When I first got to college in the Fall I got drunk because it made me feel comfortable at parties. My drinking did not interfere with my academics. However when I returned in the Spring, I got drunk to get over the depression of a recent breakup. My grades suffered drastically and I realized I needed to slow down a bit. However, by my Junior year I was drinking nightly. I hit bottom around the end of last Spring semester. I felt like I was on a mission to self-destruct.
Anonymous
I know I have to be careful ‘cause I don’t want to turn out like my father or grandmother. They both got sick from alcoholism and my grandmother died from it. I need to learn that I am not special or different from them. I can have problems in the future.
Anonymous
I am a recovering alcoholic. I realized I was addicted to alcohol when I was seventeen. I wish the rest of the students in my dorm would understand that this stuff is real and it could happen to them.
Anonymous
Chapter 6. Alcohol Use Disorder... physical, chronic, progressive
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DSM V Assessment of an Alcohol Use Disorder
As indicated elsewhere in this book, most college students do not drink at a high risk level. Most however do drink. When they drink, their pace is such that there is little to no impairment. Since there is minimal impairment, if any, they do not experience any negative outcomes due to their drinking and there is no increase in their tolerance to alcohol. As a matter of fact they may generally have a “take it or leave it” attitude about drinking.
There are many other students however that may be experiencing an alcohol use disorder. An AUD is classified as mild, moderate or severe. Alcohol use disorders span a wide variety of problems arising from alcohol use and cover eleven different criteria. The DSM-5 allows clinicians to specify the presence and severity of an AUD, depending on how many symptoms are identified. Assessment of a potential AUD consists of questions about the presence of certain symptoms exhibited by the drinker within the previous year:
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Impaired Control
1. Is alcohol consumed in larger amounts or over longer periods of time than was intended?
2. Has there been a persistent desire or unsuccessful effort to cut down or control alcohol use?
3. Has there been a great deal of time spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects?
4. Have you experienced craving, or a strong desire or urge to use alcohol?
Examples for College Students: Your usual number of drinks has much less effect than before. You can now drink more than your friends who used to outdrink you. You might bring only a six pack to the party but then end up “mooching” off friends for more beer. Your life beyond the party scene is diminishing. You are pre-occupied in class thinking about partying. You feel a need to drink before social activities.
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Social Impairment
5. Has there been recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home?
6. Has alcohol use continued despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol?
7. Have important social, occupational, or recreational activities been abandoned or reduced because of alcohol use?
Examples for College Students: You’ve been “written up” by residence hall staff due to an alcohol related incident. You were arrested due to drinking. You miss class and fail to submit projects on time. You miss work. Your athletic performance is diminishing. You have inordinate problems with relationships including but not limited to violent arguments and/or fights with family members, friends, teammates, etc. You rely on alcohol to help you socialize. In order to drink. you have given up or cut back on activities that were once important and/or fun for you, or gave you pleasure. Simple responsibilities such as proper diet, laundry, personal appearance may be neglected.
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Risky Use of Alcohol
8. Has there been recurrent alcohol use in situations in which it is physically hazardous?
9. Has alcohol use continued despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by alcohol?
Examples for College Students: More than once you have gotten into situations while, or after, drinking that increased your chances of getting hurt (driving, boating, swimming, operating machinery, etc.). Risky sexual encounters may result in sexually transmitted infections, unplanned pregnancy, and/ or emotional complications. You have ulcers, stomach problems or other gastrointestinal issues. You are depressed. You are experiencing blackouts.
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Pharmacological Criteria
10. Has tolerance increased, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of alcohol.
11. Have you experienced withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol
b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
Examples for College Students: Your tolerance has continued to increase. You drink significantly more alcohol now than when you entered college. You drink significantly more than most of your friends even though you are smaller than them. You continue drinking long after your friends decide to quit drinking or leave the party. You drink in the morning to “cure” or relieve the symptoms of a hangover. If you quit drinking for an extended period, you experience trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? You “sense” things that were not there.
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The DSM-5 assessment does not define an alcohol use disorder with the same precision as a doctor who is diagnosing a physical diseases. Each category of AUD (mild, moderate or severe) is not a completely discrete entity. Therefore, specific evaluation of the presence of an AUD or the level of the disorder, if present, is not clearly defined.
A few mild symptoms identified in the DSM-5 can be an indication of the start of a drinking problem and a developing alcohol use disorder. In the presence of just a few of these conditions, over time the number and severity of symptoms can grow and add up to an AUD if heavy drinking continues. The symptoms toward the top of the list tend to be early signs of potential trouble. The symptoms further down the list indicate movement along a high risk path to a severe AUD including addiction. One or two of these experiences for yourself could be reason for concern, depending on the particular symptom(s) and the severity. Two or three symptoms indicate a mild AUD, four or five symptoms indicate a moderate AUD, and six or more symptoms indicate a severe AUD.
