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The prevalence of alcohol use in America has led to some uncertainty about what constitutes having a good time versus having a drinking problem. From a clinical standpoint, some individuals have a mild, moderate, or severe alcohol use disorder.
The Diagnostic and Statistical Manual of Mental Disorders – 5 (DSM-5) is a key diagnostic tools for mental health clinicians, including addiction treatment specialists. The DSM-5 sets forth 11 questions/factors that can guide clinicians in the diagnosis and grade of an alcohol use disorder.1 The number of factors present determines the severity grade of the alcohol use disorder. In 2012, research conducted by the National Institute on Alcohol Abuse and Alcoholism estimated that 17 million Americans in the 18+ age group (7.2 percent overall) had an alcohol use disorder.2
Understanding Blood Alcohol Content
The liver is a key player in the metabolism of alcohol (a depressant). Typically, the liver processes 1 ounce of alcohol per hour. If individuals consume more than 1 ounce of alcohol each hour, the excess alcohol will accumulate in the blood and body tissues until the liver is ready to metabolize it. This is why blood alcohol content rises when drinks are rapidly consumed.
As a rule of thumb, 1 ounce of alcohol translates into one standard drink, which equals a 12-ounce beer, 5 ounces of wine, or 1.5 ounces of hard liquor. Smartphone technology is now available to help estimate one’s blood alcohol content on free or low-cost apps such as iDrinkSmarter, IntelliDrink, and Drink.app.
Source: Brown University, App Advice
The National Survey on Drug Use and Health (NSDUH) provides reliable information about alcohol and other drug use patterns across the US. In the 2013 survey, the review included an analysis at rates of current alcohol abuse, heavy drinking, and binge drinking. The 2013 NSDUH made the following findings for the 12+ age group:
The national rates on alcohol use disorder and other alcohol use patterns provide a backdrop to better understand the rates in Texas. According to a 2014 survey of various research reports on drug use in Texas, alcohol is the most common drug of abuse.4In 2011-2012, the percentage of the population aged 12 and older who drank in Texas is slightly lower than the national average (48.2 percent versus 51.9 percent).
The 2011-2012 rates were similar to 2008-2009 rates, when 49.6 percent of Texas residents reported in one survey that they had consumed alcohol in the past month. In 2011-2012, among Texas residents aged 12 and older, 6.5 percent were considered to have a history of alcohol dependence (i.e., in the alcohol use disorder diagnostic range) compared to 6.6 percent of the US population overall.5
A review of reports on alcohol consumption among secondary school students in Texas reveals that the majority of students have at least tried alcohol. Highlights of the reports include:
The 2013 Texas Survey of Substance Abuse Among College Students reveals the prevalence of alcohol use on campuses across the state.7 The survey involved 200 online questions that 11,283 students aged 18-26 answered. The students were matriculated across 45 college campuses in the spring of 2013. According to survey answers, 81 percent of participants had drank alcohol at least once in their lifetime, 75 percent in the last year, and 62 percent in the last month.8 This data reveals that young adults who drank at least once in their lives are likely to be current drinkers as well.
Texas #1 for Drunk Driving Fatalities
In 2013, there were 1,337 drunk driving deaths in Texas, the highest in the nation. Of all traffic accident deaths, 39.5 percent involved alcohol. Car accidents involving alcohol resulted in 99,195 arrests and 71,030 DUI convictions. In addition to the cost of lives, taxpayers subsidized fatal car accidents to the tune of $6.2 billion.
Most students do not consider themselves to have a problematic relationship with alcohol. According to self-assessment responses, of all college students who reported drinking, 53 percent considered themselves light drinkers, 26 percent moderate drinkers, 4 percent heavy drinkers, and 0.5 percent problem drinkers.9 In terms of feeling drunk, the study concluded that in a 30-day period students felt drunk on 2.27 days on average.10
Regarding binge drinking, more than a third of students had engaged in this activity at least once in the past 30 days. Forty-three percent of males and 38 percent of females reported that they consumed at least 4-5 drinks in at least one sitting in the past 30 days.
Fewer reported having engaged in binge drinking numerous times. Fourteen percent of males and 5 percent of females reported that they had at least 4-5 drinks on at least six days in the last 30 days.11
One of the greatest concerns about college drinking is the perception that there is little risk of developing an alcohol use disorder because the practice is largely considered a rite of passage on college campuses.
Underage Drinking in Texas
In 2013, research shows that on average, a drink costs 78 cents, but in terms of the fallout associated with drinking (healthcare costs, lost work, pain and suffering, etc.), taxpayers pay $3.50 for each drink an underage person consumes (for a total cost of $5.5 billion).
