Understanding AUD (Alcohol Use Disorder)

When I was 19 years old, I fell in love with an alcoholic. Of course, I didn’t know it at the time. It’s not like he handed me a card or introduced himself as one. He was neither sloppy nor unintelligible. On the contrary, he was exciting, artistic, funny, philosophical, and evidently knew how to have a good time. For his alcohol tolerance was as vast as he was charming.

The first night we met, he regaled me with Seinfeld quotes; he spoke of minimalism, existentialism and a determined drive to succeed. He hypnotized me with his quick wit, insight and perspective. And he did it all while drinking. All evening, he never took a break from it, and I thought nothing of it. After all, so much of our entertainment revolves around drinking. Historically, it is what we do to have fun, relax, commiserate or bond.

That night was the first of many we would share. Nearly five years were filled with both unbridled happiness and unmitigated pain. The nights I spent listening to him play guitar under a moonlit night, were rivaled with days spent calling friends and hospitals in search of him. He only knew how to live two ways: Either on the wagon – which was always short lived – or so far removed from it. There was never an in between. Perhaps, the only medium was me, trying to reel him in toward balance, hoping that my love would be reason enough for him to change. I was wrong.

There was so much I didn’t realize then; so much I didn’t know.

But since then, here’s what I’ve learned:

Alcoholism is a Disease

This was sometimes difficult to grasp. A disease, really? It sure, didn’t look like a disease or have the same characteristics as one. After all, every time my ex opened another bottle of beer, it was a choice not a biological compulsion. Right?

According to the National Council on Alcoholism and Drug Dependence, alcoholism is described as a mental obsession that causes a physical compulsion to drink. Like a song on repeat that you cannot get out of your head, so is that unrelenting and tenacious urge to drink.

And when the problem becomes so severe – when an individual drinks too much over a long period of time – they experience longer-term effects, which includes Alcohol Use Disorder (AUD).

Described as a chronic relapsing brain disorder, AUD is characterized by an inability to stop or control alcohol use despite adverse consequences. AUD causes changes in the brain, hijacking regions involved with pleasure, learning, stress, decision making, and self-control.

Because when we drink, surges of dopamine are released into our brain’s basal ganglia, an area responsible for controlling rewards.

It’s that same pleasurable sensation we experience after eating, exercising or having sex. So it only makes sense that alcohol consumption is so appealing.

But with every peak there is a valley, and with continued alcohol use, there most certainly is a dark valley. I experienced that with my ex. While our nights would start out as fun, they would inevitably take a turn for the worst. He required more alcohol because as it turns out, the nerve cells in his basal ganglia became tolerant to alcohol’s effects, reducing its ability to produce the same “high” that it once did. Therefore, he would consume more and consume more frequently, thus creating a vicious cycle of use.

The Cycle of Addiction

Research has found that drinking can disrupt the balance between the basal ganglia and the amygdala, the region of the brain that avoids pain and unpleasant experiences.

So alcoholics not only have to drink more to reach that original high, they can’t stop drinking because the pain of doing so is so severe. Normally, a healthy person can control their impulse to drink. Their judgment and decision making circuits are still relatively intact. But a person with AUD, has a very powerful impulse to drink, even though they’re aware that stopping is in their best interest. I remember my ex’s stints of sobriety caused painful withdrawals and bouts of depression, so much so that it always motivated him to drink again.

Diagnosis and Symptoms of AUD

AUD is diagnosed when a person exhibits two or more symptoms from a list of criteria that is identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) distributed by the American Psychiatric Association (APA). A person diagnosed as having AUD, will classify as either mild (2-3 symptoms), moderate (4-5 symptoms), and severe (6 or more symptoms).

According to an article published by a Very Well Mind, The DSM-5 lists 11 symptoms that are used to determine AUD. They are as follows:

1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or b) A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Alcohol’s Effects on the Body

Whether consumed too much or occasionally, alcohol can take a serious toll on your health.

According to NIH’s website, here’s how:

Brain: Alcohol interferes with the brain’s communication pathways, and thus changes its physical structure and how it functions. These disruptions can change mood and behavior, and make it harder to think clearly and move with coordination.

Heart: Whether you drink you binge drink or drink excessively over a long period of time, it can damage your heart, causing problems including:

• Cardiomyopathy – Stretching and drooping of heart muscle
• Arrhythmias – Irregular heart beat
• Stroke
• High blood pressure

Liver: Heavy drinking takes a toll on the liver, leading to a slew of problems such as:

• Steatosis, or fatty liver
• Alcoholic hepatitis
• Fibrosis
• Cirrhosis

Pancreas: Alcohol can eventually lead to pancreatitis, a dangerous inflammation and swelling of the blood vessels in the pancreas that prevents proper digestion.

Cancer: Research studies reveal there’s a connection between alcohol drinking and several types of cancer. Evidence shows that the more alcohol a person drinks— especially a person that drinks regularly over time—the higher his or her risk of developing an alcohol-associated cancer. In 2009, data showed an estimated 3.5 percent of all cancer deaths in the United States (about 19,500 deaths) were alcohol related. For more information, visit Cancer.gov.

Treatment for Alcohol Use Disorder

A big part of Alcohol Use Disorder recovery is working with a trained professional to better understand the relationship with alcohol and to learn how to cope with triggers. Examples of therapies include:

• Cognitive behavioral therapy: Teaches how to recognize and avoid situations in which you are most likely to drink and to cope with other problems and behaviors that may lead to alcohol misuse.
• Motivational enhancement therapy: Helps build confidence and motivation to stop drinking.
• Family therapy: Help families become aware of their own needs and prevents substance misuse from moving from one generation to another.
• Brief interventions: Gets the person to reduce their level of drinking or change their harmful pattern of drinking.

Medications

Combined with behavioral treatment and support, medication can help reduce cravings, maintain abstinence and assist with withdrawals symptoms. Currently, there are three FDA-approved medications approved:

• Naltrexone (Revia, Depade, Vivitrol): reduces the craving for alcohol
• Acamprosate (Campral): reduces post-acute withdrawal symptoms during the early stages of alcohol abstinence
• Disulfiram (Antabuse): causes unpleasant symptoms such as flushing, nausea, vomiting, and headache when you drink alcohol

Alcohol Use Disorder Facts

• An estimated 15 million people in the United States have Alcohol Use Disorder.
• In 2018, approximately 5.8 percent or 14.4 million adults in the United States ages 18 and older had AUD, including 9.2 million men and 5.3 million women.
• Adolescents can also be diagnosed with AUD. In fact, in 2018, an estimated 401,000 adolescents ages 12–17 had AUD.

Like any other disease, I couldn’t will or love the illness away. I couldn’t force sobriety on my ex. And I couldn’t convince him to seek help. But I did learn about the disease, I offered support and provided him with as much information he was willing to absorb. Because I realized that he wasn’t the only one that needed help, I did, too. And gaining a level of understanding was the first step.