Alcoholism: How much is too much?

Alcoholism: How much is too much?


[♪ INTRO ] Alcohol can cause … a lot of problems. Just drinking too much can poison and kill
you, but so can the impaired judgment while driving, or the diseases it puts you at greater
risk for. Lots of people drink fairly regularly without
any of these problems, though. And not everyone who has a little too much
once in a while is an alcoholic. So how do you know when drinking becomes a
problem? It mostly has to do with symptoms of addiction
like tolerance and withdrawal, along with how your drinking affects your relationships
and responsibilities. Even though the amount you drink is a big
health risk on its own and a super important part of the problem, diagnosing alcohol use
disorder — the clinical term for alcoholism — isn’t really about hard numbers. For that, most psychiatrists turn to the Diagnostic
and Statistical Manual of Mental Disorders, or DSM, which lists two main types of symptoms. First, there are the signs that have to do
with the physical aspects of dependence, like addiction, tolerance, and withdrawal. For example, if you find yourself needing
more alcohol to get the same effect, drinking a lot more than you intended, or failing to
cut back on drinking when you’ve tried. Other symptoms are more about how your drinking
affects your home life and responsibilities. Like if your drinking has interfered with
your relationships or responsibilities at work or at home, or has put you or others
at risk, but you still don’t stop. The DSM lists 11 symptoms in all, and if you
have any two of them, that’s enough to be diagnosed with alcohol use disorder. The more symptoms someone has, the more severe
it gets. But no matter where they fall on the spectrum,
people with alcohol use disorder are drinking so much that it puts their relationships,
responsibilities, and maybe even their life at risk. There are a thousand different ways to get
to that point, but they all come down to one thing: alcohol has a sedative effect, which
makes you less anxious and more relaxed. And the more you associate drinking alcohol
with that relaxed feeling, the more your brain’s reward system gets involved. If thinking about a drink makes your brain
release a lot of dopamine, the neurotransmitter that’s involved in the motivation to seek
rewards, you’re going to have a very strong urge to satisfy that thought. It’s the same basic process that drives
most addictions. But alcohol doesn’t affect everyone in exactly
the same way. From studies and statistics, we know that
things like your genetics and experiences can make you more or less likely to develop
a disorder. For example, certain genes seem to change
how enzymes that metabolize alcohol work, which changes how it affects your brain. Everyone has enzymes in their liver called
alcohol dehydrogenases, which convert alcohol into acetaldehyde, a chemical that won’t affect
the brain the same way. But some people have genes that make those
enzymes faster at their job, compared to other variants of those genes. People with the genes that make the enzymes
faster tend not to drink as much and are at a lower risk of alcoholism, probably because
less alcohol gets a chance to interfere with their neurotransmitters. But people with genes that make the enzyme
slower have a higher chance of developing a disorder. Those genetic differences help explain what
researchers have known for years: that a family history of alcoholism puts people at higher
risk. But as usual, genes aren’t the whole story. Researchers have also found that just living
with alcoholics can put people at a greater risk, both through additional stresses and
being exposed to that kind of drinking behavior. For example, a study published in the Journal
of Abnormal Psychology in 1991 looked at 454 adolescents, since that’s a stage of life
when you’re at a high risk for starting to develop an unhealthy relationship with
alcohol. In the study, having alcoholic parents made
people more likely to report dependence themselves. But it mattered whether their parents’ alcoholism
was in remission or not — meaning, whether they got sober. Children of sober alcoholics drank less overall,
and were less likely to report negative consequences or dependence, than those whose parents still
drank. Even though the genetic risk factors were
still there, their environment made a difference, too. But risk factors are just that — risk factors. They don’t determine your fate. For a lot of people with alcohol use disorder,
recognizing and admitting that they have a problem is incredibly difficult, and getting
help can seem even harder. That’s part of what the disorder does to
your brain — it takes away your control. But you can still choose to get help to regain
that control. The most common treatments are mutual-help
groups, like Alcoholics Anonymous. These programs can be helpful because you
have peer support available when you need it the most. And research has found that people participating
in AA for the first time have more days where they don’t drink. Rehab also tends to work well, partly because
it’s designed to remove the triggers that might encourage you to drink. People who check into inpatient rehab programs
report longer periods of abstinence, and the longer the stay, the more helpful it seems
to be. Some medications can help too, especially
when people just need to get alcohol out of their system so they can start on long-term
treatments. A drug called Naltrexone, for example, can
reduce cravings for alcohol, and studies have found that people who take the drug end up
drinking less, and on fewer days, compared to a placebo. There’s also evidence that cognitive behavioral
therapy can be effective. That’s where you work with a therapist to
identify things that trigger you to drink and find healthier ways to cope. Not everyone will respond to every kind of
treatment, but doctors and psychologists have so many tools in their arsenal that if you
realize you want help, odds are you’ll find one that makes sense for you. Thanks for watching this episode of SciShow
Psych, which was brought to you by our patrons on Patreon. If you want to learn more about what makes
our weird human brains do the things they do, you can go to youtube.com/scishowpsych
and subscribe. [♪ OUTRO ]

