Is Alcohol Use Disorder a mental illness?

Alcohol addiction is a complicated disease with psychological, biological and social components, and like other chronic illnesses, addiction ofttimes involves cycles of relapse and remission. Some people can drink alcohol - and even over consume on occasion - without it becoming an addiction. For others, drinking can turn into mild, moderate or severe alcohol use disorder - which is the term now used by medical professionals instead of alcoholism or alcoholic.

So, why do some people become addicted to alcohol while others don't?

There are multiple factors involved with alcohol use disorder including age, genetics, biology, environmental and social influences, but one common aspect applies universally: alcohol effects our brain's reward centre. Bursts of dopamine (the feel good hormone) are released when we eat good food, listen to music or exercise for example, urging us to "do that again".  According to research by biological psychologists, individuals who are more susceptible to addiction - as well as those who are genetically susceptible to certain mental health disorders- likely have lower levels of dopamine in their brains. Research also shows that when the brain reward centres for these individuals are flooded with alcohol induced levels of dopamine, the connection between drinking, the resulting pleasure and cues linked to the experience, 'teach' the brain to pursue alcohol instead of healthier goals and activities. This means that the need for addictive substances becomes hardwired in the brain to the point that the brain can't distinguish between healthy rewards and alcohol rewards.

Does the medical community recognise alcohol use disorder as a disease?

Yes, AUD has been identified as a disease characterised by compulsive decision-making, impulsive behaviour and relapse. The disease theory of AUD is based on the following:

• Biological in nature (illness already exists in itself)
• Does not rectify itself (doesn't go away or healitself)
• Exhibits recognisable signs or symptoms
• Has a predictable timeline of development
• It's progressive (can get worse if left untreated)

In what way is AUD a mental health disorder?

Like depression and other mental illnesses, addiction is a serous medical condition that is rooted in brain changes. Addiction is defined as "not having control over doing, taking or using something to the point where it could be harmful to you" it creates a dysfunction in key circuits in the brain including reward, motivation and memory circuits which is reflected in an individual pathologically pursuing reward and/or relief from substances.

Mental and emotional symptoms occur long before physical symptoms show up. If that side isn't appropriately treated, long-term alcohol abuse can lead to physical complications.

How do mental illnesses and AUD corrolate?

Rather than thinking in terms of cause-and-effect, it's helpful to view the coexisting nature of each condition. One will almost always follow the other creating a comorbidity and dual-diagnosis. To make AUD more challenging, co-occuring disorders tend to provoke each other. When a mental disorder is ignored, the alcohol addiction can worsen and vice versa. Having a co-occuring disorder can make treatment more complicated, but recovery is possible when al diorders are treated at the same time.

Alcohol in the U.K.

In England, there are an estimated 602,391 dependent drinkers, and concerningly, only 18% are receiving treatment. Alcohol is now 74% more affordabke than it was in 1987. From 2008-2019 alcohol became 13% more affordable which backs up international research evidence that the consumption of alcohol is sensitive to changes in affordability. In broad terms, when alcohol is more affordable, more is consumed; when alcohol becomes less affordable, less is consumed.

So, what is the U.K. doing about AUD and alcohol accessibility?

In October 2020 the government opened a call for evidence, partially focused on the public health impact of alcohol harm. This is an important opportunity for the government to rationalise an outdated and unfair system and to put harm reduction at the heart of alcohol tax policy. Many organisations are calling for four key changes to the way alcohol is taxed. These are;

• Alcohol duty to at least cover the costs of alcohol to society

Alcohol must be taxed in proportion with the harm it causes. Alcohol duty currently contributes around £12bn a year in revenue, while alcohol harm is estimated to cost between £27bn and £52bn a year – more than double, and possibly up to four times as much.

• Alcohol to be taxed according to strength

To have the greatest impact on health, the duty system should recognise that stronger drinks create more harm and should be taxed at a higher rate per unit than lower-strength drinks. This scaled approach would encourage producers to reformulate their drinks and create better quality drinks at lower strengths.

• Alcohol duty to be consistent across drink types

The current system creates a market for cheap, high-strength products, which do most damage to health. The system should be consistent across drink types, rather than giving preferential tax rates to some and not others.

• Alcohol duty to automatically increase in line with inflation or earnings

To ensure it always performs a harm reduction role, duty can’t be indefinitely frozen or allowed to stagnate. This would make sure progress is made towards reducing harm and improving health, year-on-year.

Minimum unit pricing model research from Sheffield University has found that introducing an MUP across the UK would significantly cut alcohol-related deaths and illnesses. Setting an MUP has no impact on the price of drinks that are already sold for more than that amount, which includes most, if not all, drinks sold in pubs, clubs and restaurants. Instead, it  mostly affects the very cheap strong ciders which cause severe harm to the heaviest drinkers, and drinks sold by supermarkets at multi-purchase discounts.

It's estimated that every day, 20 people die as a result of their drinking. But alcohol harm is not inevitable. If you're concerned about your own or someone else's alcohol consumption, visit the NHS website which has lots of helpful information as well as links to support, useful contacts and links.

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