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Alcohol use disorder (AUD) is a medical condition categorized as the inability to stop or control alcohol use. For those with alcohol addiction, the inability to stop drinking is present regardless of the consequences that may occur from their continued alcohol use. Over time, abruptly ending alcohol use could become fatal without proper medical care.
AUD looks different for everyone, making it difficult for people to see themselves as having an alcohol problem, especially if they don’t drink every day. The truth is, drinking every day is not a prerequisite for alcohol use disorder. Some of the most dangerous alcohol use conditions often involve binge drinking or drinking large amounts of alcohol in one sitting, rather than consuming a few drinks daily.
Completing an assessment from a qualified substance use treatment professional is the best strategy for determining if someone truly has a substance use disorder and what the level of severity may be.
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Alcohol addiction is a serious, large-scale condition that millions of people in the United States struggle with. In 2021 alone, it’s estimated that up to 29.5 million people met the requirements for alcohol addiction.
Even with its potential medical consequences, alcohol is still a highly used, and abused, substance. It is also a highly addictive substance that rewires how the brain functions.
Regardless of its impact on the body, alcohol does one thing well: producing a feeling of euphoria and numbing negative feelings. The brain is hardwired to focus on enjoyable behaviors that stimulate its reward center, called the striatum. Other important areas of the brain, including the basal ganglia, amygdala, and prefrontal cortex, are associated with the reward system in the brain.
An easy way to understand how alcohol interacts with the brain’s reward system is to think of substance use disorders as a cycle that includes three phases: reward development, reward reduction, and executive functioning difficulties. In each phase, the addiction grows more intense, and the user becomes increasingly unable to stop. Thinking of addiction in this way can make it easier to understand how individuals can “fall into” a substance use disorder without realizing it.
The first phase of a developing alcohol addiction is using alcohol specifically for its reward effects. Many people use these effects to manage social environments with reduced inhibitions and anxiety. While many people have experienced this behavior and its effects without consequences, this pleasurable activity may lead to developing a daily habit for some.
Depending on how frequently someone consumes alcohol, the brain will continue to build a sense of “excitement” and, ultimately, motivation to consume alcohol. This then develops into an encouraged behavior pattern that makes the individual “excited” about consuming alcohol. This excitement translates into urges, or cravings, to use alcohol. The brain will find ways to associate alcohol with other information, such as people, places, and things (e.g., sports games) where drinking is generally experienced.
This cycle can become the foundation for multiple substance use disorders and other addictions. It is not uncommon to find food, sex, drugs, and even impulsive behaviors (e.g., shopping) becoming unhealthy coping strategies for negative emotions. Escapism from mental health struggles, like depression or anxiety, stressful situations, and stressful environments, frequently result in some form of substance use disorder to self-medicate from discomfort.
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The second phase of a developing alcohol addiction is when many realize they have a problem, as it tends to include the more negative symptoms associated with alcohol use. In this stage, many individuals experience unwanted withdrawal symptoms after they stop drinking alcohol, such as increased stress, feeling irritable, difficulty feeling pleasure, sleep disruption, increased anxiety, and many more negative feelings.
Once this phase begins, drinking becomes less about pleasure and more about feeling “normal,” resulting in a cycle of alcohol use characterized medically as alcohol use disorder.
In the third phase, the physical and emotional dependence on alcohol impacts how the brain determines its executive functioning within the prefrontal cortex. Executive function refers to three major types of brain function: working memory, mental flexibility, and self-control. When alcohol addiction reaches this phase, the brain becomes “preoccupied” with alcohol, resulting in a reduced capacity to perform the duties and responsibilities commonly required in daily life.
This phase is generally seen in more severe alcohol use disorders and can require a dedicated plan of treatment to help someone recover. Unfortunately, this cycle can be experienced for quite a while, with many individuals struggling for decades before they truly realize they have an alcohol use disorder and decide to seek help. However, recovery is out there for those interested in ending the cycle of addiction to live their life again.
Alcohol is a central nervous system (CNS) depressant, which slows down important parts of the body’s functioning. The CNS is responsible for intelligence, memory, emotions, physical abilities, and personality. When alcohol is ingested, it stops the flow of chemical signals in the brain, resulting in the feeling of intoxication.
These chemical signals are generally referred to as neurotransmitters. They are an essential part of the brain’s ability to function, including regulating virtually all of the body’s organs and managing daily tasks, like working, eating, and sleeping. Think of these neurotransmitters as cars going down the highway taking various exits to reach their destinations. Alcohol, on the other hand, functions as a blockade on the highway, cutting off all traffic to certain areas of the brain, resulting in the effects of intoxication from alcohol consumption.
When enough alcohol is used frequently, it can change how the brain operates over time, even changing the brain’s physical structure. Alcohol can cause loss of physical mass, or decay, within the brain, resulting in long-term memory loss, difficulty concentrating, poor stress management, and serious medical conditions such as alcohol-related Dementia or Wernicke-Korsakoff Syndrome (sometimes referred to as wet brain).
The brain isn’t the only part of the body that experiences significant changes from alcohol use. Chronic alcohol use has a long list of associated health conditions. The constant presence of alcohol in the body can result in organ failure due to being overworked or underused. Research has found that several factors may increase the likelihood of medical conditions and alcohol-related fatalities. These include the amount of alcohol consumed, how frequently it is consumed, and the type of alcohol being consumed.
There are over 20 medical conditions that are directly related to alcohol use and its impact on the body, with many more conditions that have connected relationships as well. Some of the most common forms of medical conditions related to alcohol use include:
Alcohol misuse and addiction are some of the oldest medical conditions in human history, and medical care has grown incredibly sophisticated in its ability to help people recover. Many treatment options exist and can propel those struggling with an alcohol use disorder onto the right path for long-term recovery. If you believe recovery is right for you or your loved one, contact a treatment provider today to discuss available options for rehabilitation facilities.
Travis Pantiel, LMHC, MCAP
Travis Pantiel is a Licensed Mental Health Counselor and a National Board-Certified Counselor with specialized expertise in the co-occurring disorder treatment field.
Reviewed by Doctor of Addiction Medicine
Dr. Ashish Bhatt, MD
Addiction Center’s Medical Content Director, Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.
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