100 comments

  1. As the child of alcoholic parents, watching them struggle with their addiction tuned me in to what kind of hell it can be to quit after the habit has already formed. I've managed to make it to adulthood without following in their footsteps, and my parents managed to get sober just three years ago after liver damage began threatening my mother's health. Dad never admitted he had a problem, but accepted that he needed to quit if mom was gonna stay on the wagon. I'm kinda amazed they finally made it after watching them fight it my entire childhood/teen years.

  2. Is there any research into the overall well being of people, men specifically, drinking alcohol consistently? I don't think women are evolved to drink as much for a few obvious reasons. But men certainly are the ones who drink far more, and always have. I am just wondering about the positive effects of men who drink 3 or 4 beers every night too "take the edge off" hard labor jobs. Or is that just a case of habit, and dopamine rewards, that a healthy and active drinking person can find more good than bad in there lives from alcohol?

  3. Acamprosate is another drug that can help a patient wean themselves off the booze, along with supportive therapy. It helps counteract certain changes in brain chemistry — through means still unknown — to help protect the brain from neurotoxic reactions to withdrawal, while also lessening the symptoms of that withdrawal.

  4. I actually was diagnosed with alcoholism and take a drug called disulfiram. It is a acetaldehyde dehydrogenase inhibitor, meaning is stops the conversion of acetaldehyde into acetic acid after alcohol is converted to acetaldehyde. This causes the chemical to build up creating really bad hangovers if you drink. It's sort of like operant conditioning. If you drink you get positive punishment, so over time you associate drinking with a feeling of pain rather than pleasure.

  5. so, driking a full cup of pure vodka and not feeling any diference is the enzyme slow ? or fast as hell?
    Coz i disliked the flavour so, i drink it all at once and the other guys was suprised… also 1 of them was knocked down after 2 cups but driking normally …

  6. This is great, this question is so close to just being a value judgement outside of the scope of science, but since it's so important to do some science about alcoholism, it's nice to know that researchers put so much thought and care into what they consider alcoholism. Thanks for the thorough review!

  7. I feel AA would be more useful if it was less court mandated and passing a narrative that if it doesn't work for you, you aren't trying and not good enough. That seems line it would push the opposite effect and ignores many other treatment options that fluid actually work for the individual.

    That's my main issue with AA, not even therm, just the government and the way it implements is way on drugs

  8. Whats disgusting about alcoholics, especially violent ones is they literally have NO idea how much damage THEIR drinking does. I've got 35 years experience dealing with one and the subsequent effects. PTSD and flashbacks are a common occurrence for us victims.

  9. My whole family tree is made up of alcoholics and yet I can go months without drinking and be fine. I also find that it takes quite a lot of it to get me actually drunk and to keep me buzzed. Maybe I've got the One For All of booze?

