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Alcohol Use Disorder Diagnosis & Treatment

Alcohol Use Disorder Diagnosis & Treatment

What comes to mind when someone mentions alcohol? For many, alcohol is often associated with the temporary avoidance of daily struggles. Whether or not we have the habit to drink, it is a known fact that people may tend to have “blackouts” whenever they’re really drunk – and are unable to recall anything during these periods of time. As for young adults, perhaps it could also be attributed to their keen desire to look “cool” and to show off their high alcohol tolerance to their friends. However, alcohol can be addictive, and frequent heavy drinkers run the risk of becoming alcohol-dependent and hence developing alcohol use disorders. But what actions can we take if we find ourselves constantly wanting to submit to such an altered state of being, and seeing the appeal in losing control of ourselves as a form of escapism?

 

What is an Alcohol Use Disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; 

DSM–5; American Psychiatric Association, 2013), an alcohol use disorder is essentially characterised by “a problematic pattern of alcohol use leading to clinically significant impairment or distress as manifested by at least two of the following, occurring within a 12-month period”: 

  1. Alcohol is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  4. Craving, or a strong desire or urge to use alcohol.
  5. Recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school, or home.
  6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  8. Recurrent alcohol use in situations where it is physically dangerous.
  9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
  10. Tolerance.
  11. Withdrawal.

In regards to the disorder’s severity, it is safe to say that an individual categorised under the ‘mild severity’ category would display two to three of the above symptoms, while those under ‘Moderate’ would display four to five. For persons who develop six or more of such symptoms, they would, unfortunately, be diagnosed to be severely alcohol-dependent. 

In the development of alcohol abuse, we need to recognise that the physiological and psychological reward system in our brains are what contributes to the clouding of negative consequences and effects associated with alcohol dependence and addiction. In other words, the possibility for change is tough, and the learnt habit can be hard to kick. Positive and negative reinforcements play a major role, especially in the beginning stages of alcohol abuse. Positive reinforcement occurs when the chances of an individual performing an activity (in this case, drinking) is heightened due to his previous experience of feeling rewarded by the “high” he or she obtains when getting drunk. On the contrary, negative reinforcement occurs when the probability of alcohol-seeking behaviour increases upon allowing the drinker to avoid certain situations or negative stimuli. Therefore, it can be said that alcohol abuse is fuelled by the physiological and psychological reward system, thus increasing one’s motivation to consume more alcohol, though sometimes a little too much. 

Alcohol addiction can be greatly detrimental to our lifestyles, as well as to our physical and mental health. Known to be a depressant, alcohol can have a significant impact on our brain’s activity. If you’re drinking unhealthy levels of alcohol in an attempt to manage other mental health conditions such as anxiety or depression, stop it immediately! Alcohol affects neurotransmitters in your brain, potentially worsening your pre-existing condition. As such, it is crucial that we help people with alcohol use disorders to move past their addiction to a more fulfilling lifestyle. 

 

What forms of treatment can I consider?

Alcohol abuse can be treated with psychiatric or psychological intervention, sometimes a combination of both. 

When it comes to psychiatric medications, psychiatrists may prescribe medications used primarily to treat alcohol withdrawal by targeting the GABA neurotransmitters in the brain, allowing the brain to restore its natural balance when the person abstains from alcohol. Another common medication prescribed mainly affects the individual’s alcohol metabolism. The drug increases the concentration of acetaldehyde, a product formed when alcohol is broken down. The buildup of this acetaldehyde induces undesirable effects such as vomiting, hence holding the person back from consuming large amounts of alcohol. However, despite these drugs being the commonly prescribed medications, it is extremely dangerous for one to source and consume them without first consulting a professional psychiatrist. Everyone’s case is different, and people may have differing medication needs. 

Another form of treatment one can consider is Cognitive Behavioural Therapy (CBT). CBT is an effective method which focuses on helping one identify and uproot negative or irrational thoughts and/or behaviours. Being highly solution-focused, such forms of therapy can include trying to help these individuals to recognise situations in which they are inclined to drink, and how they can better repress themselves. As such, the main goal would be for these people to recognise their problematic behaviour, and subsequently cut down on and adhere to healthy alcohol consumption levels. Since the impact of alcohol abuse is usually not limited to the individual, family therapy may also be recommended at times, especially if the individual’s alcoholic behaviour causes others distress. 

All in all, alcoholism is not a matter to be taken lightly, as alcohol can certainly bring harm to both our physical and mental health if not consumed in moderation or at healthy levels. Do seek treatment immediately if you find that your alcohol-use patterns are interfering with your quality of life, or if you constantly find yourself craving higher doses each time.

 


References

1 DiClemente, C.C.. (2006). Addiction and change. How addictions develop and addicted people recover. New York, NY: The Guilford Press.

2 Gilpin, N.W., & Koob, G.F. (2008). Neurobiology of alcohol dependence. Focus on motivational mechanisms. Alcohol Research & Health, 32, 1850195.