Alcohol Use Disorder

Updated: Aug 19, 2020

Contributors: Antoine Douaihy & Dennis C. Daley

Edited by: Amy Wenzel

Book Title: The SAGE Encyclopedia of Abnormal and Clinical Psychology

Chapter Title: "Alcohol Use Disorder"

Pub. Date: 2017

Access Date: April 13, 2017

Publishing Company: SAGE Publications, Inc.

City: Thousand Oaks,

Print ISBN: 9781483365831

Online ISBN: 9781483365817

DOI: http://dx.doi.org/10.4135/9781483365817.n39

Print pages: 96-99

The SAGE Encyclopedia of Abnormal and Clinical Psychology

Alcohol Use Disorder

Alcohol use disorder (AUD) refers to a cluster of cognitive, behavioral, and physiological

symptoms associated with the loss of or impaired control of alcohol consumption, impairment

resulting from drinking, risky use of alcohol (e.g., while driving a vehicle or operating

machinery), and physiological dependence (referred to as alcoholism or alcohol addiction).

Alcohol use is common among various age groups in the United States; alcohol is used to

socialize, relax, and celebrate, among other reasons. However, problematic alcohol use can

result in various medical, psychological, social, spiritual, and financial problems for the

individual, family, and society. This entry first presents information on alcohol consumption

and its consequences. Then, the entry examines various factors of alcohol-related disorders.

The entry concludes with a discussion of treatment and relapse.

Alcohol Consumption and Its Consequences

A standard alcoholic drink has about 14 grams of ethanol, which is found in a 12-oz. bottle or

can of beer, one wine cooler, a 5-oz. glass of wine, or a standard 1.5-oz. shot of 80-proof

spirits, such as gin, vodka, or whiskey. According to the National Institute on Alcohol Abuse

and Alcoholism (NIAAA), moderate alcohol consumption—up to one drink per day for women

and two for men—may decrease the risk for heart disease, stroke, and diabetes for some

individuals. However, individuals under the age of 21 years and pregnant women are advised

to abstain from drinking alcohol.

Individuals whose alcohol consumption exceeds these limits are at risk for harmful

consequences. NIAAA reports that excessive drinking can lead to motor impairment,

confusion, memory problems, and concentration problems, and contribute to AUD and

alcohol dependence. Drinking excessively can also lead to vehicle and other accidents,

violence, suicide, or homicide. For instance, about 60% to 70% of reported domestic violence

incidents involve alcohol use. Half of all violent crime is alcohol or drug related (victims and

perpetrators). Even mild to moderate alcohol problems can cause harm to individuals,

families, and communities.

NIAAA reports and other surveys and studies reveal the following:

Nearly two thirds of 12th graders, one half of 10th graders, and more than one fourth of 8th graders have consumed alcohol during their lifetime; during the past month, 37.4% of 12th graders, 23.5% of 10th graders, and 9% of 8th graders have drunk alcohol.
College students drink more often, including binge drinking (five or more drinks per occasion) or heavy drinking (five or more drinks five or more times per month), than same-age peers not in college.
Nearly 700,000 college students are assaulted and nearly 100,000 are sexually assaulted or raped each year by other students who have been drinking.
Nearly 1 in 5 college students meet the criteria for an AUD, and 1 in 4 report academic consequences from drinking.

Alcohol-related problems are the third leading cause of preventable deaths in the United

States; only smoking and obesity account for more deaths. Each year in the United States,

more than 88,000 deaths are attributed to alcohol, at a cost of hundreds of billions of dollars.

Globally, alcohol problems represent the fifth leading risk factor for premature death and

disability and the first leading factor among people between 15 and 49 years of age. Alcohol

contributes to more than 200 medical diseases and injuries, and in 2012, it accounted for 3.3

million deaths, almost 6% of all deaths in the world.

Alcohol affects every organ system in the body. It affects several neurotransmitter systems in

the brain, including the opioidergic, gamma-aminobutyric acid, glutamate, serotonin, and

dopamine systems. Increased opiate levels help explain the euphoric effect of alcohol,

whereas its effects on the gamma-aminobutyric acid system cause anxiolytic (antianxiety)

effects. Long-term excessive use of alcohol increases the risk for heart disease, elevated

blood pressure, and stroke. Heavy and prolonged drinking causes neurological and mental

health problems related to brain and peripheral nervous system damage. Chronic alcohol use

is associated with deficits in problem-solving skills, problems in remembering and retrieving

information, and personality changes. Chronic alcohol abuse can lead to gastritis and

pancreatitis and to severe damage to the liver, including cirrhosis of the liver, which occurs in

10% to 20% of all individuals who are severely addicted to alcohol.

