What you need to know about alcohol use disorder

In hindsight, real estate developer Brinton Motheral recognizes his many “last straws.” He was going to learn to control his alcohol abuse, he told himself, the day he crashed his car. Slapped his girlfriend. Was sent home by his own staff for being disruptive. The day he gave away a condo.

Finally, said Motheral, 69, of Pittsburgh, “I got sick and tired of being sick and tired.” At age 38, he quit drinking and checked into the Greenbriar Treatment Center in Washington, Pennsylvania. Since then, he has seen alcoholism treatment evolve, beginning with the terminology.

Motheral calls himself a “recovering alcoholic, not former alcoholic, because it’s chronic, like heart disease or diabetes,” he said. “I’m sober, but I’ll always have the disease.”

The Diagnostic and Statistical Manual of Mental Disorders (DSM), started calling alcoholism an “alcohol use disorder (AUD)” in 1980 instead of a “personality disorder.”

This junked the notion that AUD “is a moral failing or a character flaw,” said Harold Urschel, a neuropsychologist and chief medical strategist for Dallas, Texas-based Enterhealth. He is also the author of “Healing the Addicted Brain.”

Motheral is a member of an AUD peer group that has grown to about 18 million adults in the U.S., according to the National Institutes of Health. That’s more than the combined populations of Colorado, Missouri and Wisconsin.

You are at higher risk for AUD if you are male or had your first drink in your teens, according to NIH. If you have at least one parent with AUD, it could be in your genes.

“We’ve identified at least 25 gene variations that influence how you react to alcohol and other drugs,” said Norman Hoffman, adjunct psychology professor at Western Carolina University and president of Evince Clinical Assessments.

The science

behind AUD

Doctors study how alcohol affects your brain – physically and psychologically.

In an MRI, a normal brain looks like the smooth, rubber facsimile we tossed around in middle school science class. An AUD brain looks more like a dog’s old, chewed-up toy.

“Alcohol injures the brain’s limbic system, especially, which is the Intel chip of the brain,” Urschel said. “This affects your judgment, organizing and insight,” he said.

“That’s why the last person to understand he has AUD is the person with AUD,” added Motheral.

Your family must be wrong to tell you to get help, you reason. So you concoct new ways to hide the disorder that controls you. “To hide it from her husband, one woman would sunbathe on her stomach and use a straw to drink from a bottle she had buried under the (chaise) in her backyard,” said Hoffman.

For those who get sober, though, doctors have good news: Your brain can repair itself.

The hard part, said Motheral, is step one: quit drinking and endure detox. Your brain screams, “Drink!” while your body protests with nausea, insomnia, restlessness or sweating.

At this point, doctors hear, “Can’t I learn to be a social drinker and just have a glass of wine?”

No, said Urschel. “I beg other doctors to stop telling people to have a drink a day,” he said. “One, this is not OK for people with AUD. Two, better to learn to reduce stress with a 30-minute jog instead of alcohol.”

Getting help

Those who have AUD can seek help at an addiction-treatment clinic, where counselors offer “been-there” support. Those who cannot afford rehab can find outpatient treatment.

Urschel’s Enterhealth clinic offers many treatment options, including neuropsychology, medication and psychotherapy. Part of assessment there is a six- to eight-hour neurocognitive test that tells the doctor what an MRI cannot. Through a pokerlike card game, for example, he can gauge your impulse control.

“The test isn’t new,” said Urschel. “Similar ones have been used with Alzheimer’s (disease) and stroke patients. But using it for this is new.”

As your alcohol-free brain rejuvenates, therapy helps you learn why you drink and helps you map your new, sober life.

“When you get sober, you have to take responsibility for yourself. That’s scary!” said Motheral. “But you also have time you didn’t have when you were drinking. I used it to be with my daughter.”

Treatment at clinics also includes linking you to peer-led groups in the community, such as Alcoholics Anonymous (www.aa.org).

If you don’t subscribe to AA’s emphasis on religion (seven of its 12 steps refer to God or a spiritual awakening), check out Secular Organizations for Sobriety, or SOS (www.sossobriety.org).

“SOS also stands for ‘save ourselves,’ ” said Jim Christopher, who started the organization at his kitchen table in 1985. “We empower you instead of disempower you.”

AUD treatment also includes prescribed drugs. Campral (acamprosate) restores your brain’s chemical balance after you’re sober.

“Naltrexone, which decreases your desire to drink, enables many people to be outpatients instead of inpatients,” said Hoffman.

Smaller clinics focus on AUD subgroups. Many of the patients at the El Cajon, California-based McAlister Institute, for example, are “traumatized and brokenhearted” single moms, said Marcia Robinson, director of its women and children’s center. “When their addictions have consequences such as DUI accidents, they’re court-ordered to come here.”

At McAlister, you bring your kids. “We all help watch the kids while the women get sober, learn job skills and find housing,” said Robinson.

Warriors Heart in Bandera, Texas, serves veterans, police officers and first responders. “Week One, you detox and you’re in a fog,” said CEO Josh Lannon. “Then, we help you plan your new life.”

Beyond counseling, Lannon’s toolbox includes journaling and animal-assisted therapy. “There’s no one answer that works for everyone,” he said.

The next step is to see the big picture, to view AUD as “systemic and communitywide,” said Joseph Lee, a psychiatrist and a medical director at the Hazelden Betty Ford Foundation in Center City, Minnesota.

“We know how to ID at-risk kids and intervene early,” said Lee. Tight social-services budgets limit implementation of some AUD programs, but “we’re at least talking about it,” he said. “No longer are we ignoring the elephant in the room.”