  10. Although I do not drink anymore, I drank heavy for years, without any addiction and could quit cold turkey with zero withdrawal/detox symptoms.

    My last stint went on for ~7 years. The last 2 years, I would drink 20+ beers a day. Decided one day I was tired of it and stopped.

  11. Personally I’ve never understood how people become alcoholics. I’m 21 been drinking since 17 but I drink strictly on weekends when I’m out, I never crave alcohol during the work week, nor do I drink alone or every have any at my house. It’s always just been a party thing but I do drink a good amount on the days I do

  12. Lots of debate in the comments about whether AA should be considered an effective "treatment", or in fact a treatment at all. My own feeling is that AA is a shame-based treatment with its roots in Puritanism. I suppose it's better than nothing, but we have much better alternatives now.

  13. Really Masterclass? A 2 minute 20 second ad and no option to skip? I don't want to turn my ad blocker back on but I'm gonna.

  14. I saw my life falling before my eyes during my alcoholic stint, so before it got worse, I knew I had to change. I still drink, but its less often and I'm glad I did it before it got worse.

  15. I consider myself lucky that I've never had a problem with alcohol. Grandfather was an alcoholic, father was an alcoholic, sister was an alcoholic. Don't get me wrong, I LOVE Scotch, bourbon, tequila… I consume alcoholic beverages on most days actually. But for whatever reason I don't have any trouble controlling my intake. I know how much is safe (even healthy), and I can easily stay within those limits.

  16. I'm 32 and it's interesting because like most drugs I think alcohol stopped having any positive relaxing effects. I "stress drank" a couple of years ago because of a job and it became a problem- I managed to cut back and now I'm cautious about drinking too much or too often because I feel like it just makes my anxiety much worse.

  17. I got addicted to alohcol because I have severe anxiety so would drink letting me fall asleep without heart palpitations, it eventually started to interfere with my work until spiraling out of control around the time my step father died from booze and bills in his sleep. I ended up on effexor after I stopped drinking to help treat my anxiety conditions properly.

  18. What’s that Officer?
    You want me to balance on one foot and say the alphabet backwards?
    I can’t even do that when I’m sober!

    Uh oh.

  19. Just a side note on the recommendation of rehab for anyone in the US: you may want to watch the Last Week Tonight story (titled "Rehab" easily enough), as there are a lot of concerns with companies claiming to be useful in the rehabilitation process. I'm not sure if this is a common issue elsewhere, but it's definitely something to be aware of if you're a US resident seeking a rehab facility.

  20. May body sort of rejects alcohol, like for instance I think most of it is purely disgusting when it comes to taste and I only drink then mixed with any juice

    Beer is pretty much the only thing I'll drink without making faces and even that only on parties
    I never drink alcohol cause I have the sudden urge to

  21. I drink… quite abit. Am i an addict? Probably.

    Do i really care? No. Not really.
    While drinking too much has many,many,MANY bad consequences…

    It also has some good benefit for myself… honestly i could live a very productive and fufilling life being drunk half the time…

    Except of course i couldnt drive, do math reliably, and always having to pee is encumbersome… to say the least.

  22. John Oliver exposed the rehab industry just this week. This just shows that "sci" channels are voiced over wikipedia articles mashed together. Where is the research?

  23. I've always preferred the sensation of being high over drunkenness. I just stick with good ol mary jane.

  24. I have what I've called for decades, "An Addictive Personality", meaning that I have to be very careful about the addictive substances I take into my body, because I could very easily go to them at the slightest provocation. What brought about my awareness of this aspect of my personality was after coming down from heroin addiction of "Chasing the Dragon" while in the service in Thailand during the Vietnam conflict.

    My plane ride home on a common carrier which was least to the military was delayed 12 hours in Bangkok Thailand. I could not let anyone else know what I was going through for fear of a military reprisal. by the time I got to Travis 24 hours later for mustering out, I was down, and vowed then to never allow myself to get to that point again. I had a short stent in the mid seventies with alcoholism, but managed to master it and cut back by will alone because I got married and two children.

