What is Alcoholism?
Alcohol use has become normalized in many cultures, from how it is portrayed in media, to drinking at social gatherings with friends and family to cracking a cold beer after work.
Many argue that alcohol use is a choice, and a person chooses to become intoxicated or drunk. While this may be the case when someone is abusing alcohol, no one voluntarily becomes an alcoholic.
Alcoholism is commonly known as an addiction to alcohol. Alcohol is the most abused substance in Canada. In 2018, Statistics Canada reported that 19.1% of Canadians aged 12 and older (roughly 5.9 million people) were reported as heavy drinkers.
The World Health Organization (WHO) has reported 3.3 million alcohol-related deaths globally. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines alcohol misuse as a drinking pattern that brings blood alcohol content (BAC) to 0.08% or higher in 2 hours.
As the term ‘alcoholic’ has created a negative connotation for people who struggle with alcohol addiction, health professionals are slowly replacing that label with alcohol use disorder (AUD), alcohol dependency, or addiction involving alcohol.
A common misconception for people with AUD is that alcohol is the root of the problem. There is still a social stigma around addiction, alcoholism, or being an addict as addiction is seen as a personal weakness, poor decision, or moral failing.
Dependence involving alcohol (or any other substance or addictive behavior) takes over a person’s life, creating a significant amount of pain, guilt, and shame, and pain and suffering for those around them.
Causes of Alcholism
According to The American Society of Addiction Medicine, addiction is a “primary, chronic disease of brain reward, motivation, memory, and related circuitry”. It is characterized by the inability to consistently abstain, impairment in control, cravings, diminished recognition of significant problems with one’s behaviors and relationships, and a dysfunctional emotional response (under-reacting or overreacting).
It is recognized as the pathological pursuit of reward, or relief using substances, sometimes with other behaviors. Every human being is vulnerable to addiction because of genetics, brain circuitry, environment, exposure to addictive substances, and unhealthy behaviors.
Pathological means that activity becomes an obsessive, uncontrollable, and unconscious act. Brain pathways get entrenched by repeated reward and/or relief-based activities. This pathology becomes more powerful than choice, which is one reason it is so hard to quit without help.
When someone is struggling with alcohol dependence, the choice to stop is impaired and loses the ability to make healthy decisions despite having good intentions. Addiction targets the natural reward system in the midbrain that has evolutionarily developed to promote our survival.
All humans are hardwired with the reward circuitry that is designed for food and sex. We need food to survive and sex to procreate. The human brain is designed to make these pleasurable to promote the survival of the human species.
The human brain is designed to make these pleasurable to promote the survival of the human species. When we find something pleasurable, there is a release of the neurotransmitter dopamine, among others, which makes us more likely to engage in that behavior again.
Dysfunction in this circuitry is addiction. Addiction hotwires the reward circuitry and removes the “off” switch, so the brain continually starts to crave experiences that give it a “high.”
This dysfunction is amplified exponentially if mood-altering substances such as alcohol are introduced into the brain because they add more “feel good” chemicals. This abundance further alters brain chemistry, and the brain requires more to feel “normal.”
For those struggling with addiction involving alcohol, if the brain doesn’t receive regular doses of the chemicals it’s craving, the person with an addiction will likely experience alcohol withdrawal symptoms.
This can range from mild irritability, anger outbursts, and increased reactivity to more severe symptoms such as tremors and withdrawal seizures. Withdrawal symptoms are a major factor why people have difficulty abstaining on their own without adequate support and treatment.
There is a lot of substance abuse in society which has become normalized for many. We often hear “everyone is drinking” but that doesn’t mean because everyone does it, that makes it okay.
When assessing for substance abuse, it includes hazardous use (episodic binge drinking greater than the low-risk guidelines) and harmful use (continuous or daily use). For someone with an addiction involving alcohol, they may have been abusing alcohol in the past with minimal negative consequences but once the reward circuitry gets hijacked, they are no longer able to abstain as there is a growing desire for more and more.
When dealing with an addiction issue, it is critical to know what is happening because our brain is involved in everything we do, including how we think, feel, behave, and get along with others.
The brain is the organ of judgment, personality, character, and decision-making. When your brain works properly, you work properly. When your brain is troubled, you are much more likely to struggle with mood, behavior, impaired judgment, and inaccurate thinking.
Warning Signs of Alcoholism
Not all signs of AUD are as obvious as getting a DUI arrest or getting unintentionally drunk. Smaller signs to be aware of are constant jokes about alcoholism, losing friendships or relationships, memory loss, and anger during a confrontation about excessive drinking.
Effects of Alcohol in Everyday Life
Addiction involving alcohol (or any other substance or addictive behavior) is a brain disease that takes control over a person’s life. It can create a significant amount of pain, guilt, and shame for the person affected and pain and suffering for those around them.
Addiction is a very misunderstood disease, and many people consider its most severe forms as homelessness, crime, broken relationships, unemployability, and so on.
