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DSM-5 Psychiatric Disorder: Alcoholism
Table of Contents
DSM-5 Psychiatric Disorder: Alcoholism
Many people drink alcohol as a way to relax or to celebrate a special occasion. However, people with alcohol use disorders drink excessively, endangering both themselves and others. According to the American Psychological Association, alcoholism is defined as an addiction to the consumption of alcoholic liquor or the mental illness and compulsive behavior resulting from alcohol dependency (APA, 2018). Alcohol is a central nervous system depressant that reduces anxiety, inhibition, and feelings of guilt (APA, 2018). It lowers alertness and impairs perception, judgment, and motor coordination. In high doses, it can also cause loss of consciousness and even death (APA, 2018). Alcohol is a legal drug but one that carries a significant risk of both physical and psychological addiction.
Alcoholism is a disease characterized by the habitual intake of alcohol to the degree that it obstructs physical or mental health (APA, 2018). People diagnosed with alcoholism are dependent on the substance meaning that they have lost responsible control over their usage. Alcohol-dependent people are unable to stop drinking once they begin. Alcohol dependence is characterized by a term called tolerance, which refers to the need to drink more to achieve the same “high” and withdrawal symptoms if suddenly stopped (APA, 2018). Physical withdrawal symptoms include nausea, sweating, restlessness, irritability, tremors, hallucinations and convulsions (NIAA, n.d.).
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The most signs and symptoms of alcohol abuse are poor coordination, slurred speech, impaired thinking, and memory impairment (NIAA, n.d.). According to the National Institute on Alcohol Abuse and Alcoholism, psychological and behavioral symptoms of alcoholism come in the form of several warning signs (NIAA, n.d.). Some of these signs include drinking longer or more than one intends to, trying to cut back on intake but unable to, and wanting alcohol so badly they cannot think of anything else (NIAA, n.d.). Other warning signs include having problems with work, school, or family because of their habit and continuing to drink even though it has damaged relationships. The user may have scarified activities that were once important to them in order to drink. They may continue to drink even though it makes the individual depressed or anxious, hurts their health, or often leads to memory blackouts. They may find themselves having to drink more than they used to in order to get the effect they want or found that they experienced the aforementioned withdrawal symptoms when the buzz wore off (nausea, sweating, restlessness, irritability, tremors, hallucinations and convulsions) (NIAA, n.d.).
Diagnosis occurs when an individual meets the specific criteria outlined in the DSM-5. Exhibit A depicts an evaluation criteria form that is used to classify alcohol use disorder as either mild, moderate, or severe (Exhibit A). Here are the 11 criteria listed in the DSM-5 (NIAA, n.d.):
- Feeling powerless to control one’s level of alcohol use
- Declining to engage in social activities or hobbies that used to be of interest
- Having a desire to stop or decrease drinking but being unable to do so
- Using alcohol in high-risk situations, such as while swimming or driving
- Devoting significant time and resources to drinking
- Developing a tolerance for alcohol (e.g., needing more alcohol over time to match the feelings from earlier use)
- Experiencing cravings for alcohol when not drinking
- Experiencing withdrawal symptoms when not drinking (e.g., cravings, sweating, shaking, and nausea)
- Facing problems at work, home, or school because of alcohol use
- In reaction to the discomfort associated with withdrawal, having to drink to feel better
- Continuing to use alcohol even when it is leading to social, physical, relationship, and personal problems
Alcohol use disorder defined by DSM-5 criteria is a highly prevalent and disabling disorder that often goes untreated in the United States. There is an overwhelming amount of statistics that demonstrate the significance of this disease. According to the National Institute on Alcohol Abuse and Alcoholism, 15.1 million adults ages 18 and older have an alcohol use disorder (NIAA, n.d.). About 6.7 percent of adults who had an alcohol use disorder in the past year received treatment. An estimated 623,000 adolescents ages 12–17 have an alcohol use disorder. About 5.2 percent of youth who have an alcohol use disorder in the past year received treatment (NIAA, n.d.).
There are four main factors that contribute to the causes of alcoholism: psychological, social, genetic, and physiological (NIAA, n.d.). It is important to note that not every alcoholic is equally affected by each factor.
An individual’s psychological characteristics can provoke irresponsible drinking habits, such as impulsiveness, low self-esteem, and the need for social acceptance (NIAA, n.d.). Some individuals drink to cope with or self-medicate emotional problems. Social and environmental factors such as peer pressure and how easily accessible the alcohol is can also make an individual vulnerable to alcoholism (NIAA, n.d.).
