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<h2>The Link Between Isolation and Addiction</h2>
Although it can be difficult to determine whether loneliness can lead to addiction or whether addiction itself contributes to social isolation, both share common risk factors.1 These factors may include genetic vulnerability to mental illness, early exposure to trauma or chronic stress, or issues in areas of the brain that relate to both substance use and mental illness.1

For most people, occasional loneliness is a part of life. It can occur because of life changes, like moving, changing jobs, or grief and loss, and lead to feelings of depression and <a href="https://alcoholrehab.com/alcoholism/effects/alcohol-induced-anxiety/">anxiety.</a> People with diagnosed mental health conditions have been found to have higher rates of substance abuse, with about 1 in 4 people with severe mental illness having a co-occurring substance use disorder diagnosis.1

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<h2>Effects of Isolation and Addiction</h2>
Isolation and addiction can impact your mental and physical health. Your relationships with others, your self-esteem, and even your ability to function at work or school may be affected. Some people even experience health consequences, such as poor adherence to treatment or medication, due to isolation and addiction.1 Some other potential <a href="https://alcoholrehab.com/alcoholism/effects/health-problems/">effects of alcohol misuse</a> and isolation include: 1,4,5
<ul>
 	<li>Guilt and shame. This may lead to increased drinking or using drugs to cope or change the way you feel.</li>
 	<li>Altered neural pathways in the brain. A change in brain chemistry can result in a desire to keep using drugs or alcohol, even at the expense of your relationships with others.</li>
 	<li>Harmful behavior. This may include accidents, injuries, or antisocial behavior.</li>
 	<li>Relationship Problems. Your relationships with others may be affected because of addiction such as romantic, social, or family relationships.</li>
 	<li>Social problems.  Financial insecurity, losing your job and even homelessness can be examples of social problems resulting from addiction.</li>
</ul>
<h2>Isolation in Addiction Recovery</h2>
Relapse is common in early recovery, and being socially isolated can put you at a higher risk. A 2018 study of 195 people found that social isolation more than doubled participants’ risk of relapse.7 Connecting with others in similar situations may help you on your path to sobriety.  You might consider joining a peer support group like Alcoholics Anonymous, which has been found by many to reduce isolation and maintain abstinence from drugs or alcohol.7 Relating to other people in recovery and learning from their experiences can not only provide insight into your own challenges but also help heal your relationships with others.

Alcoholics Anonymous meetings are typically guided using the 12-step model, an approach that prompts participants to admit their wrongs, take accountability for their actions, and make amends with others.8 As members increase their sobriety time, they become “sponsors,” or mentors, to others in early recovery. There is significant evidence that not only receiving peer support but also providing it to others in this way can reduce loneliness and isolation and aid in maintaining abstinence from drugs and alcohol.7 Others might find peer support through joining sober activities like participating in religious services, joining clubs or other group activities, and spending time with sober friends and family members.2
<h2>Treatment for Addiction and Isolation</h2>
If you are experiencing alcohol use disorder and isolation, there is hope for recovery with appropriate clinical treatment and peer support. Talk to a medical or mental health professional to <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/decide-for-rehab/">determine what treatment option is right for you</a>. Treatment options may include: 9
<ul>
 	<li><a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/inpatient/">Inpatient Treatment</a>. Patients live in the facility full-time, and it is typically a <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/30-day-program/">30-day</a>, 60-day, or 90-day program. In an inpatient facility, you have medical supervision and participate in behavioral and other therapies during the day.</li>
 	<li><a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/outpatient/">Outpatient Treatment</a>. Rehab where the patient, in some cases, may attend 3 to 6 hours per day, participate in group, family, and/or individual therapy. Patients typically go home when not in treatment and are able to work or go to school.</li>
 	<li>Individual Counseling. Also held in an outpatient setting, individual counseling is 1-on-1 with a therapist, rather than in a group, and focuses on addressing areas of functioning that have been impaired by substance use, such as interpersonal relationships.</li>
 	<li>Alcoholics Anonymous, <a href="https://alcoholrehab.com/12-steps-aa/">12-Step Meetings</a>, and Other Peer Support. Peer support groups reinforce what is taught in clinical treatment and provide participants with a place to talk about challenges and life experiences.</li>
</ul>
<h3>Sources</h3>
<ol>
 	<li>National Institute on Drug Abuse. (2020, April). <a href="https://www.drugabuse.gov/download/1155/common-comorbidities-substance-use-disorders-research-report.pdf?v=5d6a5983e0e9353d46d01767fb20354b">Common comorbidities with substance use disorders research report</a>.</li>
 	<li>American Psychological Association. (2019, May). <a href="https://www.apa.org/monitor/2019/05/ce-corner-isolation">The risks of social isolation</a>.</li>
 	<li>Journal of Aging and Health. (2016, March). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681688/pdf/nihms722476.pdf">Association of alcohol use and loneliness frequency among middle-aged and older adult drinkers</a>.</li>
 	<li>Addictive Behaviors. (2018, July). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753023/pdf/nihms494900.pdf">Shame mediates the relationship between depression and addictive behaviours</a>.</li>
 	<li>United Kingdom National Health Service. (2018, August 21). <a href="https://www.nhs.uk/conditions/alcohol-misuse/risks/">Risks: alcohol misuse</a>.</li>
 	<li>International Journal of High Risk Behaviors and Addiction. (2014, September). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295122/pdf/ijhrba-03-03-22688.pdf">Emotional and social loneliness in individuals with and without substance dependence disorder</a>.</li>
 	<li>Youth and Society. (2018). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889144/pdf/nihms-747231.pdf">Alone on the inside: The impact of social isolation and helping others on AOD use and criminal activity</a>.</li>
 	<li>Alcoholics Anonymous. (2016, August). <a href="https://aa.org/assets/en_US/smf-121_en.pdf">The twelve steps of Alcoholics Anonymous</a>.</li>
 	<li>National Institute on Drug Abuse. (2018, January). <a href="https://www.drugabuse.gov/download/675/principles-drug-addiction-treatment-research-based-guide-third-edition.pdf?v=74dad603627bab89b93193918330c223">Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).</a></li>
</ol>
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Loneliness, Isolation and Addiction

<h2>How Do I Choose the Right Rehab for Alcoholism?</h2>
People who misuse alcohol to the extent that they cannot control their alcohol consumption, despite the negative consequences may be diagnosed with an Alcohol Use Disorder (AUD). 8 Research has shown that rehabilitation treatment can be very effective in helping individuals maintain a life of sobriety.2

According to NIAAA, about a third of people who successfully complete a rehabilitation program show no further symptoms 1 year later and have fewer alcohol-related problems. When it comes to selecting a treatment setting, it is important to familiarize yourself with the available options, such as:
<ul>
 	<li><a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/inpatient/">Inpatient </a>– Patients live in the facility full-time, and it is typically a 30-day, 60-day, or 90-day program. In an inpatient facility you have medical supervision and participate in behavioral and other therapies during the day.3 </li>
 	<li>Extended Care or Long-term Rehab – A form of inpatient rehab that is also residential, and is unique for its longer length of stay (typically between 6 and 12 months, depending on the program).2</li>
 	<li><a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/outpatient/">Outpatient </a>– Rehab where the patient, in some cases, may attend 3 to 6 hours per day, participate in group, family, and/or individual therapy. Patients typically go home when not in treatment and are able to work or go to school.3, 1</li>
</ul>
It is recommended to reach out to a facility directly to get more information about accreditation, treatment approach, or length of stay.
<h2>Determine Your Rehab Goals and Needs</h2>
Treatment for alcohol misuse is most effective when it addresses multiple facets of a person’s life, including their physical and mental health, family relationships, occupational functioning, social functioning, and any legal problems.2 A major focus of behavioral treatment for alcohol misuse is goal-setting—working with a professional to consider each of these factors and determine what you want to change.3 Many people enter treatment with the goal of total abstinence from all substances, or to develop skills to <a href="https://alcoholrehab.com/alcohol-recovery/aftercare/risk-of-relapse/">prevent relapse</a>.2

When setting goals in alcohol rehab, it may be helpful to use the SMART goals format.5

SMART is an acronym for:6
<ul>
 	<li>Specific: What do you want to accomplish?</li>
 	<li>Measurable: How will you know when you have accomplished your goal?</li>
 	<li>Achievable: How will you accomplish your goal?</li>
 	<li>Realistic: Can you accomplish your goal with the resources that you have?</li>
 	<li>Timed: When will you have successfully accomplished your goal?</li>
</ul>
<h2>Factors to Consider When Choosing A Rehab Facility</h2>
Once you have considered your needs, preferences, and goals for treatment, it may be time to choose a rehab facility. Be sure to consider other important factors such as:
<ul>
 	<li>Inpatient vs. outpatient.</li>
 	<li>Treatments and therapies.</li>
 	<li>Amenities.</li>
 	<li>Financial cost.</li>
 	<li>Location.</li>
 	<li>Length of treatment.</li>
</ul>
<h3>Inpatient vs. Outpatient</h3>
Inpatient rehab treatment can be highly successful, and treatment duration of 90 days or more is associated with positive outcomes in maintaining abstinence from substance abuse.2 However, inpatient rehab may also be more expensive depending on the facility and length of stay.3 Many treatment programs are covered by insurance and in some cases, there may be payment options or assistance available.

