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What is Alcohol Use Disorder (AUD)?

Alcohol use disorder (AUD) is a growing problem in the United States and around the world. It occurs when a person drinks heavily and cannot control their alcohol use. They continue to drink despite the negative effects it has on their life.

Those addicted to alcohol also develop withdrawal symptoms after they stop drinking. These symptoms can range from mild to severe. They may include shaking, tremors, intense sweating, extreme cravings, and more.

Some people become addicted to alcohol over time, while others do not. The cause of alcohol use disorder (AUD) can be attributed to a variety of factors, including:

  • Biological factors
  • Social factors
  • Psychological factors
  • Environmental factors

14.1 million people (18 and over) struggle with an alcohol use disorder. The disorder encompasses alcohol abuse, alcohol addiction, and alcoholism.

The National Institute on Alcohol Abuse and Alcoholism report from 2017 

Risk Factors of Alcohol Use Disorder (AUD)

These are some risk factors associated with alcohol addiction:

  • Early drinking — Drinking from an early age increases the risk of developing an AUD later in life.
  • Peer pressure — Pressure from friends and family can contribute to excessive drinking and addiction. Today’s media also pushes alcohol as a way to wind down or deal with stress. These influences can increase your risk.
  • High levels of stress — High-stress levels increase your risk of addiction. Whether your stress comes from your job, finances, or relationships, finding a coping mechanism is essential to reduce the risk of turning to alcohol.
  • Family history — Genetics play a large role in problem drinking. Genetic mental illnesses also increase your likelihood of developing an addiction.
  • Previous trauma — A history of emotional or physical trauma can increase the risk of AUD.
  • Other mental health disorders — Alcohol can be a method of self-medication for those with mental health issues. This, in turn, can lead to alcohol addiction.
  • Gender — Alcohol use disorder (AUD) affects men more than women. Women also metabolize alcohol differently than men. Their bodies absorb more alcohol and reach a higher BAC even after drinking the same amount.
  • Regular drinking over a long period — When you drink more alcohol, your body develops a tolerance, and alcohol dependence forms over time. Because of this tolerance, your body needs more alcohol to feel the same effects. Drinking alcohol in moderation can be harmless, but over time it can develop into abuse or addiction.

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What Causes Alcoholism?

When it comes to alcohol addiction, every person is different. An alcohol use disorder can be triggered by a variety of factors, including:

Biological Causes

Genetic factors and a family history of alcoholism can contribute to your risk of developing an AUD.

However, there isn't just one "alcoholic gene" that increases a person's risk of developing alcoholism.

Studies show that AUD is a complex genetic disease, and hundreds of genes can impact the risk. Certain gene combinations can also make you more susceptible.

Two genes that have the strongest known link to alcoholism include:

  • ADH1B — People with this gene metabolize alcohol slower, so they experience fewer adverse side effects.
  • GABRB1 — This gene associates with the production of gamma-aminobutyric acid (GABA). Consuming alcohol alters the amount of GABA available to the brain, causing relaxation and anxiety relief. This is known as “self-medicating."

Certain gene variations decrease your risk of developing alcoholism.

For example, if you have the beta-klotho gene, it may be easy for you to control your drinking behaviors. In other words, you can cut yourself off after one or two alcoholic beverages.

People who don't have the beta-klotho gene may find it difficult to have just one or two drinks.

According to the NIAAA, genetic factors account for about 50% of the reason why people develop an AUD.

Psychological Causes

Different psychological factors can contribute to the risk of alcohol use disorder (AUD).

A person’s poor coping skills regarding stress, negative feelings, and boredom can make them vulnerable to alcohol addiction. If they are unable to handle stressors, alcohol can make coping easier for them.

AUD often co-occurs with a mental health disorder (dual diagnosis). Depression, anxiety, bipolar disorder, and schizophrenia are common. People who have received a dual diagnosis often drink alcohol to relieve unpleasant symptoms.

Some people also believe alcohol controls their symptoms better than medications. They also claim to experience no adverse side effects. However, using alcohol as a "crutch" to ease symptoms increases the risk of alcoholism.

Social and Environmental Causes

Many social and environmental factors increase the risk of alcohol addiction. For example, people are often encouraged to drink in social situations, such as on college campuses.

While drinking in college may seem ordinary, it can lead to alcoholism down the road. This is because college students tend to binge drink. This type of drinking can continue even after someone leaves college, potentially leading to an AUD.

Binge drinking is a harmful drinking pattern that makes someone’s blood alcohol concentration (BAC) level rise to 0.08 percent or higher. Men reach this BAC after consuming about five drinks within two hours. Women reach this BAC after consuming about four drinks within two hours.

