Your brain becomes “wired” to drink.
Alcohol is one of the most commonly used substances. While health experts define safe and moderate drinking as no more than two drinks per day for men and one drink per day for women, many people in the United States exceed these recommendations. Where does it cross the line to alcohol use disorder?
Drinking too much alcohol is concerning, and there are many negative health effects of binge-drinking, but this itself does not qualify for alcohol use disorder, or AUD.
“A lot of people will use substances. They'll drink, they'll smoke weed, or whatever, and they'll be able to self-regulate. They'll be able to stop. It won't be something that takes a prominent role in their life,” says Jonathan Avery, MD, director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital.
AUD is defined as a brain disease associated with compulsive use of alcohol, loss of control over intake, and negative effects when not drinking, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). About 15 million people in the U.S. live with AUD, making it the most common substance use disorder in the country.
The Effects of Alcohol Use Disorder
There are a lot of misconceptions and stigmas surrounding AUD—and substance use disorders in general—but it’s important to remember that AUD is a brain disease that requires professional treatment.
“What's happening, really, when one's using alcohol or any substances chronically, is that you need it to sleep or not feel anxious just because it's become a part of your brain,” says Dr. Avery. “Drinking or using substances becomes the answer to [everything] because your brain is sort of wired in that direction.”
The effect on the brain is “cruel,” according to Dr. Avery: “Your brain is motivating you to drink, and then alcohol impairs your cognition, lowers your IQ, lowers your ability to think well.”
One of the defining features of AUD is that it impairs the life of the patient—their work life, their relationships, their finances, and so on. These things can be more obvious to the patient, as they struggle to keep a job or a healthy relationship.
While that’s going on, the body is silently suffering from the damage of alcohol. “The body's not meant to metabolize those levels of alcohol in an ongoing way, and so the liver suffers, the stomach suffers, the esophagus suffers, really all organ systems,” says Dr. Avery. “It's a poison, and for those that are drinking in an ongoing way, it poisons everything.”
Getting Treatment for Alcohol Use Disorder
Unfortunately, many people do not seek help for AUD until it’s forced upon them after something tragic happens, such as a car accident while intoxicated, a lost job, a divorce, or a health complication.
“You want to intervene early, when you're thinking, ‘Hey, maybe I'm drinking too much to medicate sleep or anxiety, or I should listen to my significant other or family when they're saying I'm drinking too much,’” says Dr. Avery. “You want to be the captain of your ship and make these changes before you're forced to.”
Dr. Avery is the director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital.
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A lot of people will use substances.
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They'll drink, they'll smoke weed, or whatever,
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and they'll be able to self-regulate.
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They'll be able to stop.
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It won't be something that takes a prominent role in their life.
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Certain folks, though, either from genetic predispositions
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or from having co-occurring mental health issues or trauma,
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they'll start using a substance and then find it very hard
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to curb their use over time, and once it starts impairing
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your function, that's when you have an addiction.
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What's happening, really, when one's using alcohol
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or any substances chronically,
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is that you need it to sleep or not feel anxious
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just because it's become a part of your brain,
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and the way that plays out is that drinking or using substances
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becomes the answer to every question
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because your brain's sort of wired in that direction.
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What to do after school, after work.
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What to do when you're feeling anxious, bored,
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want to have fun, and you lose that menu of options
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of things that you can do,
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and with your brain tricking you in that direction,
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the rest of your body can't keep up
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because the body's not meant to metabolize those levels
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of alcohol in an ongoing way and so the liver suffers,
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the stomach suffers, the esophagus suffers,
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really all organ systems. Alcohol is such a dirty drug.
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And then in a cruel way, your brain's motivating you to drink,
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and then alcohol impairs your cognition, lowers IQ,
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lowers your ability to think well.
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And so it's a poison, and for those that are drinking
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in an ongoing way, it poisons everything.
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The good news for anyone that's developed
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an alcohol use disorder or substance use disorder
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is that you can change behavior, and you want
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to change behavior before you develop the physical,
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emotional consequences that mandate change.
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And so, you know, I work here in the hospital
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and unfortunately I'm seeing a lot of people who have
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to make changes because their liver is failing
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or they're having brain consequences from chronic alcohol use,
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and you don't want to be at that point.
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And so you want to intervene early, when you're thinking,
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hey, maybe I'm drinking too much to medicate sleep or anxiety,
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or I should listen to my significant other or family
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when they're saying I'm drinking too much,
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because what happens often is that external events
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or physical events cause you to change, and you don't want that
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to be the thing that causes you to change.
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You want to be the captain of your ship
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and make these changes before you're forced to.
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But it's also important to intervene early so you can learn
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to live life without it, to learn to cope,
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and part of the process in early recovery,
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part of the process in adolescence for all of us, really,
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is to figure out how it's okay to be us.
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How we can be okay in our own skin and function in social
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and work settings without relying on substances
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and other things to get us through.
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And if you can answer that question, how can I be okay
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being me, then you can answer that question of how I can
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stay away from substances and how my life can be better.
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Alcohol and drug abuse statistics. American Addiction Centers, 2020. (Accessed on April 17, 2020 at https://americanaddictioncenters.org/rehab-guide/addiction-statistics.)
Alcohol use disorder. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism. (Accessed on April 17, 2020 at https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders.)Risky drinking and alcohol use disorder: epidemiology, pathogenesis, clinical manifestations, course, assessment,and diagnosis. Waltham, MA: UpToDate, 2020. (Accessed on April 17, 2020 at https://www.uptodate.com/contents/risky-drinking-and-alcohol-use-disorder-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis.)