Outpatient rehab is typically a day program, in which participants are in treatment for a few hours per day and go home at night.3 Some outpatient rehab programs might have flexible hours, such as evening or weekend sessions, to accommodate participants’ work or family commitments. This may be a good option for those with milder addictions but maybe a less optimal choice for those with serious, long-term addictions or for those with dual diagnosis conditions. 2

Many alcohol rehab facilities offer follow-up programs, such as <a href="https://alcoholrehab.com/12-steps-aa/">12-step meetings</a> or other support groups, to assist patients as they return to their daily lives. Alcoholics Anonymous is a 12-step model where people in various stages of recovery come together to provide mutual support and discussion.2

Because recovery is a life-long process people often stay in Alcoholics Anonymous or other 12-step groups long after they have completed treatment for additional support and to find community with others.2


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<h3>Treatments and Therapies</h3>
Behavioral counseling and peer support are common treatment elements across rehab facilities. In recent years, some rehabs have started including Medication-Assisted Treatment (MAT). Medications may help to manage <a href="https://alcoholrehab.com/drug-addiction/withdrawal/">withdrawal</a> symptoms, discourage or replace substance use, or treat underlying mental health problems as part of treatment.6

Addiction is a complex disease that has an impact on the brain’s structure and function.2 Utilizing MAT in conjunction with behavioral counseling is part of a “whole-person” approach to treating substance abuse, by addressing both the physiological and psychological needs of the patient.7
<h3>Amenities</h3>
Some treatment centers might be considered “luxury rehabs,” and include certain amenities, such as yoga classes, massage therapy, gyms or other fitness activities, and a desirable location. While including these activities may be beneficial to your overall wellness, these additional comforts may also come at a higher cost.
<h3>Locations</h3>
Depending on your situation, you may benefit from choosing a rehab program close to home, or getting some distance may be a better option. You may choose to stay close to home to have family support nearby.2  Others may desire to get away from their neighborhood, as people, places, and things can trigger a relapse in early recovery.2
<h3>Length of Treatment</h3>
Length of treatment can vary between settings and programs. For example, inpatient rehab is generally a 30-day, 60-day, or 90-day program. Outpatient rehab may have a shorter duration. Many programs are taking a more individualized approach in recent years, working with patients to create an individual care plan that meets their unique needs, rather than prescribing a fixed treatment duration.6
<h2>Find a Rehab Facility Near Me</h2>
The first step on your recovery journey is deciding to pursue treatment. By taking the time to think through your needs, goals, and preferences, you are already on the path to making life-long changes. By contacting an <a href="https://alcoholrehab.com/contact/">addiction helpline</a> today, you can find out more information about rehab and find an option that is right for you.3
<h3>Sources</h3>
<ol>
 	<li>Substance Abuse and Mental Health Services Administration. (2021, October 25). <a href="https://www.samhsa.gov/find-help/atod">Find Help: ATOD</a>.</li>
 	<li>National Institute on Drug Abuse. (2018, January). <a href="https://www.drugabuse.gov/download/675/principles-drug-addiction-treatment-research-based-guide-third-edition.pdf?v=74dad603627bab89b93193918330c223">Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)</a>.</li>
 	<li>National Institute on Alcohol Abuse and Alcoholism. (2021, August). <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help#pub-toc4">Treatment for Alcohol Problems: Finding and Getting Help</a>.</li>
 	<li>American Society of Addiction Medicine. (2015, May 13). <a href="https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/">What are the ASAM levels of care?</a>.</li>
 	<li>American Journal of Lifestyle Medicine. (2017, August 14). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796229/pdf/10.1177_1559827617729634.pdf">Goal Setting and Action Planning for Health Behavior Change</a>.</li>
 	<li>Substance Abuse and Mental Health Services Administration. (2008). <a href="https://www.ncbi.nlm.nih.gov/books/NBK64827/pdf/Bookshelf_NBK64827.pdf">A Guide to Substance Abuse Services for Primary Care Clinicians.</a></li>
 	<li>Substance Abuse and Mental Health Services Administration. (2021, October 13). <a href="https://www.samhsa.gov/medication-assisted-treatment">Medication-Assisted Treatment (MAT).</a></li>
 	<li>American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5, Washington, D.C.: American Psychiatric Association.</li>
</ol>
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Choosing the Right Rehab for Alcoholism

<h2>What is Alcohol Detox?</h2>
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), AUD involves a pattern of alcohol use that causes significant impairment and distress.3 Alcohol dependence (and the associated withdrawal syndrome) is a key feature of many cases of AUD and is one of the most frequently encountered problems in medical settings, second only to depression.1 

A period of supervised alcohol detox is often the first part of treatment or rehabilitation for AUD. It involves a set of interventions, which often includes medication, that is designed to help you stop drinking and safely withdraw from alcohol. In addition to keeping you stable throughout withdrawal; detox programs help prepare you for additional treatment for AUD.1 

The course of any given individual’s alcohol withdrawal symptoms is sometimes unpredictable. Additionally, it is not always easy to identify those at risk for an eventually severe or complicated withdrawal. The Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that, in addition to these reasons, given the ever-present possibility of an adverse withdrawal experience, hospitalization (or some form of 24­ hour medical care) is commonly the preferred setting for acute alcohol detoxification.2 
<h2>Alcohol Detox Process</h2>
Alcohol detox may be the first step in the recovery process before you enter an ongoing treatment program. Though alcohol detox can occur on an <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/inpatient/">inpatient</a> or <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/outpatient/">outpatient</a> basis, an inpatient medical setting may be advisable for people who are heavy alcohol users, or those with a history of significant alcohol withdrawal symptoms, a history of withdrawal seizures or delirium tremens, or co-occurring serious medical or psychiatric illnesses.1 

In many detox programs, you can expect to experience three important elements of care, which include:2 
<ul>
 	<li>Evaluation. You receive a comprehensive evaluation to assess your overall health and the severity of the problem to determine the appropriate detox setting for your needs.</li>
 	<li>Stabilization. This is the active detox phase where you undergo withdrawal with medications, medical supervision, and support.</li>
 	<li>Fostering entry to treatment. You receive assistance with entering the appropriate substance abuse treatment setting once detox is complete.</li>
</ul>
<h2>Alcohol Detox and Withdrawal</h2>
People may experience different symptoms during the detox phase. In some cases, the <a href="https://alcoholrehab.com/alcoholism/withdrawal/">symptoms of alcohol withdrawal</a> will be relatively mild, while others may experience severe and possibly life-threatening withdrawal complications.1 

The acute alcohol withdrawal syndrome may include:2,6 
<ul>
 	<li>Autonomic hyperactivity (sweating, elevated heart rate, increased blood pressure).</li>
 	<li>Tremors</li>
 	<li>Anxiety</li>
 	<li>Headaches</li>
 	<li>Insomnia</li>
 	<li>Gastrointestinal upset (nausea and vomiting).</li>
 	<li>Appetite loss.</li>
 	<li>Impaired concentration.</li>
 	<li>Poor judgment and poor memory</li>
 	<li>Increased sensitivity to light or noise.</li>
 	<li>Delusions (meaning you believe something that isn’t true).</li>
 	<li>Hallucinations (meaning you see, feel, or hear things that aren’t there).</li>
 	<li>Grand mal seizures (the kind most people think of when they think of seizures).</li>
 	<li><a href="https://americanaddictioncenters.org/alcoholism-treatment/delirium-tremens-symptoms-and-treatment">Delirium tremens (DTs),</a> a severe and potentially deadly form of withdrawal that may involve a cluster of symptoms including hallucinations, severe disorientation, and agitation.</li>
</ul>
In some cases, people may also develop a more protracted withdrawal syndrome, which involves persistent symptoms that last beyond the more typical duration for alcohol withdrawal.7 These protracted symptoms can include tremor, insomnia, anxiety, depression, and lack of energy, as well as increased breathing rate, body temperature, blood pressure, and pulse.7 In some cases, these symptoms can last up to a year or more. Though not everyone experiences them, they remain a particular concern in those who do, since they can promote relapse as an attempt to mitigate their troublesome nature long after drinking first stops.7
<h2>How Long Does it Take to Detox From Alcohol?</h2>
An exact timeline for alcohol withdrawal symptom onset, severity, and symptom resolution can vary from person to person. In many cases, physically uncomfortable symptoms such as insomnia, tremors, gastrointestinal upset, or nausea start between 6-12 hours after your last drink.1 Hallucination can start 12-24 hours after your last drink; seizures can start 24-48 hours after the last drink; more rarely, DTs can start anywhere from 1-4 days after the last drink, should they develop.1, 7 

It is important to note, people can progress through symptoms at different rates.2 Generally speaking, symptoms start to subside after a few days, but DTs can last up to 5 days.7 ,8 

Undergoing detox with medical supervision can not only help you remain safe and comfortable, but it can also provide immediate medical care if you develop serious and potentially dangerous complications like seizures or DTs.

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<h2>What Happens During Alcohol Detox?</h2>
People often want to know <a href="https://americanaddictioncenters.org/withdrawal-timelines-treatments/alcohol">how long does it take to detox</a>, but this timeline is different for everyone.2 Your age, health, nutritional factors, and any co­occurring medical or psychiatric conditions can affect the character and severity with which you experience withdrawal.2 For some people, mild to moderate symptoms might resolve almost right away, while other symptoms, such as seizures, can remain a risk for longer periods of time.2 Below is a general timeline of what you can expect during the detox process.
<h3>Day 1 of Alcohol Detox</h3>
Between 6-12 hours after your last drink, you may experience mild symptoms such as insomnia, tremors, mild anxiety, gastrointestinal upset, headache, sweating, or loss of appetite. These symptoms tend to resolve in a few days.7  Between 12-24 hours after your last drink, you can have a risk of developing hallucinations. Hallucinations usually resolve in 48 hours.7,2
<h3>Day 2 of Alcohol Detox</h3>
During the second day of detox, you may experience continued symptoms from day 1 that could possibly worsen. You may have an increased risk of developing hallucinations as well as additional withdrawal symptoms such as seizures or DTs.1,7  
<h3>Day 3-7 of Alcohol Detox</h3>
Over the course of the week, your symptoms may fluctuate. Certain withdrawal symptoms may slowly improve, while others may resolve quickly.2 The risk for DTs can be higher starting at 48 hours after your last drink, and seizures can also occur and recur, which is why it’s important to receive medical supervision during detox.1 
<h3>After 1 Week of Alcohol Detox</h3>
Many of your symptoms may begin to taper off by this point.6 However, some people may experience more persistent symptoms as part of a more protracted withdrawal syndrome.7 
<h2>Alcohol Detox Medications</h2>
During the course of acute alcohol withdrawal, many troublesome symptoms can be medically managed.1 

Some of the medications that are currently used to treat alcohol withdrawal include:1, 6 
<ul>
 	<li>Benzodiazepines, such as diazepam or chlordiazepoxide. Benzodiazepines are often used in treatment of alcohol withdrawal and can help to minimize symptoms and decrease the likelihood for and severity of withdrawal complications. For example, they are helpful for decreasing seizure and delirium risks.</li>
 	<li>Anticonvulsants like carbamazepine. These can help minimize withdrawal symptoms and reduce the potential for seizures.</li>
 	<li>Adrenergic medications like clonidine. These can be used as adjunct therapy to manage autonomic withdrawal symptoms like increased blood pressure and rapid heart rate, but do not prevent seizures or delirium.</li>
</ul>
Beyond the acute withdrawal period, additional FDA-approved medications may be initiated to help people prevent relapse and maintain abstinence during treatment for alcohol use disorder.2 These drugs are not considered detox medications, as they are typically not started until a period of abstinence from active drinking has first been achieved.5 Medications that may be used in the longer-term to manage AUD include:2, 5, 9 
<ul>
 	<li>Naltrexone. By blocking some of the rewards associated with alcohol use, <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/naltrexone-assisted-recovery/">naltrexone</a> can help people maintain abstinence from drinking.</li>
 	<li>Acamprosate. Through a mechanism thought to involve a balancing of certain brain chemistry previously disrupted by chronic alcohol use, <a href="https://alcoholrehab.com/drug-addiction/treatment/gaba-agonist-acamprosate/">acamprosate</a> can help prevent relapse and reduce urges to drink.</li>
 	<li>Disulfiram. Although <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/disulfiram-to-treat-alcoholism/">disulfiram</a> doesn’t reduce cravings, when used daily, it discourages drinking by resulting in unpleasant symptoms when you ingest alcohol.</li>
</ul>
<h2>What Happens After Alcohol Detox?</h2>
Alcohol detox is often the first step on the path to recovery .10 <a href="https://alcoholrehab.com/alcohol-recovery/">Recovery</a> is an ongoing, lifelong process that requires commitment and dedication. This is why it’s important to have a treatment plan in place once detox is complete. Treatment can address the underlying issues that may have contributed to the addiction, prevent relapse, and help you regain control of your life.

