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CHARTOFF LAB
Neurobiology of Motivated Behavior Laboratory (NMBL)
Basic Neuroscience Division
McLean Hospital, Harvard Medical School
Ask Dr. Chartoff
Addiction Education Society
Is it considered addiction if someone I know drinks a lot but not to the point of getting drunk?
Short answer: This person may have an alcohol addiction problem.
Long answer: See below - at least TWO of the criteria (DSM-5 Alcohol Use Disorder Criteria) listed below must be met.
According to the DSM-5, alcohol use disorder is “a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following [criteria], occurring within a 12-month period.”
1) Alcohol is often taken in larger amounts or over a longer period than was intended.
[Do you drink more than you mean to?]
2) There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
[Do you want to stop, but can’t?]
3) A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
[Is drinking taking over your life?]
4) Craving, or a strong desire or urge to use alcohol.
[If you can’t drink, are you thinking about drinking?]
5) Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
[Is your drinking getting in the way of day-to-day activities?]
6) Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
[Is drinking getting in the way of your relationships?]
7) Important social, occupational, or recreational activities are given up or reduced because of alcohol use. [Are you sitting things out because of alcohol?]
8) Recurrent alcohol use in situations in which it is physically hazardous.
[Are you drinking in risky settings, or doing risky things while drinking?]
9) Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
[Do you know drinking isn’t good for you, but you do it anyway?]
10) Tolerance, or needing increased amounts of alcohol to achieve intoxication, or having a diminished effect with continued use of the same amount of alcohol.
[Do you need to drink more than you used to?]
11) Withdrawal, or the characteristic withdrawal syndrome for alcohol as well as drinking alcohol (or taking a benzodiazepine) to relieve or avoid alcohol withdrawal symptoms.
[Do you feel withdrawal symptoms when you stop drinking?]
What are some ways to stop doing drugs and alcohol if they’re so addictive?
For people with addiction, the great battle in the brain is between two powerful forces: The overpowering feeling of NEED to take the drug and the overpowering feeling of DESIRE to stop taking the drug.
Recovery from addiction always includes a back and forth between not taking the drug (abstinence) and taking the drug (relapse). Recovery from addiction is the slow, difficult process of teaching the brain to act on the desire to stop taking the drug as much as possible.
Science- and medical-backed ways to stop doing drugs and alcohol depend primarily on the person and the drug(s). In most cases, combinations of medications and therapy are the most effective.
Alcohol:
Medications:
Naltrexone
Disulfiram
Acamprosate
Therapy:
12-step programs (e.g., Alcoholics Anonymous)
Cognitive Behavioral Therapy (CBT) -seeks to help patients recognize, avoid, and cope with the situations in which they're most likely to use drugs.
Contingency management - uses positive reinforcement such as providing rewards or privileges for remaining drugfree, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
Opioids:
Medications:
Methadone
Buprenorphine
Extended-release naltrexone
Therapy (evidence increasingly shows that medications are the most effective for opioids):
Nicotine:
Medications:
Nicotine replacement therapies (available as a patch, inhaler, or gum)
Bupropion
Varenicline
Therapy (not considered particularly effective)
Stimulants and/or cannabis
Medications:
None available
Therapy:
12-step programs
Cognitive Behavioral Therapy (CBT)
Contingency management
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