Mental Health Deep Dives

Alcohol Use Disorder

Alcohol Use Disorder (AUD) affects as many as 28 million Americans, or just under 10% of the population, according to the National Institutes of Health. The disorder is characterized by a person continuing to consume alcohol even when it causes social, academic, or physical problems, using alcohol in unsafe situations, feeling strong urges or cravings to drink, or being unable to limit the amount consumed once they begin. AUD is the most widespread substance use disorder in the United States and reaches nearly every community in the country.

Diagnosing AUD typically involves questions about drinking patterns, screenings, and sometimes imaging tests because heavy alcohol use can leave a physical toll on the body. Long term alcohol misuse can damage the liver, inflame the pancreas, weaken the heart, and even change brain structure. Treatment often begins with detoxification, known colloquially as “detox,” for two to seven days, usually completed at an inpatient care center, followed by therapy, behavioral interventions, and medication. In addition to medications like disulfiram, which causes negative reactions if alcohol is consumed, and oral Naltrexone, which reduces the pleasurable effects of alcohol, other medications such as Acamprosate and long acting injectable Naltrexone are increasingly used to reduce cravings and support long term recovery.

While these clinical details matter, they do not tell the whole story, especially for young people and those living in rural communities.

Alcohol use among teens and young adults is uniquely concerning because their brains are still developing into their mid twenties. Repeated alcohol use during this time can interfere with the systems that control decision making, motivation, and impulse control. Research from the Center for Behavioral Health Statistics and Quality shows people who begin drinking before age 15 are significantly(6 times) more likely to develop dependence later in life. Early drinking is not always part of a party culture. In many rural areas it happens in isolation, at a friend’s house, in a pasture, or before driving long distances, and these environments can turn dangerous quickly.

For many rural youth, alcohol becomes more than recreational. It can serve as an escape from boredom, loneliness, family stress, or the lack of extracurricular activities. When alcohol is normalized in the home or community, the line between experimentation and dependence can blur. Warning signs often appear slowly. These can include drinking alone, lying about alcohol use, hiding bottles, needing more alcohol to feel the same effects, struggling in school, withdrawing from friends, or becoming defensive when questioned. What adults may dismiss as a temporary phase can actually be the early stages of a developing disorder.

Even when families recognize the problem, getting help can be difficult. People in rural areas often live far from the nearest detox or treatment center and lack reliable transportation. Youth focused services are even more limited, and those under 18 often face additional barriers such as lack of confidentiality and the need for parental consent. Fear of community judgment can also keep people from seeking help, since privacy is harder to maintain in a small town.

Because of these barriers, some people benefit from harm reduction strategies. Not everyone struggling with alcohol is ready or able to stop drinking entirely. Reducing the frequency of drinking, avoiding drinking and driving, and replacing alcohol with safer coping mechanisms can reduce harm and create a safer path toward eventual treatment. These approaches are backed by research and are especially important in areas where treatment options are limited.

It is important to remember that recovery is a medical journey, not a moral one. AUD alters brain chemistry, including the systems that regulate cravings, stress, and self control. These neurological changes explain why willpower alone is not enough and why relapse is common. Compassion, access to treatment, and evidence based medication significantly increase the chance of long term success. Sometimes the most powerful first step is simply opening a door for conversation. Approaching someone with honesty and empathy and saying something like, “I care about you and I have noticed some changes that worry me,” can create an opening for help that shame never will.

AUD is preventable, treatable, and survivable. With better access to care and a community that understands what this disorder truly is, recovery is possible. Addressing alcohol misuse among rural youth is not just about reducing drinking. It is about expanding opportunity, reducing stigma, and building environments where healthier choices are realistic options.

By Trace Ribble