Learn / Alcohol Addiction and Recovery
Alcoholism can be devastating. And because drinking is both legal and socially acceptable, it can be difficult to recognize when you have a problem. But when you’re ready to seek help, there are many ways to get treatment for alcohol addiction.
This substance use disorder may interfere with your physical and mental health, your work, and your most important relationships. In extreme cases, it can even be fatal. In order to find the right kind of treatment, it’s important to understand the severity of the problem.
“Alcohol use disorder (AUD) is a medical condition1 characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.” While it’s possible to drink in moderation, many people use alcohol unsustainably. Because the overuse of alcohol may begin in response to stress, it can be hard to recognize when the drug itself is exacerbating that stress.
This disorder is extremely common, both in the U.S. and internationally. In fact, “alcohol is the most common drug of abuse in our society and, as a consequence, alcoholism is a devastating socio-economic problem estimated to account for 4% of the global burden of disease.” Because of this, alcohol addiction has been the subject of a great deal of study,2 as experts attempt to distinguish between appropriate and unhealthy alcohol use.
Occasional or purely social drinking does not necessarily constitute a substance use disorder. However, for people who are already vulnerable to addiction—because of trauma, genetics, social circumstances, and similar factors—these seemingly acceptable behaviors can lead to AUD. And any amount of drinking can be dangerous for people who have a history of misusing alcohol.
According to the American Psychological Association, moderate drinking “lies at one end of a range that moves through alcohol abuse to alcohol dependence.”3 And because alcohol use disorders can worsen over time, your behavior may slowly progress through the following patterns, leading up to a time when you need help.
In the U.S., moderate alcohol consumption is defined by the CDC4 and other government agencies as “limiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more.” It’s important to note that the gender differences here are based on scientific research, not social norms.
According to the BBC, “researchers are finding that women’s bodies are affected differently by alcohol than men’s bodies5 – for reasons that go beyond mere size. Scientists have discovered that women produce smaller quantities of an enzyme called alcohol dehydrogenase (ADH), which is released in the liver and breaks down alcohol in the body.”
For people of any gender, 1 to 2 drinks per day may seem like a low number. The difference between American social norms and the CDC’s definition of moderation is illuminating. With this information in mind, it’s not surprising that alcohol abuse is so prevalent.
“Alcohol abuse is a drinking pattern3 that results in significant and recurrent adverse consequences.” People with AUDs may face problems at work, in school, or with family and friends. They may even encounter legal problems caused by drunken behavior, such as DUIs. Because alcohol misuse “is associated with poor decision-making,”6 habitual drinkers often engage in reckless behavior. The results of that behavior can range from inconvenient to violent, and may have long-lasting effects on your life.
It’s never too soon to begin recovery. If you exhibit any of the signs of alcohol use disorder, it’s best to seek treatment immediately. And it’s even better if you can get help before developing a physical dependence on alcohol.
Over time, people who abuse alcohol often develop a dependence on the drug. In this stage, a person has “lost reliable control of their alcohol use.” You may be at this stage even if you occasionally take a day off from drinking. “Alcohol dependence is characterized by tolerance3 (the need to drink more to achieve the same ‘high’) and withdrawal symptoms if drinking is suddenly stopped.”
If you’re physically dependent on alcohol, you should absolutely not attempt to stop drinking on your own. Without proper medical supervision, detox can be extremely dangerous and even fatal. Alcohol withdrawal has “a broad range of symptoms7 from mild tremors to a condition called delirium tremens, which results in seizures and could progress to death if not recognized and treated promptly. The reported mortality rate for patients who experience delirium tremens is anywhere from 1 to 5%.”
Although the prospect of withdrawal may be daunting, continuing to drink heavily is equally dangerous, if not more so. Long-term alcohol abuse can have countless physical effects,8 possibly causing harm to the heart, liver, pancreas, and immune system, and even causing cancer. This behavior can also severely damage your interpersonal relationships.
Research has conclusively demonstrated that “alcoholism has a pervasive detrimental impact on family life.9 Alcoholism contributes to marital and family discord, loss of employment and difficulty sustaining job performance, legal conflicts, verbal and physical abuse, inadequate parenting, and sexual inadequacy.”
Many people with AUDs struggle with unhealthy interpersonal dynamics, and report that the quality of their intimate relationships has suffered. This applies not only to romantic partnerships, but also to more complex dynamics. If just 1 person in a family has an alcohol use disorder,10 the entire family is affected. For example, their spouse, children, or siblings may need to take on additional responsibilities in order to make up for their poor behavior. Social events may also be disrupted, including important milestones like weddings or graduations.