Depending on your unique needs, you may enter inpatient or outpatient treatment. Inpatient treatment means you live onsite and receive round-the-clock care. It can be helpful for anyone who needs highly supportive care, people with more severe addictions or co-occurring mental health disorders, or those without supportive home environments.10 

Outpatient treatment means you live at home but travel to a rehab facility anywhere from one to several times per week.10 Some people first start out in inpatient treatment and transition to outpatient care as their recovery journey progresses.

If you’re ready to take back control of your life, American Addiction Centers is ready to help you find a treatment option that’s suited to your needs. Call our free, confidential, 24/7 helpline at 1-888-966-8152 to find out more about your rehabilitation options.
<h3>Sources</h3>
<ol>
 	<li>Sachdeva, A., Choudhary, M., &amp; Chandra, M. (2015). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606320/">Alcohol withdrawal syndrome: benzodiazepines and beyond</a>. Journal of clinical and diagnostic research, 9(9), VE01–VE07.</li>
 	<li>Center for Substance Abuse Treatment. (2015). <a href="https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4131.pdf">Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131</a>. Rockville, MD: Center for Substance Abuse Treatment.</li>
 	<li>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</li>
 	<li>National Institute on Alcohol Abuse and Alcoholism. (2021, April). <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder">Understanding alcohol use disorder</a>.</li>
 	<li>Substance Abuse and Mental Health Services Administration and National Institute on Alcohol Abuse and Alcoholism. (2015). <a href="https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4907.pdf">Medication for the treatment of alcohol use disorder: A brief guide. HHS Publication No. (SMA) 15-4907</a>. Rockville, MD: Substance Abuse and Mental Health Services Administration.</li>
 	<li>Bayard, M., McIntyre, J., Hill, K. R., &amp; Woodside, J., Jr (2004). <a href="https://www.aafp.org/afp/2004/0315/p1443.html">Alcohol withdrawal syndrome</a>. American family physician, 69(6), 1443–1450.</li>
 	<li>Trevisan, L. A., Boutros, N., Petrakis, I. L., &amp; Krystal, J. H. (1998). <a href="https://pubs.niaaa.nih.gov/publications/arh22-1/61-66.pdf">Complications of alcohol withdrawal: pathophysiological insights</a>. Alcohol health and research world, 22(1), 61–66.</li>
 	<li>Rahman A, Paul M. (2021, August 27). <a href="https://www.ncbi.nlm.nih.gov/books/NBK482134/">Delirium Tremens</a>. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing.</li>
 	<li>Winslow, B. T., Onysko, M., &amp; Hebert, M. (2016). <a href="https://www.aafp.org/afp/2016/0315/p457.html">Medications for alcohol use disorder</a>. American family physician, 93(6), 457–465.</li>
 	<li>Substance Abuse and Mental Health Services Administration. (2019, October). <a href="https://findtreatment.gov/content/treatment-options/types-of-treatment/">Treatment options: Types of treatment</a>.</li>
</ol>

Alcohol Detox

<h2>What is a Relapse?</h2>
Relapse is a return to substance use after a period of abstinence.1

The recovery process is a time of reflection, personal development, and commitment. <a href="https://www.alcohol.org/guide-alcoholism-treatment/planning/">Recovery from alcohol</a> misuse involves creating new habits and addressing feelings and emotions that may have been ignored for a long time. As a result, it requires people to develop and implement new coping skills to deal with difficulties when they arise.

It is important to note the difference between lapse and relapse, two terms often referred to when discussing recovery. Here's what each term means:4
<ul>
 	<li>A lapse is a "slip" when a person may have one drink and then returns to sobriety.</li>
 	<li>A relapse is the continued use of alcohol or drugs after the initial lapse.</li>
</ul>
A relapse is not always a sudden decision. The warning signs may occur for weeks or even months before a person ultimately makes the decision to use alcohol, again.4
<h2>What are the Stages of Relapse?</h2>
Addiction medicine physician Steven Melemis explains in his research that relapse tends to be a gradual process with three distinct stages.5
<ul>
 	<li>Emotional Relapse. At this stage, it does not necessarily mean a person is thinking about using alcohol again, but they may be neglecting self-care and their coping strategies. For example, isolating, not reaching out for support, and bottling up emotions.</li>
 	<li>Mental Relapse. During a mental relapse, a person may fantasize about drinking alcohol. This creates an internal struggle where they may minimize the consequences of using drugs or alcohol to justify using again.</li>
 	<li>Physical Relapse. At this point, drinking alcohol/or drug use begins and soon escalates to an uncontrollable level.</li>
</ul>
<h2>How Common is Alcohol Relapse?</h2>
Recovery is considered an ongoing, lifelong process, and relapse is often a part of that process. The Journal of the American Medical Association reports that 40% to 60% of people, who seek treatment for substance abuse, will relapse within 1 year.

As mentioned earlier, warning signs may appear weeks or months before an actual relapse.4 One of the biggest indicators someone might be headed for a lapse or relapse is halting the new behaviors learned in early recovery, which can make you vulnerable to triggers.4
<h2>Alcohol Relapse Triggers</h2>
Triggers are essentially reminders of the various reasons that caused you to misuse alcohol in the first place. Living near a bar or a place where you used to drink, being in a relationship with someone who is still using alcohol or other substances are risk factors that may trigger a relapse .5 

Common triggers include:
<ul>
 	<li>Withdrawal symptoms.</li>
 	<li>Chronic stress.</li>
 	<li>Certain people or places.</li>
 	<li>Peer Pressure</li>
 	<li>Relationship problems.</li>
 	<li>Financial stress.</li>
 	<li>Uncomfortable emotions, such as loneliness, anger, and anxiety.</li>

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</ul>
<h2>Alcohol Relapse Prevention Tips</h2>
There are ways you can implement your own relapse prevention plan. For example, having people you can call for support, a list of 12-step program meetings you can attend, and strategies that focus on self-care.

Strategies focused on self-care may include:5
<ul>
 	<li>Exercise.</li>
 	<li>Healthy diet.</li>
 	<li>Quality sleep.</li>
 	<li>Breathing exercises.</li>
 	<li>Meditation.</li>
 	<li>Take up a hobby like painting, yoga, running, or another creative endeavor.</li>
 	<li>Be honest with your support group about your struggles</li>
 	<li>Avoiding triggers (certain people and places).</li>
</ul>
<h2>What do to When a Relapse Occurs</h2>
A relapse does not mean you have failed in recovery. Treatment of addiction involves changing deeply entrenched behaviors. Chronic use of alcohol or drugs can cause brain structure and function to alter, and it takes time for the brain to heal itself.8 Having feelings of regret, shame, or guilt after a relapse is not uncommon, but the sooner you intervene the easier it may be to get back on track.

If you have already completed a treatment program, reach out to your therapist, psychiatrist, or medical doctor to get their advice on the next steps. You should also talk to the people in your support system (family, friends, and sponsors) to help determine the best course of action.8 Don't be discouraged if it has taken you a while to get help again, take this as an opportunity to adjust your treatment plan and find a <a href="https://www.alcohol.org/rehab-centers/">rehab</a> facility that is individualized to your needs.

Furthermore, it’s important to remember you are not alone, about half of people who <a href="https://americanaddictioncenters.org/alcoholism-treatment">seek treatment for substance</a> abuse experience a relapse. 8 Re-entering a treatment program can help you to again stop using alcohol and reduce the risk of future relapses.8,9
<h3>Sources</h3>
<ol>
 	<li>Larimer, M., Marlatt, A., &amp; Palmer, R. (1999). <a href="https://pubs.niaaa.nih.gov/publications/arh23-2/151-160.pdf">Relapse Prevention.</a> National Institute of Alcohol Abuse and Alcoholism, niaa.nih.gov. Vo. 23, No. 2. p. 151.</li>
</ol>
<ol start="2">
 	<li>National Alliance on Mental Illness. (May 2020). <a href="https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Substance-Use-Disorders">Substance use disorders</a>.</li>
 	<li>American Psychological Association. (July 2017). <a href="https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral">What is cognitive-behavioral therapy?</a></li>
 	<li>S. Department of Veteran Affairs. (September 27, 2020). <a href="https://www.va.gov/WHOLEHEALTHLIBRARY/tools/reducing-relapse-risk.asp">Reducing relapse risk</a>.</li>
 	<li>Melemis, S. (September 3, 2015). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/">Relapse prevention and the five rules of recovery.</a> National Center for Biotechnology Information.</li>
 	<li>Menon, J. and Kandasamy, A. (February 2018). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844157/">Relapse Prevention.</a> Indian Journal of Psychiatry and National Center for Biotechnology Information.</li>
 	<li>National Institute on Drug Abuse. (July 2020). <a href="https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery">Treatment and recovery.</a></li>
 	<li>National Institute on Drug Abuse. <a href="https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery">Drugs, Brains, and Behavior: The Science of Addiction Treatment and Recovery</a>.</li>
 	<li>Mohammadpoorasl, A., Fakhari, A., Akbari, H., Karimi, F., Arshadi Bostanabad, M., Rostami, F., &amp; Hajizadeh, M. (2012). <a href="https://www.omicsonline.org/addiction-relapse-and-its-predictors-a-prospective-study-2155-6105.1000122.php?aid=5072">Addiction relapse and its predictors: A prospective study</a>. Journal of Addiction Research &amp; Therapy, 3(1), 1–3.</li>
</ol>
&nbsp;

&nbsp;

Alcoholism and Relapse: Risks, Signs, and Prevention

<h2>What is Drug Detox?</h2>
The concept of detoxification, or medically managed withdrawal, describes the set of interventions designed to safely manage the physical and psychological symptoms that some people experience when withdrawing from certain drugs.1 There are distinct withdrawal syndromes associated with different types of drugs, alcohol, and some prescription medications. The purpose of drug detox is to keep you as safe and comfortable as possible while your body clears itself of the substances you've been using.8

