Alcoholism (Alcohol Use Disorder)

Alcohol use disorder is a medical condition that affects millions of people worldwide, making it difficult to control drinking despite serious harm to health, relationships, and daily life. The good news is that effective treatments exist, and most people with this condition can reduce their drinking or stop entirely with the right support.

alcohol use disorder, AUD, alcohol abuse, alcohol dependence, alcohol addiction

Table of contents

• What is Alcohol Use Disorder?
• Signs and Symptoms
• What Increases the Risk
• Effects on Health
• How Addiction Develops in the Brain
• Diagnosis
• Treatment Options
• Recovery and Long-term Support

What is Alcohol Use Disorder?

Alcohol use disorder (AUD) is a medical condition in which a person has an impaired ability to stop or control alcohol use despite serious problems with their health, work, relationships, or safety.^[1] Some people also refer to this condition as alcoholism, alcohol abuse, alcohol dependence, or alcohol addiction.^[1]

This disorder is considered a brain disorder that can be mild, moderate, or severe.^[1] Lasting changes in the brain caused by drinking too much alcohol keep the disorder going and make people vulnerable to drinking again even after they stop.^[1]

Alcohol use disorder is the second most common form of substance abuse in the United States, after tobacco addiction.^[2] An estimated 10% of adult men and 5% of adult women have alcohol use disorder in the United States.^[2] Globally, around 400 million people aged 15 years and older live with alcohol use disorders, and approximately 209 million people live with alcohol dependence.^[3]

The condition is not a choice or character flaw. It is a common medical condition that can happen to anyone, and evidence-based treatment is available.^[10]

Signs and Symptoms

The symptoms of alcohol use disorder focus on changes in mood and behavior rather than physical issues alone.^[11] Healthcare professionals diagnose AUD when a person has two or more of the following symptoms. AUD can be mild with two to three symptoms, moderate with four to five symptoms, or severe with six or more symptoms.^[10]

Common signs include:

• Being unable to limit the amount of alcohol you drink^[6]
• Wanting to cut down on drinking or making unsuccessful attempts to do so^[6]
• Spending a lot of time drinking, getting alcohol, or recovering from hangovers^[11]
• Feeling a strong craving or urge to drink alcohol^[11]
• Failing to fulfill major obligations at work, school, or home due to repeated alcohol use^[6]
• Continuing to drink even though it affects relationships with family, friends, and colleagues^[11]
• Giving up important social, work, or recreational activities because of alcohol^[11]
• Using alcohol in physically hazardous situations^[11]
• Continuing to drink when you have a medical condition or mental disorder that gets worse when you drink^[11]
• Having a high tolerance for alcohol, needing to drink more to get the same effect^[11]
• Having withdrawal symptoms such as headache, nausea and vomiting, anxiety, and fatigue when you stop drinking^[2]

As alcohol abuse progresses, a person may have blackouts, which are episodes where they completely forget what occurred while they were drunk even though they were conscious at the time.^[2] Personality changes can also occur, and the ability to function in daily life—such as holding a job or maintaining relationships—can seriously decline.^[2]

What Increases the Risk

A person’s risk for developing alcohol use disorder depends in part on how much, how often, and how quickly they drink alcohol.^[1] Alcohol misuse—defined as drinking in a manner, situation, amount, or frequency that could cause harm to the person or those around them—over time increases the risk of AUD.^[1] This includes binge drinking (four or more drinks for women or five or more drinks for men during an occasion) and heavy alcohol use (eight or more drinks per week for women or 15 or more drinks per week for men).^[1]

Other factors that increase the risk include:

Drinking at an early age: Research shows that among people ages 26 and older, those who began drinking before age 15 were more likely to report having AUD in the past year compared to those who waited until age 21 or later to begin drinking. The risk for females in this group is higher than that of males.^[1]

Genetics and family history: Genetics play a significant role, with heritability accounting for approximately 60%.^[1] Children of parents who have trouble with alcohol have a fourfold increased risk of the disorder.^[2] However, like other chronic health conditions, AUD risk is influenced by the interplay between a person’s genes and their environment.^[1]

