WHAT IS ALCOHOL USE DISORDER?

Alcohol use disorder, also referred to as alcoholism or alcohol dependency, is when a person is physically or mentally addicted to alcohol and unable to stop even after repeated attempts. For most people, drinking socially will not lead to abuse or dependence. However, there are millions of people who do have a physical dependence to alcohol. No matter what the consequences are, the craving for alcohol is so strong they will continue to drink, often ruining their own life and the lives of others. This chronic disease gets worse over time and is heavily influenced by a person's genetic factors and family environment. In fact, family history is the biggest risk individuals' face in becoming addicted.


Patterns of consumption that indicate alcohol use disorder include:

• Uncontrollable cravings or preoccupation with alcohol
• Loss of control over consumption
• Increased tolerance (needing more alcohol to get the same affect)
• Physical dependence (unpleasant withdrawal symptoms when alcohol is taken away)

While some people are able to recover from their alcohol use disorder without help, the majority of alcoholics need professional support to recover from their disease.


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Because of the socially acceptable nature of alcohol, alcohol abuse is widespread in our society impacting adolescents, teens and adults. Binge drinking is the most common form of alcohol abuse. About 17.6 million people, or 1 in every 12 adults, suffer from alcohol abuse or addiction. Unlike alcohol use disorder, people who abuse alcohol will not experience the severe cravings or uncontrollable drinking spells as an alcoholic, but the desire to drink is still strong enough that they will continue to drink to an unhealthy point despite the resulting negative consequences.


What does alcohol abuse look like?

• Drinking every day or drinking too much at a time, including binge drinking.
• Continuing to drink even when it causes problems like missing work or harming personal relationships.
• Drinking to the point of legal problems such as driving while drunk (intoxicated) or destructive/aggressive behavior.

For some people, continuing to abuse alcohol can lead to alcohol use disorder (also called alcohol dependence or alcoholism).

On college campuses, an alarming and dangerous form of alcohol abuse called "Drunkorexia" is being reported by health centers. Drunkorexia is when someone restricts food calories to make room for alcoholic drink calories. Others may purge their food and alcoholic drink to avoid the calories. Despite the known risks of these behaviors, studies have shown that 30% of women between 18 and 23 diet so they can drink.


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Binge drinking is the most common form of alcohol abuse in the United States. It is a serious problem on college campuses, with underage drinkers and even middle age adults. Binge drinking is defined as the consumption of 5 or more drinks for men, 4 for women, in a two-hour period. More than 15% of Americans reported binge drinking in the past 30 days, including 1 in 4 high school students (CDC, 2010).

A newer trend in binging drinking is the consumption of alcohol mixed with energy drinks and caffeinated beverages. These drinks are popular among young people and consumed by 31% of 12- to 17-year-olds and 34% of 18- to 24-year-olds. Studies show these beverages can enhance the dangers of binge drinking. For example, drinkers who consume alcohol mixed with energy drinks are three times more likely to binge drink than drinkers who do not report mixing alcohol with energy drinks. Also, drinkers who consume alcohol with energy drinks are twice as likely to:

• be in a situation to be taken advantage of sexually
• to take advantage of someone else sexually
• and to ride with a driver who was under the influence of alcohol

For more information on the affects of energy drinks, caffeine and alcohol check out this fact sheet from the CDC.

Short and Long Term Risks of Alcohol Abuse
You do not need to be an alcoholic to abuse alcohol. Also, you should not ignore the short and long term risks caused by binge drinking. Being informed is the best way to create a healthy lifestyle. Short term risks include: car crashes, violence (including child abuse and sexual assaults), risk of HIV and other sexually transmitted diseases, and unintended pregnancy. Long-term risks include liver disease, cancer, stroke, heart disease, and other chronic diseases (Freiden & Brewer, CDC 2010).

Alcohol poisoning is another result of binge drinking that can have fatal consequences. Common drinking behaviors on college campuses such as drinking games, chugging, mixing different types of alcohol consumed (i.e. switching between hard liquor and beer), not eating before going out and drinking more than one drink an hour all can lead to over-drinking and possibly alcohol poisoning.

Tips for Preventing Over Drinking
Know your limit, set a plan for your evening, alternate between drinking alcoholic and non-alcoholic beverages, have a designated sober person in your group to help everyone be safe and keep to the plan of preventing over-drinking. Strive to find ways to relax and have fun without the aid of alcohol.


