Understanding Alcohol Use Disorder: Stigma and Identification

Ty Johnston, PharmD Candidate

“I had to drink so as not to go crazy. It didn’t make me feel good; it didn’t fill me with warmth and good cheer. It had become a dreary necessity.”¹

Do you know someone who seems to be struggling with a drinking problem? Is there someone in your life who drinks so much or so frequently that you question whether you should be concerned? And if so, what do you do to help them? Many of us are no stranger to going out and drinking with friends; social drinking has become a normalised part of society and is often encouraged by people we know. But how do you know when someone is partying too hard? In part one of a two-part series, we shed some light on the stigma behind alcohol addiction, otherwise known as alcohol use disorder, how to identify the problem, and specific steps you can take to help others suffering from this issue. We’ll follow up with part two on the consequences of the disorder and available treatment options. 

Alcohol Addiction

Can you imagine a life where you need a drink first thing in the morning just to feel normal? What if you constantly had a feeling of emptiness inside you that could only be replaced with alcohol? Or what if a loved one was heavily drinking, and you were left dealing with the consequences? Why can’t that person just stop? Can’t they see they’re hurting themselves and those around them?

Well, the solution to this problem isn’t as simple as you may think.  

The media often publicizes addiction to medications like opioids or habits like gambling. However, addiction to alcohol is even more common but not as frequently talked about. Although alcohol is the most commonly abused substance in Canada, alcohol use disorder is typically not recognised simply due to the social acceptance of drinking. To emphasize this point, here are some concerning statistics: in Canada, 34.4% of males and 23.4% of females are heavy drinkers, with 16.6% of people who consume alcohol at a level that puts their long-term health at risk.² So, how do you identify when too much is too much? And what do you do about it?

The Basics of Alcohol Use Disorder

To understand Alcohol Use Disorder (AUD), it’s important to first define addiction. Addiction is a state of being enslaved to something that’s psychologically or physically habit-forming, to an extent where stopping it causes severe harm.³

Alcohol addiction is characterised by the following psychological and physical components:⁴

• Psychological: When someone drinks alcohol, it activates several reward pathways in the brain, mainly those of serotonin and dopamine – meaning alcohol makes you feel good. But over time, overuse of alcohol causes the body to lose the ability to produce this good feeling. The brain chemistry changes in a way that a person only feels normal under the influence of alcohol, and without it, they feel empty. This is why people get craving response without alcohol and become psychologically dependent.
• Physical: When someone has been overusing alcohol for long periods of time, the body becomes physically dependent. Their body has adapted to the presence of alcohol, and abruptly quitting will cause withdrawal symptoms. Alcohol withdrawal can have very serious medical consequences including, seizures, hallucinations, and even death. Medical treatment is required to prevent these complications from occurring. For this reason, it’s difficult and sometimes impossible to go “cold turkey” and quit alcohol abruptly. 

In comparison to other mental illnesses, alcohol dependence has been highly stigmatized with 49-85% of the population attributing the disease to “bad character.”⁴ However, AUD is just as concerning as other forms of addiction, and these stereotypes must be broken to ensure people receive the help and support they need. It’s helpful to think of these situations like this: people with alcohol use disorder are no longer using alcohol for a high; instead, they keep using it to avoid feeling low (to avoid withdrawal). 

Are They Struggling with AUD?

There are 4 questions that are commonly used to detect alcohol dependence or heavy drinking. These questions are part of a medical tool known as the CAGE questionnaire:⁴

• Have you ever felt you should Cut down on your drinking?
• Have other people Annoyed you by criticizing your drinking?
• Have you ever felt Guilty about your drinking?
• Have you ever taken a drink in the morning to steady your nerves or get rid of a hangover? (Known as an Eye-opener)

If a person answers yes to 2 or more of these questions, there is a good chance that drinking is having consequences on their physical and social health. Other questions to ask include:⁵

• Do you drink alone when you feel angry or sad?
• Does your drinking ever make you late for work?
• Does your drinking negatively affect your family?

If a person answers “yes” to any of these questions, it’s possible they have a drinking problem. Note this isn’t always true for every case, for example, many alcoholics don’t drink when they’re alone but do when they’re with different social groups. If you’re unsure of whether alcohol is having detrimental impacts on your life, seek help from a healthcare professional.

What Do I If I Know Someone is Struggling with AUD?

Many people don’t recognize when their drinking habit has become problematic, while others are not ready to get help with their drinking. The most important step to take is for the person to recognize how their drinking is affecting their quality of life and ability to function. Here are some tips on how to talk to someone you’re concerned about:⁶

• Do not make excuses: It’s important to refrain from protecting the person from the consequences of their drinking.
• Timing: The best time to talk is shortly after an alcohol-related problem has occurred, such as an argument or accident. Talk to the person when they are sober, calm, and in private.
• Be specific: Express concern for their well-being and use specific examples of how drinking has previously caused problems.
• Get help: Understand the treatment options available so that you’re prepared if they’re willing to get help from a healthcare professional.
• Avoid judgement and accusation: Remember that it’s a condition which you’re trying to help them overcome.

It’s important to know that there are medical treatments available. We’ll explore the different treatment options in part 2 of the series. Many people will require medication to help them overcome AUD or alcohol withdrawal. Additionally, there are many support programs available for people with AUD and for people impacted by a loved one who has the illness.

The Bottom Line

Alcohol use disorder is a serious medical condition that is underreported and not talked about enough. It’s important to avoid stereotyping people suffering from the illness, but also to recognize common warning signs. AUD impacts not just one person’s life, but the lives of those close to that person. Most importantly, medical and psychiatric help are available to help people overcome the illness.

As always, we hope you took away something valuable from this piece. If you have any questions or concerns regarding this article or others, feel free to reach out to us on Instagram, Facebook, or at ask@orbishealth.ca with your feedback. We’d love to hear from you.

RESOURCES

1. http://www.businessinsider.com/heres-what-its-like-to-be-an-alcoholic-2014-2
2. https://www150.statcan.gc.ca/n1/pub/82-625-x/2017001/article/54861-eng.htm
3. http://www.dictionary.com/browse/addiction
4. DynaMed Plus: Alcohol Use Disorder.  
5. https://pubs.niaaa.nih.gov/publications/handout.htm
6. https://www.psychologytoday.com/ca/conditions/alcohol-use-disorder