Mental health conditions and history of trauma: A wide range of psychiatric conditions—including depression, post-traumatic stress disorder, and attention deficit hyperactivity disorder—are associated with an increased risk of AUD.^[1] People with a history of childhood trauma are also vulnerable to AUD.^[1]

Effects on Health

Drinking alcohol excessively can have immediate and long-term effects on health.^[5]

Short-term effects of excessive drinking can include:

• Injuries such as motor vehicle crashes, falls, drownings, and burns^[5]
• Violence including homicide, suicide, sexual violence, and intimate partner violence^[5]
• Alcohol poisoning, where high blood alcohol levels affect body functions like breathing and heart rate^[5]
• Sexually transmitted infections or unplanned pregnancy from sex without protection^[5]
• Miscarriage, stillbirth, or fetal alcohol spectrum disorder from alcohol use during pregnancy^[5]

Long-term effects of heavy drinking can seriously damage multiple organs and systems:

The liver, stomach, heart, brain, and nervous system can be seriously damaged by heavy drinking.^[2] Heavy drinking can lead to the liver becoming enlarged, a serious condition that cannot be completely reversed but can be prevented from getting worse by stopping drinking.^[2] Potential complications include cirrhosis of the liver, alcohol-induced hepatitis, and alcohol-induced cardiomyopathy.^[11]

Drinking alcohol increases the risk of several types of cancer, including cancer of the mouth, throat, larynx (voice box), esophagus, liver, and breast.^[2][5] Alcohol is a chemical carcinogen, and drinking any alcoholic beverages, including red and white wine, beer, and liquor, is linked with cancer.^[5] Women who drink heavily are at higher risk of developing breast cancer and osteoporosis.^[2]

Regular drinking can affect the body’s ability to fight infections, and heavy drinkers tend to catch more infectious diseases.^[15] People who drink heavily may not eat adequately, so they may develop vitamin and mineral deficiencies.^[2]

Drinking can affect sleep quality, disrupting sleep patterns and preventing deep sleep.^[15] It can also affect mood, as there is a strong link between heavy drinking and depression, and hangovers often make people feel anxious and low.^[15]

Worldwide, around 2.6 million deaths were caused by alcohol consumption in 2019, including 1.6 million deaths from noncommunicable diseases, 700,000 deaths from injuries, and 300,000 deaths from communicable diseases.^[3] In the United States, about 178,000 people die from excessive alcohol use each year.^[5]

How Addiction Develops in the Brain

Alcohol has a powerful effect on the brain, producing pleasurable feelings and blunting negative feelings.^[4] These feelings can motivate some people to drink alcohol again and again, despite possible risks to their health and well-being.^[4]

Research shows that over time, drinking to cope with stress—while it may provide temporary relief from emotional discomfort—tends to enhance negative emotional states between bouts of alcohol consumption. These changes can motivate further drinking and cause an individual to become stuck in an unhealthy cycle of alcohol consumption.^[4]

As individuals continue to drink alcohol over time, progressive changes may occur in the structure and function of their brains. These changes can compromise brain function and drive the transition from controlled, occasional use to chronic misuse, which can be difficult to control.^[4] The changes can endure long after a person stops consuming alcohol and can contribute to relapse in drinking.^[4]

Addiction can be framed as a repeating cycle with three stages, primarily involving three key regions of the brain: the basal ganglia, the extended amygdala, and the prefrontal cortex.^[4] A person may go through this three-stage cycle over the course of weeks or months, or progress through it several times in a day.^[4]

Diagnosis

Healthcare providers diagnose the condition by doing a physical examination to look for symptoms of conditions that alcohol use disorder may cause.^[11] If your provider suspects that you have a problem with alcohol, you may be referred to a mental health provider.^[9]

To assess your problem with alcohol, your provider will likely:

• Ask you questions related to your drinking habits and may ask for permission to speak with family members or friends^[9]
• Perform a physical exam and ask questions about your health, as there are many physical signs that indicate complications of alcohol use^[9]
• Suggest lab tests and imaging tests to identify health problems that may be linked to your alcohol use^[9]
• Complete a psychological evaluation that includes questions about your symptoms, thoughts, feelings, and behavior patterns^[9]

While there are no specific tests to diagnose alcohol use disorder, certain patterns of lab test results may strongly suggest it.^[9]