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Family Influence

The possibility of alcohol abuse in someone with a family history of alcoholism is very high. Research reveals that genetics do influence the development of alcoholism and is the reason why alcoholism seems to run in families. Experts recommend talking to children to make them aware of any family history of alcohol addiction and emphasize to them that some people are not able to consume alcohol without drinking to excess.

The genetics of alcoholism is complicated. Many factors contribute to the development of the disease. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), genes are responsible for about 50% of the risk for alcohol use disorder, so genes alone do not determine whether someone will become an alcoholic. Environmental factors, as well as gene and environment interactions account for the remainder of the risk. For more information on the role genetics play in the development of alcoholism go to the Collaborative Studies on Genetics of Alcoholism (COGA) funded by the NIAAA.

One important point to emphasize is that adolescents with a family history of alcohol abuse tend to try alcohol at an earlier age than their peers without a family history of alcohol abuse. The younger a child starts drinking, the greater likelihood they will develop problems with alcohol dependence. The chart to the right illustrates these findings from the NIAA.

Parents make a difference and strongly influence their child's understanding and perceptions of alcohol. For instance, children seeing parents celebrate by going out and drinking gives them the association that alcohol is a reward. As a parent, you can model responsible drinking habits, openly discussing dangers associated with alcohol use, and express disapproval of underage drinking. These three things can make a difference in your child's attitude and consumption of alcohol. The key reason children chose not to drink is because of parent disapproval, according to a Columbia University study.




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Underage Drinking

Alcohol use is a pervasive problem infecting today's youth. Studies show that children are beginning to drink alcohol at an earlier age than ever before. One survey determined that parents believe their kids start drinking around age 16-17, but in actuality, the age group is closer to 11-13. Every year more than 4,700 adolescents and teens die from underage drinking. To reduce the problem, we need to look at the main reasons for why it occurs:

• Cultural influences
• Peer pressure
• The good feeling that youths and teenagers get from consumption.

An estimated 1 in 100 parents believes their teen binge drinks, but 1 in 7 actually DO binge drink (MADD, 2015). Parental influence has a profound effect on the attitudes and behaviors of children involving alcohol use. Therefore, it is important for parents to talk to their kids about drinking. Studies show that children who begin drinking before the age of 15 were five times more likely to develop problems with alcohol than those who started after they were 21.


When parents talk to their children, they should:

• Speak early and often.
• Not mix messages.
• Be specific.
• Be clear about consequences.
• Set realistic standards and boundaries.
• Be honest.

An open relationship with children can help make it easier for parents or guardians to communicate with them, and discuss the importance of control and moderation. The NIAAA has a helpful fact sheet about underage drinking.

At this age, teens' decisions are heavily influenced by their peers. Parents should do their best to make it clear to their children that they should choose their close friends carefully so as to avoid peer pressure to drink.

It may be tempting for parents to allow underage drinking at their house thinking they are providing supervision and creating a safer use of alcohol. Prom season and graduation time may make this idea especially tempting. Statistically speaking, the opposite is true and children with parents that have a permissive attitude toward alcohol are more likely to abuse it as they get older. Learn more about the myths of underage drinking at drugfree.org and the serious legal consequences of hosting underage drinking parties for both parents and children at socialhost.drugfree.org.


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WARNING SIGNS OF ALCOHOL USE DISORDER

Alcohol is a mood altering depressant and can fundamentally change a person - mentally and physically. Family history or genetics are just one factor that can lead to alcohol use disorder. Additional factors that can increase vulnerability include the existence of anti-social behavior, a transforming life event, and even a person's culture. No matter what the cause, though, it is important to recognize the signs and symptoms of alcohol use disorder.

Signs of an alcohol use disorder include:

• Frequently drinking more than intended;
• Wanting to stop drinking but being unable to;
• Developing a tolerance to alcohol;
• Feeling symptoms of withdrawal when stopping;
• Letting personal and professional responsibilities falter in favor of drinking, and
• Spending an extreme amount of time trying to get and drink alcohol.

