What is Alcohol Addiction (Alcohol Use Disorder)?
Addiction is a brain disease and when treated like a chronic medical illness, results are similar to other chronic medical illnesses such as hypertension, asthma, and diabetes.1,2 This means that long term treatment is necessary and it is not going to disappear the way an acute illness would resolve after a short term treatment.
It often has its roots in genetics, mental health conditions, trauma, and unstable living situations. Effective treatment for Alcohol Use Disorder involves counseling and group support. Medications are often useful to help with cravings. Medications including naltrexone (oral and intramuscular) and acamprosate. Treatment often involves treatment for underlying conditions such as depression, anxiety, and trauma. Family members may also need support.
It is characterized by tolerance, cravings, and withdrawals. It is marked by the inability to stop using despite harmful consequences of using alcohol that can affect personal relationships, education, and employment. Harmful consequences of Alcohol Use Disorder include: dysfunctional relationships, inability to hold a job, injuries to self and others while intoxicated, legal issues related to OUI (operating under the influence), cirrhosis, gastrointestinal bleeding from esophageal varices, anemia, and Wernicke-Korsakoff syndrome.
There are three phases of addiction3:
The Binge/Intoxication phase is characterized by rapid release of dopamine in the reward centers of the brain. As addiction progresses, it takes more of the substance to achieve the same effect. Often, the individual uses the opiates just to achieve a feeling of normalcy.
The Withdrawal/Negative Affect phase is characterized by dysphoria, emotional pain, and irritability. There is an increase in anxiety and stress like responses.
The Preoccupation/Anticipation phase occurs weeks to months after withdrawals are completed, it is characterized by craving and it is a key element of relapse. It is characterized by increased cravings, increased brain levels of dopamine and glutamate. It is also characterized by decreased activity in the areas of the brain that regulate decision making, inhibitory control and working memory
Addiction is defined by the American Society of Addiction Medicine as:
Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.
Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.
Alcohol Use Disorder is diagnosed based upon the 11 criteria established by the DSM-V:
Alcohol is often taken in larger amounts or over a longer period of time than intended.
There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
Craving, or a strong desire to use alcohol.
Recurrent alcohol use resulting in 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.
Important social, occupational or recreational activities are given up or reduced because of alcohol use.
Recurrent alcoohol use in situations in which it is physically hazardous
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.
Tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of alcohol to achieve intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount of alcohol
*Withdrawal, as manifested by either of the following:(a) the characteristic alcohol withdrawal syndrome(b) the same (or a closely related) substance are taken to relieve or avoid withdrawal symptoms
Criteria from American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,. Washington, DC, American Psychiatric Association
Reading List/helpful links:
Volkow, N, G. Koob, and A. McLellan. Neurologic Advances from the Brain Disease Model of Addiction. N Engl J Med 2016;374:363-371.
Mclellan AT, et.al. Drug Dependence, A Chronic Medical Illness, implications for Treatment, Insurance, and Outcomes Evaluation. JAMA 2000: 284:1689-169
Koob G, and N. Volkow. Neurobiology of Addiction: A neurociruitry analysis. Lancet Psychiatry. 2016 August; 3(8):760-773