Addiction has moderate and mild degrees of severity, which are harder to identify. Moderate addiction can progress to severe addiction but is often associated with less severe (non-immediate life-threatening) symptoms.
Mild addiction is a less extreme version of moderate addiction but can still progress to moderate and severe cases. It may look as innocent as addictive thinking.
Addictive thinking includes low self-esteem, avoiding conflict, emotional hypersensitivity, denial, rationalization, all-or-nothing thinking, assigning blame, playing the victim, and self-pity.
A person can be gainfully employed, have a family life, and by society standards, be successful but still have mild addiction and suffer inexplicable sadness, often feeling irritable, restless, and discontent.
You may be surprised by people who have hidden or “kept under control” their needs since they are able to be responsible and productive—they are known as high-functioning alcoholics.
People tend to overlook signs of alcoholism in functional alcoholics due to their success but noticeably effects on quality of life, relationships, and life expectancy eventually catch up.
All humans have some degree of addictive thinking when they are feeling stressed or insecure but when it is predominant, the person likely has mild addiction and uses substances to mask their negative feelings.
Risk Factors for Alcoholism
The reality is that alcohol is not healthy for anyone but in limited amounts, health complications from alcohol are minimized. In Canada, low-risk drinking guidelines are based on the average person, but the effects of alcohol vary greatly from one person to another so it’s important to know your limits.
While alcohol is a temporary fix to elevate moods, long periods of alcohol abuse have numerous health risks such as fatigue, memory loss, hypertension, heart problems, and diabetes, to name a few.
In worse cases, it can lead to a higher risk of mental disorders or suicide. Chronic alcoholics also have a higher chance of developing cirrhosis, where irreversible damage occurs in the liver and scar tissue gradually replaces healthy liver cells.
Other health issues include gastritis or pancreatic damage, inhibiting the body to process food, absorb vitamins, and produce hormones to regulate metabolism.
Health risks for women include disrupted menstruation, and birth defects in newborns like a small head, heart problems, developmental and cognitive problems known as fetal alcohol spectrum disorder. Men will have difficulty maintaining an erection.
Many of the health complications in people with alcohol use disorder struggle are permanent and long-lasting, however, there are ways to combat this issue.
All of us need to take responsibility for our behaviors and be accountable for our actions but blaming oneself or someone else for a condition beyond their control only increases shame.
Once the person recognizes they did not choose to behave badly, and that their behaviors are secondary to dysfunction in their brain, they can then start to focus on recovery and appreciate the disease is only a part of them and doesn’t define them.
One helpful way to avoid this path of dependency is to understand yourself. Know how factors like weight and size, genetics, and family history affect you.
Understand how mixing alcohol with other substances or medications, stress, hunger, and lack of sleep impact the body.
Men should keep a limit of 15 drinks per week. The recommendation is no more than three standard drinks on most days, four on special occasions. For women, the recommendation is 10 drinks per week. That’s two standard drinks on most days, three on special occasions.
When someone has an addiction, depending on the severity of their disease, it is challenging to get well on their own and will need the support of family, friends, community, and health care providers who understand addiction.
Treatment and Recovery
Addiction can manifest in many ways so it’s important not only to focus on abstinence from alcohol, other mood-altering substances, and addictive behaviors but to understand what is driving the desire to seek out these substances.
At Health Upwardly Mobile (HUM) in Calgary, we understand the road to recovery is difficult. Our highly trained healthcare providers can offer the help and support needed to begin the recovery process. Whether a person’s problem involves alcohol, heroin, prescription medications, or compulsive behaviors involving gambling, sex, relationships, or food, we are here to help treat this disease. Addiction is not curable but with appropriate treatment and holistic recovery, there is hope for a happy and healthy life.
We take a holistic approach to health; therefore, we will be exploring biological, psychological, social, and spiritual dimensions, rather than looking at health issues or diagnoses in isolation. As addiction is a chronic disease, treatment is providing continuing care so people can access support as needed indefinitely. Treatment options will vary among programs and health care providers, so it’s important to do some research to determine the best fit. Professional treatment includes both inpatient (residential programs) and outpatient programs, intensive outpatient programs, individual and group psychotherapy to name a few. We will monitor and manage the patient’s condition over time to decrease the frequency of flare-ups, sustain periods of remission, and optimize the person’s level of functioning.
Other options are community support programs like Alcoholics Anonymous, SMART Recovery, and Refuge Recovery. Anyone struggling with alcohol misuse can find more information with their local healthcare provider, mental health services administration, and alcohol rehab. There is no one right way to get help and the type of treatment required will be determined by the acuity of the problems as well as willingness, readiness, resources, and accessibility.
The goal of recovery is to reach one’s potential and achieve a full, rewarding, and happy life at home, at work, and in their community. The person can manage conflict and stress in a healthy way and have healthy boundaries to mitigate the risk of relapse. With appropriate support and treatment, a person can improve their overall mental health and quality of life.