The typical pattern of development for an alcohol use disorder begins with someone occasionally using alcohol and then increasing use as a substitution for certain personal needs or as a coping mechanism for stress and other life issues. Because the use of alcohol results in feeling relaxed, being free of inhibitions, and temporarily reduces stress and pain, individuals continue to use it for its reinforcing effects. For some individuals, this use becomes compulsive and results in negative consequences in numerous areas of life. No two people share the exact same experiences, so what contributes to each disorder will vary.
Risk Factors for the Development of an Alcohol Use Disorder
There are a number of different risk factors for the development of an alcohol use disorder. It is important to understand that a risk factor is not something that means the individual will most certainly develop the disorder, but its presence is associated with an increased potential for the person to develop a specific type of disorder. Risk factors are not the direct causes; they are conditions that can influence an outcome to move in a certain direction.
Certain risk factors carry more weight than others, and the presence of more than one risk factor certainly increases the potential to develop an alcohol use disorder.
However, even individuals who have multiple risk factors for developing an alcohol use disorder may not ever develop one.
Major professional organizations, such as the National Institute of Drug Abuse, the American Society of Addiction Medicine, and the American Psychiatric Association, list numerous risk factors that are associated with the development of an alcohol use disorder:
- Heredity: A person’s genetic makeup/background is a strong risk factor for the development of an alcohol use disorder. Individuals who have first-degree relatives with substance use disorders (a first-degree relative is a parent or sibling) are at a higher risk to develop an alcohol use disorder than individuals who do not have this type of family history. The genetic association is not as strong for secondary relatives and so forth; however, even having an uncle, aunt, or cousin with a substance use disorder increases the risk that one will develop an alcohol use disorder.
- Gender: Males are more likely to develop alcohol use disorders than females.
- The presence of another psychological disorder: People who have a formal diagnosis of another psychological/psychiatric disorder are at a higher risk for the development of substance use disorders, particularly alcohol use disorders. The terms dual diagnosis or co-occurring diagnoses refer to individuals diagnosed with some psychological disorder, such as depression, ADHD, or another disorder, and a substance use disorder.
- Stress: Stress describes an individual’s reaction to a particular environmental event or situation. People who have significant stress in their lives are at a higher risk to develop alcohol use disorders. Stressful events can include things like abuse occurring in childhood, family strife in adulthood or childhood, poor parenting, early issues at home, exposure to natural disasters or traumatic events, being the victim of crime, etc.
- Friends: The types of people one associates with, especially during adolescence and young adulthood, can influence the development of an alcohol use disorder.
- Perceived social support: People who believe they are isolated or alone are at a higher risk to develop alcohol use disorders. Is important to note that even though many individuals actually have strong social support groups, the perception that one does not have adequate social support, such as family, friends, etc., is a stronger predictor of the development of a substance use disorder.
- Aggressiveness or deviant behavior: Individuals who have a history of aggression or delinquent behaviors are more likely to develop substance use disorders.
- The age drinking starts: The age at which a person begins using alcohol is related to their potential to develop an alcohol use disorder. Typically, individuals who drink alcohol or even smoke tobacco in childhood or early adolescence have a higher probability of developing an alcohol use disorder.
- Other individual physiological differences: A number of different physiological differences are associated with an increased risk to develop an alcohol use disorder. One example is the notion of an individual tolerance to alcohol. People who naturally need more alcohol to achieve the effects that the majority of people achieve the lower doses are at a higher risk to develop an alcohol use disorder.
- Other demographic variables: Several other demographic factors, such as being in a lower social economic class, living in areas with high rates of drug abuse or high crime, and having parents who condone regular alcohol usage, are associated with increased probabilities to develop an alcohol use disorder.
The Effects of Long-term Alcohol Abuse
Alcohol is a central nervous system depressant that affects every organ in the body when it is chronically abused. There are thousands of books and journals devoted to the long-term effects of alcohol abuse at both the systemic level right down to the cellular level of every system of the human body. Some of the long-term effects of chronic alcohol abuse include:
- Damage to personal and professional relationships
- Chronic isolation and loneliness
- A loss of productivity at work and home
- An increased financial burden due to loss of productivity and limited opportunities
- The potential for physical injuries due to accidents or as a result of intentional acts, such as self-harm or assault from others
- The development of sexual issues, such as impotency
- Increased risk to have children with developmental disabilities, such as fetal alcohol syndrome, ADHD, conduct issues, etc.
- Cardiovascular problems, including increased potential for heart attack and stroke
- Increased potential for serious liver damage
- Increased potential for serious gastrointestinal issues, such as ulcers.