Prolonged alcohol abuse also leads to changes in physical appearance. When you drink, alcohol is absorbed into your bloodstream and distributed throughout your body. The serious damage excessive drinking inflicts on your organs and general health is widely known, but did you know that it can also change the appearance of your skin, hair and even weight? Physical "red flags" of alcoholism (aside from the immediate withdrawal symptoms) include:

• Broken capillaries on the nose and face
• Yellowing of the eyes and skin (indicates potential problem with liver functioning)
• Breath that smells of alcohol on a consistent basis
• Notable weight loss or weight gain
• Dry skin
• Brittle hair and fingernails
• A flushed, ruddy facial appearance
• Evidence of aging more rapidly than usual, such as a sudden increase in wrinkles and age spots
• A noticeable decrease in personal hygiene such as showering and dental care

If reading these signs and symptoms cause you any amounts of concern, speak to your loved one or seek help from a medical professional. Alcoholism is a disease and a physical addiction that cannot be healed through willpower alone. Our resources page offers a list of local and national resources.


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CONSEQUENCES OF OVER CONSUMPTION

Did you know...approximately 79,000 people die each year from alcohol-related incidents, mainly illnesses and motor vehicle accidents? How about that excessive drinking can also cause short and long-term memory loss and may increase the risk for depression? What about the loss of a college scholarship?

If you think getting a hangover is the worst thing that can happen from drinking too much, then you are wrong. From that first sip, alcohol is absorbed into your bloodstream. Within 10 minutes its immediate effects can be felt (source: NIAAA). As you drink, you increase your blood alcohol concentration (BAC) level, which is the amount of alcohol present in your bloodstream. The higher the BAC, the more impaired you become by alcohol's effects. What starts with a feeling of relaxation and reduced inhibitions moves to slurred speech, motor impairment and confusion. The more you drink, the higher your BAC becomes and the graver the effects can be, including coma, breathing problems and even death.

It cannot be overstated, the over consumption of alcohol carries many consequences. Please watch this video segment sharing how one night of excessive drinking ruined two lives.

THE HEALTH CONSEQUENCES?
Because alcohol is absorbed into the bloodstream, over time, excessive alcohol use (in the form of heavy drinking and/or binge drinking) can lead to numerous health problems including chronic diseases, neurological impairments and social problems. Liver failure is the most common damage, followed by the kidneys and other organs. Alcohol is linked to causing other health hazards such as:

• Increased risk for obesity
• Increased risk for stroke and high blood pressure
• Increased risk for breast cancer and cancer of the pancreas
• Birth defects, if consumed during pregnancy
• Suicide
• Dementia, stroke and neuropathy
• Liver diseases, including fatty liver, alcoholic hepatitis, cirrhosis
• Gastrointestinal problems, including pancreatitis and gastritis
• Alcohol abuse or alcoholism.

Click here to learn the effects of alcohol on specific parts of the body

In addition, there are a myriad of other unintentional injuries that can result from intoxication such as motor-vehicle traffic crashes, falls, drowning, burns and firearm injuries.

THE PERSONAL CONSEQUENCES?
Alcohol alters your brain's functioning. Therefore, most people that abuse alcohol or have an alcohol addiction suffer from serious social problems brought on by their drinking.
Problems include:

• Unemployment
• Lost productivity on the job
• Family problems, which can lead to estrangement with parents or divorce if you are married
• Violence including child maltreatment, sexual assaults, fights and even homicide

Sadly, every year, an estimated 696,000 students ages 18-24 are assaulted by another student who has been drinking and 97,000 students ages 18-24 experience alcohol-related sexual assault or date rape. (Source: NIAAA)

For college students, abusing alcohol on campus comes with stiff financial and academic consequences. Disciplinary action, community service, hefty financial fines, loss of on campus housing and even expulsion from school can be the result of alcohol related misconduct.

THE LEGAL CONSEQUENCES?
According to the NCADD (National Council on Alcoholism and Drug Dependence), alcohol, more than any illegal drugs) plays a particularly strong role in the relationship to crime and other social problems. Alcohol is a factor in 40% of all violent crimes today which include murder, rape, assault, child and spousal abuse. According to the Department of Justice, 37% of almost 2 million convicted offenders currently in jail, report that they were drinking at the time of their arrest.