Rather than confuse yourself with definitions and labels, it might serve you better to analyze what impact alcohol is having on your life. At the end of this chapter is the DSM-5 questionnaire that can help. It will not assess whether or not you are an alcoholic, but it will help you, at the very least, determine if alcohol is or is not affecting your life and the potential presence of an Alcohol Use Disorder. If you have any doubts or questions about your self assessment, speak to a counselor at your school or back at home. If there is some sign of an AUD, it is critical that you make adjustments to your drinking patterns by cutting back on your quantity and frequency of drinking. Again, seek help at your campus counseling center or mental health facility if you have difficulty making such an adjustment.
Can you consume alcohol and not experience any serious alcohol problems? As you can see, drinkers with a Mild Alcohol Use Disorder may be doing just that. They drink occasionally. They may get impaired but do not experience any problems. But – and it’s a huge but – as explained earlier, each time they drink to impairment their tolerance increases. We know that if they continue to drink to impairment, their tolerance will continue to increase. As a result, they will eventually move to a Moderate Alcohol Use Disorder and possibly to a Severe Alcohol Use Disorder. This path to a severe AUD illustrates why increasing tolerance is always an indicator of increased risk for a severe AUD.47 The student who brags about his or her ability to consume excessive quantities of alcohol is actually revealing, and ignorantly bragging about, his or her increased risk for being diagnosed with an Alcohol Use Disorder.
Many students believe that high-risk drinking in college is simply an expected phase of life they go through, that it is a rite of passage. Many believe they will simply discontinue their high-risk consumption after they graduate. Does “I’ll quit when I graduate” sound familiar? Research indicates that this is the case for many students but not always the case. Based on a 27-year follow-up of college students begun in 1950, we see that 50 percent of those students who drank five or more drinks on four or more days per week while in college experienced alcoholism or other serious alcohol-related problems during a twenty year period after college.39 Today, unfortunately, many more students fit this drinking profile than was true when this study began.
Two important questions frequently asked by many college students regarding drinking are, “What’s the difference between a social drinker, a problem drinker and an alcoholic?” and “What does alcohol dependent mean?” Understandably, the complex nature of alcoholism or other drug addiction prohibits an extensive, in-depth look at these questions within the confines of this book. However, a brief look at the the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard reference work for assessing psychiatric illnesses including addiction, can provide a better understanding of this extremely complex lifestyle related health problem.
The DSM-5 integrates alcohol abuse, alcohol dependence and alcoholism into a single disorder called an Alcohol Use Disorder (AUD). An AUD is a condition characterized by the harmful consequences of repeated alcohol use, a pattern of compulsive alcohol use, and (sometimes) physiological dependence on alcohol identified by increased tolerance and/or symptoms of withdrawal. There is often craving for alcohol that makes it difficult to think of anything else until drinking resumes. This disorder is only diagnosed when these behaviors become persistent, disabling and/or distressing. Consequently, from a clinical standpoint, terms such as alcohol dependent, problem drinker, alcohol abuser, social drinker, etc. are of no real value in understanding or identifying problematic alcohol use
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The Bottom Line
An Alcohol or other Drug Use Disorder, is a physical disease with physical cravings – it’s also an emotional and psychological disease. At first you may choose when and where and what to drink, but once you have started using, there could come a point at which you can no longer choose whether to continue. At that point, the choice belongs to the disorder, and the disorder will always choose its own survival over yours. As a result, self diagnosis of an alcohol use disorder is often inaccurate with the drinker more often than not minimizing the seriousness of the situation. Accurate diagnosis of this disorder should be conducted by a qualified practitioner trained in psychiatric diagnosis and evidence based treatment. If you find yourself in this situation, help is there for the asking, but you must ask. Reach for the telephone, reach for the telephone book or go online, look under Alcoholism or Drug Abuse (or Alcoholics Anonymous), pick a number, and dial it. Better yet, call your campus counseling center. Someone at the other end is there waiting to hear.
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Personal Challenge: Identifying Alcohol Problems
Goal
To assess the role alcohol may be playing in your life.
Instructions
Circle the word that best describes your answer to the following questions.
(Electronic version currently under construction.)
Within the past year:
1. Yes-No Is alcohol consumed in larger amounts or over longer periods of time than was intended?
2. Yes-No Has there been a persistent desire or unsuccessful effort to cut down or control alcohol use?
3. Yes-No Has there been a great deal of time spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects?
4. Yes-No Have you experienced craving, or a strong desire or urge to use alcohol?
5. Yes-No Has there been recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home?
6. Yes-No Has alcohol use continued despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol?
7. Yes-No Have important social, occupational, or recreational activities been abandoned or reduced because of alcohol use?
8. Yes-No Has there been recurrent alcohol use in situations in which it is physically hazardous?
9. Yes-No Has alcohol use continued despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by alcohol?
10. Yes-No Has tolerance increased, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of alcohol.
11. Yes-No Have you experienced withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol
b. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
Scoring for this exercise can be found in the Challenge Results section at the end of this book.
Reflections
After completing the survey, ask yourself the following questions:
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How do you feel about the results of this survey?
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What role does alcohol play in your life?
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Is alcohol having a negative impact on your college career?
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Do you know what campus resources are available to assist people with alcohol or other drug problems?