Alcohol Use Disorder
According to the National Institute on Alcohol Abuse and Alcoholism, in 2018, an estimated 7.8 percent of American adults aged 18 and older, approximately 20 million people, had a diagnosable alcohol use disorder. Men have alcohol use disorder almost twice as often as women; of the estimated 17 million affected adults, 14.2 million were men and 5.7 million were women. Adolescents are not immune. In 2018, an estimated 955,000 young people between 12-17 years of age had this disorder.
No two individuals who experience alcohol abuse are the same; however, DSM-5 provides clinicians with a set of 11 factors that can guide them in the diagnosis of an alcohol use disorder and its severity grade. In short, if a person has experienced at least two of the 11 factors (or symptoms) in the past year then the person is considered to have an alcohol use disorder. The existence of two or three symptoms equals a diagnosis of mild alcohol use disorder, while four to five symptoms is considered moderate, and six or more is considered severe.
To provide insight into the alcohol use diagnostics process, consider the following sample of four possible symptoms:
Overall, the 11 factors address both the physical and psychological components of alcohol use disorder. The distinction between physical dependence and psychological addiction is an important one to understand. The psychological component of addiction does not refer to the effects alcohol has on one’s mental state, such as disordered thinking. Rather, it refers to how the person’s thoughts and actions become geared toward obtaining alcohol and consuming it, even to the exclusion of important responsibilities.
As the National Institute on Drug Abuse explains, physical dependence is a component of addiction, but it is not synonymous with addiction. In other words, a person can be physically dependent on alcohol or another drug of abuse without being psychologically dependent on it.
There are two main hallmarks of physical dependence. First, the body will build a tolerance, which is a natural process. As tolerance builds, a person who consumes alcohol will require a higher volume in order to experience the familiar effects. Second, the body will go through withdrawal if intake of the familiar drug ceases or if there is a significant reduction in the usual amount. When a chronic alcohol abuser stops drinking the signs of withdrawal will set in. They may continue to drink in order to avoid feeling such symptoms.
Individuals with an alcohol use disorder (alcoholism) will likely experience the symptoms of physical dependence as well as psychological effects.
Alcohol Withdrawal Syndrome (AWS) is a set of symptoms that occur when someone who is physically dependent upon alcohol suddenly stops drinking, drastically reduces their alcohol intake or the person has not had any alcohol within the past 3-4 hours. Signs and symptoms of the various stages of alcohol withdrawal may include:
Alcohol shakes which are also called tremors or jitters, are one of the tell-tale symptoms of alcohol withdrawal. Shakes or tremors commonly affect the hands, but can also be seen in other areas, such as the arms or legs. Tremors can also be an indicator of a withdrawal complication known as delirium tremens DTs), which can present 2-3 days after someone who is dependent on alcohol ends a long and intense drinking binge. DTs can be life-threatening and involves changes in mental status, hallucinations, delusions, and trouble regulating involuntary body functions such as blood pressure, heart rate and body temperature. Alcohol shakes commonly arise 6-8 hours after drinking is stopped, and peaks in 10-30 hours after your last drink. Tremors or shakes are a common sign of alcohol withdrawal but are also warning signs of more serious issues and complications associated with alcohol misuse. It is important to be aware of the dangers of tremors so you can understand when you should seek medical help for alcohol-related shakes.
Thom Kessler, LMFT, RAS
Licensed Marriage & Family Therapist
Registered Addiction Specialist
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Marriage & Family Therapist and Registered Addiction Specialist