Each year, there are an estimated 1,043,000 underage drinkers in Texas. Underage drinking exposes young Texans to myriad potential troubles, including violence, car accidents, high-risk sex, poisoning, psychosis, fetal alcohol syndrome in children of youth mothers, public crimes, medical treatment, and rehab services. In 2012, underage alcohol use was involved in 73 homicides, 49,400 non-fatal crimes, 80,700 property crimes, and 1,512,000 public order crimes in Texas.
Only a fraction of underage Texans who needed treatment for alcohol use actually received rehab services. In 2012, there were only 465 admissions to alcohol rehab services in the 12-20 age group (4 percent of all admissions for alcohol treatment in Texas).
Source: Underage Drinking in Texas
As the National Institute on Drug Abuse reports, there is a huge gap in America between the annual need for treatment and the annual number of drug rehab center admissions. In 2013, while 22.7 million individuals (8.6 percent of the population) needed rehab treatment for alcohol or other drug abuse, only 2.5 million (0.9 percent of the group in need) received treatment at a dedicated rehab center.12
In Texas, of those individuals who sought treatment at a publicly funded rehab programs in Texas, 28 percent had a primary problem with alcohol.13
The Texas Department of Health Services provides data on alcohol treatment admissions to state-funded programs, including certain characteristics of incoming clients. The most current data available covers 2006. In that year, all admissions to state-funded programs totaled 55,155. Of these admissions, 14,488 involved alcohol as the primary drug of abuse.15 The following is an excerpt of the characteristics of the group that sought treatment primarily for alcohol abuse:
A closer look at these treatment statistics on alcohol compared to other primary drugs of abuse reveals that more people sought recovery services for this drug than for any other (alcohol was the only drug with an admissions number in the five digits). In terms of employment rates, with the exception of marijuana (36 percent) the alcohol admissions group had the highest rate (26 percent).
Second only to individuals admitted to state-funded rehabs with downers as their primary drug of abuse ($10,694), the alcohol admissions group had the highest average income ($8,734). Regarding living circumstances, in the alcohol admissions group, 67 percent lived with family while 14 percent were homeless.17 From a consideration of this data on the whole, a profile emerges as to the most likely characteristics of a person who sought treatment in Texas-funded rehab centers in 2006: male, living with family, approximately 39 years of age, and started drinking as a teenager.
Treatment approaches in rehab centers in Texas and the rest of the world follow two main practices. First, individuals must be detoxed from or gradually weaned off all substances. Second, therapy is a required as part of the abstinence maintenance phase of treatment after detox.
In cases of alcohol withdrawal, the process can go beyond simply uncomfortable and become life-threatening. As a result, it’s essential that those who are addicted to alcohol undergo medical detox. Withdrawal symptoms from alcohol range from milder effects, such as anxiety and/or shakiness, to high-risk complications, such as seizures and/or delirium tremens (DTs). DTs can lead to death in 1-5 percent of cases.18
A supervised medical detox from alcohol dependence can be aided by FDA-approved targeted medications, including disulfiram (Antabuse), naltrexone (oral, non-extended), naltrexone (Vivitrol, an extended-release formulation), and acamprosate (Campral).19 In addition to these targeted medications, the prescription drug topiramate (approved for epilepsy and migraines) has been shown to be effective off-label for alcohol detox assistance. Medications can ease the symptoms associated with withdrawal as well as curb cravings for alcohol.
In addition, supervised medical detox adds a physical layer of protection against relapse. With care workers present and services expressly designed to accommodate the needs of recovering individuals, there is potentially less likelihood that individuals will abandon the recovery process during the detox phase.
Therapy is a cornerstone of treatment in alcohol abuse recovery programs. As the National Institute on Drug Abuse (NIDA) explains, there are different therapy approaches that have been designed for or adapted to the addiction recovery setting.20 Studies have considered the effectiveness of certain approaches vis-à-vis specific drugs of abuse, such as alcohol. Research on the following therapy approaches has shown that they can be effective in the treatment of alcohol abuse:
It is established in the field of addiction treatment and research that alcohol abuse is a treatable disease. Although there may not be a cure for alcohol addiction, this condition can be effectively managed and relapse is preventable.
After graduation from a structured treatment program, any number of aftercare services may be engaged, chief among them is Alcoholics Anonymous. Perhaps the most well-known recovery group organization, there are at least 113,000 groups worldwide.26 There may not be a definitive statistic on the success of AA, but the organization reports that the average length of sobriety among members is more than eight years (likely due to a host of contributing factors).27 AA is a longstanding testament to how individuals in long-term recovery can support one another and bolster participants’ efforts to maintain sobriety.