Introduction:

Alcohol use disorder (alcoholism)

Alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to

stop or control alcohol use despite adverse social, occupational, or health consequences.

Considered a brain disorder, AUD can be mild, moderate, or severe. Alcohol addiction is a
chronic relapsing disorder associated with compulsive alcohol drinking, the loss of control
over intake, and the emergence of a negative emotional state when alcohol is no longer
available. Lasting changes in the brain caused by alcohol misuse perpetuate AUD and
make individuals vulnerable to relapse.

Their use of alcohol leads to health problems or troubles at home, at work, at school, or
with the law. Many of them have lost control of their drinking; they are unable to stop or cut
down despite serious negative health consequences and the loss of valued activities or
relationships.

Incidence and Prevalence of AUD:

An estimated 400 million people, or 7% of the world's population aged 15 years and older,
lived with alcohol use disorders. About one in twelve of the population of India have AUDs,
and there is a gross variation in the patterns of alcohol use across the country.

Arunachal Pradesh has the highest proportion of men and women who drink alcohol in
India. 53% of men and 24% of women in Arunachal Pradesh drink alcohol. The states with
the highest prevalence of alcohol use are: Arunachal Pradesh, Chhattisgarh, Goa, Punjab,
Tripura.

Risk Factors Of AUD:

• Family history of alcohol abuse

• mental health conditions, such as Depression, PTSD and ADHD,
• Psychological traits of impulsiveness, low self-esteem, and a need for approval,
• environment factors like peer pressure, availability of alcohol and poverty,
• traumatic experiences and stress
• Early Exposure i.e, at a young age
• Cultural Norms such as acceptance of binge drinking
• Other substance use
Aetiology of AUD:

• Alcoholism, or alcohol use disorder, can be caused by a combination of genetic,

environmental, and psychological factors, which are:
• Genetics: A family history of alcoholism can increase the likelihood of
developing the disorder, as certain genetic factors may influence how
individuals metabolize alcohol and their susceptibility to addiction.
• Environment: Exposure to alcohol in the home, social circles, or cultural settings
can normalize drinking behaviors. Stressful life events or trauma can also
contribute.
• Mental Health: Conditions like depression, anxiety, or bipolar disorder can lead
individuals to use alcohol as a coping mechanism, increasing the risk of
developing alcoholism.
• Behavioral Factors: Personality traits such as impulsivity or risk-taking can make
someone more prone to excessive drinking.
• Social Factors: Peer pressure, societal norms, and the availability of alcohol can
also play significant roles.

DSM-5 Diagnostic Criteria for AUD:

• Drinking: Consuming more alcohol or for longer periods than intended.

• Desire Increased to Cut Down: Wanting to reduce or stop drinking but struggling to
do so.
• Time Spent: Investing significant time in drinking or recovering from its effects.
• Cravings: Intense urges to drink that dominate thoughts.
• Interference with Responsibilities: Alcohol use negatively affecting home life, work,
or school.
• Relationship Issues: Continuing to drink despite causing problems with family or
friends.
• Loss of Interests: Reducing or giving up enjoyable activities to drink.
• Risky Situations: Engaging in dangerous behaviors while drinking.
• Mental Health Effects: Drinking despite experiencing negative emotional or health
impacts.
• Tolerance: Needing to drink more to achieve the same effects or noticing diminished
effects from usual amounts.

Development of AUD:
Addiction can be seen as a repeating cycle with three stages, each linked to brain functions
and emotional experiences:

• Binge/Intoxication Stage
In this stage, people enjoy the euphoric effects of alcohol, such as reduced anxiety
and improved social interactions. Particular structures in the brain drive these
rewards and encourage repeated drinking, leading to habit formation and strong
responses to alcohol-related cues.

• Negative Affect/Withdrawal Stage

When someone stops drinking, they experience withdrawal symptoms like anxiety,
irritability, and physical discomfort. This happens because the structures in the
brain lose their sensitivity to rewards, whilst increased stress responses by a part of
the brain. People often drink again to escape these negative feelings.

