Author: James Anderson

Alcohol Use Disorder: What It Is, Risks & Treatment

Alcohol-use disorder1 (AUD) is the most common co-occurring disorder in people with severe mental illnesses, such as schizophrenia and bipolar disorder. This article reviews several aspects of AUD among mentally ill patients—prevalence and etiology, clinical correlates, course and outcome, assessment, and treatment—emphasizing practical clinical implications within each of these categories. Rather than thinking in terms of cause-and-effect, it’s helpful to view the co-occurring nature of these conditions. Mental illnesses can contribute to substance use disorders, and substance use disorders can contribute to the development of mental illnesses. For example, individuals might drink because they’re depressed (to alleviate symptoms of mental health disorders).

The organization updated the terminology again in 2013 to “alcohol use disorder,” which fits under the umbrella of substance use disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR). When this reward system is disrupted by substance misuse or addiction, it can result in the person getting less and less enjoyment from other areas of life when they are not drinking or using drugs, according to the Surgeon General’s report. PTSD may facilitate development of AUD, as alcohol is commonly used to numb memories of a traumatic event or to cope with symptoms of posttraumatic stress, and AUD may increase the likelihood of PTSD.29 The relationship between PTSD and AUD may have multiple causal pathways. First, heavy alcohol use may increase the likelihood of suffering traumatic events, such as violence and assault. Second, AUD may undermine a person’s psychological mechanisms to cope with traumatic events, by disrupting arousal, sleep, and cognition, thus increasing the likelihood of developing PTSD. Third, AUD and PTSD have shared risk factors, such as prior depressive symptoms and significant adverse childhood events.

Medical Professionals

Hosted by Amy Morin, LCSW, this episode of The Verywell Mind Podcast shares strategies for coping with alcohol cravings and other addictions, featuring addiction specialist John Umhau, MD. This is an example of a mental obsession – a thought process over which you have no control. Contributors to this article for the NIAAA Core Resource on Alcohol include the writers for the full article, reviewers, and editorial staff.

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2. For example, alcohol-abusing patients with mental disorders also are prone to abuse other potentially more toxic drugs, to be noncompliant with medications, and to live in stressful circumstances without strong support networks (Drake et al. 1989).
3. Failure to detect AOD abuse in psychiatric settings can result in mis-diagnosis; overtreatment of psychiatric syndromes with medications; neglect of appropriate interventions, such as detoxification, AOD education, and AOD abuse counseling; and inappropriate treatment planning.
4. This is of particular concern when you’re taking certain medications that also depress the brain’s function.
5. For example, ECA study participants with schizophrenia and AUD who attained abstinence had decreased rates of depression and hospitalization at 1-year followup (Cuffel 1996).

In addition to co-occurring disorders, alcohol and substance use can cause specific mental health disorders. These disorders meet the criteria of mental health disorders but are specifically attributed to alcohol and substance use. Conversely, dually diagnosed patients who achieve abstinence appear to experience better prognoses and more positive adjustment, including improved psychiatric symptoms and decreased rates of hospitalization. For example, ECA study participants with schizophrenia and AUD who attained abstinence had decreased rates of depression and hospitalization at 1-year followup (Cuffel 1996). These optimistic findings have fueled attempts to develop more effective AUD interventions among psychiatric patients (see the section “Treatment”). If you think you might have a problem with alcohol, call SAMHSA or talk to your healthcare provider.

Treatment Planning

In earlier versions of the DSM, alcoholism was categorized as a subset of personality disorders. Alcohol misuse may cause new mental health symptoms, worsen existing symptoms, and in some cases lead to the development of alcohol-induced mental health disorders. For historical reasons, the mental health and AOD-abuse treatment systems in the United States are quite separate. Despite attempts to link the two treatment systems in traditional approaches to the care of patients with dual diagnoses, poor coordination between the systems may act as a treatment barrier for these patients (Osher and Drake 1996; Ridgely et al. 1987). Multiple tools are available that detect the majority of mentally ill people who abuse alcohol.

Like depression and other mental illnesses, addiction is a very real medical disorder that is rooted in brain changes—but the condition is so much more complex than that. The connection between mental health and substance use disorders is complex. It is even more complicated during stages of alcohol withdrawal when symptoms of anxiety and depression are present regardless of whether you have a diagnosis of anxiety or depression. Recognizing alcohol use disorder as a mental health condition facilitates more empathetic and effective treatment, including therapy and group support. It involves heavy or frequent alcohol drinking even when it causes problems, emotional distress or physical harm. A combination of medications, behavioral therapy and support can help you or a loved one recover.