If you've been misusing drugs or alcohol for a long time, you may be at risk for having developed enough physiological dependence to these substances that you will experience significant withdrawal when trying to stop. Medical detox should not be seen as a substitute for comprehensive substance use disorder treatment, but rather the period of supervision and any needed interventions to safely manage withdrawal, while better preparing you to transition for continued <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/decide-for-rehab/">rehabilitation or treatment.</a> 8
<h2>Drug and Alcohol Withdrawal</h2>
When it comes to drug detox and withdrawal, the symptoms and side effects can vary significantly, depending on specific type of substance dependence. Across a range of substances, some common withdrawal symptoms include:1
<ul>
 	<li>Gastrointestinal disturbances like nausea, vomiting, and diarrhea.</li>
 	<li>Changes in appetite.</li>
 	<li>Sleep problems including both insomnia and hypersomnia.</li>
 	<li>Movement changes such as shakiness or tremors.</li>
 	<li>Body aches and pains.</li>
 	<li>Changes in mood, nervousness, and irritability.</li>
 	<li>Cravings.</li>
</ul>
<h3>Alcohol Withdrawl Risks</h3>
Amongst all the various substance withdrawal syndromes, <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/alcohol-detox/">acute alcohol withdrawal</a> can be particularly troublesome due to the risk of certain severe symptoms and withdrawal complications. Some of these include: 1
<ul>
 	<li>Nervous system instability.</li>
 	<li>Dysregulation of body temp, heart rate, and blood pressure.</li>
 	<li>Marked anxiety and agitation.</li>
 	<li>Hallucinations and delusions.</li>
 	<li>Grand mal seizures.</li>
 	<li>Delirium Tremens (commonly called DTs).2</li>
 	<li>Seizures.</li>
</ul>
It is important to note, each person may experience different side effects and varying intensities. Because of the considerable risks faced during alcohol withdrawal, medical detox may be necessary. In the case of certain other types of substances, for which a severely unpleasant or complicated withdrawal may be possible—for instance, opioids, benzodiazepines, and other sedatives—some form of inpatient medical detox may also be the most appropriate level of care at this point in early recovery from those substances.
<h2>How Long Does Drug Detox Last?</h2>
The following factors may influence the severity of the withdrawal and detox needs:
<ul>
 	<li>Substance used: Though individual differences may influence the onset and duration of withdrawal; many substances have somewhat characteristic withdrawal time frames. For instance, alcohol withdrawal symptoms may begin within 6 hours of the last drink, peak in severity over the course of the next 36 to 72 hours and resolve over the course of 2 to 10 days. 3 Withdrawal from relatively short-acting opioids like heroin may begin within 8 hours to a day of the last use, but then last for another 4 to 10 days.3</li>
 	<li>Level of Dependence: How often, how much, and how long you’ve been using the drug can lead to various magnitudes of physical dependence. The more frequently you use a certain drug and the higher your dosage, the worse your withdrawal symptoms may be.3</li>
 	<li>Medical history: Having other medical issues may complicate the withdrawal process.1</li>
</ul>
<h2>Drug Detox Process</h2>
Your treatment team will develop an individualized program for you based on your unique needs. Though the precise detox protocol that you encounter may differ somewhat from the next person, professional detoxification from alcohol and other drugs commonly involves three essential components, including:1
<ul>
 	<li>Evaluation. You receive a comprehensive evaluation to screen for any substances remaining in the bloodstream, as well as to assess your overall health needs and social situation to determine both your detox needs and the most appropriate level of post-detox treatment.</li>
 	<li>Stabilization. This is the active detox phase where you will detox with medical supervision and support and, when needed, medications for safe and comfortable withdrawal management.</li>
 	<li>Fostering entry to treatment. Detox is an important step toward recovery, but it’s not the only step. Your treatment team will emphasize the importance of continued treatment efforts once your withdrawal period has been successfully managed and will help to arrange for the transition to an appropriate substance abuse treatment setting once detox is complete.</li>
</ul>
<h2>Can I Quit Drugs Cold Turkey?</h2>
Quitting drugs or alcohol cold turkey can, in some cases, be dangerous. For example, alcohol, when stopped abruptly after chronic, long-term use, can result in seizures, delirium, and sometimes death. 1.  Although opioid withdrawal symptoms are rarely life-threatening, they can be intensely uncomfortable and difficult to stop on your own. A medically supervised detox, to keep you as safe and comfortable as possible, may be the appropriate choice in early recovery.
<h2>How Much Does Detox Cost?</h2>
Detox costs may vary depending on the specific facility chosen and the level of care needed. Because detox is medical/behavioral health treatment, your insurance companies may help pay for your care. If you are enrolled in the Medicaid program, they may be able to assist you with payment.7 There may be free and assisted rehab and detox programs available, depending on your location. Work with your insurance provider to determine what resources are available for you.
<h2>What Happens After Detox?</h2>
The goal of medical detox is to get your body free of substances and help start your recovery. Detox alone is rarely sufficient in helping a person achieve long-term recovery and is only the first stage of addiction treatment. Often, patients decide to enter a substance abuse rehabilitation program once they’re finished with their detox program. While in detox, you will work with your providers to develop a treatment plan and identify resources available for you. Over the longer term, comprehensive treatment for substance use disorders may involve inpatient treatment, outpatient treatment, or a combination of both.8 
<ul>
 	<li> Inpatient treatment: You may opt to participate in an inpatient treatment program upon completing detox. These programs offer 24/7 care and can last for a few weeks to a few months, as needed. You will learn skills for remaining sober and address any co-occurring issues you may have.</li>
 	<li>Outpatient treatment: You may engage in psychotherapy, medication treatment, and substance abuse treatment on an outpatient basis. You may take part in a program that you attend daily, or once or twice a week.</li>
 	<li>Support groups: Commonly integrated into professional treatment programs, support groups (e.g., Alcoholics Anonymous and Narcotics Anonymous) offer ongoing support to those trying to recover from substance abuse. Continued meeting attendance is an important element of many aftercare plans for long-term recovery.</li>
</ul>
It’s important that you continue to pursue <a href="https://alcoholrehab.com/alcohol-recovery/">long-term recovery</a> following detox from drugs. Your medical provider can help you choose which option is best for you.

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<h3>Sources</h3>
<ol>
 	<li>Substance Abuse and Mental Health Services Administration. <a href="https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4131.pdf">TIP 45: Detoxification and Substance Abuse Treatment | SAMHSA Publications and Digital Products.</a></li>
 	<li>Bayard, M., McIntyre, J., Hill, K., &amp; Woodside, J. (2004). <a href="https://www.aafp.org/afp/2004/0315/p1443.html">Alcohol Withdrawal Syndrome.</a> American Family Physician, 69(6), 1443–1450.</li>
 	<li>World Health Organization. (2009). <a href="https://www.ncbi.nlm.nih.gov/books/NBK310654/pdf/Bookshelf_NBK310654.pdf">Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.</a></li>
 	<li>Diaper, A. M., Law, F. D., &amp; Melichar, J. K. (2014). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014033/pdf/bcp0077-0302.pdf">Pharmacological strategies for detoxification.</a> British Journal of Clinical Pharmacology, 77(2), 302–314.</li>
 	<li>Hayashida, M. (1998). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761814/">An Overview of Outpatient and Inpatient Detoxification.</a> Alcohol Health and Research World, 22(1), 44–46.</li>
 	<li>gov. <a href="https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/parity/index.html">Substance Use Disorders | Medicaid.</a></li>
 	<li>National Institute on Drug Abuse. <a href="https://www.drugabuse.gov/download/675/principles-drug-addiction-treatment-research-based-guide-third-edition.pdf?v=74dad603627bab89b93193918330c223">Types of Treatment Programs.</a></li>
 	<li>National Institute on Drug Abuse. <a href="https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment">Principles of Effective Treatment.</a></li>
</ol>

Medical Detox

<h2>What is Alcohol Relapse?</h2>
Relapse is a return to substance use after a period of abstinence.6 Recovery from alcohol misuse involves creating new habits and addressing feelings that may have been ignored for a long time. <a href="https://alcoholrehab.com/alcohol-treatment/admissions/">Rehab treatment</a> often focuses on recognizing and understanding these emotions and other internal and external triggers that have previously been coped with by drinking or using drugs. Treatment also helps people in recovery develop new coping skills to deal with difficult emotions or stress when they arise. 7  Experiencing a relapse does not mean that your recovery has failed.4 The Journal of the American Medical Association reports that 40% to 60% of people who seek treatment for substance abuse will relapse within 1 year.
<h2>Alcohol Relapse Prevention</h2>
A relapse is not necessarily a sudden decision. Warning signs may occur for days, weeks, or even months before a person ultimately makes the decision to use alcohol, again.7

However, in addition to what you learned about your drinking patterns and triggers during treatment, there are some general ways you can prepare for a potential relapse.  These strategies may include:1
<ul>
 	<li>Reaching out for help when you are struggling or feeling isolated.</li>
 	<li><a href="https://alcoholrehab.com/12-steps-aa/">Attending a support group like AA (Alcoholics Anonymous) or SMART Recovery</a>.</li>
 	<li>Engaging in self-care activities like working out, breathing exercises, yoga, or meditation.</li>
 	<li>Establishing healthy boundaries with your family, friends, and others in your social group.</li>
 	<li>Rehearsing potentially triggering situations or finding alternatives to people, places, things, associated with drinking.</li>
 	<li>Working with a medical professional to manage medications.</li>
 	<li>Participating in evidence-based therapy for alcohol use disorder.</li>
 	<li>Working to improve your nutrition and other physical health habits.</li>
</ul>
<h2>Stages of Relapse</h2>
Addiction medicine physician Steven Melemis explains in his research that relapse tends to be a gradual process with three stages.5
<ol>
 	<li>Emotional Relapse. During the emotional stage, it does not necessarily mean a person is thinking about using alcohol again, but they may be neglecting self-care and their coping strategies. For example, isolating, not reaching out for support, and bottling up emotions.</li>
 	<li>Mental Relapse. During a mental relapse, a person may fantasize about drinking alcohol. This creates an internal struggle and bargaining where they may minimize the consequences of using drugs or alcohol to justify using again.</li>
 	<li>Physical Relapse. At this point, drinking alcohol/or drug use begins and soon escalates to an uncontrollable level.</li>
</ol>
<h2>Triggers for Alcohol Relapse</h2>
One of the biggest indicators someone might be headed for relapse is when they abandon the new behaviors learned in early recovery, which can make you vulnerable to triggers.7

 The various reasons that caused you to misuse alcohol in the first place may likely still be triggers. For example, living near a bar or a place where you used to drink, being in a relationship with someone who is still using alcohol or other substances are risk factors that may trigger a relapse .5

Common triggers may also include:
<ul>
 	<li>Withdrawal symptoms.</li>
 	<li>Chronic stress.</li>
 	<li>Certain people or places.</li>
 	<li>Peer Pressure</li>
 	<li>Relationship problems.</li>
 	<li>Financial stress.</li>
 	<li>Uncomfortable emotions, such as loneliness, anger, and anxiety.</li>
</ul>


