Alcohol kills more people than opioids each year. While the opioid crisis warrants the attention it receives, society still allows for thousands of people to harm themselves and others by drinking alcohol. Totals from 2006-2010 in the United States show that more than 100,000 people died from alcohol-related causes.
From liver disease to various types of cancer, chronic alcohol use is associated with serious health issues. Numbers from 2010 estimate the economic burden in the United States was around $249 billion.
Unfortunately, the numbers also show how few people actually get the help they need. Overall, less than 10 percent of the people needing treatment benefit from quality detox, followed by a long-term treatment program to address their substance use and its underlying factors.
Alcohol is produced when certain combinations of grains, fruits, or other sources of sugar are fermented. The process of fermentation results in carbon dioxide (the bubbles in alcoholic beverages) and ethanol, which produces the intoxication effect after drinking it.
Almost all cultures and modern societies have rituals around the use and enjoyment of alcohol. In the United States, it’s legal and regulated, but it’s important to know when you or someone you love has lost control of their drinking.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the standard tool for clinical professionals and researchers for the classification of mental health and substance use disorders. The DSM-5 includes alcohol in its “Substance-Related and Addictive Disorders” category and outlines the dangers of use, abuse, and dependence.
Review some of the following to see if they apply to you, or someone you love:
The brain and the body are constantly seeking harmony to function well. The medical term is homeostasis, and it means that when anything disrupts the CNS, efforts must be made to return to a certain level of stability. For example, when the body becomes hot from exercise or being outside in the sun, we sweat to cool off or reach the previous level of homeostasis.
Over time, alcohol use will interfere with the CNS’ ability to return to a balanced state.
Everything we do affects our central nervous system. The foods we eat, how much sleep we get, the quality of the air and water we ingest, and even things like stress and unseen toxins in cleaning products will have some kind of an effect.
Alcohol enters the bloodstream, and from there, it travels to the other organs like the heart, liver, and the brain, where depressive effects are most noticeable. Alcohol will slow the response times of neurotransmitters that send signals for functions like heart rate and breathing.
The liver is the workhorse of the body, and alcohol is metabolized through the liver. A healthy human liver can process one unit of alcohol per 60 to 90 minutes. That means roughly one pint of beer, one standard glass of wine, or one alcoholic beverage with a one-ounce shot per hour.
When alcohol is taken with other substances, such as opioids, the side effects of alcohol intoxication can range from manageable to life-threatening such as slurred speech, impairment in attention or memory, depressed breathing, slowed heart rate, stupor or even coma. For example, both alcohol and opioids have depressive effects on breathing and heart rate, so combining the two can be lethal.
Alcohol poisoning is the result of too much alcohol present in the bloodstream. Everyone will react differently to an excessive amount of alcohol; therefore, it’s important to recognize the warning signs of potential alcohol poisoning and know what to do. Some signs to be concerned about: cold, clammy skin, vomiting, seizures, slowed breathing.
Do not let someone “sleep it off” if you’re worried they may have alcohol poisoning, as their breathing and heart rate could stop in their sleep. They could also vomit and not be able to clear it from their throat, causing them to choke on the vomit and die from lack of oxygen. Call 911 if you are worried someone might have alcohol poisoning.
Alcohol withdrawal can be fatal and should not be undertaken alone. The extent and severity of the withdrawal symptoms will depend on the type, frequency, and amount of alcohol used by the individual. Typically the experience of withdrawal involves the opposite of the effect the drug produced. For example, because we know alcohol suppresses the heart rate, one might experience a racing heartbeat when they stop drinking.
Withdrawal symptoms can be acute or chronic. Acute withdrawal symptoms usually begin within four to twelve hours after reduction in use and can include:
In extreme cases, chronic withdrawal symptoms can begin days after the last drink, continue for 14 days or more after the last use, and will often be a less severe experience of the symptoms that occurred during the acute phase.
In some cases, some withdrawal symptoms can continue to a lesser degree for months after stopping the use of alcohol. Sleeping problems, for example, can persist long after someone has stopped drinking.
It is critical to get the help you need to successfully manage withdrawal symptoms and begin a life without the use of alcohol. Long-term alcohol use can negatively affect nearly every organ system, notably the gastrointestinal, cardiovascular, immune, and the central and peripheral nervous systems. The risk of certain types of cancer, such as liver, stomach, and breast cancer, increases with prolonged use over time.
When medically managed, most of the severe withdrawal symptoms are alleviated within seven to ten days. However, it is important to note that treatment following a medically managed detox will result in a better success rate. Safely removing alcohol from the brain and body is only the first step. There are other psychological, emotional, and behavioral issues to address that will set you up for continued sobriety.
When someone has an alcohol use disorder, they may experience acute withdrawal symptoms if they suddenly stop drinking. These may occur 12 to 24 hours after their last drink. These symptoms may include cravings, insomnia, vomiting, depression, and even seizures.
The symptoms occur when the brain and central nervous system begin to withdraw from alcohol. The severity and discomfort of these symptoms often push someone right back into drinking alcohol again.