Alcohol abuse can even represent a physical danger to family members. According to the WHO, “Evidence suggests that alcohol use increases the occurrence and severity of domestic violence.” This can quickly lead to a vicious cycle, because intimate partner violence “can lead to alcohol consumption11 as a method of coping or self-medicating.”
Unfortunately, these aren’t the only relationships that may be affected by alcohol abuse.12 “Scientists and nonscientists alike have long recognized a two-way association between alcohol consumption and violent or aggressive behavior.” And that aggression may alienate people close to you, exposing you to triggers without the benefit of social support. It can be extremely difficult to find your way out of this cycle without professional help.
It can be hard for some people to know when to stop drinking, either for the night or for good. And there’s a scientific reason for that. Karen Szumlinski, Professor of Neuroscience at the University of Santa Barbara, recently discovered a mechanism by which the human brain develops a temporary aversion to alcohol, which is activated when you’ve had enough (or too much) to drink.
Specifically, Szumlinski and her team studied a chemical process in a brain structure called the bed nucleus of the stria terminalis (BNST). This process, she says, “serves as a brake to reduce or at least curb your alcohol consumption.13 But if any kink happens in that little bit of signaling there, you lose the brakes. Your brake line has been cut, and now you exhibit uncontrolled drinking behavior.”
If you struggle to regulate your drinking habits, you may need help to realize you have a problem. Many people enter recovery due to the advice of loved ones.
According to experts, receiving social pressure to reduce drinking14 is the main reason that most patients get help. One study found that more than 90% of respondents “received pressure from at least one source,” which may have been a loved one, an employer, or even the legal system.
It’s clear that the majority of people recovering from AUD depend on external voices to provide feedback and set boundaries. You may also decide for yourself that you want to improve your relationships. In the same study, 25% of people cited this desire as a reason to stop drinking.
Although interpersonal dynamics rank highest, some people also seek recovery to improve their own health. Alcohol abuse causes significant physical problems. This is true even for “functional alcoholics,” who may not notice the relationship issues caused by their drinking.
According to the National Institutes of Health, this subtype of people who misuse alcohol15 makes up “19.5% of U.S. alcoholics. Typically middle-aged, well-educated, with stable jobs and families. About one-third have a multigenerational family history of alcoholism, about one-quarter had major depressive illness sometime in their lives, and nearly 50% were smokers.”
Although these patients may not exhibit visible or dramatic signs of an alcohol use disorder, they may experience dangerous physical symptoms that worsen over time. Perhaps for this reason, 15% of those in recovery have cited a desire to improve their health as a reason to stop drinking.14
When you’re ready to get help for alcohol abuse, there are numerous available treatments. You can choose between these options based on the severity of your addiction, and whether you’re physically dependent on alcohol. And as you progress through the stages of recovery, you’ll likely benefit from different forms of therapy.
Medically supervised detox normally lasts for a matter of days. During this time, you’ll be closely monitored by a medical team, who may prescribe non-addictive medications to alleviate the physical symptoms of withdrawal. If you’re physically dependent on alcohol (or any other substance), detox can be uncomfortable or even dangerous. For that reason, it’s extremely important to undergo detox with proper medical care.
If you think you’d benefit from this type of care, you can learn about your options by reviewing our directory of medical detox centers here.
Either before or during your stay at a detox facility, you’ll work with a team to figure out what comes next. Physical healing is just the first step; focusing on mental health will help you avoid relapse and begin moving forward. If your addiction is severe enough to require inpatient detox, it’s absolutely vital that you also make a plan for longer-term recovery.
Inpatient rehab for alcohol misuse usually lasts for at least a few weeks, although some programs may allow you to stay longer. During your time in residence, you will probably engage in some combination of one-on-one talk therapy, group sessions, recreational therapy, experiential therapy, and other modalities. You may also work with a medical team to improve your physical health.
Remember that inpatient rehab is just one step in the long process of recovery. No matter how effective the program is, it’s unlikely that you’ll be completely “fixed” by the time you leave. Fortunately, most rehab providers are well-equipped to help you plan for life after rehab.
Intensive outpatient programs (IOPs) provide addiction treatment while you live at home or in another facility. These programs can be appropriate for patients whose insurance won’t cover residential rehab.
In an IOP, you’ll likely attend daily therapy sessions, including individual counseling and support groups. Some programs let patients go to work or school at the same time. Others have a rigorous schedule, requiring you to attend therapy the way you might attend a job.