    At 72, I have been on "Medical Marijuana" for five years because Peripheral Neuropathy in my feet, (non diabetic) of which the doctors said there was nothing more they could do, but offer drugs. I opted for Medical MJ and have found it not in the least addictive as was proven by my abstinence on our 11 day stay in Hawaii recently because Hawaii does not have a reciprocity clause in their Medical MJ laws. I suffered no issues what so ever, but I did have to take ibuprofen every night though, so I could sleep.

  25. AA is a cult that fetishises drinking, isolates people from others, promotes a confessional, self-shaming bonding process linked to an acceptable Western deity. It has a "success" rate of less than five percent. It is offered up as a last resort for the hopeless. If you "fail" at AA it is because you are morally defective. Run as far away from this cult as you can.

  26. AA & Rehab don't work. When your doctor tells you if you don't stop you will die in a matter of months, that works.

  27. AA has a 3% success rate and claims you're always an addict plus intertwines religion with so-called recovery. You should be ashamed to have mentioned them as helpful.

  28. Can your brain release chemicals of pleasure in relation to negative thoughts of powerlessness grief or self pity? Can certain localizations or types of thought create an addictive self activating stimuli without the use of any drugs or alcohol? Just curious because I've never touched a drop of alcohol in my life and other people have labeled me as drunk before. Was wondering if, like DMT, your brain had something similar to it that produces an equivalent of the chemical reaction that happens in the brain when you drink alcohol.

  29. What's weird in our family is that our parents aren't alcoholics, but all four of us kids are (two in recovery, two not). Our parents each grew up with an alcoholic parent though. So, we all won the lottery when they brought those single copies of alcoholic genes into the mix, and they recombined to give us two copies.

    Well, I can't say this for sure with my siblings – only me. I'm making an educated guess, based on a doctor-ordered genetic test for something else. It turned out that I have two copies of a mutated liver enzyme strongly correlated with alcoholism. But, considering I got one copy from each parent, and they aren't alcoholics, it's possible they only have one copy of the mutated gene and one functional copy. Then, lucky us, we all possibly got the mutated gene from each of them. I know I did.

    But, my parents were traumatized by their alcoholic parents, and they repeated the behavior with us. In other words, they acted like active alcoholics. So, it's hard to tell how much is affected by environment. I was never going to be able to process alcohol normally. So, I wonder if even if I grew up in a functional family, if I was going to be an alcoholic anyway. Trauma added fuel to that fire for sure. My genes though are a huge part of the story.

    Same ole question: Nature vs. Nurture

  30. What about cultural influences? In some countries like France and Belgium alcohol is much more accepted than in the USA. Nobody will think it's weird for a 15 year old to drink a glass of wine in France or have a beer in Belgium. Even though legally drinking age is 16.

  31. Some of this is extremely unscientific. Most of your statements sound like xenophobia. This is like calling atheism or homosexuality a disease. The DNA and enzyme stuff was good though. The DSM stuff was extremely weak and unscientific.

    It's inconvenient to administer hard tests for tolerance and enzyme presence, but that doesn't make the extremely weakly grounded rules of thumb that the DSM gives science. We shouldn't pass this stuff as science, this undermines scientific rigor and the public trust of it.

    Even if we were to take the DSM seriously, as the courts do, you can have situations where someone who's a loner in college does badly and isolates himself for years and does poorly at work because of the shame. But if he were to ever take a sip of kombucha, the DSM would consider him an alcoholic and so would the court should he ever get into any trouble.

    This wreaks of lazy convenient parables passing as science.

  32. my parents never drunk alcohol but I developed alcoholism in my early 20s. It's not in my genes and not because I was around drinkers. but even then I was a functioning alcoholic that worked and did normal stuff. I just finished every single day off by getting completely wasted, quite often to the point of vomiting. I was always gonna drink tho. According to my parents, when I was 3 years old, I apparently got drunk at a wedding by sneaking under the tables and emptying peoples wine glasses. Probably should have died that day but I guess I wasn't done drinking yet. Some people just like alcohol and im one of them. I don't drink much these days, but I still drink around 3 times a week but now i drink less than 24 units which is better than the 100s i used to drink every week. And I never even went to rehab…

  33. I’m glad I haven’t started drinking. I injured my liver a couple years ago, so I’m not even sure if my body could handle it!

