Although it is popularly known as alcoholism, the correct term to refer to this condition is alcohol use disorder, a term adopted by the main diagnostic manuals and the scientific community.
Alcohol use disorder is a health condition that goes beyond the social consumption of alcoholic beverages. It involves persistent and problematic patterns of use, capable of compromising physical and mental health, interpersonal relationships, and professional performance. Even so, the topic is still surrounded by stigma and misinterpretations, which hinders both the recognition of the problem and the search for specialized help.
In this article, you will understand what alcohol use disorder is, how it manifests itself, and what the appropriate guidelines are for treatment. Furthermore, throughout the text, we also have the insights of Dr. Renata Rigacci Abdalla, a psychiatrist and coordinator of the postgraduate medical course at São Leopoldo Mandic, who provides a clinical and specialized perspective on the subject.
What is alcohol use disorder?
This disorder is characterized by a pattern of alcohol consumption that includes excessive use, as well as signs of tolerance and withdrawal. Loss of control over alcohol consumption, when not treated early, can lead to physical, social, and occupational consequences.
In an interview, Dr. Renata Rigacci Abdalla highlights the physical impacts that alcohol use disorder can have.
"Alcohol use is linked to many physical illnesses, such as cancer, liver disease, and cardiovascular conditions, but also to mental health issues. Therefore, alcohol use is related to depression, anxiety, and involvement in risky behaviors.".
What are the causes of alcohol use disorder?
Alcohol use disorder can affect anyone, regardless of gender, race, or age, and its causes are not precisely understood. Generally, many individuals with alcohol abuse exhibit certain personality traits, such as shyness, loneliness, hostility, and self-destructive impulsivity. In addition, depression and other addictions are common.
Social factors, such as culture and childhood education, which directly impact consumption patterns and behavior after alcohol intake, should also be considered. Genetic factors also play a significant role in the development of the disorder. According to the MSD Manuals, there is evidence that the risk of developing a substance use disorder is 45% to 65% higher due to genetic factors. These individuals may even exhibit greater resistance to intoxication.
Signs and symptoms of the disorder
Typically, frequent alcohol intoxication presents clear, often obvious signs. Even so, it's common for those around the person to identify the problem even before the patient themselves.
A person suffering from alcohol use disorder experiences impairments in their ability to socialize and work, which can result in job loss and weakened or frustrated relationships.
Furthermore, the person becomes more prone to suffering and causing accidents due to intoxication. Injuries, for example, can become increasingly common. The patient may also have problems with the law, being arrested for driving under the influence of alcohol and, in some cases, losing their driver's license.
“Alcohol is directly and indirectly linked to many deaths. We can see alcohol as a factor that increases the chances of a person engaging in risky behaviors such as violence, traffic accidents, and suicidal behavior. So, the impact is enormous,” comments Dr. Renata Rigacci.
Diagnosis of alcohol use disorder
The diagnosis of alcohol use disorder is predominantly clinical and is based on the identification of behaviors related to drinking habits, according to the guidelines established by the Diagnostic and Statistical Manual of Mental Disorders, 5th ed–Text Revision (DSM-5-TR).
The manual considers a diagnosis of alcohol use disorder when the patient exhibits two or more of the following behaviors within a 12-month period:
- Consuming larger quantities of alcohol or for longer periods than initially intended;
- Intense and persistent craving for alcohol;
- Unsuccessful attempts to reduce or control consumption;
- Repeatedly failing to fulfill obligations at work, home, or school due to alcohol use;
- Continuing to consume alcohol despite social or interpersonal problems related to its use;
- Abandoning important social, professional, or recreational activities due to alcohol consumption;
- Using alcohol in situations that involve physical danger;
- Continuing to consume alcohol even when faced with a physical illness or mental disorder caused or aggravated by alcohol;
- Having an alcohol tolerance;
- To experience symptoms of alcohol withdrawal or to consume alcohol because of withdrawal.
Furthermore, it is important for the doctor to be aware of health problems related to alcohol consumption, such as liver diseases, including cirrhosis and other related conditions.
Treatment of alcohol use disorder
Treatment for alcohol use disorder varies depending on the identified risk level and severity of the condition.
“Alcohol use disorder is considered a chronic condition, but it is controllable,” explains Dr. Renata Rigacci. “Therefore, there is a need to personalize this treatment, mainly because there are patients who will not be able to return to contact with the substance. In other cases, it may be that, eventually, they can use it in a more controlled way.”.
At the mildest level of the disorder, when the patient is considered a high-risk drinker, intervention usually begins with raising awareness about the risks of the condition progressing, as well as recommending that alcohol consumption be reduced or stopped.
At the second level, when there are already more significant impairments related to alcohol use, the recommendation is referral for treatment through rehabilitation programs. In these cases, care generally involves a combination of psychotherapy with medical follow-up, in an outpatient rehabilitation setting.
Finally, in cases considered severe, especially when there are associated medical or psychiatric complications, the recommended treatment is inpatient rehabilitation programs, ensuring intensive and multidisciplinary follow-up.
"The goal of treatment is to reduce this suffering and the impacts of this disorder so that the patient and those around them can have a better quality of life," Rigacci emphasizes.
It's important to remember that medication can also be used to treat substance use disorders, provided it's combined with psychotherapy, never used in isolation.
“Currently, we have medication treatment for alcohol use disorder. However, we need to address comorbidities when they are present, because we know that this favors the treatment of the disorder,” he continues. “But we also rely on psychotherapeutic follow-up, changes in habits and lifestyle. Overall, it is a long-term, multidisciplinary treatment, but very effective.”.
Postgraduate studies in Psychiatry
Alcohol use disorder is just one of the issues addressed by Psychiatry. Eating disorders, neurodegenerative diseases, and other mental health conditions are also part of this medical specialty's scope.
In the postgraduate Psychiatry program at São Leopoldo Mandic, students learn through practice, conducting consultations with real patients, selected according to the course curriculum and the content covered in the classroom.
Click here to learn about the postgraduate medical course in Psychiatry at São Leopoldo Mandic.