- Increased potential to develop many types of cancers
- Massive nerve damage and permanent damage to the central nervous system (the brain and spinal cord)
- Potential deterioration of emotional and cognitive faculties
- Development of other psychological/psychiatric disorders, such as depression, anxiety disorders, and even psychotic disorders
- Development of physical dependence and addiction
Living with a Functioning Alcoholic
The term functional alcoholic is a misnomer as an individual with an alcohol use disorder is not fully functional. For instance, if there was any way to compare their level of functioning while they are using alcohol to their level of functioning when they have recovered from the alcohol use disorder, it is a safe bet to acknowledge that the person’s overall level of functioning would be improved without using alcohol. Perhaps a better term would be “a high functioning” person with an alcohol use disorder.
There may actually be a relatively high proportion of individuals who appear to be able to negotiate their alcohol use disorder and maintain their occupational and personal responsibilities at a level that is minimally satisfactory. However, the terms functional alcoholic or someone with a substance use disorder who is high functioning are subjective definitions that really have little bearing on the seriousness of the chronic abuse of alcohol in anyone.
Individuals with alcohol use disorders who are relatively high functioning are most likely not going to admit that they have an issue with alcohol, and they are more likely to rationalize their use as something they need in order to function. However, anyone who chronically drinks large amounts of alcohol will experience ramifications of the alcohol use. Loved ones of people who have alcohol use disorders often grapple with codependency. Being codependent is not a clinical term, but it does describe a situation where a person has an excessive reliance on an individual who has some type of disorder or illness. The loved one becomes enmeshed in the relationship with the person with the disorder and begins to rationalize concerning aspects of that person’s disorder in order to excuse it, feed into the person’s behavior, and even contribute to it.
Individuals who may believe that they are enmeshed in a relationship with someone who has an alcohol use disorder may wish to investigate organizations like Co-Dependents Anonymous or Al-Anon, and compare their experiences with others who are involved in these types of relationships.
These groups can provide excellent support for individuals who are in relationships with people who have substance use disorders, offer advice on how to recognize and understand aspects of their relationships, and provide references for professional help. It is also helpful to understand how many individuals with alcohol use disorders are able to cover up various aspects of their dysfunctional behavior.
The so-called symptoms of codependency are so general that they cannot be defined as an actual clinical syndrome; however, there may be some utility in trying to understand the notion of feeding into someone’s disorder and becoming part of the problem. According to the book Understanding the High Functioning Alcoholic, high-functioning individuals with alcohol use disorders may exhibit the following:
- They tend to restrict their drinking to specific times or situations. This situation fosters the illusion that they are in control of their drinking; however, they are not. Restricting abuse of alcohol to specific times or days may still be alcohol abuse, depending on how the drinking affects the person’s life.
- They often ask family or friends to cover up for them when they have issues as a result of their alcohol use, such as not going to work because of a hangover, being unable to pay bills when too much is spent on alcohol, etc. They are able to draw others in and rationalize the dysfunctional aspects of their alcohol use disorder. This fosters the illusion that these behaviors are just “normal” for them.
- Despite being labeled as “high functioning,” they still break personal commitments and shrug off responsibilities because of drinking. However, they are able to draw others into this notion and avoid personally accepting the consequences for the behavior. They defuse responsibility for their own dysfunctional behavior and draw family members and others into their disorder. The situation creates a toxic relationship and results in everyone involve rationalizing the behavior.
- Many still struggle with issues like depression, anxiety, or another psychological disorder even though they have convinced others that these issues are normal for them. This situation contributes to the toxic relationship, and other members of the family begin doing the same thing. The relationship becomes one of deceit, cover-ups, and resentment, but the behavior is still rationalized.
- Spouses and other relatives who become part of the toxic relationship begin to feel responsible for the person with the alcohol use disorder. Everyone involved attempts to control others and manipulate them to maintain an outward appearance of a functional family unit, whereas in reality, this is simply an allusion.
- These individuals often withdraw or isolate themselves from others. When they are not working or attending to family commitments, they often spend time alone drinking. They are able to convince others that this is “normal” for them.
The only long-term solution to this issue is to recognize the situation for what it is and get everyone into some type of treatment program. When an individual has a substance use disorder, and the family system is dysfunctional and enmeshed in a web of dysfunctional relationships, these issues will not resolve by themselves. It is not unusual for this type of toxic situation to linger for years. It is highly recommended that anyone who suspects an issue with alcohol abuse seek consultation with a licensed mental health professional to ascertain the extent of the issue, decide if the issue requires a treatment intervention, and then follow through with the results of the professional assessment.