Heavy drinking and binge drinking are serious issues for many Americans. The 2019 National Survey on Drug Use and Health (NSDUH) found that more than 25% of adults engaged in binge drinking in the previous month, and 6.3% reported heavy alcohol use in the past month. The same survey estimated that almost 15 million people ages 12 and up had alcohol use disorder (AUD).
Although alcohol is prevalent in American culture, the substance can be dangerous, even deadly. According to the NSDUH, emergency department visits connected to alcohol increased by 47% between 2006 and 2014. Additionally, around 95,000 people die each year for reasons related to drinking. Many of these deaths were preventable.
Managing an alcohol addiction is not easy, but understanding the root causes of cravings and how to manage them can help decrease the prevalence of alcohol use disorders and the number of alcohol-related deaths we see each year.
Any addiction, including alcohol, exists on a spectrum. Some people will develop a mild addiction, while others will have a severe addiction. Understanding the levels of alcohol addiction can be a helpful place to start.
Generally, there are four levels of alcohol consumption — a moderate level, binge drinking, heavy alcohol use, and alcohol use disorder.
For someone of legal drinking age, moderate drinking is considered two drinks per day for a man and one for a woman. However, certain people should refrain from drinking alcohol entirely, including anyone:
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), binge drinking is a pattern of drinking that equals four or more drinks per two hours for a woman or five or more for a man, resulting in a BAC level of 0.08 g/dL or higher.
Heavy alcohol use is considered four drinks a day or more than 14 drinks a week for a man, or three a day or seven a week for a woman per the NIAAA. The Substance Abuse and Mental Health Services Administration (SAMHSA) views heavy alcohol use as binge drinking that happens five or more days a month for anyone.
Neither heavy alcohol use nor binge drinking necessarily means someone has an alcohol use disorder, but these drinking patterns can increase the likelihood of alcohol addiction.
When someone cannot stop or control their alcohol consumption despite how it affects their work, their relationships, or their health, they have developed an alcohol use disorder. AUD can range from mild to moderate to severe.
The science of any addiction starts in the brain. The hippocampus is the part of the brain where emotions, memory, and learning come together to influence behavior. In other words, a person’s behavior is shaped by the decisions that the hippocampus forms. The amygdala, connected to the hippocampus, is the part of the brain that helps people experience emotions. The hippocampus is also related to the nucleus accumbens, a part of the reward circuit, and the ventral tegmental. As dopamine, a chemical messenger in the brain, moves between the nucleus accumbens and the ventral tegmental area, the mind connects reasoning with emotion.
Alcohol encourages the brain to release dopamine. This action causes a short-lived state of pleasure that the hippocampus forms into memory. Over time, the body adapts and learns that alcohol triggers dopamine release, resulting in pleasurable feelings. When the brain doesn’t release high amounts of dopamine, cravings can begin.
Even though each person can experience cravings differently, all cravings signify that the body is in a state of anticipation. Sometimes, a person will experience a craving because of specific triggers, such as a situation, place, or person associated with drinking. At the same time, not consuming alcohol can also trigger cravings.
Just as the cause of a craving is highly subjective, how a person’s body experiences cravings will be different, sometimes even contradictory. One individual may find themselves with a depressed heart rate. Another person may experience an elevated feeling of arousal. No matter how cravings are triggered or experienced, they are symptoms of addiction.
The first step to managing alcohol cravings is understanding what a trigger is. Triggers fall into two categories: external and internal. A person, place, thing, or even time of day would fall into the category of an external trigger. An internal trigger may be the result of an emotion, which can be positive or negative. An internal trigger may also be a fleeting thought or a response to a physical feeling like a headache.
Recognizing common triggers may take some time, but documenting frequent triggers can help individuals learn what to look for and how best to respond.
If the triggers are physical, they may be related to alcohol withdrawal. This will require the assistance of a medical professional. Fortunately, individuals can use a relapse prevention plan to manage external triggers effectively.
Actively eliminating triggers, especially in early recovery, is wise because cravings can be extremely severe at that time. Understanding what lies beneath the triggers can also help someone make lasting changes. For instance, if an individual finds anxiety, stress, or other strong emotions are linked to a trigger to drink, learning a healthier way to process their feelings may reduce their urge to drink.
Having a plan to manage alcohol consumption can help someone with AUD deal with external triggers. It can also be effective for someone who wants to cut back on the amount of alcohol they consume. Regardless of why they are interested in developing a coping strategy, the key is to identify what causes their alcohol cravings. The next step is to determine the activities the person associates with their drinking. And finally, the individual should make a list of methods or strategies to calm or distract themselves until the craving passes.
When experienced in the moment, cravings can be extremely intense. However, it is important to remember that a craving typically only lasts three to five minutes. While it can be challenging, knowing that the urge to drink alcohol is short-lived can help people overcome it.
There are several coping strategies individuals can use to manage alcohol cravings, including:
Another avenue for managing cravings is medications. The FDA has approved several medications that can help people recover from AUD.
The option that has been used the longest is disulfiram (Antabuse). This drug alters how the body breaks down alcohol. Someone taking this medication may experience a physical reaction to drinking that can include nausea, vomiting, headaches, and sweating.
Another option, naltrexone, stops individuals from experiencing any of the pleasurable feelings that come from drinking. In addition to taking away the feelings of reward that can come from drinking, this medication can also reduce a person’s cravings because it reduces the idea that drinking results in pleasure.
The drug acamprosate (Campral) helps ease withdrawal symptoms, like insomnia, anxiety, restlessness, and sadness, that can sometimes last for months after a person stops drinking. Both acamprosate and naltrexone seem to work best for people who have already stopped drinking.
Medications and therapy can play an essential role in helping people manage alcohol cravings.
Alcoholism is a chronic disease, and, like any chronic disease, it can be managed but not cured. One study looked at the rates and predictors of relapse among someone with AUD and found that short-term remission for those that sought treatment ranged from 20% to 50%. The range was due to the severity of the person’s addiction and various remission criteria. This means that anyone attempting to recover from alcohol addiction can relapse.
Generally, the odds of relapse depend on an individual’s:
A person’s expectations can play a significant role in whether or not they relapse. If they think they have the skills to manage high-risk situations and have a high degree of perceived control, they may be better able to avoid potential relapse. Most high-risk situations typically involve frustration, anger, or social pressure. Fortunately, many of the coping mechanisms previously discussed can help individuals manage these kinds of high-risk situations.
When individuals relapse, it is important to understand that relapse is not a failure.
Relapse can often lead to feelings of shame or depression. This can lead to further self-medicating with alcohol. However, if individuals can remember that relapse is common and reach out to someone in their support network instead, they can lessen the severity of their relapse.
From there, individuals should create an updated relapse prevention plan that can help them prevent future relapses. Repetition of those efforts can increase someone’s odds of long-term recovery.
Not every strategy for handling cravings and relapse will work for everyone. In fact, finding the tools that work best can be a process of trial and error. Each person is in charge of their recovery. The more effort individuals put into creating a safety net for themselves, the more likely they will be able to manage cravings and avoid relapse.
Alcohol addiction and cravings can make individuals feel like they’ve lost control of their lives. But there’s hope. Our evidence-based approaches can help individuals say goodbye to alcohol for good. All of our treatment programs begin and end with love, empathy, and direction for a healthier, happier, and sober future. Contact us today to learn more.