult to inhibit impulsive urges. Impulsivity can lead to aggression and risky sexual behavior. Alcohol intoxication causes observable symptoms. These symptoms include slurred speech; unsteady gait; a lack of coordination; impaired memory/attention; involuntary rapid eye movements (nystagmus); and even coma. Heavy alcohol use can cause many health problems. These problems often involve the gastrointestinal, cardiovascular, and nervous systems. In addition, the interaction between alcohol and other drugs can be fatal. This is especially true with other drugs that depress the central nervous system such as sedatives, hypnotics, and anxiolytics LINK.