While these programs provide sufficient treatment for many patients, they don’t offer the same protected environment that you’d find in an inpatient rehab. This can leave you vulnerable to external triggers, including unstable relationships. However, people with strong community support may benefit from staying close to home during recovery.
After initial treatment, such as detox or inpatient rehab, some patients move into sober living environments. Here, you’ll share a living space with a cohort of people who are also in recovery. This allows residents to both receive and provide support, practicing interpersonal skills.
Some sober living environments enforce a strict set of rules, such as a curfew or a minimum number of weekly support groups. You may also be required to attend individual therapy during your stay.
Alternatively, you may choose to live in a therapeutic community. These environments also have certain rules, and usually maintain a zero-tolerance policy regarding substance use. However, they use a more collaborative framework than some other facilities, giving residents greater responsibility and more say in how the house is run. These groups believe in the power of mutual support, and members rely on each other for mutual support throughout recovery.
You may be required to attend inpatient rehab before moving into a sober living environment. Every one of these programs has its own guidelines about each person’s length of stay. Some residents think of this time as a transitional period, spending only a few weeks on-site between receiving treatment and returning home. Other patients join these communities for the long term.
Support groups can be helpful at any stage of recovery. During inpatient rehab, most patients will attend some form of regular group meeting, whether it’s a peer-led program or a more structured therapy session. Alcoholics Anonymous (A.A.) is one well-known support group specifically designed to help AUD patients.
12-Step programs like A.A. are faith-based support groups. Members of A.A. are encouraged to “cultivate spirituality16 and related practices as a new way of living.” Data has shown that this is an extremely effective way to approach recovery from alcohol abuse.
If faith-based recovery isn’t a good fit for you, there are a number of other support groups available, like SMART Recovery.17 During SMART Recovery meetings, “participants find and develop the power within themselves to change and lead fulfilling and balanced lives.” Rather than following 12 predefined steps, each person creates their own personal plan for sustainable healing, and receives mutual emotional support from other members.
No matter which philosophy resonates with you, support groups can be helpful at every stage of recovery. Because most groups are free of charge, they are extremely accessible to people from all walks of life. And you can attend sessions as often as you need to; in many cities, it’s possible to find a different session for every day of the week.
This can help you meet new people in a healthy context. You’ll be able to join a community and learn valuable interpersonal skills. And by sharing this mutual support, you may gain insight into how to heal your relationships with people outside the group.
When you love someone with an AUD, it can be hard to know what to do. Before they get help, you may be called on to handle emergency situations, ranging from the inconvenient to the dangerous. And if the person is a close enough family member, you may feel obligated to help, no matter what it costs you.
There are a number of ways to help your loved one get into treatment. In extreme cases, you may even consider sending them to rehab involuntarily.18 However, it’s important to remember that your needs matter, too. Whether or not they get help, you may need to heal from your own experiences of their addiction.
Some residential rehabs offer family programs, which may take place on-site or remotely. Depending on the specific facility, you might be able to participate in family therapy with a loved one in treatment, or you might even attend a group that’s only open to people outside the program. Either of these options may help you get the professional support you need, from a provider who understands the impact addiction can have on loved ones.
If your loved one doesn’t attend treatment, or if their rehab doesn’t have a family program, you might consider going to a free Al-Anon19 meeting. This 12-Step group is specifically designed for friends and family members of people with substance use disorders, including alcoholism.
Your personal healing process is different from that of healing your relationship. First, take some time to get support, center yourself, and learn how to meet your own needs. After that, you can start thinking about whether you want to work through things with your loved one.
Like any other type of recovery, this can be a complex and alinear process. Be patient with yourself—and with your loved one, if you decide to maintain the relationship. It’s okay to go slowly.
After you get treatment for alcohol abuse, life may look very different. Because alcohol is legal and widely available, it can be especially hard for people with AUDs to avoid triggering situations. Over time, though, you can learn when it’s appropriate to challenge yourself, and when you need to set firm boundaries. For example, you may be able to sit in a friend’s kitchen while they drink a glass of wine, even if you never feel comfortable going to a bar. There is no right or wrong way to proceed here; just the right or wrong way for you.
As you approach treatment and recovery, remember that it’s still possible to enjoy life. There are countless ways to have fun without drinking. Living healthily doesn’t just mean being sober; it also means learning how to enjoy yourself in a sustainable way.
If you or a loved one struggles with alcohol abuse, you can learn more about our rehab programs for alcohol addiction here.
Reviewed by Rajnandini Rathod
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