Treatment Options

The good news is that no matter how severe the problem may seem, evidence-based treatment with behavioral therapies, mutual-support groups, and medications can help people with AUD achieve and maintain recovery.^[1] Most people with AUD can benefit from some form of treatment, and many substantially reduce their drinking and report fewer alcohol-related problems.^[10]

Treatment for alcohol use disorder can vary depending on your needs and may include:^[9]

Detox and withdrawal management: Treatment may begin with a program of detoxification or detox. This usually takes two to seven days.^[9] If you’re dependent on alcohol to function, it’s recommended you seek medical advice to manage your withdrawal.^[12] Depending on your level of alcohol dependency, you may be able to detox at home, possibly with medication to help ease withdrawal symptoms. A tranquilizer called chlordiazepoxide is usually used for this purpose.^[12] If your dependency is severe, you may need to go to a hospital or clinic to detox, as withdrawal symptoms will be severe and likely need specialist treatment.^[12]

Withdrawal symptoms will be at their worst for the first 48 hours and should gradually start to improve as your body begins to adjust to being without alcohol. This usually takes 3 to 7 days from the time of your last drink.^[12]

Brief intervention: If you are worried about your drinking or have had an alcohol-related accident or injury, you may be offered a short counseling session known as a brief intervention. This lasts about 5 to 10 minutes and covers risks associated with your pattern of drinking, advice about reducing the amount you drink, alcohol support networks available to you, and any emotional issues around your drinking.^[12]

Behavioral therapies: These may include individual counseling, group counseling, or family therapy. Treatment helps you understand your relationship with alcohol, develop skills to stop or reduce drinking, build a strong social support system, work to set reachable goals, and cope with triggers that may cause relapse.^[9]

Medications: Several medications are available to help achieve abstinence or reduce drinking. These include drugs that help reduce cravings or make drinking unpleasant.^[9] Medications may include acamprosate, disulfiram, and naltrexone.^[10]

Mutual-support groups: Programs like Alcoholics Anonymous (AA) have been helping alcoholics recover for more than 80 years.^[8] AA’s program of recovery is built on the simple foundation of one alcoholic sharing with another.^[8] Helping each other is a key to staying sober.^[8]

Treatment programs: These may include outpatient programs, residential inpatient stays, or online therapy programs.^[9] The choice between moderation (drinking less) and abstinence (not drinking at all) is yours, though abstinence is strongly recommended if you have liver damage, other medical problems made worse by drinking, are taking medication that reacts badly with alcohol, or are pregnant or planning to become pregnant.^[12]

Recovery and Long-term Support

Less than 20% of patients remain abstinent for a full year, and among patients who have been sober for 2 years, the relapse rate is 40%.^[13] Patients who have been sober for 5 years are likely to remain sober, but they are still at risk for relapse.^[13]

Frequent follow-up is essential to support the person in recovery. The most common mistake is assuming too soon that the patient is stable.^[13] Recovery means that patients can handle the stresses of everyday life without alcohol. Therefore, patients must develop and rehearse strategies to cope with high-risk situations.^[13]

Successful recovery requires being able to:

• Learn to say no to drinking in social situations^[13]
• Handle heavy-drinking friends who will try to undermine sobriety^[13]
• Handle stress and avoid symptoms of anxiety^[13]
• Avoid boredom by finding new activities to fill time previously spent drinking or recovering from drinking^[13]
• Learn to get along again with family and close friends^[13]
• Identify other situations that can lead to drinking and develop ways to cope with them^[13]

Patients should have a list of phone numbers of people they can call when they are having a difficult time coping.^[13] They should also spend time thinking about circumstances during which they feel at highest risk for relapse and make a written list with specific responses to each of these high-risk situations.^[13]

When patients have the urge to drink, several techniques can help, including self-distraction (getting involved with an alternate activity they enjoy), thought stopping (not dwelling on thoughts of drinking), reprogramming (avoiding activities that remind them of drinking), and use of social support structure.^[13]

Benefits of cutting down or stopping drinking include feeling better in the mornings, being less tired during the day, better looking skin, feeling more energetic, better weight management, improved mood, better sleep, and improved relationships.^[15] By drinking less, you can improve your health in the short and long term. Even a small change can make a big difference.^[17]