• Preoccupation/Anticipation Stage
In this stage, individuals become fixated on obtaining alcohol after a break. The
prefrontal cortex, which helps with decision-making and impulse control, is
impaired, leading to cravings and compulsive behaviors as they plan to drink again.

Evidence based Treatment for AUD:

AUD can be addressed by the following possible treatment options:
• Behavioral Treatments:
Behavioral treatments are aimed at changing drinking behavior through counseling.
Some of the different ones are:
• Cognitive behavioural therapy
CBT seeks to eliminate destructive thought patterns and help to realise that
emotions are linked to thoughts. CBT helps to alter thoughts so that negative
emotions are not allowed to arise in the first
place. CBT takes time to implement, and patience in the process is key.
• Holistic Therapies
Holistic therapies help promote a balanced and healthy lifestyle. Some common
forms of holistic therapies include mindfulness, reflexology, acupuncture and yoga.
It is thought that living a healthier and balanced life is conducive to addiction
recovery.
• Dual-diagnosis therapy
 Dual-diagnosis therapy aims to treat mental illnesses that commonly co-occur with
alcoholism. These illnesses commonly include anxiety, depression and post-
traumatic-stress-disorder which alcohol is self medicated to cope.
• Medications:
Medications help people stop or reduce their drinking and prevent a return to
drinking These medications are prescribed may be used alone or in combination
with counseling.
• Mutual-Support Groups:
Alcoholics Anonymous® (also known as "AA") and other 12-step programs provide
peer support for people quitting or cutting back on their drinking. Combined with
treatment, mutual-support groups can offer a valuable added layer of support.
• Starting with a Primary Care Provider:
For anyone thinking about treatment, talking to a primary care provider is an
important first step—they can be a good source for treatment referrals and
medications. A primary care provider can also:
o Evaluate a person’s drinking pattern
o Help craft a treatment plan
o Evaluate overall health
o Assess whether medications for AUD may be appropriate

Brief Summary of the Case:

Satish is a daily wage worker suffering from Alcohol dependence disorder. His family
is afflicted with people with addiction to nicotine and tobacco, hence his behavior is
not condemned. He was fired of his job as a semi-skilled worker at a cloth printing
factory due to irregular attendance and untoward behavior whilst in a delirious state
of inebriation at the work place, all due to his condition. His family of five: wife, 3
children and him, shows conflict and dysfunction due to his tumultuous nature due
to drinking and negligence to matters of livelihood.

There is a debt of 2 lakhs in his name owed to a thakur zamindar with no near future
of paying it off as he is the sole working man albeit seems to squander the money on
alcohol, leaving nothing for the household and naught for paying off the debts. He is
in a place in life where he remains stagnant in repetitive haze and short moments of
clarity marked with desperation and ignorance of his plight responsibilities. With
great consideration, his treatment plan is made to accommodate his needs and
situation. He is put on detoxification, counselling both behavioral and CBT, some
medications and is scheduled for AA meets. He is also supervised for relapse
prevention.
 Identification of Data:
Name: Satish Bhatia

Diagnosed problem: Alcohol use disorder

Referral: By Wife

Case history:
• Personal Details:

Satish is a 42-year-old male who is an 8th grade dropout due to his father requiring
an extra hand at the farm and him being the only son among 5 children. His parents
tended to him out of necessity with occasional small bursts of subtle affection with
regards to him being the future patriarch. His relationship with his father was of
seeking validation of being useful.

• Socio Economic Status and (SEC):

His parents both had an addiction to chewing tobacco and his paternal of smoking
local cannabis. The economic situation in his childhood was of a struggling one,
where his father was working at a brahmin’s farm of paddy and other accessory
crops, whilst their mother was a housewife but would sometimes be employed to
help households in tending to livestock whilst away. His family now is in debt (from
marrying off his remaining 3 sisters after the death of his parents) which he cannot
pay off given his meagre pay and him squandering it away on alcohol. His wife and
him squabble on his arrival, after he wastes away at the streets, about his spending,
the thatched roof and broken leg of one of the two charpai they own in their withered
mud house, the atmosphere he creates around his children, losing a decent job
which had better conditions and concessions than any other job, and most of all his
inability to work the family into debt-lessness and normalcy. His job at construction
sites is more contractual than regular aiding in maintaining his dependency.

