Alcoholism and Alcohol Abuse Treatment and Recovery

About one in ten people has an alcohol problem or will develop one. Are you concerned about your drinking? Have you ever wondered if you have a problem? Maybe you suspect the answer, but are afraid to admit it. This is your chance to do something about it.

If you do have a problem, you don’t have to suffer in silence. There is help. Many people have overcome their alcohol problem and are living happier lives.

Table of Contents

Do You Have and Alcohol Problem?
Alcohol Withdrawal
Alcoholism and Alcohol Abuse Treatment
How to Help Someone with Alcoholism

Alcoholism and Alcohol Abuse: AddictionsAndRecovery.org

What are Alcoholism, Alcohol Abuse and Alcohol Dependence?

These conditions are part of a spectrum called Alcohol Misuse Disorders. The two defining characteristics of an Alcohol Misuse Disorder are the following:

  1. You have difficulty controlling how much alcohol you drink. For example, once you start to drink, one drink leads to more drinks, and the next day you realize you drank more than you would have liked.
  2. You continue to drink even though it has negative consequences in your life. For example, drinking has hurt your relationships, but you continue to drink.

There is a more detailed definition below. But those are the two key criteria.

The Difference Between Alcoholism, Alcohol Dependence and Alcohol Abuse

There used to be a distinction made between alcohol abuse and alcohol addiction. But now it is understood that Alcohol Misuse Disorders fall into a spectrum with no clear or distinct categories. The term Alcohol Misuse Disorder is used by DSM 5 and ICD-10 to describe all the conditions in this spectrum. The terms alcoholism, alcohol dependence, and alcohol abuse have fallen out of favor, in an effort to avoid negative associations, but they can be considered equivalent.

(DSM 5 is the The Diagnostic Manual of the American Psychiatric Association, and ICD-10 is the International Classification of Disease of the World Health Organization.)

Do You Have a Drinking Problem?

The CAGE test for alcohol addiction is a simple and accurate self-test to help you decide if you have a problem. Answer yes or no to each question.[1]

  1. Have you ever thought you should Cut down your drinking?
  2. Have you ever felt Annoyed when people have commented on your drinking?
  3. Have you ever felt Guilty or badly about your drinking?
  4. Have you ever had an Eye opener first thing in the morning to steady your nerves or to get rid of a hangover?

To get your score, give one point for each yes answer.

The Probability that You are Addicted to Alcohol

The CAGE test for alcoholism was given to over 500 randomly selected people, and these are the results.[2]

If you scored 1, there is an 75% chance you're addicted to alcohol.
If you scored 2, there is an 85% chance you're addicted to alcohol.
If you scored 3, there is a 95% chance you're addicted to alcohol.
If you scored 4, there is a 99% chance you're addicted to alcohol.

There is an even more detailed test for alcoholism and alcohol abuse called the AUDIT test developed by the World Health Organization.

You don’t have to hide an alcohol problem anymore. Because of the courage of many high-profile individuals who have come forward, an alcohol problem is finally being treated as a serious health condition.

To understand how far we have come, when the above study was published in 1987, only 63 percent of the individuals who were identified as having an alcohol problem had been detected by their physicians, and in only 24 percent of those cases did the physician address the problem with the individual.[2]

How Much Drinking is Too Much?

The maximum limit for alcohol use have been set by the National Institute of Alcohol Abuse and Alcoholism.[3]

  • For men, more than 4 drinks in a day, or more than 14 drinks per week
  • For women, more than 3 drinks in a day, or more than 7 drinks per week
  • A standard drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of spirits

A study of over 26,000 people showed that individuals who drink more than the maximum limit have a high risk of becoming alcoholics. [4]

What is Moderate Alcohol Use or Social Drinking?

When struggling with the question of whether you have an alcohol problem or not, it helps to know what is a social drinker. [5]

  • For men, no more than 2 drinks per day
  • For women, no more than 1 drink per day
  • Some guidelines suggest at least 2 non-drinking days per week.

It is important to note that even low-risk drinking is not no-risk drinking. A review of over 200 medical studies showed that even moderate alcohol use increases risk of some cancers, especially cancers of the mouth, larynx, and esophagus. [6]

Standard Alcohol Drink Size: AddictionsAndRecovery.org

Alcohol Use Statistics: Drinking Percentiles

A study of over 44,00 college students in 1997 found the following pattern of alcohol use:[7]

  • 37% of students drank less than 1 drink per week.
  • 50% of students drank no more than 1 drink per week.
  • 70% of students drank no more than 4 drinks per week.
  • The top 20% of students drank at least 8 drinks per week.
  • The top 10% of students drank at least 13 drinks per week.
  • The top 5% of students drank at least 20 drinks per week.

These are useful statistics to know when dealing with adolescents who say “everybody drinks to get drunk in college.”