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<h2>What Happens After an Alcohol Relapse?</h2>
Treatment of chronic diseases, such as alcohol use disorder, involves changing deeply rooted behaviors, and relapse doesn’t mean treatment has failed. 7 When a person recovering from an addiction experiences a relapse, it’s important to communicate with your doctor. Treatment may need to be modified, added or otherwise adjusted.7

Having feelings of regret, shame, or guilt after a relapse is not uncommon, and while it’s important to acknowledge those feelings, it’s also important to move on and get back on track. 5 It may also be helpful to talk to the people in your support system (family, friends, and sponsors).6
<h2>Treatment for Alcohol Relapse</h2>
Stopping alcohol or drug use is just one part of a long and complex recovery process. When people enter treatment, addiction has often caused serious consequences in their lives. 7 Behavioral therapies help people in addiction treatment modify their attitudes and behaviors related to substance abuse. As a result, they can learn healthier ways to handle stressful situations and other triggers that might cause a relapse. Behavioral therapies used in the treatment of AUD and that may be helpful for those experiencing a relapse include: 7
<ul>
 	<li>Cognitive-behavioral therapy. This helps patients recognize, avoid, and cope with the situations in which they're most likely to use alcohol or drugs.</li>
 	<li>Contingency management. Positive reinforcement is encouraged, such as providing rewards or privileges for remaining substance free, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.</li>
 	<li>Motivational enhancement therapy.  This type of therapy uses strategies to make the most of people's readiness to change their behavior and enter treatment.</li>
 	<li>Twelve-step facilitation (TSF).  Typically delivered in 12 weekly sessions, this helps to prepare people to become engaged in 12-step mutual support programs. 12-step programs, like Alcoholic Anonymous, are not medical treatments, but provide social and complementary support to those treatments. TSF follows the 12-step themes of acceptance, surrender, and active involvement in recovery.</li>
</ul>
Furthermore, it’s important to remember you are not alone, about half of people who seek treatment for substance abuse experience a relapse. 7<a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/decide-for-rehab/"> Re-entering a treatment program can help you</a> to again stop using alcohol and reduce the risk of future relapses.7,8
<h3>Sources</h3>
<ol>
 	<li>Zgierska, A. and Burzinski, C.A. (2020, September 17). <a href="https://www.va.gov/WHOLEHEALTHLIBRARY/tools/reducing-relapse-risk.asp">Reducing Relapse Risk</a>.</li>
 	<li>National Institute on Drug Abuse. (2020, June 3). <a href="https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment">How effective is drug addiction treatment?</a>.</li>
 	<li>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).</li>
 	<li>National Institute on Drug Abuse. (2020, July 10). <a href="https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery">Treatment and Recovery</a>.</li>
 	<li>Melemis S. M. (2015). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/">Relapse Prevention and the Five Rules of Recovery</a>. The Yale journal of biology and medicine, 88(3), 325–332.</li>
 	<li>Larimer, M., Marlatt, A., &amp; Palmer, R. (1999). <a href="https://pubs.niaaa.nih.gov/publications/arh23-2/151-160.pdf">Relapse Prevention.</a>National Institute of Alcohol Abuse and Alcoholism, niaa.nih.gov. Vo. 23, No. 2. p. 151.</li>
 	<li>National Institute on Drug Abuse. <a href="https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery">Drugs, Brains, and Behavior: The Science of Addiction Treatment and Recovery</a>.</li>
 	<li>Mohammadpoorasl, A., Fakhari, A., Akbari, H., Karimi, F., Arshadi Bostanabad, M., Rostami, F., &amp; Hajizadeh, M. (2012). <a href="https://www.omicsonline.org/addiction-relapse-and-its-predictors-a-prospective-study-2155-6105.1000122.php?aid=5072">Addiction relapse and its predictors: A prospective study</a>. Journal of Addiction Research &amp; Therapy, 3(1), 1–3.</li>
</ol>

Alcohol Relapse: Understanding Addiction and Relapse

<h2>What is Binge Drinking?</h2>
Binge drinking is a common, often dangerous, and even fatal, problem in the United States. It's a pattern of heavy alcohol use that raises a person's blood alcohol content (BAC) to .08% or above.1 This typically happens when men consume 5 or more drinks or women consume 4 or more drinks in about 2 hours.

The concentration of .08% is significant because in many states it is considered the level at which a person is intoxicated and too impaired to drive. 2  One in 6 adults in the United States, engages in binge drinking, on average, 4 times per month, consuming 7 drinks each binging episode. 1 
<h2>Binge Drinking Differences Between Men and Women</h2>
Binge drinking is most common in adults ages 18-34 and is twice as common among men than women.1 Binge drinking is also common among older populations.

For women, reaching a BAC of .08% can happen after consuming about 4 drinks in 2 hours; for men, about 5 drinks in 2 hours.1 However, many factors make up a person’s physiological response to alcohol, including body type, tolerance, and whether alcohol is consumed on an empty stomach or in the presence of other substances. 3 
<h2>Why Do People Binge Drink?</h2>
People engage in binge drinking for many different reasons that include the following:
<ul>
 	<li>Social (peer) pressure.</li>
 	<li>The desire to “take the edge off” in an awkward situation or environment.</li>
 	<li>A negative coping skill to relieve fear, <a href="https://alcoholrehab.com/alcoholism/effects/alcohol-induced-anxiety/">anxiety</a>, or depression.</li>
 	<li>Temporarily escape from the world’s problems.</li>
 	<li>The inability to control alcohol consumption.</li>
</ul>
<h2>Binge Drinking: Symptoms, Signs, and Dangers</h2>
While not everyone who engages in binge drinking develops an <a href="https://americanaddictioncenters.org/alcoholism-treatment">alcohol use disorder</a> (AUD), binge drinking may increase the risk of AUD and other health issues. There are certain criteria an individual must meet in order to be diagnosed with an alcohol use disorder, and although binge drinking is not specifically one of those criteria, binge drinking in the presence of other behaviors can potentially increase the likelihood of developing an alcohol use disorder.

Additionally, binge drinking increases the risk of acute harm like blackouts and overdose as well as risky behaviors like unsafe sex, domestic violence, unplanned pregnancy, and car accidents.4
<h3>Short-Term Effects of Binge Drinking</h3>
The following are short-term effects of binge drinking:
<ul>
 	<li>Nausea</li>
 	<li>Vomiting</li>
 	<li>Hangovers</li>
 	<li>Memory loss</li>
 	<li>Personal Injury</li>
 	<li>Alcohol poisoning (can lead to death)</li>
 	<li>Blackouts (When you consume alcohol in excess, the brain is unable to keep short-term information in your memory. A blackout occurs when you cannot remember what happened when you were drinking. You might experience a partial or total blackout).</li>
</ul>
The following are warning signs that you may have a binge drinking problem:
<ul>
 	<li>Consuming more than four drinks in a day</li>
 	<li>Forgetting what happened while you were drinking</li>
 	<li>Feeling guilty or ashamed when you drink too much</li>
 	<li>Feeling that you need to reduce your drinking</li>
 	<li>Feeling surprised when you drank more than you planned</li>
 	<li>Having people in your life comment on how much you drink</li>
 	<li>Ditching responsibilities to make time to drink</li>

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</ul>
<h3>Long Term Effects of Binge Drinking</h3>
While alcohol use continues to be socially acceptable, the effects on your health should not be underestimated. Long-term health effects associated with binge drinking include the following: 6 
<ul>
 	<li>Heart disease</li>
 	<li>Brain damage</li>
 	<li><a href="https://alcoholrehab.com/alcoholism/effects/alcoholic-liver-disease/">Liver disease</a></li>
 	<li>Cancers</li>
 	<li>High blood pressure</li>
</ul>
Binge drinking has been shown to increase the risk of certain types of cancers such as breast, colorectal, and esophageal cancers, among others.4 

Chronic health issues for heavy drinkers are determined by a variety of factors such as the number of years of alcohol use, genetic background, and gender. Some studies show that women might be particularly vulnerable to alcohol’s effects on major organ systems like the heart and liver.5

Alcohol is deeply embedded in contemporary culture that the idea of quitting can seem challenging. Not only is alcohol legal and available just about anywhere, from gas stations to grocery stores, it’s also often the centerpiece of social gatherings across all demographics.
<h2>Treating Alcohol Use Disorder</h2>
When drinking begins to feel out of control, if you’re drinking too much, too often, or if it is having a negative impact on your health, work, or relationships, it might be time to consider <a href="https://www.alcohol.org/treatment/">treatment</a>.

More than 14 million adults, 18 and older, have an alcohol use disorder.7 Many others who may not meet the specific criteria for an AUD may still struggle with controlling their drinking.7

Treatment options for alcohol use disorder include:9 
<ul>
 	<li>Behavioral therapies. <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/cognitive-behavioral-therapy/">Cognitive-behavioral therapy (CBT)</a> has been proven to be an effective treatment for substance use disorders. It is based on the premise that psychological problems are based on negative thought patterns and destructive behaviors. CBT practitioners help people learn better ways of coping, positive self-talk, and healthy ways to manage stress.8</li>
 	<li>Certain medications can help reduce cravings and withdrawal symptoms for people in the recovery process. Naltrexone, Disulfiram, and Acamprosate Calcium are approved by the FDA to help treat alcohol use disorders.9</li>
 	<li>12-step programs or other support groups. AA and SMART Recovery are effective treatment programs for many people.10</li>
 	<li>In-patient treatment/rehab centers. For people with severe alcohol use disorders, a residential treatment setting with medical staff available 24/7 might be necessary for the beginning stages of the <a href="https://www.alcohol.org/rehab-centers/">recovery process</a>. Withdrawal from alcohol can be dangerous in long-term, heavy drinkers.</li>
</ul>
It is important to know, there is a wide range of treatment options available to address your individual needs.
<h2>Find Treatment for Binge Drinking</h2>
Alcohol recovery treatment is a process of introspection and behavior change that takes time. However, the <a href="https://www.alcohol.org/rehab-centers/residential-programs/">benefits can be life-changing</a>.

Recognizing a problematic pattern of alcohol use is an important first step in the recovery process and getting treatment can provide the help you need on a path toward a healthier life.