CONSEQUENCES OF A DUI
Unfortunately, all too often, an intoxicated person decides to drive. In 2015, 10,265 people died in drunk driving crashes - one every 51 minutes - and 290,000 were injured. The highest percentage of drunk drivers are between the ages 21 to 24 (30 percent%), followed by ages 25 to 34 (29 percent%) and 35 to 44 (24 percent%). Drunk driving costs the United States $132 billion a year - that's $500 from each adult per year. (Sources: MADD and National Highway Traffic Safety Association). If you are arrested and incarcerated for driving under the influence (DUI) then that price tag just increased to about $7,000.

In Massachusetts, the legal limit of blood alcohol content (BAC) for individuals 21 years and older is .08. The limit for individuals under 21 is .02.

Individuals who make the choice to get behind the wheel while intoxicated are taking the risk of possible arrest and incarceration. They will be asked to participate in a field sobriety test. Individuals who fail a sobriety test are arrested, searched, fingerprinted and locked in a cell for the night.

DUI offenders often lose current student loans; if they have not applied for one yet, they may now be ineligible. The individual is also required to explain over and over on job applications why they were arrested, and disclose information about the DUI they acquired.

Additional DUI fees include:

• Victim witness fee
• DUI victim fee
• Head injury fund
• State DUI fee
• Alcohol education program
• Probation supervision fee
• Towing of the vehicle
• Attorney fees

These expenses can add up to over $7,000 per offense.

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RECOVERY & RESOURCES

It's important to understand that recovery from an alcohol use disorder is not a journey to travel alone. Although there are steps someone can take to change their behaviors when it comes to abusing alcohol, someone suffering from alcoholism will find it difficult or impossible to quit on their own. If you are concerned about yourself, please take the FutureHealth self-assessment quiz to better understand if your drinking behaviors are cause for concern.

Alcohol use disorder recovery is a journey and there are different forms of treatment available. If you are interested in learning more about a self help path for alcohol abuse or a drinking problem, please read our Treatment and Self-Help page on How to Stop Drinking and Start Recovery to find if this type of treatment is right for you or your loved one.

ALCOHOL USE DISORDER TREATMENT
Treatment for alcohol use disorder (alcoholism) requires a detoxification program in a hospital or medical facility since the user is physically dependent on alcohol. Alcohol treatment centers provide medical attention, assistance with withdrawal (using medications to reduce the desire to drink and lessen withdrawal symptoms) and provide support needed to get a drinking problem under control. Programs can last 30, 60 or 90 days depending on severity of the disease.
To increase a person's chance for full recovery, an "after" plan is needed for when an alcohol treatment program is completed. Supports groups like Alcoholics Anonymous are popular and some recovering alcoholics choose to live in a sober house to help the transition to their new sober lifestyle.

TREATMENTS CENTERS
Choosing the right treatment center is important. To better understand what to look for in a treatment center please read "How to Choose a Treatment Center."
SUPPORT GROUPS
Find local help and aftercare programs in your area, including Alcoholics Anonymous. Our listings include meeting times and locations. Click here to find an AA meeting now.

• www.aa.org -- Alcoholics Anonymous
• www.al-anon-alateen.org -- Al-Anon Family Group Headquarters

SOBER HOUSING
Sober housing residences are a safe alternative to an apartment or house, for individuals whose goal is to develop life-long coping skills to stay sober. These houses are professionally designed communities that produce success and are located throughout the United States. A sober living home can be the last step in your journey from addiction to a healthy lifestyle. Click on the links below to find the right sober housing for you.

• www.soberhousing.net/ -- Sober Housing
• www.oxfordhouse.org -- Oxford House
• www.myrecoveryhome.com/consultation.htm -- My Recovery Home
• www.libertyhouse.org -- Liberty House

ONLINE RESOURCE CENTERS
For more information, statistics and research on alcohol abuse and addiction please visit:

• www.niaaa.nih.gov -- National Institute on Alcohol Abuse and Alcoholism
• www.samhsa.gov/ -- Substance Abuse and Mental Health Services Administration
• rethinkingdrinking.niaaa.nih.gov/ -- Rethinking Drinking: Alcohol and Your Health
• www.aca-usa.org -- American Council on Alcoholism
• www.ncadd-sfv.org/about-us -- National Council on Alcoholism
• www.nofas.org/ -- National Organization on Fetal Alcohol Syndrome

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