• Physical Health and Characteristics:

He is a man standing at 174 cm (5’7’’ ft) weighing 85kg. He complains of blurred

vision and headaches, and says a doctor said it is high blood pressure, but he knows
not of it being possible to happen to him. He said another doctot said after he
 complained of pain in his joints, that he may be at risk of developing , a type of
arthritis. He seemed to never have fallen sick before in his life.

• History and Attitude towards Counselling:

He has never met up with a professional to address his dependency on alcohol, he

never even knew it to be a possibility and never thought that it was a problem to be
addressed. His attitude towards this was being amused and dismissive. He thought
himself to be in control of things, and was convinced with the fact that he could stop
consuming alcohol any time he so wished to.

• Recorded Signs and Symptoms:

He came to the interview not well groomed and seemed to lack sleep. He seemed
dazed and fidgety: always scratching at his beard and the right index cuticle and
spaced out to the wall to his right. He spoke in a manner that was arrogant, and with
touchy topics he would be easily agitated, defensive and had an angry inflection to
his voice. He said he had everything in control and that the only reason he drank was
because of stress and because he wanted to treat himself. He also seemed to be
impaitient at questions he deemed to be ridiculous such as if drinking ever
interfered with his relationship with people or if he thought of his health problems to
be due to alcohol abuse or if it easily aroused negative feelings of entitlement or
anger when under the influence.
Pedigree Analysis:
 Concluding Comments:
Satish Bhatia is a low functioning Alcoholic who has never tried quitting alcoholic
and uses it to cope with his emotions and problems. He is in denial about all his
problems being caused by his drinking habits but shows willingness to get better.
His treatment plan is drawn, with him put on detoxification, counselling both
behavioral and CBT, some medications and is scheduled for AA meets. He is also
supervised for relapse prevention.

Alcoholism can lead to significant social isolation and a loss of self-esteem, as

individuals often withdraw from friends and family due to shame or stigma. In the
workplace, this disorder can result in issues such as poor performance, absenteeism,
and strained relationships with colleagues, ultimately jeopardizing career advancement.
Family dynamics are frequently disrupted, leading to conflicts and emotional distance,
which can have lasting effects on loved ones. Financial problems also arise as excessive
drinking often leads to increased spending on alcohol and potential job loss, creating
additional stress. Moreover, individuals struggling with alcoholism may experience
suicidal thoughts and impulsive behaviors, heightening the risk of self-harm. Overall,
worsening mental health is a common consequence, as alcohol use can exacerbate
conditions like anxiety and depression, creating a vicious cycle that is difficult to break.

Treatment for alcoholism usually involves several approaches tailored to individual

needs. It often starts with detoxification, where individuals safely withdraw from alcohol
under medical supervision. Counseling and therapy, including cognitive-behavioral
therapy and support groups like Alcoholics Anonymous, help address underlying issues
and provide community support. Medications may be prescribed to reduce cravings or
deter drinking. Rehabilitation programs, either inpatient or outpatient, offer structured
treatment plans that include therapy and education. Lifestyle changes, such as healthy
eating and exercise, also support recovery. Finally, ongoing aftercare and relapse
prevention strategies are essential for maintaining long-term sobriety. Overall, a
comprehensive approach that addresses both physical and mental health is crucial for
effective treatment.

References:
NCERT Grade XII Psychology Textbook
American Psychiatric Association. (2013). Diagnostic and statistical manual of
mental disorders (5th ed.).

Substance Abuse and Mental Health Services Administration (SAMHSA) Alcohol

Use Facts and Resources

National Institute of Mental Health (NIMH) Substance Use and Co-occurring Mental
Disorders

WWW.NIAAA.NIH.GOV.COM

WWW.WHO.COM

WWW.MAYOCLINIC.COM