Click <a href="https://americanaddictioncenters.org/treatment-centers">here</a> for more information about treatment options near you or call 1-866-251-7453 to speak with someone today.
<h3>Sources</h3>
<ol>
 	<li>Center for Disease Control (CDC). (2019, December). <a href="https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm">Binge Drinking</a>.</li>
 	<li>National Highway Traffic and Safety Administration. (1998). <a href="https://one.nhtsa.gov/people/injury/research/pub/alcohol-laws/08history/1_introduction.htm">Final Report: Legislative History of .08 per se Laws.</a></li>
 	<li>Paton, A. (2005, January). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC543875/">Alcohol in the Body</a>. National Center for Biotechnology Information. (NCBI), Volume 330.</li>
 	<li>National Institute on Alcohol Abuse and Alcoholism. (May 2021). <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/binge-drinking">What is Binge Drinking?</a></li>
 	<li>S. Dept. of Health and Human Services, National Institutes of Health and the National Institute on Alcohol Abuse and Alcoholism. (October 2004). <a href="https://pubs.niaaa.nih.gov/publications/aa63/aa63.htm">Alcohol Alert</a>.</li>
 	<li>Molina, P. and Nelson, S. (2018). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104963/">Binge Drinking’s Effects on the Body</a>. Alcohol Research, Current Reviews and the National Institute on Alcohol Abuse and Alcoholism, Volume 39, (1), 99-109.</li>
 	<li>National Institute on Alcohol Abuse and Alcoholism. (August 2021). <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help">Treatment for Alcohol Problems: Finding and Getting Help</a>.</li>
 	<li>American Psychological Association. (July 2017). <a href="https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral">What is Cognitive Behavioral Therapy?</a></li>
 	<li>gov. (2015). <a href="https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4907.pdf">Medication for the Treatment of Alcohol Use Disorder: A Brief Guide.</a></li>
 	<li>SMART Recovery. (n.d.). <a href="https://www.smartrecovery.org/intro/">Introduction to SMART Recovery</a>.</li>
 	<li>Center for Disease Control (CDC). (May 11th, 2021). <a href="https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm">Alcohol Use and Your Health</a>.</li>
</ol>
&nbsp;

Binge Drinking

<h2>How Much Alcohol Is Recommended?</h2>
There is not a universally recognized “safe level” of alcohol consumption. Even moderate levels of drinking may pose a health risk, according to some studies. 2

However, the 2020-2025 Dietary Guidelines for Americans recommend that adults of legal drinking age can choose not to drink, or to drink at moderate levels, which is defined as limiting intake to 2 drinks or less in a day for men or 1 drink or less in a day for women, on days when alcohol is consumed.4

It is important to note, the Centers for Disease Control (CDC) and National Institute on Alcohol Abuse and Alcoholism both define a standard drink contains around 0.6 ounces of pure alcohol, which roughly translates to 12 ounces of 5% ABV (alcohol by volume) beer, 5 ounces of 12% ABV wine, or 1.5 ounces of 40% ABV distilled spirits (e.g., gin, vodka, rum, tequila, whiskey).2 ,3

Some people are advised to avoid alcohol altogether, including:2 
<ul>
 	<li>Women who are pregnant or may become pregnant</li>
 	<li>If you are under the legal age for drinking.</li>
 	<li>People with certain medical conditions.</li>
 	<li>People who take medication that may interact with alcohol.</li>
 	<li>If you are in recovery from alcohol use disorder (AUD) or can’t control the amount you drink.</li>
 	<li>If you plan to drive, operate machinery, or participate in any activity that requires alertness and coordination.</li>
</ul>
Research indicates that excessive drinking can significantly increase the risk of short-term harm, such as injuries, as well as the risk of long-term health problems. 2,18 <a href="https://alcoholrehab.com/alcoholism/signs-of-alcoholism/binge-drinking/">Binge drinking</a> can increase an individual’s risk of developing an alcohol use disorder.18
<ul>
 	<li>Binge drinking is a pattern of drinking alcohol that brings a person’s blood alcohol concentration (BAC) to 0.08 percent or higher. This pattern corresponds to an average adult consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours.</li>
 	<li>Heavy drinking is defined as consuming 15 or more drinks a week (male) or 8 or more drinks a week (female).</li>

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<h2>Effects of Alcohol on the Cardiovascular System</h2>
Heavy daily alcohol consumption and binge drinking increase the risk of developing cardiovascular disease.

Some of the cardiovascular conditions associated with high levels of alcohol use include:
<ul>
 	<li>Increased blood pressure, or hypertension.</li>
 	<li>Alcoholic cardiomyopathy (weakened heart muscle).</li>
 	<li>Atrial fibrillation.</li>
</ul>
<h3>Increased Blood Pressure and Hypertension</h3>
Numerous studies have confirmed the association of drinking alcohol at higher than moderate levels with an increase in blood pressure. Binge drinking and chronic, heavy alcohol use is associated with high blood pressure or hypertension.

Consistently elevated blood pressure can cause your heart to have to work harder to pump blood, which can lead to increased stress on your heart.14 Over time, this can lead to a risk of serious cardiac problems such as stroke, heart attacks, heart failure, and coronary artery disease.15 
<h3>Weakened Heart Muscle</h3>
Long-term heavy alcohol consumption can induce cardiomyopathy, a weakening and thinning of the muscles of the heart. When your heart muscle is weakened, it can’t pump blood to your organs efficiently. This can lead to shortness of breath, fatigue, weakness, muscular atrophy, swelling in the hands and feet, and can eventually lead to heart failure. 1,6,7,19

Continuing to drink, particularly heavily, can lead to worsening symptoms, arrhythmias, clots in the cerebral arteries, and ultimately heart failure. Survival is directly associated with the amount of alcohol use and duration of use, and data suggests that abstaining from drinking can result in improved outcomes and reduced inpatient hospital admissions.
<h3>Atrial Fibrillation</h3>
Atrial fibrillation is a form of arrhythmia, which is an irregular, and often rapid or quivering heart rhythm.8 Binge drinking episodes are associated with a higher risk for more severe atrial fibrillation.10 Atrial fibrillation resulting from alcohol use typically resolves following abstinence, with additional episodes of heavy or binge drinking associated with more severe cardiovascular consequences, such as stroke or heart failure.18
<h2>Alcohol and Heart Disease</h2>
The conditions mentioned above can increase your risk of severe cardiovascular complications, including heart disease. While individual factors can play a role in cardiac conditions, binge drinking, and heavy alcohol use can significantly increase the risk of developing heart problems such as:
<ul>
 	<li>Heart attack, or myocardial infarction. A heart attack can occur when part of the heart muscle isn’t getting enough blood. The more time that passes without blood flow to the heart, the greater the damage to the heart muscle. 1,6</li>
 	<li>Stroke. A stroke can happen when blood supply to part of the brain is interrupted, which prevents the brain tissue from getting oxygen. Heavy drinking increases the risk for both hemorrhagic and ischemic strokes. 1,15</li>
 	<li>Heart failure. Heavy alcohol use can lead to cardiomyopathy and atrial fibrillation, which can, over time, lead to heart failure.1,6</li>
</ul>
Studies suggest that continuing to drink when cardiovascular symptoms appear, particularly heavily, can increase the likelihood of more severe symptoms and death.1,19 Conversely, when faced with cardiovascular conditions arising from alcohol, abstinence can provide numerous benefits to your heart, including lowering high blood pressure, resolving atrial fibrillation, and improving cardiac function and prognosis.7  It is recommended to discuss your health situation with your primary care physician, who can conduct an evaluation to help determine the appropriate level of care and treatment for your specific needs.16
<h2>Finding Alcoholism Treatment</h2>
Choosing to <a href="https://alcoholrehab.com/alcohol-treatment/">start treatment for an alcohol use disorder</a> can be an important step to improve your overall health and wellbeing. This can be especially important if you or someone you care about are struggling with alcohol misuse and have pre-existing or alcohol-associated heart conditions. As previously mentioned, chronic alcohol use can negatively impact your heart, increase your risk for many heart conditions, and potentially lead to death.7 

Treatment can look different for everyone but often includes a combination of <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/alcohol-detox/">detox</a>, <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/inpatient/">inpatient</a> or <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/outpatient/">outpatient</a> rehab, and continued care or <a href="https://alcoholrehab.com/alcohol-recovery/aftercare/">aftercare</a>. Most people benefit from some form of treatment.17 More than 30%  of people who receive treatment for alcohol use disorder report no further symptoms one year later, while other people can reduce their alcohol use and report fewer alcohol-related problems, according to the NIAAA.16
<h3>Sources</h3>
<ol>
 	<li>Piano, M. R. (2017). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513687/">Alcohol's effects on the cardiovascular system</a>. Alcohol research: Current reviews, 38(2), 219–241.</li>
 	<li>Centers for Disease Control and Prevention. (2020, December 29). <a href="https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm">Dietary guidelines for alcohol</a>.</li>
 	<li>National Institute on Alcohol Abuse and Alcoholism. (n.d.). <a href="https://pubs.niaaa.nih.gov/publications/practitioner/PocketGuide/pocket_guide2.htm">What is a standard drink?</a></li>
 	<li>Spaak, J., Tomlinson, G., McGowan, C. L., Soleas, G. J., Morris, B. L., Picton, P…&amp; Floras, J. S. (2010). <a href="https://journals.physiology.org/doi/full/10.1152/ajpheart.00700.2009">Dose-related effects of red wine and alcohol on heart rate variability</a>. American journal of physiology. Heart and circulatory physiology, 298(6), H2226–H2231.</li>
 	<li>Brunner, S., Drobesch, C., Herbel, R., &amp; Sinner, M. F. (2021). <a href="https://academic.oup.com/europace/article/20/suppl_1/i16/4929951">Effects of acute alcohol consumption on cardiac excitation, conduction, and repolarization: results from the Munich Beer Related Electrocardiogram Workup Study (MunichBREW)</a>. Clinical research in cardiology, 110(6), 916–918.</li>
 	<li>Zakhari, S. (1997). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826791/">Alcohol and the cardiovascular system: molecular mechanisms for beneficial and harmful action</a>. Alcohol health and research world, 21(1), 21–29.</li>
 	<li>Maisch B. (2016). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013142/">Alcoholic cardiomyopathy: The result of dosage and individual predisposition</a>. Herz, 41(6), 484–493.</li>
 	<li>Centers for Disease Control and Prevention. (2021, September 27). <a href="https://www.cdc.gov/heartdisease/atrial_fibrillation.htm">Atrial fibrillation</a>.</li>
 	<li>Chiva-Blanch, G., &amp; Badimon, L. (2019). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020057/">Benefits and risks of moderate alcohol consumption on cardiovascular disease: Current findings and controversies</a>. Nutrients, 12(1), 108.</li>
 	<li>American Heart Association. (2016, September 30). <a href="https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/tachycardia--fast-heart-rate">Tachycardia: Fast heart rate</a>.</li>
 	<li>Gopinathannair, R., &amp; Olshansky, B. (2015). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447058/">Management of tachycardia</a>. F1000prime reports, 7, 60.</li>
 	<li>American Heart Association. (2020, October 14). <a href="https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults">What is cardiomyopathy in adults?</a></li>
 	<li>American Heart Association. (2016, October 31). <a href="https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure/how-high-blood-pressure-can-lead-to-heart-failure">How high blood pressure can lead to heart failure</a>.</li>
 	<li>Husain, K., Ansari, R. A., &amp; Ferder, L. (2014). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038773/">Alcohol-induced hypertension: Mechanism and prevention</a>. World journal of cardiology, 6(5), 245–252.</li>
 	<li>National Blood Clot Alliance. (n.d.). <a href="https://www.stoptheclot.org/about-clots/afib-2/">Atrial fibrillation (afib) and clot-provoked stroke</a>.</li>
 	<li>National Institute on Alcohol Abuse and Alcoholism. (2021, August). <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help">Treatment for alcohol problems: Finding and getting help</a>.</li>
 	<li>Chikritzhs T, Fillmore K, Stockwell T. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19594799">A healthy dose of skepticism: four good reasonsto think again about protective effects of alcohol on coronary heart disease</a>. Drug Alcohol Rev2009;28:441–4.</li>
 	<li>National Institute on Alcohol Abuse and Alcoholism. (May 2021). <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/binge-drinking">What is Binge Drinking?</a></li>
 	<li>Shaaban, A., Gangwani, M., Pendela, V. and Vindhyal, M., 2021. <a href="https://www.ncbi.nlm.nih.gov/books/NBK513322/">Alcoholic Cardiomyopathy</a>.</li>
</ol>