Many people wonder why some individuals can use alcohol without problems while others cannot. The answer to this lies in genetics. Genetic predisposition make can cause increased risk of developing alcohol dependence. Scientific research supports that having an alcoholic family member increases your chances of developing alcoholism (NIAA, n.d.). Environmental factors subjective to the individual, such as living conditions, peer pressure, and the accessibility of alcohol determine if a person with genetic predisposition ever develop the disease (NIAA, n.d.). Heavy drinking can cause physiological changes that often make staying under the influence the only way to avoid discomfort. Individuals with alcohol dependence sometimes continue to drink to reduce or avoid withdrawal symptoms (NIAA, n.d.).
It is impossible to treat alcohol dependence in patients who continue to use alcohol. In order to work towards achieving sobriety, the patient must be detoxified, which is the process of riding the body of the substance (APA, 2018). It is only then that any meaningful or effective therapy can begin in order to treat other emotional problems (APA, 2018). According to the American Psychological Association, lack of motivation to seek treatment, strong denial, severe impairment, and insufficient psychosocial support are strong indicators that a patient needs detoxification. If the individual’s living situation encourages chronic substance abuse or the risk of dangerous withdrawal symptoms, or if the patient suffers from a coexisting medical or psychiatric illness, professional detoxification is crucial in addition close psychiatric monitoring (APA, 2018).
Alcohol withdrawal causes many medical complications which makes a complete physical examination with laboratory tests vital to treatment. Special attention to the liver and nervous system is taken (APA, 2018). Patients withdrawing from alcohol who exhibit violent withdrawal symptoms should receive a benzodiazepine (such as chlordiazepoxide or diazepam). A high-calorie, high-carbohydrate diet supplemented by multivitamins is important. To treat dehydration, patients are administered fluids either orally or intravenously. The need for encouraging verbal support is imperative in the treatment of severe alcohol withdrawal (APA, 2018). Verbal support is important for patients who are experiencing severe withdrawal since they are often very confused and frightened (APA, 2018).
Rehabilitation is a form of treatment that combines both medical and psychological components. A person is likely to successfully complete an alcohol rehabilitation program if he or she is following an addiction treatment plan that is based on their individual wants and needs (Azrin, Godley, & Sisson, 1982). These care plans are usually created by addiction specialists based on an assessment as well as the patient’s personal input (Azrin et al., 1982). The duration and commitment to the rehabilitation treatment program for alcohol increases the patient’s chances of achieving long-term sobriety.
Addiction relapse is common and should be dealt with in a nonjudgmental manner. Alcohol abuse requires long-term commitment to therapy and upon use, detoxification should be arranged immediately. In order to avoid relapse, patients should commit to a support program, such as Alcoholics Anonymous (AA).
Alcoholics Anonymous is a fellowship of men and women who have battled alcohol use disorder. AA’s Twelve Steps are “a group of principles, spiritual in their nature, which, if practiced as a way of life, can expel the desire to drink and enable the sufferer to become sober” (SAA, n.d., p. 1). Among the many ways that participation in Alcoholics Anonymous (AA) helps its members stay sober, spending more time with individuals who support efforts toward sobriety and increased confidence in the ability to maintain abstinence in social situations in the program’s most important strategy. According to the Addiction Journal, researchers reported that AA plays an important role in order to achieve a successful recovery with regard to the behavior changes associated with maintaining sobriety (SSA, n.d.).
Perhaps the most important way an alcoholic can achieve and maintain sobriety is by finding a purpose. Alcoholics often have personal issues in life that prompt their initial drinking habits that lead to addiction. When they become sober, it is important that they have strong coping strategies (SSA, n.d.). Failure to develop effective coping strategies that control the individual’s daily stress levels could cause relapse. There is never any guarantee that an alcoholic will have another shot at recovery, so all efforts need to be made to prevent relapse (SSA, n.d.).
Alcoholism is an addictive and destructive disease that does not have any definitive treatment. It is extremely challenging for an alcoholic to admit that they have a problem and begin the treatment process. Although the statistics in regard to people affected by alcoholism are staggering, there is hope for sobriety. It is crucial to identify the warning signs of alcoholism and treat them as early as possible. While there is no cure for alcoholism, there are endless resources for those struggling with addiction.
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