Understanding the Stages of Alcohol Use Disorder: Causes and Treatment

Alcohol use disorder (AUD) is one of the leading public health challenges in the United States. The 2021 National Survey on Drug Use and Health found that 29.5 million people ages 12 and older had AUD in the previous year. 

This is an alarming number, considering AUD’s negative impact on our physical and emotional well-being. To understand how to treat or prevent this condition, let’s first consider what causes AUD and explore the three stages of alcohol use disorder. With this solid foundation, we can safeguard our health and ultimately, thrive. 

What Is Alcohol Use Disorder (AUD)?  

Alcohol use disorder (AUD) is more than just a challenge in controlling alcohol consumption; it's a serious and nuanced medical condition. At its core, AUD is defined by a persistent pattern of alcohol use that results in significant impairment or distress. This condition goes beyond the occasional overindulgence, marking a profound and often detrimental impact on a person's life, affecting their social interactions, work responsibilities, and overall health.

What Causes AUD?

Various factors, such as genetic predisposition, environmental influences, and changes in brain chemistry all influence AUD. Research suggests that certain genes may increase a person’s susceptibility to developing AUD. Environmental factors, such as stress, peer pressure, and the availability of alcohol, also contribute significantly to its onset and progression.

At the neurological level, alcohol consumption increases dopamine levels. Dopamine, known as the “feel-good” neurotransmitter, plays a major role in the brain's reward system. This dopamine release creates a sense of pleasure and euphoria, reinforcing alcohol use and urging us to drink more despite negative consequences. Over time, our brain adapts to these elevated dopamine levels, leading to tolerance — a need for increased amounts of alcohol to achieve the same effect.

Another key neurotransmitter that alcohol affects is gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the brain. Alcohol enhances the inhibitory effects of GABA, leading to relaxation and sedation. However, chronic alcohol use disrupts this balance, affecting neural pathways and potentially leading to dependency. As our brain becomes accustomed to alcohol’s presence, withdrawal symptoms emerge in its absence, further complicating the addiction cycle.

In understanding AUD, it's critical to recognize that this condition is not a matter of lack of willpower or moral failing. It's a serious medical issue requiring a compassionate, multifaceted approach to treatment, encompassing medical intervention, psychological support, and lifestyle modifications. As our understanding of AUD deepens, so does our ability to provide more effective and targeted interventions, offering hope and support to those affected by this complex disorder.

Is Alcohol Use Disorder a Disease?

Classifying alcohol use disorder (AUD) as a disease is pivotal for both its understanding and management. This categorization aligns AUD with other chronic conditions such as diabetes or heart disease, underscoring its seriousness and the necessity for systematic, ongoing care. AUD is characterized by significant disruptions in brain function, particularly in how the brain regulates pleasure, stress, and decision-making. This disruption is not just a temporary concern; it often results in long-lasting changes to brain structure and function, similar to how chronic diseases can permanently affect other organs.

The disease model of AUD also shifts the perspective from a moral failing or lack of willpower, as discussed above, to a medical condition that requires treatment and compassion. It plays a vital role in reducing the stigma associated with AUD, encouraging people to seek help and adhere to treatment plans, much like they would for any other chronic disease.

The 3 Stages of Alcohol Use Disorder

Alcohol use disorder (AUD) is not a static condition. It instead evolves through various stages, each with its own characteristics and challenges. Understanding these stages provides insight into the progression of the disorder and guides effective intervention strategies.

• Early stage. This initial phase is often marked by patterns of binge drinking or an increased tolerance to alcohol. People in this stage may not drink daily, but when they do, they consume large amounts, often exceeding social drinking norms. The increase in tolerance — needing more alcohol to feel its effects — is a key indicator of the brain adapting to the alcohol's presence. At this stage, the impact on daily life may be less noticeable, with people maintaining their social and occupational responsibilities. However, the seeds of dependency are often sown during this phase.
• Middle stage. As AUD progresses to the middle stage, patterns of regular drinking emerge, driven largely by a desire to avoid withdrawal symptoms. These symptoms can range from mild discomfort to severe physical and psychological distress, making abstaining from alcohol increasingly difficult. During this stage, the consequences of alcohol use become more apparent and damaging. Work performance may decline, relationships may suffer, and there may be legal or financial problems due to alcohol-related issues. The affected person often begins to prioritize drinking over other activities and responsibilities.
• Late stage. In the late stage of AUD, alcohol use is typically chronic and accompanied by significant physical and mental health problems. The body may show signs of long-term alcohol abuse, such as liver damage, cardiovascular problems, or neurological issues. Mentally, people may experience depression, anxiety, or other mental health disorders. Social and occupational functioning is often severely impaired, and the person may be unable to maintain stable employment or relationships. This stage is also marked by a high risk of dangerous drinking behaviors, such as drinking despite known health problems or driving under the influence.