In addition to these factors, learned behaviors can affect how a person perceives alcohol later in life. Even without a genetic component, you can still develop AUD when raised in a specific type of environment.

Families that encourage drinking increase the risk of alcoholism among family members. Growing up around people with addiction also predisposes someone to develop an AUD.

Other known risk factors for alcohol use disorder include:

  • Drinking more than 15 alcoholic beverages per week (men)
  • Drinking more than 12 alcoholic beverages per week (women)
  • Drinking more than 5 alcoholic beverages per day at least once a week (binge drinking)
  • Receiving a diagnosis for a mental health disorder
  • Having a parent with an alcohol use disorder

Side Effects of Excessive Alcohol Use

Alcoholism puts people at an increased risk for a variety of health problems, including:

  • Liver disease — Hepatic steatosis, alcoholic hepatitis, and cirrhosis are all linked to alcohol use.
  • Digestive problems — Alcohol damages your digestive system and can lead to health problems, including gastritis, ulcers, and pancreatitis.
  • Heart problems — Drinking can raise your blood pressure and lead to heart failure and stroke.
  • Diabetes complications — Alcohol increases your risk of hypoglycemia or low blood sugar.
  • Sexual organ issues — Men may experience erectile dysfunction, while women may experience menstruation issues.
  • Increased risk of cancer — Mouth, throat, liver, esophagus, colon, and breast cancers have all been linked to long-term drinking habits.
The Health Effects of Alcohol

These are only some of the alcohol problems that heavy drinkers may experience. It is important for anyone struggling with alcoholism to seek medical advice to avoid health complications.

Symptoms of Alcohol Use Disorder (AUD)

The symptoms of alcoholism can range from mild to severe (based on how many symptoms you have).

The most common signs of alcohol use disorder include:

  • Not being able to limit or stop alcohol use
  • Drinking more or for longer than intended
  • Unsuccessful attempts to cut down or quit drinking altogether
  • Spending a lot of time obtaining, using, or recovering from alcohol
  • Strong cravings for alcohol throughout the day
  • Failure to fulfill responsibilities at work, school, or home due to alcohol consumption
  • Continuing to drink alcohol even though you know it's causing physical, social, and/or interpersonal problems
  • Giving up hobbies to drink
  • Avoiding social settings that do not serve alcohol
  • Drinking in dangerous or risky situations
  • Developing an alcohol tolerance (which means you have to drink more to feel the desired effects)
  • Withdrawal symptoms appear after you stop drinking (sweating, nausea, shaking, severe anxiety, etc.)

Treatment for Alcohol Use Disorder (AUD)

Common treatment options for AUD include:

Inpatient Treatment

Inpatient treatment is an effective option for alcohol use disorder (AUD). This type of treatment takes place at a licensed residential treatment center. Patients receive 24-hour comprehensive and structured care. They also undergo medical detox, which may include medication-assisted treatment (MAT).

Outpatient Treatment

Outpatient treatment helps people with less severe alcohol use disorders. It works around a person's schedule and does not provide 24-hour care.

If you or a loved one struggles with an alcohol use disorder (AUD), there is help available. Common addiction treatment programs include support groups, alcoholics anonymous (AA), and professional detoxification (inpatient or outpatient treatment). 

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Resources

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“Alcohol Facts and Statistics.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, 6 Dec. 2019, https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics.

Augier, Eric, et al. “A Molecular Mechanism for Choosing Alcohol over an Alternative Reward.” Science, American Association for the Advancement of Science, 22 June 2018, https://science.sciencemag.org/content/360/6395/1321.

Edenberg, Howard J, and Tatiana Foroud. “Genetics and Alcoholism.” Nature Reviews. Gastroenterology & Hepatology, U.S. National Library of Medicine, Aug. 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056340/.

“Genetics of Alcohol Use Disorder.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, 21 Sept. 2018, https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders/genetics-alcohol-use-disorders.

Hussong, A. M., Huang, W., Curran, P. J., Chassin, L., & Zucker, R. A. (2010). Parent alcoholism impacts the severity and timing of children's externalizing symptoms. Journal of abnormal child psychology38(3), 367–380. https://doi.org/10.1007/s10802-009-9374-5

Morozova, Tatiana V., et al. “Genetics and Genomics of Alcohol Sensitivity.” Molecular Genetics and Genomics, vol. 289, no. 3, 2014, pp. 253–269, www.ncbi.nlm.nih.gov/pmc/articles/PMC4037586/, 10.1007/s00438-013-0808-y.

Saad, Marcelo, et al. “Are We Ready for a True Biopsychosocial-Spiritual Model? The Many Meanings of ‘Spiritual.’” Medicines (Basel, Switzerland), MDPI, 31 Oct. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750603/.

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