Stages of Alcoholism: The Functioning Alcoholic

  • Early stage: You regularly drink too much, but you haven’t suffered many consequences. This is when it’s easiest to make a change. But it is also when denial is highest.
  • Middle stage: This is the classic functioning alcoholic. You still have a job, but your relationships are beginning to suffer.
  • Late stage: Drinking is affecting your job. You have had legal problems, financial problems, or medical problems due to your drinking. This is what people think alcoholism is like, but this is the end of the line.

Alcoholism is progressive. The consequences get worse over time. It's never easy to quit. But if you have already suffered some consequences, there's never a better time to quit than now.

Alcohol Withdrawal Symptoms

Alcohol withdrawal occurs because your brain works much like a spring. Alcohol is a brain depressant that pushes down on the spring. When you suddenly stop drinking it is like taking the weight off the spring. The spring rebounds, your brain produces excess adrenaline that causes withdrawal symptoms:

  • Anxiety, Irritability, Headache, Insomnia
  • Muscle tension, Shaky hands
  • Sweating, Nausea, Vomiting
  • Chest tightness, Palpitations

Serious Alcohol Withdrawal Symptoms

If you suddenly stop regularly drinking large amounts of alcohol, you may be at risk of a seizure, stroke, or heart attack. A medically supervised detox can minimize your withdrawal symptoms and reduce the risk of dangerous complications. These are some of the potentially dangerous symptoms of alcohol withdrawal:

  • Grand mal seizures
  • Heart attacks
  • Strokes
  • Hallucinations
  • Delirium tremens (DTs)

The Neuroscience and Brain Chemistry behind Alcohol Withdrawal

In alcohol withdrawal, what goes on in the brain? GABA is the main calming neurotransmitter of the brain. GABA and adrenaline in the brain are supposed to be in balance during normal brain functioning. Frequent drinking causes the brain to produce less GABA, because the brain begins to rely on the alcohol you drink for part of its calming. So, frequent drinking causes your brain chemistry to be out of balance. When you suddenly stop drinking, your brain doesn’t have enough GABA neurotransmitter, and there is a relative excess of adrenaline, which causes all the withdrawal symptoms.

Alcohol Detox (Detoxification) to Prevent Withdrawal

Detoxification, or detox, involves taking a short course of medication to help reduce or prevent withdrawal symptoms. Medications such as Valium (diazepam), Librium (chlordiazepoxide), or Ativan (lorazepam), the benzodiazepine family, are usually used for detox.

Detox can be done as either an inpatient or outpatient depending on the person’s health, their volume of drinking, and their past history of withdrawal. Detox is always done under close supervision. A common plan for outpatient detox is to prescribe a high dose of medication on the first day, and then gradually reduce the dose over the next 5-7 days. People with serious alcohol abuse may be admitted to hospital.

This is general medical information, and not tailored to the needs of a specific individual.

Alcoholism Treatment

If you have decided you have an alcohol problem, there is help and hope. Self-help groups, online groups, your physician, counsellor, alcohol rehab, and websites like this are all potential supports.

Using supports helps you feel like you’re not alone. They give you confidence that you can change. They show you techniques that have worked for others. Asking for help and using supports dramatically increases your chances of success.

Learn more about treatment recovery skills and relapse prevention through these links. You can change your life. Below are the various kinds of alcohol addiction supports that exist.

Self-Help Groups

Addiction self-help groups are an important resource of recovery for two reasons. First, they're effective. Millions of people have recovered through them. Second, they're free and universally available.

You feel like you’re not alone. You meet people who are going through the same thing. Addiction is an isolating disease. Self-help groups give you the chance to reach out and receive help.

You believe that recovery is possible. You see that other people have recovered from addiction, and you develop confidence that you can also change your life.

You won't be judged. It’s probably difficult for you to talk about your drinking, because you're afraid nobody will understand you and they'll criticize you. So you bottle everything up inside, which makes you feel more guilt and shame, and makes you want to drink even more. The people at a self-help group won't judge you because they've have heard it all before. They've done it all before. They know you're not crazy. You're addicted.

For more information, here is a list of recommended links to addiction self-help groups.

Alcohol Counseling

The first step in recovery is deciding if you have a problem. This can be difficult, because your addicted-self will try hard to convince you that you don't have a problem. This is where a trained professional can gently help. They can keep you from tricking yourself and prevent you from slipping back into denial. They are trained to look for signs of trouble.

Counselors and health professionals can also help maintain your motivation for change, which is so important in the journey of recovery. They can act like your personal trainer. Counselors and health professionals can help you develop healthy coping skills so that you won’t be tempted to turn to drugs or alcohol to self-medicate.

For more information, here is a list of addiction counselors, therapists, psychologists, psychiatrists, and addiction physicians, listed by country. Each website has a directory or health professional register for finding help in your area.