Persons who have a severe addiction to alcohol are prone to alcohol withdrawal syndrome,

which is characterized by anxiety, tremulousness, elevated pulse and blood pressure, and

possible seizures and confusion, which could lead to death if untreated. Dementia, suicide,

and homicide are serious consequences of severe alcohol addiction. Alcohol is also

responsible for a number of other conditions, such as mouth and oropharyngeal cancers,

esophageal cancer, liver cancer, and breast cancer.

Moreover, prenatal exposure to alcohol can result in fetal alcohol syndrome, which involves

mental and growth impairments, birth defects of the face and limbs, and behavioral problems

including attention-deficit/hyperactivity disorder.

Alcohol-Related Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),

there are five categories of alcohol-related disorders: (1) alcohol use disorder, (2) alcohol

intoxication, (3) alcohol withdrawal, (4) other alcohol-induced disorders, (5) and unspecified

alcohol-related disorder.

Prevalence

Approximately 7.2% of (or 17 million) adults in the United States aged 18 and older had an

AUD in 2012. This includes 11.2 million men and 5.7 million women. In 2012, an estimated

855,000 adolescents of ages 12 to 17 years had an AUD.

AUD is more prevalent among men, Whites, Native Americans, younger and unmarried adults,

and those with lower incomes. The prevalence of AUD declines with increasing age. The

prevalence in elderly populations is approximately 3%.

Screening

The U.S. Preventive Services Task Force and NIAAA recommend that clinicians screen all

adult clients 18 years of age or older for alcohol use. The following screening tools can be

used:

The abbreviated three-question Alcohol Use Disorders Identification Test Consumption, which detects at-risk drinking and alcohol problems.
Single-question: “How many times in the past year have you had five (four for women) or more drinks in a day (more than the daily recommended NIAAA drinking limits)?”
The CAGE (need to Cut down on drinking, Annoyance, feel Guilty about drinking, and need for Eye-opener), which is a short screening test for alcohol problems.

When a client is identified as engaging in at-risk alcohol use, clinicians are advised to perform

a full assessment, including analysis of consumption pattern; review of whether drinking

pattern meets the criteria for AUD; evaluation for signs of physiological and behavioral

dependence, cognitive impairment, and medical harm; and identification of motivation for

change. Then, the clinician should engage the client in a discussion about hazardous

drinking and provide the client with a brief motivational intervention to reduce the client’s

alcohol misuse.

Diagnosis

AUD is diagnosed when a person shows a problematic pattern of drinking leading to

significant impairment or distress. Typically, this pattern includes a strong desire to take

alcohol, difficulties in controlling its use, persisting in use despite harmful consequences,

giving a higher priority to alcohol use than to other activities and obligations, increased

tolerance, and a physical withdrawal state. In the DSM-5, AUD has specifiers for severity:

mild, moderate, and severe. There are 11 possible symptoms (behavioral and physical) of the

“use disorder,” of which two are necessary to achieve a severity specifier of mild, four for

moderate, and six for severe.

Comorbidities

Many individuals with AUD also have other substance-related or mental health disorders,

such as antisocial or borderline personality, bipolar, schizophrenia spectrum, depressive,

anxiety, or attention-deficit/hyperactivity disorder. Having an AUD increases the risk of a

mental health disorder and can affect the individual’s response to treatment. Similarly, having

a mental health disorder raises the risk of having AUD and can affect response to treatment

and recovery. Symptoms of either disorder can contribute to a relapse of the other disorder.

The recommended treatment approach for co-occurring mental health and substance use

disorders such as AUD is integrated treatment when possible by the same provider or

treatment team. For maximum benefit, treatment needs to focus on both types of disorders.

Treatment

There are many evidence-based behavioral, pharmacological, and combined treatments for

AUD, which can be offered in medical and clinical inpatient, residential, or ambulatory

settings. Treatment aims to help the individual stop (or reduce) alcohol use and manage the

challenges of recovery, such as cravings, negative thinking, social pressures to drink, and

interpersonal conflict or upsetting emotional states.

Motivational interviewing helps clients strengthen their motivation and commitment to change

their alcohol use. Motivational interviewing addresses ambivalence about change and elicits

specific goals and reasons for change in an atmosphere of acceptance and empathy.