Alcohol and the Heart: Effects and Treatments

<h2>Alcohol and Liver Damage</h2>
The liver serves many essential functions in our bodies such as aiding in digestion and helping to metabolize and clear toxins from the blood. The liver is also where alcohol and many medications are broken down so they can clear our bodies.11
Chronic alcohol use can contribute to the development of alcohol-related liver disease (ALD). ALD follows a progression of conditions that starts with alcoholic fatty liver disease. Fatty liver disease is caused by a buildup of fat in the liver and is typically classified as caused by alcohol or if the cause is non-alcohol-related—such as obesity or diabetes. It is possible to stop or reverse alcoholic fatty liver disease by stopping alcohol use.11
With the continued use of alcohol, however, ALD will progress to alcoholic hepatitis, a state of inflammation that begins to damage cells in the liver. Continued consumption of alcohol further damages the liver and progresses to the final stage of ALD. End-stage ALD is called cirrhosis of the liver, and is characterized by irreversible scarring, a decline in liver function, and will eventually lead to liver failure and death.

<h2>Types of Alcohol-related Liver Disease</h2>
Alcohol use is directly responsible for approximately half of the incidents of liver disease worldwide.1 Liver disease often follows a progression of conditions from fatty liver to alcoholic hepatitis to cirrhosis of the liver, if drinking continues. Below is a detailed description of each stage: 1,4,5
<ul>
 	<li>Fatty Liver. Alcoholic fatty liver disease is caused by a buildup of fat in the liver. Relatively mild fatty liver (or hepatic steatosis) may be asymptomatic and can develop even with moderate patterns of alcohol consumption, though heavy drinking increases the likelihood. It is possible to stop or reverse this condition with continued abstinence from alcohol.</li>
 	<li>Alcoholic hepatitis. Continued drinking can lead to chronic liver inflammation, known as alcoholic hepatitis. Symptomatic hepatitis may include some jaundice and an enlarged liver. More advanced disease may include anemia and coagulation problems. Attempts to manage alcoholic hepatitis may include alcohol abstinence, nutritional support, and in some cases, corticosteroid therapy. If drinking continues, the condition may become progressively severe, with chronic inflammation eventually leading to extensive, irreversible necrosis of liver tissue.</li>
 	<li>Cirrhosis of the liver. Cirrhosis of the liver occurs when hepatic fibrosis and scar tissue become extensive, potentially resulting in portal hypertension and a shrunken, non-functioning liver. Cirrhosis of the liver is irreversible. However, quitting alcohol can stop it from getting worse.</li>
</ul>
<h2>Symptoms of Alcohol-related Liver Disease</h2>
Symptoms commonly appear only after severe liver damage has already occurred, although some people do show nonspecific symptoms in earlier stages of the disease.5,8  At its various stages of progression, some signs and symptoms of ALD can include:2,5,8
<ul>
 	<li>Yellow tint to the skin and/or to the white of the eyes.</li>
 	<li>Loss of appetite (anorexia).</li>
 	<li>Weight loss.</li>
 	<li>Fever</li>
 	<li>Liver enlargement (early ARLD).</li>
 	<li>Abdominal pain/discomfort.</li>
 	<li>Skin that is intensely itchy.</li>
 	<li>GI bleeding.</li>
 	<li>Easy bruising.</li>
 	<li>Swollen or distended abdomen (ascites).</li>
 	<li>Edema of lower legs and feet.</li>
 	<li>Blotchy red discoloration on the palms of the hands.</li>
 	<li>Small or shrunken liver (later stage ARLD)</li>
 	<li>Characteristic changes on blood tests (serum transaminases).</li>
 	<li>Portal hypertension caused by high blood pressure in the liver.</li>
 	<li>Esophageal varices, which means that veins in the esophagus are enlarged.</li>
 	<li>Variceal rupture and hemorrhage</li>
 	<li>Hepatic encephalopathy, which may include confusion and marked changes in behavior.</li>
 	<li>Imaging evidence (CT, MRI, ultrasound) of characteristic changes such as liver nodularity and enlarged spleen.</li>
</ul>
<h2>Risk Factors for Alcohol-related Liver Disease</h2>
ALD is associated with chronic and heavy alcohol use. However, even occasional <a href="https://alcoholrehab.com/alcoholism/signs-of-alcoholism/binge-drinking/">binge drinking</a>—consuming between 4 and 5 alcoholic drinks within a 2-hour period—can lead to a buildup of fat in the liver and increase the risk of developing alcoholic steatosis as the first stage of alcoholic liver disease.1,5

Other factors that may influence an individual’s risk of alcoholic liver disease include:1,6,7,8
<ul>
 	<li>Drinking Patterns. Drinking 40 to 80 grams ethanol/day by males (roughly 3 to 6 standard drinks) and 20 to 40 grams/day (1.5 to 3 standard drinks) by females for 10 to 12 years has been a predictor of more severe cases of ALD in past studies.1</li>
 	<li>Weight. Obesity can contribute to fatty liver disease and may be correlated with alcohol-related liver damage.</li>
 	<li>Concurrent health issues. Medical comorbidities such as hepatitis B and C can make alcohol-related liver disease progress faster.</li>
 	<li>Genetics. Studies suggest that there may be a genetic component to alcohol-related liver disease. Genetic vulnerability may explain why a relative minority of heavy drinkers develop liver problems.</li>
 	<li>Age. Older adults may be more likely to show signs of liver damage.</li>
 	<li>Gender. Women are at increased risk of developing alcohol-related liver disease than men are due to potential metabolic and body composition differences that result in higher average blood alcohol concentrations from comparable amounts of alcohol being consumed.</li>
 	<li>Smoking. Cigarettes have been linked to an increased risk of developing alcoholic cirrhosis and can impair liver functioning.</li>
 	<li>Other substances. If you take prescription medications, over-the-counter drugs, or even supplements, this can affect your liver. Additionally, these can also interact with each other, alcohol, or other drugs to further damage your liver.</li>
</ul>
<h2>Diagnosing Alcohol-related Liver Disease</h2>
It is important to be honest with your doctor about your use of <a href="https://alcoholrehab.com/alcoholism/signs-of-alcoholism/am-an-alcoholic/">alcohol and other substances</a>, as it can have a major impact on your health. Since alcohol-related liver disease can be tough to detect in some cases, your doctor may want to conduct some testing in order to confirm their suspicion based on your symptoms and history of alcohol use, or rule it out as a potential diagnosis.2 In order to diagnose alcohol-related liver disease, your doctor may do the following:2,4,5,8
<ul>
 	<li>Exam. The doctor will talk to you about your symptoms, your drinking, your eating habits, and conduct a physical examination, paying attention to your abdomen and your extremities. This is to identify any causes that can cause or contribute to your symptoms, and determine which part of your body is affected.</li>
 	<li>Bloodwork. Certain blood markers can be analyzed to assess how well your liver is functioning. If liver disease is already present, it can give your doctor an indication of the severity or progression of the disease. Blood tests can also check for viral diseases that could additionally complicate issues, such as hepatitis.</li>
 	<li>Imaging. This can be used to rule out other issues, such as obstructions in the bile ducts or tumors, which can cause similar issues, and it can give your doctor a better idea of what kind of liver disease you have, if any. Imaging that is commonly used can include ultrasound, a CT scan, an MRI scan, and/or abdominal ultrasonography, which are able to gather images of your liver.</li>
 	<li>Liver biopsy. If your doctor reasonably suspects that you have alcoholic cirrhosis, but can’t confirm it any other way, they may conduct a biopsy, where a thin needle is inserted into your liver and some cells are removed to be looked at under a microscope. This can help your doctor understand how severe the disease is, and allow them to understand how best to treat you.</li>
 	<li>Procedures. If your stomach has become very swollen (ascites), the doctor may draw out some of the fluid to examine it, evaluate what it is from, and relieve the pressure you may be feeling because of it. When portal hypertension, enlarged esophageal blood vessels, and the potential for upper gastrointestinal tract bleeds are an issue, endoscopic examination may be necessary.</li>

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<h2>Treating Liver Disease and Alcoholism</h2>
If you have been diagnosed with ALD it is recommended to stop drinking.11 Abstinence is the only way of possibly reversing liver damage, in the early stages, or in more advanced cases, preventing it from becoming worse.11 It is important to discuss treatment options with your healthcare provider; these can include counseling, medications, <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/decide-for-rehab/">and a treatment program.</a> If you are physically addicted to alcohol, a <a href="https://alcoholrehab.com/alcohol-treatment/types-of-treatment/alcohol-detox/">medically supervised detox is recommended for a safe withdrawal</a>. It can be dangerous to stop drinking on your own. A rapid reduction in alcohol can lead to withdrawal symptoms including anxiety, agitation, hallucinations and seizures. Your doctor can recommend a program that best meets your needs. This may include:11

 Nutrition therapy: Nutritional deficiencies are very common in people with ALD. Your doctor may recommend a special diet, as well as vitamin and nutritional supplements, to combat the effects of malnutrition and help you gain weight if needed. You may be referred to a nutritionist who can assist you with meal 9 Alcohol-Related Liver Disease planning. If you have trouble eating enough to get the vitamins and nutrients you need, your doctor may recommend giving you a special nutrient-rich liquid intravenously or via tube feeding.

Medications: Depending on the severity of your disease, your doctor may recommend medications to help reduce liver inflammation. These drugs have shown some short-term benefit in increasing survival. Steroid treatment with prednisolone is usually the first-line medication, followed by pentoxifylline, if steroid therapy doesn’t work. No alternative medicine treatments have been found to cure alcohol-related hepatitis.

