Alcohol abuse is a pattern of frequently drinking alcohol to excess. It may include drinking in an unsafe manner, finding it difficult to limit the amount of alcohol consumed, or binge drinking. This pattern of drinking often causes problems in multiple areas of the drinker’s life. For pregnant women or those under the age of 21, any use of alcohol may be classified as alcohol abuse.

Alcohol abuse can exact a high cost. Adverse consequences of alcohol abuse commonly include damaged relationships, lost jobs or school expulsion, auto accidents, legal issues, and health problems. While physical or mental damage can occur with the first bout of excessive drinking, typically it’s long-term drinking that causes the most serious, possibly permanent, effects.

Even short-term alcohol abuse can affect the parts of the brain that control mood, behavior, motor function, and memory. Alcohol poisoning or long-term alcohol abuse can cause brain, liver, and heart damage, along with an increased risk of serious diseases like cancer. Alcohol abuse can lead to alcohol addiction.

What is binge drinking?

Binge drinking can be deadly. It doesn’t happen only with people who regularly use alcohol. It can happen with adolescents, teens, and occasional drinkers, as well as those who drink frequently. Binge drinkers consume an excessive amount of alcohol in a short time, bringing their blood alcohol concentration to 0.08 or higher.

It takes about 5 standard drinks for men and 4 standard drinks for women for the BAC to reach that level. A standard drink is defined as 1.5 oz. of 80 proof liquor, 5 oz. of 12% alcohol wine, 8-9 oz. of 7% alcohol malt liquor, or 12 oz. of 5% alcohol beer.

Once the BAC reaches 0.08 the liver can’t process the alcohol fast enough to rid the body of toxicity. The unprocessed alcohol floods the body, continuing to raise the BAC. This increases the risk of alcohol poisoning, which is a medical emergency. Alcohol poisoning can have a dangerous effect on breathing, gag reflex, heart rate, blood pressure, and body temperature. The result can be heart failure, choking to death, coma, or death. According to the Centers for Disease Control and Prevention (CDC), 6 Americans die every day from alcohol poisoning.

According to the National Institute of Alcohol Abuse and Alcoholism, most binge drinkers are not alcohol dependent. The Institute also states that, “most people younger than 21 who drink alcohol report binge drinking, often consuming large amounts.”

Binge drinking is risky drinking and can have life threatening consequences. Even a single bout of binge drinking can disrupt brain function to cause depression, memory loss, or seizures. Binge drinking increases the danger of the following:

  • Auto accidents
  • Unsafe sex
  • Violent behavior, including suicide
  • Falls, burns, drowning
  • Alcohol dependence
  • Alcohol poisoning

Alcohol Use Disorder.

The U.S. National Library of Medicine defines alcohol use disorder as a medical condition, “in which you drink alcohol compulsively; can’t control how much you drink; and feel anxious, irritable, and/or stressed when you are not drinking.” Alcohol use disorder includes alcohol abuse, alcoholism, and alcohol dependence.

The latest version of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) was published in 2013. This American Psychiatric Association’s manual lists the diagnostic features of all recognized mental illnesses, including alcoholism. One major change in this edition is the combining of alcohol abuse, alcoholism, and alcohol dependence into one category, entitled Alcohol Use Disorders.

Alcohol use disorders are ranked from mild to severe, but all include drinking that is at a level where harm or distress are a factor. Alcohol abuse would fall under the mild to moderate end of the spectrum but is still classified as an alcohol use disorder. Those abusing, but not yet addicted to alcohol have difficulty controlling their drinking but do not yet have the physical craving of someone at a higher level of alcohol use disorder.

Signs and risks of alcohol use disorder.

Anyone who drinks alcohol may have one or more of the following signs. Depending on the number of signs a drinker has, he or she may fall into the mild, moderate, or severe category of alcohol use disorder. Alcohol abuse may fall at the mild level, where physical dependence has not yet taken hold.

