Erasing the Stigma: Alcohol Addiction is a Mental Health Disorder
By Aleena Kuriakose
Alcohol use disorder (AUD) is one of the most stigmatized mental disorders.
AUD is recognized as a disease, and more specifically, a mental illness.
Although there is no set cure, AUD can be treated and alleviated through professional care, support groups, and therapy.
Alcohol addiction, also referred to as alcohol dependence, is one of the most severely stigmatized mental disorders. Stigma surrounding substance abuse creates barriers to accessing essential care for individuals and their families. Many of the stigmas associated with alcoholism include linking people to characteristics such as laziness, lack of willpower, failure, violent tendencies, argumentative behaviors, and irresponsibility. A study conducted in 2014 examined whether stances toward alcohol dependence and affected individuals changed between 1990 and 2011 (Schomerus et al., 2014). Unfortunately, negative stereotypes persisted over the two decades as 55% of respondents agreed that alcohol dependence is an illness like any other, more than 40% stated that the condition was a sign of weakness, and 30% accepted that victims of alcoholism are to blame themselves for their problems (Schomerus et al., 2014). The study’s results demonstrate how promoting the illness concept of alcoholism was not easy and was ineffective in eliminating these detrimental stereotypes of alcoholism. This article aims to clarify what alcohol use disorder is, its causes, and suggestions for treatment, in the hope of erasing the stigma surrounding this mental illness.
What is Alcohol Use Disorder?
Alcohol use disorder (AUD) is a chronic disease characterized by uncontrolled drinking and preoccupation with alcohol. It is an inability to control drinking due to both a physical and emotional dependence on alcohol. According to the American Psychiatric Association, AUD is a mental disorder in which the drug causes long-term changes in brain function and is classified by the Diagnostic and Statistical Manual of Mental Disorders as a psychological condition. Overall, it is a complex disease with psychological, biological, and social aspects. Like many other chronic illnesses, addiction involves cycles of relapse and remission.
Why do some people become addicted to alcohol or other drugs while other people don't?
Some people can drink alcohol, and at times over-indulge, but have no problem. However, for others, the first drink can turn a person’s drinking into mild, moderate, or severe AUD. The explanation for this disparity is complex because multiple risk factors have to be considered including age, genetics, biology, environment and social influences, but most significantly, our brain’s reward center. Simply put, when people do activities they enjoy, such as listening to their favorite music or eating tasty food activates the brain’s reward center by releasing dopamine - a “feel good” chemical that urges an individual to repeat that certain activity. Consequently, those who are genetically vulnerable to certain mental health disorders like AUD possess lower levels of dopamine in their brains. And so it is important to understand that these biological differences in brain chemistry are genetic and not a person’s choices.
In terms of AUD, research shows that when victims of AUD drink, their brain reward centers are flooded with alcohol or drug induced dopamine, which “teaches” the brain to constantly seek to the point where it can no longer distinguish what is healthy and what is harmful for a person’s health.
According to the National Institute on Drug Abuse, “This is why a person who misuses drugs eventually feels flat, without motivation, lifeless and/or depressed, and is unable to enjoy things that were previously pleasurable. The person needs to keep taking drugs to experience even a normal level of reward—which only makes the problem worse, a vicious cycle."
Alcoholism is Recognized as a Disease
Since 1956, the American Medical Association (AMA) has recognized alcoholism as a disease indicated by compulsive decision-making, impulsive behavior, and relapse. The AMA’s basis for alcoholism is based on the following criteria:
Biological in nature (illness exists in and of itself)
Does not go away or heal on its own
Exhibits observable signs or symptoms
Is progressive (can get worse—even fatal—if left untreated)
Has a predictable timeline of development and recovery
How is Alcoholism a Mental Health Disorder?
According to a definition by the American Society of Addiction Medicine (ASAM), "Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors." Similar to depression and other mental illnesses, addiction is a true medical disorder that stems from brain changes, yet is so much more complex.
Symptoms and Treatment
Symptoms of AUD include:
Being unable to limit the amount of alcohol you drink
Wanting to cut down on how much you drink or making unsuccessful attempts to do so
Spending a lot of time drinking, getting alcohol or recovering from alcohol use
Feeling a strong craving or urge to drink alcohol
Failing to fulfill major obligations at work, school or home due to repeated alcohol use
Continuing to drink alcohol even though it is causing physical, social or interpersonal problems
Giving up or reducing social and work activities and hobbies
Using alcohol in situations where it's not safe, such as when driving or swimming
Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount
Experiencing withdrawal symptoms — such as nausea, sweating and shaking — when you don't drink, or drinking to avoid these symptoms
Treatment for AUD includes:
Detox and withdrawal: Treatment may start with a detoxification program or detox, which generally takes two to seven days. Sedating medications may be required to prevent withdrawal symptoms. Detox is usually conducted at an inpatient treatment center or at a hospital.
Learning skills and establishing a treatment plan: This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center.
Psychological counseling: Counseling and therapy for groups and individuals help gain a better understanding of the problem with alcohol and support recovery from the psychological aspects of alcohol use.
Oral medications: Disulfiram (Antabuse) is a drug that may help prevent you from drinking, although it won't cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Naltrexone, a drug that blocks the “good feelings” alcohol induces, may prevent heavy drinking and reduce the desire to drink. Acamprosate may help you combat alcohol cravings once you stop drinking. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick after taking a drink.
Injected medication: Vivitrol, a version of the drug naltrexone, is injected once a month by a healthcare professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol use disorder to use consistently.
Continuing support: Aftercare programs and support groups help people recovering from AUD to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group.
Treatment for psychological problems: AUD commonly concurs with other mental health disorders such as anxiety or depression. If this is the case, you may need talk therapy (psychotherapy), medications or other treatment.
Spiritual Practice: People who are involved with a type of regular spiritual practice may find it easier to maintain recovery from AUD or other addictions.
Diagnosing, addressing, and treating AUD is crucial for an individual’s physical, emotional, and spiritual health. If not diagnosed and treated properly, there can be severe health consequences including liver disease, digestive problems, heart problems, diabetes complications, menstruation issues, eye issues, birth defects, bone damage, neurological complications, weakened immune system, increased risk of cancer, medication and alcohol interactions. However, if negative stereotypes and stigma exist surrounding AUD, they may pose a barrier for a person who is struggling and in dire need of professional support and treatment. Therefore, take the time to spread awareness of how AUD is a mental health disorder and those suffering should be loved, supported, and professionally treated.
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Hazelden Betty Ford Foundation. (n.d.). Is alcoholism a mental illness? Hazelden Betty Ford. https://www.hazeldenbettyford.org/articles/why-is-alcoholism-classified-as-a-mental-illness.
Mayo Clinic Staff. (2018, July 11). Alcohol use disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/diagnosis-treatment/drc-20369250.
Schomerus, G., Matschinger, H., & Angermeyer, M. C. (2014). Attitudes towards alcohol dependence and Affected individuals: Persistence of negative stereotypes and Illness beliefs between 1990 and 2011. European Addiction Research, 20(6), 293–299. https://doi.org/10.1159/000362407