Alcohol Use Disorder: Causes and Treatments

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Alcohol Use Disorder: Causes and Treatments

Did you know that alcohol use disorder, and the harmful use of alcohol more generally, account for 5.3% of all deaths globally? Beyond the 3 million deaths per year caused by alcohol worldwide, alcohol use is also a contributing factor to hundreds of diseases and injuries.

The vast majority of human beings who consume alcohol are able to moderate their use in a way that does not impact their lives and functioning to any great extent, but 283 million people around the world suffer from what is called alcohol use disorder.

People who live with alcohol use disorders have difficulty controlling how much or how often they drink. This leads to a need for more and more alcohol to achieve the same effect. Over time, it can lead to physical dependence, meaning that when one stops drinking alcohol, they may experience withdrawal symptoms like shaking, nausea, and sweating. Alcohol use disorder has a profound effect on mental and physical health, and invariably takes a toll on the sufferer’s relationships, work, and quality of life.

In this article, we try to answer some common questions about what causes alcohol use disorder, and what can be done to treat it.

We have come a long way since the days when addiction was believed to be a purely moral failing that we should be able to overcome through hard work and strong will alone, but there is still a good deal of misunderstanding and disagreement about the mechanism of addiction and how to manage it.

What Causes Alcohol Use Disorder? Nature vs. Nurture

The term “nature vs. nurture” is used to discuss many medical and mental health conditions when the origin of that condition is not fully understood, or is particularly complex. In other words, when we ask whether something is caused by “nature” or “nurture”, we are considering whether it was genetics and biology, or the environment that has had a greater effect on someone’s condition.

It isn’t always easy to determine whether nature or nurture is to blame, and in fact, it usually isn’t just one or the other. Biology and genetics interact with environmental factors like parenting, relationships, and trauma to create different effects.

Alcohol Use Disorder and Genetics

Studies consistently show that genetics make up as much as 50-60% of a person’s risk of developing alcohol use disorder.

There are many ways in which the involved genes can lead to addiction. Genes can affect the way the body metabolizes alcohol. Genetics can determine the level of dopamine — a neurotransmitter responsible for generating feelings of pleasure and reward — present in our brains. Genes can even affect the way the brain processes memory, affecting the ways in which we learn — or do not learn — from our mistakes.

The role of genetics and biology in addiction is complicated, but having this context can help people to understand that while people may have some agency in their ability to heal an addiction to alcohol, becoming addicted is not a choice.

Alcohol Use Disorder and Environment

While genetics play a major role in addiction, the effect of our environment can’t be underestimated.

In many cases, alcohol is used as a means to cope with painful feelings, stress, anxiety, and mood swings. While genetic factors can influence the development of maladaptive coping mechanisms like alcohol use, so can the environment a person is raised in.

In a home where the adults commonly use alcohol to cope with stress, children and adolescents may learn that this is an effective way to relieve anxiety. In a home where caregivers are permissive about the use of alcohol, children and adolescents may be introduced to alcohol early on in their development, which is a known risk factor for addiction. For those who have a childhood or adolescence marked by trauma and are not offered effective mental health support, they may have found that drinking provides a distraction from pain.

Environmental risk factors for alcohol use disorder include, but are not limited to:

  • Poverty
  • Community violence
  • Social isolation
  • Emotional or material neglect
  • Physical, emotional, or sexual abuse
  • Pressure to perform academically
  • Easy availability of alcohol

None of these factors alone can explain why someone develops an addiction to alcohol. Whether someone becomes addicted to drugs or alcohol depends on a confluence of factors. A person with a high genetic predisposition to addiction might grow up in a loving and supportive environment where all their needs are provided for, and avoid addiction entirely. Someone else might experience trauma and abuse, but never crave drugs or alcohol because they lack genetic markers for the disease.

Treatment Options for Alcohol Use Disorder

While the stigma around addiction is improving, treatment for and research about alcohol use disorder still lags behind other major public health concerns like heart disease and diabetes. In fact, one of the most common treatment options for alcohol use disorder, Alcoholics Anonymous, was developed in response to the lack of formal treatment for the condition.

So, what are some of the treatment options to overcome Alcohol Use Disorder?

Alcoholics Anonymous

For nearly a century, AA has been an option for people struggling with alcohol use disorder. Founded in 1935 in Akron, Ohio, AA’s premise is based on the idea that “alcoholism” is a malady of the mind, body, and spirit. While we take many of these ideas for granted now, in 1935, the idea that excessive alcohol use is a “disease” was groundbreaking.

The 12 steps of AA recommend that followers surrender their egos, engage in deep reflection, make amends to those they have harmed during their time drinking, and connect with a “higher power”. AA members work the steps with the help of a “sponsor”—an AA member who has completed all 12 steps and maintained sobriety for at least one year. It is believed that done correctly, these steps can lead to life-long sobriety. While the program has been helpful to many people over the years, its actual success rate is not known. It is notoriously difficult to study the success rate of AA because its members remain anonymous.

Individual and Group Psychotherapy

Individual therapy, also known as “talk therapy” is a very effective way to get to the root of an addiction or change behaviors that are contributing to addiction. In addition to working through the issues that have led to addiction, and helping the client make changes to the behaviors that support the addiction, a good therapist can help connect their clients with other resources and help them to put a recovery plan into action.

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Group therapy can provide a safe and structured environment to connect with others struggling with addiction under the guidance of a licensed mental health professional.

Much like individual therapy, group therapy is effective in getting to the root of problems that lead to addiction, and in correcting negative patterns that perpetuate it. Group therapy can be particularly effective in recovery from alcohol use disorder because of the support and encouragement fellow group members provide.

Therapeutic groups support members with a wide range of challenges. While there are groups that are designed specifically for those in recovery from alcohol use disorder, other groups are tailored to address issues like depression, social anxiety, eating disorders, OCD, grief and loss, and anger management. Even groups that aren’t specifically meant to treat addiction can help to address co-occuring problems that have enabled an addiction to take hold.

Medication Assisted Treatment

The evidence in favor of medication assisted treatment for alcohol use disorder is strong, and has been coming into favor as a helpful treatment for the disorder in recent years.

There are several medications available by prescription that can be helpful in treating alcohol addiction:

  • Naltrexone (aka. Vivitrol or Revia): Naltrexone is a medication that can be taken either as a monthly injection or as a daily pill. Naltrexone blocks opioid receptors in the brain, therefore reducing alcohol cravings.
  • Acamprosate (aka. Campral): Acamprosate affects brain receptors in a way that reduces alcohol cravings.
  • Disulfiram (aka. Antabuse): Disulfiram prevents the breakdown of alcohol in the body. When people taking Disulfiram drink alcohol, it causes them to feel very ill, creating a negative association with alcohol.

Managing alcohol cravings with medication can be a highly effective method for helping people to remain sober. These medications and others indicated for the treatment of Alcohol Use Disorder can be prescribed by a physician, psychiatrist, or nurse practitioner.

Inpatient Rehab

There are times when alcohol use disorder becomes so unmanageable that the best option can be to enter into an inpatient treatment facility. One of the reasons why inpatient treatment may be necessary is that withdrawal from alcohol can be extremely dangerous, and even life-threatening. In an inpatient facility, medical professionals can provide medications and other support to make sure the withdrawal is safe.

Inpatient treatment can also offer a refuge for those who are being affected by their environment, and provide intensive therapy and support over a period of around 30-90 days. One of the downsides of inpatient treatment is that it can be very expensive, even when insurance is able to cover some of the cost.

Alcohol use disorder is a complex disorder with a variety of treatment options, but like any mental health challenge, a foundation of education about the disorder is the first step in managing it.

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