Liver transplant: For people with advanced alcohol-related cirrhosis, the only treatment option may be a liver transplant. However, active alcoholics do not usually qualify as suitable organ recipients. For transplant to be an option, you’d need to find a transplant center that would consider you and then meet the requirements of the program, including abstaining from alcohol for six months prior to transplant and agreeing not to resume drinking afterward.

Research has shown that treatment can be very effective in helping individuals maintain a life of sobriety, no matter how grave the problem may seem.12

The type of treatment that will be most suitable may be determined by several individual factors such:
<ul>
 	<li>Previous attempts to quit.</li>
 	<li>The amount of current alcohol use and corresponding level of physical dependence.</li>
 	<li>Co-occurring medical and/or mental health conditions.</li>
 	<li>Additional substance use.</li>
</ul>
Within a comprehensive treatment plan, individuals may experience private and group therapy, family counseling, behavioral therapies, support group meetings, wellness activities, and medication treatments.13 Behavioral therapies can help individuals focus on identifying and changing the behaviors that led to addiction in the first place.12
<h3>Sources</h3>
<ol>
 	<li>Osna, N.A., Donohue, T.M., &amp; Kharbanda, K.K. (2017). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/pdf/arcr-38-2-147.pdf">Alcoholic liver disease: Pathogenesis and current management</a>. Alcohol research: Current reviews, 38(2), 147-161.</li>
 	<li>Torruellas, C., French, S.W., &amp; Medici, V. (2014). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155359/pdf/WJG-20-11684.pdf">Diagnosis of alcoholic liver disease</a>. World journal of gastroenterology, 20(33), 11684-11699.</li>
 	<li>National Institute on Alcohol Abuse and Alcoholism. (2021, April). <a href="https://www.niaaa.nih.gov/sites/default/files/publications/Alcohol_Use_Disorder_0.pdf">Understanding alcohol use disorder</a>.</li>
 	<li>Patel, R., &amp; Mueller, M. (2021). <a href="https://www.ncbi.nlm.nih.gov/books/NBK546632/#_NBK546632_pubdet_">Alcoholic liver disease</a>. Treasure Island, FL: StatPearls Publishing.</li>
 	<li>National Health Service. (2018, August 10). <a href="https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/">Alcohol-related liver disease</a>.</li>
 	<li>Schuppan, D., &amp; Afdhal, N.H. (2008). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2271178/pdf/nihms-42379.pdf">Liver cirrhosis</a>. Lancet, 371(9615), 838-851.</li>
 	<li>Roerecke, M., Vafaei, A., Hasan, O.S.M., Chrystoja, B.R., Cruz, M., Lee, M., … Rehm, J. (2019). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776700/pdf/nihms-1534273.pdf">Alcohol consumption and risk of liver cirrhosis: A systematic review and meta-analysis</a>. American journal of gastroenterology, 114(10), 1574-1586.</li>
 	<li>Jackson, W. (2021, May). <a href="https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/alcohol-related-liver-disease/alcohol-related-liver-disease">Alcohol-related liver disease</a>.</li>
 	<li>American Liver Foundation. (n.d.) <a href="https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/non-alcoholic-fatty-liver-disease/">Nonalcoholic fatty liver disease (NAFLD)</a>.</li>
 	<li>Saberi, B., Dadabhai, A. S., Jang, Y. Y., Gurakar, A., &amp; Mezey, E. (2016). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913072/">Current management of alcoholic hepatitis and future therapies</a>. Journal of clinical and translational hepatology, 4(2), 113–122.</li>
 	<li>American Liver Foundation. (2017). <a href="https://liverfoundation.org/wp-content/uploads/2019/11/Alcohol-Related-Liver-Disease-Brochure-2017.pdf">Alcohol-Related Liver Disease</a></li>
 	<li>[13]. National Institute on Alcohol Abuse and Alcoholism. (2014). <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help">Treatment for Alcohol Problems: Finding and Getting Help.</a></li>
</ol>

Alcoholic Liver Disease

<h2>What is Anxiety?</h2>
Anxiety is an emotion everyone experiences at one point or another. For example, you may feel nervous before speaking in front of a crowd, starting a new job, or find yourself worrying while stuck in traffic. In certain situations, these anxious feelings can be helpful, such as motivating you to be prepared or alerting you to be extra cautious. However, when fear and distress become overwhelming and those feelings alter from helpful to harmful, an anxiety disorder may be the cause. 3

More than 40 million adults have an anxiety disorder, making it the most common health concern in the United States. 3 There are many types of anxiety disorders, with varying symptoms. All are characterized by having persistent, excessive fear or worry in situations that are not threatening.3

The most common types of anxiety disorders include:
<h3>Generalized Anxiety Disorder (GAD)</h3>
Someone diagnosed with GAD may experience long periods of ongoing anxiety. The constant worry impacts their daily life and interferes with their ability to function.4  
<h3>Panic Disorder</h3>
A panic attack is a sudden onset of intense anxiety. Panic disorder occurs by having reoccurring panic attacks that often happen without warning. People fear they may be having a heart attack when they experience a panic attack. They struggle to breathe, their heartbeats fast, they may feel light-headed or dizzy.5 
<h3>Social Anxiety Disorder</h3>
Social anxiety disorder is more than just being shy. 6 People with this disorder often have looming fears of being judged, humiliated, or rejected. Those struggling with social anxiety disorder find social interactions such as going to school, working, and dating difficult.6 
<h3>Phobias</h3>
It’s not uncommon to avoid something that scares you. But for someone with a phobia, certain places, events, or objects can create intense feelings of irrational fear. People with specific phobias work hard to avoid any triggers and this attempt to control fear can consume their everyday life. 3
<h2>Causes of Anxiety Disorders</h2>
Research indicates a combination of factors may play a role in causing anxiety disorder. These risk factors may include3:
<ul>
 	<li>Genetics.  Anxiety can “run in the family.” Some families may have a higher-than-average amount of anxiety disorders among relatives.</li>
 	<li>Environmental. This may include a traumatic or stressful event, death of a loved one, or a diagnosis of a serious illness.</li>
 	<li>Medication. Anxiety may be a side effect of certain medications.</li>
 	<li>Drugs and alcohol. Drug and alcohol misuse or withdrawal may worsen or cause anxiety.</li>
</ul>
<h2>Can Alcohol Cause Anxiety?</h2>
Anxiety disorders commonly co-occur with <a href="https://alcoholrehab.com/alcoholism/">alcohol use disorder</a>. 1  People who misuse alcohol to the extent that they cannot control their alcohol consumption, despite the negative consequences may be diagnosed with an Alcohol Use Disorder (AUD). 9

But determining which came first is a bit more difficult.  Some studies indicate individuals who have a co-occurring anxiety disorder and alcohol use disorder report they had issues with alcohol misuse prior to developing issues with anxiety.1

Conversely, studies have also shown that many people use alcohol to cope with anxiety disorders or relieve symptoms of anxiety.12 Over time, this may develop into an alcohol use disorder.

That each disorder can influence the other suggests the relationship between anxiety and substance use disorders is more complex, and the two disorders are interrelated.1 According to this model, individuals who develop an anxiety disorder are at an increased risk of developing an alcohol use disorder and vice versa. 1 Regardless of which disorder came first, research suggests these disorders can fuel each other and progress to dangerous levels if either of them is left untreated.
<h2>Treating Co-occurring Alcoholism and Anxiety</h2>
When someone has more than one mental health disorder, such as an anxiety disorder and an alcohol use disorder it is referred to as a dual diagnosis or co-occurring disorders.1

Because each condition influences the other, studies point toward the effectiveness of integrating care.11 The goal of integrated co-occurring disorder alongside <a href="https://alcoholrehab.com/alcohol-treatment/">alcohol rehab treatment</a> is to help people learn how to maintain sobriety and manage the symptoms of their anxiety at the same time. Research has shown that people who participate in integrated treatment are more likely to stay sober, see a significant reduction of their symptoms, visit the hospital less often, live independently, maintain steady employment, and report feeling happier with their lives.11

Treatment for alcohol use disorder and co-occurring anxiety disorders will be uniquely tailored to an individual’s specific needs. Common types of treatment that can be directed toward treating either or both disorders include:7,8,11
<ul>
 	<li>Psychotherapy or “talk therapy,” including cognitive behavioral therapy.</li>
 	<li>Medications such as anti-anxiety medications and antidepressants.</li>
 	<li>Complementary health approaches, including stress relief, exercise, meditation, and relaxation techniques.</li>
</ul>
If you are suffering from an alcohol use disorder and anxiety disorder, treating both disorders simultaneously at a qualified rehab facility can offer the necessary treatment toward a healthy recovery.

<hr />
Not sure if your insurance covers alcohol treatment?
Check your insurance coverage or text us your questions for more information.
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<hr />

<h3>Sources:</h3>
<ol>
 	<li>Smith, J.P., &amp; Randall, C.L. (2012). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860396/">Anxiety and alcohol use disorders: comorbidity and treatment considerations.</a> Alcohol research: current reviews, 34(4), 414–431.</li>
 	<li>Price J.S. (2003). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181631/">Evolutionary aspects of anxiety disorders</a>. Dialogues in clinical neuroscience, 5(3), 223–236.</li>
 	<li>National Alliance on Mental Illness. (2017, December). <a href="https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders">Anxiety Disorders.</a></li>
 	<li>National Institute of Mental Health. (2016). <a href="https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad">Generalized Anxiety Disorder: When worry gets out of control.</a></li>
 	<li>National Institute of Mental Health. (2016). <a href="https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms">Panic Disorder: When fear overwhelms.</a></li>
 	<li>National Institute of Mental Health. (n.d.). <a href="https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness">Social Anxiety Disorder: More than just shyness.</a></li>
 	<li>National Institute of Mental Health. (n.d.).</li>
 	<li>National Institute of Mental Health. (n.d.). <a href="https://www.nami.org/About-Mental-Illness/Treatments/Complementary-Health-Approaches">Complementary Health Approaches.</a></li>
 	<li>American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5, Washington, D.C.: American Psychiatric Association.</li>
 	<li>National Institute of Mental Health. (2020, May). <a href="https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Substance-Use-Disorders">Substance Use Disorder.</a></li>
 	<li>Flynn, P.M., &amp; Brown, B.S. (2008).<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2200799/pdf/nihms36789.pdf">Co-occurring disorders in substance abuse treatment: Issues and prospects</a>. Journal of Substance Abuse Treatment, 34(1), 36-47.</li>
 	<li>Turner, S., Mota, N., Bolton, J., &amp; Sareen, J. (2018). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175215/">Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature</a>. Depression and anxiety, 35(9), 851–860. </li>
</ol>
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&nbsp;

Kara Stevens

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