Kindling occurs when the brain and central nervous system become desensitized to alcohol, which causes the recurrence of use to be much more severe. Symptoms will progressively worsen each time they relapse. It is a phenomenon where weak electrical or chemical stimulus results in the appearance of behavioral effects. These may include seizures when it is administered frequently.
It is not just binge drinking but the repeated effort to binge drink that will make neurons in the brain become hypersensitized. It makes future efforts much more difficult. The effect of kindling causes a person with an alcohol use disorder to resume drinking again. It makes withdrawal symptoms more dangerous and violent and triggers these dangerous symptoms much faster.
Kindling can work behaviorally and physically. Both effects are tied to overly active neurons in our brain that desensitize over time. That means smaller triggers will cause relapse, which makes for a revolving door between relapse and attempts to get better.
As you’ll find with other dangerous diseases such as cancer, the cycle will wear a person down with a substance use disorder, which, ultimately, will lead to death. The kindling effect is one of the most dangerous parts of alcohol use disorder.
When seeking treatment, it’s important to understand the difference between the various levels of care so that you can get the most out of your treatment experience.
Medical detoxification, or detox, is a medically managed process of removing alcohol from the body. Following a thorough history and physical examination, the medical staff will determine the best medication protocol to manage your withdrawal symptoms safely.
A full detox can take from three to 10 days, depending on the severity and extent of the drinking and is up to the discretion of the medical providers.
Medical complications, using more than one substance, or a history of mental health diagnoses are all examples of when a detox may take longer than usual. Treatment centers will require you to successfully complete detox in order to safely and fully participate in their programs.
Detox can take place in a hospital setting if you have severe or unmanageable medical complications, or it can take place in a stand-alone detox facility. These standalone, privately run facilities must be staffed 24 hours a day with medical personnel, as well as support staff, to monitor your symptoms and ensure the safest, most comfortable experience possible.
Specially trained staff will know how to observe your progress throughout the detox process and respond to any potentially life-threatening situations.
Residential treatment typically follows a successful detox and involves living on-site and participating in various therapies. Individual sessions with a trained therapist, as well as group and family therapy sessions, are some of what is required at each residential facility.
During this time, you will be examining patterns of thoughts, emotions, and behaviors that may have contributed to your substance use. Residential treatment length of stay will vary depending on your needs, but can typically last from 30 to 90 days following the detox.
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Outpatient treatment is intended for those individuals who are in a more stable position medically, physically, and emotionally. After the support from detox and residential care, the activities of daily living on your own are more manageable, and you will remain involved with outpatient treatment to continue your journey of recovery.
You will continue to participate in therapy on a less frequent basis and maintain connections with your support system and therapist. This is an important part of your recovery, as it will allow you to transition to the next phase of your life with the support that played such a beneficial role.
Medication-Assisted Treatment, or MAT, is a form of outpatient care. It is intended to support those who have opioid or alcohol use disorders with medication that is administered on a longer-term basis than the typical medical detox.
Medications approved by the U.S. Food and Drug Administration for the treatment of alcohol use disorder are designed to manage withdrawal symptoms, reduce or eliminate cravings to drink, and help prevent relapse. Naltrexone is a commonly used medication for those who want to stop drinking. Taking naltrexone will block the euphoric effects of drinking.
For these reasons, some studies suggest there are better outcomes for those addicted to alcohol who participate in medication-assisted treatment following detox. Some form of therapy and medical supervision will still take place during MAT, and your provider can assess whether this option is right for you.
In a recovery treatment program, you will be able to address the physical, psychological, medical, and social aspects of alcohol addiction, learning through various therapeutic tools how to manage your addictive behaviors effectively and maintain long-term sobriety. This is done through a customized treatment plan, which you will customize with your therapist, and may include some of the following common treatment modalities:
Again, it is critical to note the best outcomes for the treatment of alcohol addiction are associated with participating in the full spectrum of care. A detox treatment alone won’t give you the benefits or the support of a full continuum of therapy. There are many reasons that substance use may have grown into an addiction, but what’s most important is focusing on the resources and solutions that will help you find a new life free from alcohol use.
National Institute on Alcohol Abuse and Alcoholism. (2018, August). Alcohol Facts and Statistics. Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm
Mayo Clinic. (2018, January 19) Alcohol Poisoning. Retrieved from https://www.mayoclinic.org/diseases-conditions/alcohol-poisoning/symptoms-causes/syc-20354386
SAMHSA. (2015, July 21). Medication-Assisted Treatment (MAT). Baylor, C. Retrieved from https://www.samhsa.gov/medication-assisted-treatment
National Institute on Drug Abuse. (2018, August 09). Overdose Death Rates. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
Icahn School of Medicine at Mount Sinai. Retrieved from https://neuroscience.mssm.edu/nestler/nidappg/brain_reward_pathways.html
What is Homeostasis? (n.d.). Retrieved from https://www.scientificamerican.com/article/what-is-homeostasis/