Alcohol Detox (Detoxification)

Most severe alcohol withdrawal symptoms occur in the first three to four days after stopping. Alcohol withdrawal can sometimes be dangerous, increasing the risk of seizures, strokes, or heart attacks. These complications are uncommon, and a detox program can help you avoid the discomfort and dangers of withdrawal.

Medical detox can be managed by your family doctor, an addiction specialist, or a detox center. Most urban areas have medical and non-medical detox programs. Medical detox facilities can prescribe medications such as Valium (diazepam) to help minimize withdrawal symptoms. Non-medical detox facilities provide a safe, supportive environment to go through withdrawal, and access to medical facilities if they are needed.

Alcohol Rehab (Rehabilitation)

There is a wide range of alcohol rehab programs, including inpatient, outpatient, day-patient, and evening programs. Inpatient rehab facilities are the most structured. Generally, these programs run for 30, 60, or 90 days. There is benefit to stepping out of your environment so that you can completely focus on recovery without any distractions, as in an inpatient program. However, that is not an option for many people.

How Can Rehab Help?

Overcoming substance abuse requires learning new knowledge and skills. These are some of the skills you can learn in a rehab program:

Most addiction rehab programs have at least a one-year aftercare component that provides support as you practice applying your new skills in your everyday life. Here is a list of government websites that can help you find an addiction rehab program.

Medications

There are three drugs that can help overcome alcoholism:

  • Antabuse (disulfiram)
  • Campral (acamprosate).
  • ReVia (naltrexone)

Antabuse is the most studied of these three. Clinical trials have shown that Antabuse, and to a lesser extent acamprosate and naltrexone can help:

  • Reduce craving for alcohol [8]
  • Reduce the risk of relapse.[9, 10]

How to Help Someone with Alcoholism or Alcohol Abuse

What You Can Do: Advice for Family and Friends

If someone you love has a drinking problem, you may be struggling with how to help them and how to avoid being overwhelmed. You are probably feeling a combination of anger, fear, shame, and sometimes even guilt. At times, it may seem easier to ignore the problem. But denying it will only cause more damage to you, your family, and the person drinking. I hope some of these suggestions will help.

10 Things You Can Do

  • Educate yourself on addiction and recovery.
  • Tell the person that it is hard for you to raise the topic of their drinking, but you are concerned. You care about them, and tell them what their drinking is also doing to your family.
  • Try not to accuse or judge. Avoid name calling. This is a difficult time for both of you.
  • Provide a sober environment that reduces the triggers for using.
  • Provide enough time for recovery activities. Don’t expect them to stay sober without outside help. Meetings, counselling, rehab, aftercare all take time. Recovery is the foundation on which they will build their life. All other activates are secondary.
  • Understand that your lives will change. Do not wish for your old life back. You both need to create a new life where it is easier to not use alcohol and drugs.
  • Make sure that you both have fun. People use alcohol to escape, relax, and reward themselves. The alcoholic needs to find alternative ways to escape, relax, and reward themselves, otherwise they will turn back to their addiction.
  • Set boundaries that you all agree on. The goal of boundaries is to improve the health of the whole family. Do not use boundaries to punish or shame.
  • If you want to provide financial support, buy the goods and services the person needs instead of giving them money that they might use to buy alcohol.
  • Recognize and acknowledge the potential the person has within them.

8 Things Not To Do

  • Don’t be surprised if the person is defensive.
  • If possible, try not to be negative when dealing with them. That will only increase their feelings of guilt and shame, and may push them further into drinking.
  • Try not to punish, threaten, bribe, or preach. That may make them more defensive.
  • Do not enable. Do not provide excuses or cover up for them.
  • Do not shield them from the consequences of their drinking. People are more likely to change if they have suffered enough negative consequences.
  • Do not argue or try to discuss things with the person when they are under the influence. It won’t get you anywhere.
  • Don't try to drink along with them.
  • Don’t blame yourself. Remember the “three C’s” of dealing with an addict: You didn't Cause the addiction, You can't Control the addiction, You can't Quit drinking for them.

Things You Can Do For Yourself

  • Practice loving detachment. Discover how can you do that without feeling guilty and without being punitive?
  • Living with an alcoholic is exhausting. You also need time to recover.
  • Practice self-care. Discover what your needs are beyond the needs of the alcoholic. Discover how to take care of yourself even when the other person does not take care of themselves.
  • Avoid self-blame. You can’t control another person’s decisions, and you cannot force them to change.
  • Do not work harder than the person you’re trying to help. The best approach is to not do things for the alcoholic, but instead to be an example of balance and self-care.
  • Being a caretaker is not good for you or for them. Understand that there is only so much you can do.
  • Ask for help. Talk to a professional. Go to a support group. (Some support groups are listed below.)