  • Drinking to relax, relieve stress, or to medicate negative emotions.
  • Unsuccessful attempts to limit or stop drinking.
  • Binge drinking. Risk of alcohol poisoning.
  • Having a blackout or loss of memory after excessive drinking.
  • Drinking causes noticeable personality change.
  • Driving drunk. Causing injury or death to self or others and/or arrest.
  • Unsafe sexual behavior. Risk of STD, sexual assault, unplanned pregnancy.
  • Participating in or initiating physical violence. Anti-social behavior such as assault, domestic violence, homicide.
  • Pattern of irresponsibility including impaired reasoning and poor judgment.
  • Missing work or under-performing. Employment termination, financial problems.
  • Missing school. Suspension or expulsion.
  • Problems with personal relationships; family, friends, co-workers, yet continuing to drink.
  • Signs of irritability, insomnia, anxiety, depression, chronic fatigue.
  • Denying there is an alcohol problem, lying about the amount they drink, hiding drinking.

Levels of alcohol abuse disorder.

The DSM-5 lists specific criteria to consider when diagnosing the level of alcohol use disorder. These are the number of symptoms or behaviors that have occurred within the past 12 months. Individuals with 2-3 symptoms fall into mild category; those with 4-5 symptoms fall into the moderate category, and those with 6 or more symptoms fall into the severe category. Under the previous edition, DSM-IV, those with any 1 symptom were diagnosed with alcohol abuse.

Where does alcohol abuse fall under alcohol use disorder?

Those who abuse alcohol may have few of the above signs and risk factors, yet still, exhibit unhealthy drinking behaviors despite negative consequences. While they may not yet have developed a physical need for alcohol, alcohol is still causing problems in their lives. They may even feel shaky, anxious, or irritable after a certain amount of time without a drink.

What is the most severe form of alcohol use disorder?

Those who exhibit 6 or more symptoms as outlined by the DSM-5 fall into the most severe category of alcohol use disorder. These individuals have become physically and mentally dependent on alcohol to get through their day. They may not be able to function without alcohol and are unable to stop drinking without experiencing severe withdrawal symptoms.

How do you know if you have an alcohol problem?

The first question to ask yourself is whether drinking alcohol has caused any problems in your life. If the answer is yes, then it’s time to take a hard look at your drinking habits. Ask yourself the following questions and be completely honest with your answers.

  1. Do you drink to relax or manage stress?
  2. Have you ever operated a car, boat, motorcycle or other vehicle while intoxicated?
  3. Have you missed work or school because of a hangover?
  4. Have you ever been unable to remember what happened while drinking?
  5. Do you plan activities to include drinking?
  6. Do you find it difficult to stop once you start drinking?
  7. Do you have a problem sleeping, or have bad dreams?
  8. Do you hide how much you drink from others?

If you think alcohol is causing you problems, don’t hesitate to get help. No matter how mild or severe you believe your alcohol problem may be, there is help available.

You’ve identified an alcohol problem, what now?

It’s important to start by having a heart to heart talk with your doctor. He or she knows your medical history, including any existing conditions or medications that might affect treatment. You and your doctor can work together to determine the best treatment options.

What are the treatments for alcohol use disorder?

Those at the mild end of the alcohol use disorder spectrum may find a support group like Alcoholics Anonymous (AA) to be the right approach for them. AA is a faith-based 12-step program. It is for anyone who has identified that he or she has a drinking problem and wants to do something about it. You can start by attending either an open or a closed meeting. Open meetings are open to the public and usually feature a speaker who tells his or her story. To protect anonymity closed meetings are for members only. If you believe you have an alcohol problem, you are welcome to attend either type of meeting.

AA alone may not be enough for those with alcohol use disorder. For many, a combination of treatments, and possibly medications, may be best. Many inpatient or outpatient therapies are available, which typically offer individual and group counseling, some form of 12-step program, and other support therapies. Common therapeutic approaches include Cognitive Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET).

  • CBT is a short-term therapy designed to help you identify what triggers your drinking. Therapists work with you to develop coping skills, and ways to change behaviors by changing thought patterns.
  • MET is another short-term therapy to help you strengthen your motivation to change your drinking behavior by changing existing thoughts and behaviors. MET usually takes place over 4 sessions.

Those who have developed a physical dependence on alcohol may need to go through detoxification before undergoing therapy. It is best to be medically supervised during detox. Medical professionals will not only keep you safe, but they can also prescribe medications to help manage withdrawal symptoms.

Each person is unique and needs to find the treatment plan that’s best suited to their individual situation and goals. Your doctor or addiction specialist can help you find what will work best for your long-term recovery.

Medically Reviewed and Fact Checked By Dr. Thomaso Skorupski, D.O.

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