For example, in a recent study in New Hampshire, clients moved steadily through the stages of engagement, persuasion, active treatment, and relapse prevention, and approximately 50 percent of them achieved abstinence after 3 years of treatment (Mueser et al. 1996). Much of our current knowledge of homeless adults with dual disorders comes from National Institute on Alcohol Abuse and Alcoholism initiatives funded by the Stewart B. McKinney Act (Huebner et al. 1993). These initiatives include a 3-year, 14-project demonstration to develop, implement, and evaluate interventions for homeless adults with AOD-related problems. Two of the projects specifically have targeted homeless people with co-occurring severe mental illnesses and AOD-use disorders. Most programs integrating mental health and AOD treatment provide services on a long-term, outpatient basis in the community and attempt to minimize the time spent in inpatient, detoxification, or residential settings. Community-based treatment is emphasized because skills acquired by severely mentally ill patients in one setting (e.g., in a clinic) often fail to generalize to other settings (e.g., everyday life in the community).

Thus, a premium is placed on working with patients in their natural environments. Inpatient and outpatient services must be coordinated, however, in order to maximize long-term treatment gains. Data regarding the course and outcome of co-occurring mental illness and AUD are accumulating rapidly. For example, outpatients with schizophrenia and co-occurring AUD had twice the rate of hospitalization during 1-year followup compared with patients with only schizophrenia (Drake et al. 1989). Fewer studies have been conducted on the long-term outcomes (i.e., results more than 1 year later), but findings tend to show persistent AUD and poor adjustment (Drake et al. 1996a; Kozaric-Kovacic et al. 1995). Alcohol use disorder (AUD) often co-occurs with other mental health disorders, either simultaneously or sequentially.1 The prevalence of anxiety, depression, and other psychiatric disorders is much higher among persons with AUD compared to the general population.

But as you continue to drink, you become drowsy and have less control over your actions. It is also not uncommon for providers to conduct a reevaluation once you have maintained sobriety. This allows symptoms that can solely be attributed to your alcohol use to resolve so that your clinician can evaluate remaining symptoms without the interference of alcohol. CBT works by helping you explore how your thought patterns affect your reactions and behaviors so you can learn new ways of responding to emotions. As far back as 1933, the Standard Classified Nomenclature of Diseases listed alcoholism as a disease. Both the American Medical Association (AMA) and APA approved this classification.

Alcohol Use Disorder

Alcohol-use disorders (AUD’s) commonly occur in people with other severe mental illnesses, such as schizophrenia or bipolar disorder, and can exacerbate their psychiatric, medical, and family problems. Therefore, to improve detection of alcohol-related problems, establish correct AUD diagnoses, and develop appropriate treatment plans, it is important to thoroughly assess severely mentally ill patients for alcohol and other drug abuse. Several recent studies have indicated that integrated treatment approaches that combine AUD and mental health interventions in comprehensive, long-term, and stagewise programs may be most effective for these clients.

For example, because the brain can’t produce the same “high” as alcohol naturally, a person may experience depressive symptoms when they don’t feel as much pleasure from normal activities as they did before using alcohol chronically. You can search for an empathetic mental health professional using our Healthline FindCare tool to get more information and help finding the right treatment for you. AUD makes it harder to process thoughts and regulate emotions and behaviors, leading to mental, physical, and emotional symptoms. As a result, AUD creates many obstacles and frustrations in day-to-day life.

You also can screen for depression, anxiety, PTSD, and other substance use disorders using a number of brief, psychometrically validated screening tools, which are described in a 2018 systematic review5 and which may be available in your electronic health record system. As needed, you can refer to a mental health specialist for a complete assessment. Approximately 50 percent of clients with severe mental illnesses, such as schizophrenia and bipolar disorder, who are in community mental health settings develop AOD-use disorders during their lifetime.

It’s a disease of brain function and requires medical and psychological treatments to control it. However, alcoholism has been recognized for many years by professional medical organizations as a primary, chronic, progressive, and sometimes fatal disease. The National Council on Alcoholism and Drug Dependence offers a detailed and complete definition of alcoholism, but the most simple way to describe it is a mental obsession causing a physical compulsion to drink. Some clinical features of AUD may also precipitate sleep disorders, such as a preoccupation with obtaining alcohol and AUD-related psychosocial stressors.