Helpful Links for Family and Friends of Alcoholics

  • Al-Anon.org (al-anon.org) For family members of alcoholics.
  • Coda.org (coda.org) For co-dependent individuals.
  • Adultchildren.org (adultchildren.org) For adult children of alcoholics and addicts.

What are the Signs of Alcoholism and Alcohol Abuse? The AUDIT Alcoholism Test

One more test, if you’re unsure if you have an alcohol problem. The AUDIT (Alcohol Use Disorders Identification Test) was developed by the World Health Organization (WHO). It correctly classifies 95% of people into either alcoholics or non-alcoholics. It was tested on 2000 people before being published.

To correctly answer some of these questions you need to know the definition of a drink. For this test one drink is:
One can of beer (12 oz or approx 330 ml of 5% alcohol), or
One glass of wine (5 oz or approx 140 ml of 12% alcohol), or
One shot of liquor (1.5 oz or approx 40 ml of 40% alcohol).

1. How often do you have a drink containing alcohol?
Never (score 0)
Monthly or Less (score 1)
2-4 times a month (score 2)
2-3 times a week (score 3)
4 or more times a week (score 4)

2. How many alcoholic drinks do you have on a typical day when you are drinking?
1 or 2 (0)
3 or 4 (1)
5 or 6 (2)
7-9 (3)
10 or more (4)

3. How often do you have 6 or more drinks on one occasion?
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

4. How often during the past year have you found that you drank more or for a longer time than you intended?
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

5. How often during the past year have you failed to do what was normally expected of you because of your drinking?
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

6. How often during the past year have you had a drink in the morning to get yourself going after a heavy drinking session?
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

7. How often during the past year have you felt guilty or remorseful after drinking?
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

8. How often during the past year have you been unable to remember what happened the night before because of your drinking?
Never (0)
Less than monthly (1)
Monthly (2)
Weekly (3)
Daily or almost daily (4)

9. Have you or anyone else been injured as a result of your drinking?
No (0)
Yes, but not in the past year (2)
Yes, during the past year (4)

10. Has a relative, friend, doctor, or health care worker been concerned about your drinking, or suggested that you cut down?
No (0)
Yes, but not in the past year (2)
Yes, during the past year (4)

It may seem like the AUDIT questionnaire is an easy test to fail. If you applied this test to other aspects of your life you will almost certainly appear to be addicted to something. For example, most people watch too much television, or eat too much of a certain food. But those are so-called "soft addictions", and the AUDIT questionnaire was not designed to assess them. The AUDIT is extremely reliable when it comes to assessing alcohol addiction. (The PDF format version of the AUDIT is available through the WHO website. Copyright 1993 World Health Organization.)[11]

If You’re Still Not Convinced

If you are still not convinced that you have an alcohol problem, then try sticking to a moderate drinking plan to see if you can drink moderately. Give it six months before you decide one way or the other.

References

1.         Ewing, J.A., Detecting alcoholism. The CAGE questionnaire. JAMA, 1984. 252(14): p. 1905-7.
2.         Bush, B., et al., Screening for alcohol abuse using the CAGE questionnaire. Am J Med, 1987. 82(2): p. 231-5.
3.         National Institute of Alcohol Abuse and Alcoholism, Helping Patients Who Drink Too Much: A Clinicians Guide. 2005.
4.         Dawson, D.A., B.F. Grant, and T.K. Li, Quantifying the risks associated with exceeding recommended drinking limits. Alcohol Clin Exp Res, 2005. 29(5): p. 902-8.
5.         US Health and Human Services, Dietary Guidelines for Americans 2015-2020. 2015.
6.         Bagnardi, V., et al., Alcohol consumption and the risk of cancer: a meta-analysis. Alcohol Res Health, 2001. 25(4): p. 263-70.
7.         Meilman, P.W., C.A. Presley, and J.R. Cashin, Average weekly alcohol consumption: drinking percentiles for American college students. J Am Coll Health, 1997. 45(5): p. 201-4.
8.         Petrakis, I., et al., Naltrexone and disulfiram in patients with alcohol dependence and current depression. J Clin Psychopharmacol, 2007. 27(2): p. 160-5.
9.         Krampe, H., et al., Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome. Alcohol Clin Exp Res, 2006. 30(1): p. 86-95.
10.       De Sousa, A. and A. De Sousa, A one-year pragmatic trial of naltrexone vs disulfiram in the treatment of alcohol dependence. Alcohol Alcohol, 2004. 39(6): p. 528-31.
11.       Babor, T.F., et al., AUDIT: The Alcohol Use Disorders Identification Test. Guidelines for Use in Primary Care. World Health Organization, Department of Mental Health and Substance Dependence.  http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf. WHO.

Last Modified:March 21, 2018