Understanding Alcoholism and the Signs of Severe Drinking Problems

What Is the Official Definition of Alcoholism?

In 1990, the American Society of Addiction Medicine defined alcoholism as "a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal." The ASAM characterized it by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking.

Alcoholism is a term that is sometimes used to describe what is known as an alcohol use disorder (AUD). The term alcohol use disorder is preferred today since the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) combined the two former categorizations of alcohol abuse and alcohol dependence into a single diagnosis of alcohol use disorder. 

Alcohol use disorder is considered a progressive disease, meaning that the effects of drinking alcohol become increasingly more severe over time. Those who use alcohol may begin to show early signs of a problem. Taking an alcoholism screening quiz can help you determine whether you have the symptoms of an alcohol use disorder.

What Does Alcoholism Look Like?

Today, we know that the symptoms of alcoholism can vary from one person to the next. Because the condition is progressive, these symptoms may increase over time in terms of the number of symptoms, their severity, and their impact.

Early Symptoms

Early signs of alcoholism can include:

• An established pattern of heavy drinking
• Drinking in dangerous situations, such as when driving
• Frequent intoxication
• Planning activities around alcohol consumption
• Thinking about alcohol more frequently

Other early signs of alcoholism include blackout drinking or a drastic change in demeanor while drinking, such as consistently becoming angry or violent.

Progressive Symptoms

Progressive symptoms of alcohol abuse occur when you continue to drink after your drinking reaches a level that causes recurrent problems. These symptoms can include:

• Consuming more alcohol than planned
• Denying the existence of a drinking problem
• Drinking first thing after waking
• Experiencing mood swings and personality changes
• Experiencing symptoms of alcohol withdrawal

Physical Signs of Alcoholism

Alcohol use can have physical effects. Some of the physical signs that can develop include:

• Broken capillaries on your face and nose
• Dry skin and brittle hair and nails from the dehydrating effects of alcohol, which can result in an increased appearance of aging and wrinkles
• Poor hygiene
• The frequent smell of alcohol on the breath, which can continue for hours after heavy drinking
• Weight loss due to the neglect of eating in favor of drinking
• Yellow eyes and skin due to liver damage

What's Technically Considered Alcoholism?

The DSM-5 lists 11 symptoms of alcohol use disorder. In order to be diagnosed with AUD, a person must experience any two of these symptoms within the same 12-month period.

1. You often drink alcohol in larger amounts or over a longer period than you intend.
2. You want to cut down or control your alcohol use but your efforts may be unsuccessful.
3. You spend a lot of time getting alcohol, using it, and recovering from the effects of your drinking.
4. You have alcohol cravings.
5. Your use of alcohol results in failing to meet your obligations at work, school, or home.
6. You continue to use alcohol despite it leading to recurrent problems socially or in your relationships.
7. You give up or reduce your participation in important social, occupational, or recreational activities because of your use of alcohol.
8. You use alcohol in situations in which it is physically hazardous (such as driving, operating machinery, or performing surgery).
9. You continue to use alcohol even knowing that you have a physical or psychological problem that is caused by or made worse by alcohol.
10. You experience alcohol tolerance, either by needing more alcohol to get intoxicated or feeling diminished effects when drinking the same amount of alcohol.
11. You experience withdrawal syndrome or you use alcohol or other substances to prevent withdrawal symptoms.

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Previous definitions of alcohol dependence and alcoholism included having three of seven symptoms that included neglect of other activities, excessive use of alcohol, impaired control of alcohol consumption, the persistence of alcohol use, large amounts of time spent in alcohol-related activities, withdrawal symptoms, and tolerance of alcohol.

Is Alcoholism Genetic or Hereditary?

While the exact causes of alcoholism are not known, a number of factors can play a role. The condition is likely the result of a combination of genetic, social, psychological, and environmental factors.

• Family history: Alcohol may have a genetic component, since people may be more likely to develop alcohol use disorder if they have family members with the condition.
• Mental health conditions: People with a mental health disorder, such as bipolar disorder, anxiety, or depression, are more likely to develop problems with alcohol. People may sometimes turn to alcohol to cope with symptoms of a co-occurring mental health condition.
• Social factors: Having peers, partners, co-workers, and parents who consume alcohol regularly or excessively may make it more likely that a person will develop an alcohol use disorder.
• Stress: People may turn to alcohol to deal with feelings of stress or difficult emotions, such as anger, frustration, sadness, loneliness, or anxiety.

Types

In the DSM-5, alcohol use disorder is further classified into categories of mild, moderate, and severe.

• Mild: If you have two to three of the 11 symptoms, you could be diagnosed with a mild disorder.
• Moderate: If you have four to five symptoms, you are likely to have a moderate alcohol use disorder.
• Severe: If you have six or more of the symptoms, you have a severe alcohol use disorder.

How Is Alcoholism Treated?

Treatment for alcoholism often involves a combination of therapy, medication, and support. If you think you might have an alcohol use disorder or if you are worried that your alcohol consumption has become problematic, it is important to talk to your doctor to discuss your treatment options.

• Detox: Detox involves going through the alcohol withdrawal process. If your alcoholism is severe, you may need to go through medically supervised detox in order to manage your symptoms of alcohol withdrawal. Detox may be inpatient or outpatient and involves the use of medications to control withdrawal symptoms and complications.
• Therapy: Psychotherapy treatments, such as cognitive behavioral therapy (CBT) and motivational enhancement therapy, can help you better understand the thoughts and behaviors that are contributing to your alcohol misuse. These treatments can also be helpful for addressing symptoms of co-occurring psychological conditions, such as anxiety and depression.
• Medications: Your doctor may also prescribe medications that can help control alcohol cravings and reduce withdrawal symptoms. The three medications that are FDA-approved to treat alcohol use disorder are naltrexone, Campral (acamprosate), and Antabuse (disulfiram).
• Support groups: Online and in-person support groups can also play a role in treatment. They can be a way to meet peers going through the same thing and find information and resources to support your recovery.

Lifestyle Changes

In addition to getting professional treatment and support, there are things that you can do to help feel better and improve your chances of recovery.

• Know your triggers: In order to recover from alcohol use disorder, it is important to learn to recognize the things that tend to trigger your cravings for alcohol. These can be internal feelings or thoughts, or they can be external things or situations, such as people or places. Other common triggers can include relationship problems, work stress, or financial worries.
• Manage stress: Look for ways to cope with stressors that don't involve consuming alcohol. Mind-body strategies, such as meditation, mindfulness, visualization, deep breathing, or progressive muscle relaxation, may help you feel more relaxed and able to cope.
• Practice health habits: Good self-care is an important part of alcoholism recovery. Getting regular exercise, eating a healthy diet, and getting plenty of sleep are all things that you can do that will help you feel better both in the short term and the long term.

Keep in Mind

Alcoholism is a treatable disease, with many treatment programs and approaches available to support alcoholics who have decided to get help. Getting help before your problem drinking progresses to severe alcohol use disorder can save your life.