In each of these stages, the progression of AUD affects not just a person’s health, but also their ability to interact with others and engage in daily activities. Early recognition and intervention are crucial in preventing the progression to more severe stages and in providing effective treatment and support.

AUD Treatment

AUD treatment is a comprehensive process that addresses both the physical dependence on alcohol and the underlying psychological factors. This multifaceted approach is crucial for effective recovery and long-term sobriety.

• Detoxification. This is often the first step in the treatment process, especially for those with severe AUD. Detoxification involves safely withdrawing from alcohol, usually under medical supervision. This stage can be challenging due to the physical and psychological symptoms of withdrawal, which can range from mild anxiety and shakiness to severe complications like seizures or delirium tremens (DTs). Medical supervision during detox ensures that these symptoms are safely managed, often through the use of medication.
• Counseling and behavioral therapies. These therapies form the cornerstone of AUD treatment. Counseling, whether individual or group-based, helps people understand the root causes of their alcohol use, such as stress, trauma, or mental health disorders. Behavioral therapies, such as cognitive behavioral therapy (CBT), teach coping strategies to deal with triggers and cravings. They also guide people in altering harmful thinking patterns that contribute to alcohol abuse. Furthermore, these therapies also help in developing skills for handling everyday stressors and emotions without resorting to alcohol.
• Medication. Certain medications assist in reducing cravings and managing withdrawal symptoms. Medications like naltrexone, acamprosate, and disulfiram have proven effective in helping people maintain abstinence. These medications work by either reducing the rewarding effects of alcohol, alleviating withdrawal symptoms, or creating adverse reactions when alcohol is consumed, thus discouraging its use.
• Support groups. Support groups, such as Alcoholics Anonymous (AA), provide a community of peers who share similar experiences with AUD. These groups offer emotional support, understanding, and encouragement throughout the recovery journey. Furthermore, Reframe’s in-app forum allows users to connect with like-minded folks from around the world. Seek support, gain valuable insights, and encourage others through this anonymous feature. The sense of community and shared experience is invaluable, as it provides a space where people can discuss their struggles and successes in a nonjudgmental environment.

In addition to these core components, lifestyle changes are also crucial in AUD treatment. This includes adopting a healthy diet, engaging in regular physical activity, and establishing a supportive social network. Lifestyle changes not only support physical health but also enhance mental well-being, both of which are essential for recovery.

AUD treatment is not a one-size-fits-all process. It requires a personalized approach, taking into account a person’s specific needs, the severity of their disorder, and any co-occurring mental health conditions. With the right combination of medical care, therapy, medication, and support, people with AUD can embark on a path to recovery and regain control over their lives.

Preventing AUD: Proactive Steps

Prevention is vital and involves understanding risk factors and early intervention. Here are a few science-backed ways to prevent AUD and its associated complications: 

• Monitor alcohol intake. Keep a diary of your drinking habits to identify patterns. Note down when and why you drink. Is it when you’re stressed? Bored? Angry? Lonely? This awareness can be enlightening and a catalyst for change. You can also monitor your intake through Reframe’s personalized drink tracker, which allows you to set realistic targets and reminds you to log your drinks through SMS notifications. 
• Set realistic goals. Gradually reduce your intake and set clear, achievable targets. For example, limit drinking to weekends only. Once you’re comfortable with alcohol-free weekdays, challenge yourself to drink a mocktail when you’re out with friends instead of your usual alcoholic drink. These new habits will be easier to sustain with time and consistency. 
• Find alternatives. Engage in activities that don’t involve alcohol, such as sports or hobbies. You can also join (or start!) a club, take a new class, or reconnect with friends over coffee or tea. These activities not only distract you from drinking but also improve your overall health.
• Build a support network. Surround yourself with people who support your goals. Communicate these goals with friends and family and let them know how they can support you. For example, you might ask your friend to meet for a walk instead of your usual happy hour. Or you can ask your partner to keep alcohol out of sight, so you’re not tempted to drink. Consider joining a support group, where experiences and struggles can be shared with people who get it. We have several in the Reframe forum! 
• Seek professional help. If you're struggling, don’t hesitate to consult a healthcare provider, such as your primary care physician or a mental health specialist. They can develop a personalized plan for addressing your drinking habits or refer you to someone who can. Remember: there’s no shame in seeking help! It’s actually one of the bravest things you can do for your overall well-being. 
• Educate yourself. Learn about the effects of alcohol on the body and mind. Knowledge is power! Understanding the risks of alcohol can inspire change and keep you motivated to stick to your goals. Continue seeking out information about alcohol’s effects on your brain and body through the Reframe blog. 
• Practice self-care. Prioritize activities that promote mental and physical well-being. This includes adequate sleep, a balanced diet, and stress management. A healthy body supports a healthy mind! 

A Journey of Hope

Overcoming AUD is a journey — often challenging but always rewarding. Every small step towards a healthier lifestyle is a victory, a reclaiming of control and well-being. Remember, change is possible, and support is available. Your journey to recovery can start today!