Alcohol use disorder is way more common than you think. About 14% of the population in the United States met the criteria just in the last year. The lifetime prevalence (the percentage of people who have or had alcohol use disorder or will have alcohol use disorder at some point in their life) is over 29% in the United States. That’s more than 1 in 4 and almost 1 in 3, which is a real problem. To add to this problem, less than 10% of individuals who meet the criteria receive any treatment. That means 9 out of 10 people with alcohol use disorder never get the help they need.
It is hard to get people to realize they need help because alcohol is prevalent in our culture. You see alcohol at most restaurants and grocery stores, and alcohol is often present at professional and workplace social gatherings. The culture in the United States and many Western countries assumes that every adult has a healthy relationship with alcohol. However, if you look at the statistics, this is far from the reality.
A lot of people reach for alcohol in response to stressors in life. In our culture, it is so easy to make that mistake. A lot of people self-medicate with alcohol. It can start as nearly harmless in small amounts and moderation but quickly become a more significant problem, especially in individuals with addictive personalities.
While I would not want to underplay the extent of the problem, the statistics shared should also indicate that anyone who struggles with this disorder is not alone. Many people feel similar even if everyone's circumstances vary.
Unhealthy alcohol use is associated with increased mental health issues, hypertension, heart issues, sleep disturbance, liver disease, and many types of cancer. Intoxication also makes it more likely for an individual to encounter physical trauma and social and legal problems.
What is unhealthy alcohol use? In males, this is more than 14 standard drinks per week or more than 4 in one day. In females, it is more than 7 standard drinks per week or more than 3 in one day.
When does unhealthy alcohol use become alcohol use disorder? Alcohol use disorder involves alcohol use that leads to impairment or distress, with at least two of the following symptoms:
Drinking more alcohol than intended (or drinking longer than planned)
Wanting to cut down but engaging in unsuccessful attempts to cut down
Spending a significant amount of time to obtain alcohol or recover from intoxication
Craving alcohol
Failing to fulfill obligations due to alcohol use (work, school, or home)
Continuing use despite interpersonal problems caused by or exacerbated by alcohol use
Giving up or reducing social, occupational, or recreational activities because of alcohol use
Continuing to use it in physically hazardous situations
Continuing despite a physical or psychological problem caused or exacerbated by alcohol
Needing increased amounts of alcohol to achieve intoxication or noticing a diminished effect with the use of the same amount
Experiencing withdrawal
The decision to start treatment for alcohol use disorder depends on the individual. Someone struggling with their alcohol intake should not hold back from discussing their symptoms with their doctor out of fear of being forced to start treatment. The only treatments that will work are the ones that the person is willing to continue. A prescription for a medication does not help if the patient never takes it. When someone opts to start treatment, what is successful treatment depends on that individual's goals. Some people may want to achieve perfect abstinence, while others would be happy with reducing their intake.
There are behavioral interventions, such as counseling, 12-step support groups (e.g., Alcoholics Anonymous), and cognitive behavioral therapy to treat alcohol use disorder. For people who have severe alcohol use disorder, there are medications available alongside behavioral interventions. Naltrexone is usually the first line option, except for individuals with opioid use or liver disease. In people who cannot take naltrexone, acamprosate is another recommended medication.
Listen to the related First Line episode: Alcohol Use Disorder: Diagnostic Criteria and Treatment.