  34. When you drink so much you have no memory of where you were or what you were doing…congratulations, you're Associate Justice of the Supreme Court material!

  35. I'm going alcoholic its a disease I want to be put on Make A Wish Foundation or maybe have handicap parking why doent might insurance policy cover it shove that in your DSM5. The medical clinicians have a large hand in why its a disease $$$$$$$ my whole fam "suffers" from alcoholism the real people who are suffering is the love ones that we drag through our s*** i have multiple years in recovery and work in the holistic field of helping families piece back together there dignity and lives and most rehabs are backed by the state and forced to make them dependent on the med system for as long as they can.

  36. You know what else can kill you if you have too much? Caffeine. It also causes physical and psychological dependence, dose escalation, difficulty quitting, and sometimes psychosis if you have too much but not enough to kill you. And yet children can just go buy caffeine. At stores. Without showing ID. And very few people overdose.
    Maybe we'd all have fewer problems around alcohol if we all stopped treating it like Satan incarnate. IDK, just a thought.

  37. i wish he would have put more emphasis on "drinking at all" most people don't understand that it's either you drink cassually, or you don't drink at all.

  38. My father drank too much alcohol and broke a bunch of plates and glasses. I don't even want to drink two sip of alcohol.

  39. I am certain AA is helpful, but their religious indoctrination crap makes me avoid sending anyone needing help their way. There are other ways to get help and also to check yourself on if you think you might have a problem with alcohol. https://www.npr.org/sections/health-shots/2018/01/08/575932508/is-alcohol-a-problem-this-tool-helps-assess-risk-and-find-help

  40. Sitting on 4 beers rn. Got an soon to be opened can of PBR and finish off a jug of Mississippi Mud. After four days of not touching any. Not sure if I have a problem or not.

  41. You are well on your way to self-destructing yourself with alcohol if :

    1. You skip meals and replace them with alcohol , gives you an excuse to start drinking earlier.

    2. You don’t have an hangover even if you had quite a bit of drinks the night before.

    3. You can never just have a couple of drinks , way past the everything in moderation mindset ..

    4. You might be calm and in a good state of mind when you first arrive at the bar , but get aggressive and emotional as you drink more and more throughout the night.

    5. You often experience blackouts.

    6. You spend the most of your money on drinks.

    7. You get extremely defensive when someone argues with you about your drinking habits .

    8. You think you can quit anytime you want even though you’ve never done it .

    9. You need alcohol to feel more confident in social gatherings .

    10. You need alcohol to sleep better ..

    11. You desperately need a drink after a stressful event or a hard day at work .

    12. You start hiding your alcohol.

    13. You start buying more expensive wines and whiskey thinking you are now the wine connoisseur or the scotch expert.

    14. You start brewing your own.

    Majority of the people who posses most of these symptoms are not necessarily alcoholics , but they are psychologically addicted to alcohol , and if left untreated will eventually turn into psychical dependence …

    Alcohol is poison , carcinogenic and has ZERO benefits .. Get the poison out of your life today …

  42. I’ve been sober since 15 b/c my addicted parents said I had a problem, then they found out they had a problem as well. They sent me to rehab and a recovery home and been sober since by the grace of God!

  43. I remember my grandfather's friend wife had such a bad alcohol problem that she would drink rubbing alcohol or mouth wash

  44. Alcoholics Anonymous is great but forces religion down peoples throat. I recommend Narcotics Anonymous, very open-minded and accepting.

  45. I'm alcoholic no question I've been sober a year I used to drink 9-12 or sometimes more beers every single day now I don't drink at all. But I still think about it constantly. Any suggestions?

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