Contingency management uses positive incentives to reward clients who abstain from alcohol

(or other drugs) or adhere to treatment sessions. Cognitive behavioral therapy helps clients

learn coping skills to maintain abstinence by identifying triggers to drink. Clients also learn

problem-solving and behavioral skills to cope with high-risk situations and feelings that

increase the risk of relapse. This treatment also helps clients counteract self-defeating cognitions such as “I need a drink to feel relaxed” or “I need to drink if I want to fit in with my

peers.”

Twelve-step facilitation therapy facilitates clients’ participation in Alcoholics Anonymous (AA).

Sessions focus on acceptance of alcoholism as a disease, surrender to a higher power,

acceptance of the fellowship and recovery program promoted by AA, and active involvement

in twelve-step meetings, sponsorship, and other AA program activities. Mutual support

programs (MSPs) such as AA help individuals manage AUD in the long term by participating

in a fellowship with others in recovery who share experiences, hope, and strength. AA is the

most common MSP for AUD. Those who are active in AA (attend meetings, have a sponsor,

work the Twelve Steps, and use the “tools” of the program) are more likely to remain abstinent than those who only attend meetings. Other MSPs include Alcoholics for Christ and

Alcoholics Victorious (Christian fellowships), LifeRing Secular Recovery (for all types of

addiction and people of all faiths), Men for Sobriety and Women for Sobriety (programs that

focus on emotional and spiritual growth), Rational Recovery and SMART Recovery (for all

types of addiction), and Secular Organizations for Sobriety (a secular approach offered as an

alternative to AA and other twelve-step recovery programs). MSPs promote recovery as a

process that involves physical, cognitive, emotional, social, and spiritual change.

Marital and family approaches are used with adults and adolescents. These focus on helping

the family member with the AUD engage in treatment, attend treatment sessions, complete

treatment, stop or reduce alcohol use (e.g., less frequent and less severe relapses), and

improve functioning (e.g., work, school, family, community). These approaches may also

improve family interaction and communication, engage the family in treatment, and reduce the

burden experienced by family members of a person with AUD. Family approaches are highly

recommended for treatment of adolescents with AUD.

Because family systems and individual members are affected in many ways by a loved one’s

AUD, participation in treatment and/or MSPs for families can help family members learn more

effective coping strategies. Al-Anon is available for any family member or concerned other

affected by a loved one’s alcohol problem. It offers a twelve-step program to help family

members learn about alcohol problems, deal with their loved one with AUD, and address their

own behaviors, reactions, feelings, and recovery needs. Al-Anon uses similar tools as AA

(meetings, sponsorship, twelve-step readings). Adult Children of Alcoholics is a program for

any individual who grew up in an alcoholic family. This program also uses tools similar to

those of AA or Al-Anon. Ala-teen is an MSP for adolescents affected by a parent or other

family member’s AUD.

Medications approved by the U.S. Food and Drug Administration to treat alcohol dependence

include disulfiram, oral naltrexone, extended-release naltrexone, and acamprosate.

Medications such as topiramate, which is approved for other conditions such as migraine

headaches and epilepsy, show promise for alcoholism. Positive outcomes (e.g., less drinking,

shorter relapses, and decrease in alcohol cravings) are found when these medications are

combined with behavioral treatment. Referring clients for a medication evaluation and

monitoring adherence are ways by which nonmedical clinicians can help individuals with AUD.

Relapse and Relapse Prevention

Many intrapersonal (e.g., emotions, thoughts, cravings) and interpersonal (e.g., social

pressures to drink, conflict with others) factors may contribute to relapse. However, not using

active coping skills ultimately determines if a relapse occurs. Incorporating interventions from relapse prevention therapy can help clients (a) identify and manage early warning signs of relapse, (b) identify and manage high-risk relapse factors, (c) intervene early in a lapse or

relapse to limit the damage, and (d) make lifestyle changes to achieve a better balance. If a

client has a lapse or relapse, the focus is on learning from it to develop coping strategies for

use in the future.

Cultural Factors; Alcohol Use Disorder: Diagnosis; Alcohol Use Disorder: Epidemiology;

Alcohol Use Disorder: Gender and Sex Differences; Alcohol Use Disorder: Lifespan

Perspectives; Alcohol Use Disorder: Psychological Factors; Alcohol Use Disorder: Risk for;

Alcohol Use Disorder: Social Factors; Alcohol Use Disorder: Treatment; Alcohol Use

Screening Measures; Alcohol Withdrawal; Alcoholics Anonymous

Antoine Douaihy Dennis C. Daley

http://dx.doi.org/10.4135/9781483365817.n39

10.4135/9781483365817.n39