Turning 21 is a rite of passage—your first (legal) drink! Drinking is typically seen as a reward for something great (like getting a grant!), something to take the edge off (like when you don’t get that grant…), or a way to loosen up in social situations. On occasion and in moderation, drinking is not necessarily a problem. Unfortunately, transitioning into a problematic relationship with alcohol and meeting the criteria for Alcohol Use Disorder (AUD) is easier than it seems.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), AUD affects around 16 million people in the United States¹. In the most recent Diagnostic and Statistical Manual (the book that clinicians use when diagnosing individuals with mental disorders), there are 11 criteria associated with AUD. Binge drinking is one of those criteria, and a common step toward AUD. NIAAA defines binge drinking as reaching a blood alcohol concentration of 0.08g/dL or higher, which usually takes about 4 drinks for women and 5 for men within 2 hours¹. Other symptoms of AUD are physical withdrawal symptoms (such as seizures), craving alcohol, and the inability to stop drinking. Surprisingly, it is necessary to meet only two of the 11criteria to be diagnosed with mild AUD. This means someone does not need to be physically dependent upon alcohol to have AUD, contrary to popular belief. Individuals with AUD may be functioning professionals during the daytime but struggling with addiction behind closed doors, which can be extremely frightening and isolating for both themselves and their families.

Although AUD is a widespread disease, few receive the treatment they need. A very high percentage of those struggling with AUD who do get treatment relapse back into alcohol use. Unsurprisingly, stress is commonly cited as a reason people begin drinking after a period of abstinence. This is why a number of research labs in the alcohol abuse field focus on the interaction between stress and alcohol use. For example, the Silberman Lab at Penn State College of Medicine studies how stress and alcohol consumption (both together and separately) affect brain circuitry that is involved with emotional processing. My thesis work in that lab explores how signaling in the Bed Nucleus of the Stria Terminalis (BNST), a brain region involved in responding to stress and mediating other emotional functions, is changed by alcohol use and stress. By identifying these resulting differences, we are helping to pinpoint possible therapeutic targets to prevent stress-related relapse into AUD.

It is alarming to think how common it is for those who suffer from AUD to relapse (often partially due to stress) when trying to recover. This disease is more insidious than many realize, especially since the lines are blurred between what is culturally acceptable and what is a problem. It is important to pay attention to how often and why we are drinking, and to be aware of binge drinking. Doing so can help prevent the development or worsening of AUD.

¹https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics

By Angela Snyder

Angela is a Neuroscience PhD candidate in Dr. Yuval Silberman’s lab at Penn State College of Medicine.