Alcohol Abuse

alcohol dependence, alcohol addiction, alcoholism, alcohol use disorder

Alcohol abuse, now commonly referred to as alcohol use disorder, is a medical condition affecting millions of people worldwide. It involves an impaired ability to control drinking despite serious consequences to health, relationships, and daily life. Understanding this condition as a treatable brain disorder, rather than a personal failing, is the first step toward recovery.

Table of contents

• What Is Alcohol Use Disorder?
• How Common Is This Problem?
• What Increases the Risk?
• Signs and Symptoms
• Effects on Your Health
• How Is It Diagnosed?
• Treatment Options
• Can People Recover?

What Is Alcohol Use Disorder?

Alcohol use disorder (AUD) is a medical condition in which a person cannot stop or control their alcohol use despite serious negative consequences in their social life, work, or health. It includes conditions that some people call alcohol abuse, alcohol dependence, alcohol addiction, and the informal term alcoholism^[1].

This disorder is considered a brain disorder because lasting changes in the brain caused by alcohol misuse keep the condition going and make people vulnerable to returning to drinking after they’ve stopped^[1]. AUD can be mild, moderate, or severe, depending on how many symptoms a person has^[1].

Alcohol use disorder is a pattern of alcohol use that involves problems controlling drinking, being preoccupied with alcohol, or continuing to use alcohol even when it causes problems. It also involves having to drink more to get the same effect or having withdrawal symptoms when you rapidly decrease or stop drinking^[2].

How Common Is This Problem?

Alcohol misuse is one of the most significant public health issues. National surveys show that millions of Americans have AUD^[1]. Currently, nearly 14 million Americans—one in every 13 adults—abuse alcohol or are alcoholic. Several million more adults engage in risky drinking that could lead to alcohol problems^[4].

Worldwide, around 2.6 million deaths were caused by alcohol consumption in 2019. Of these, 1.6 million deaths were from noncommunicable diseases, 700,000 deaths from injuries, and 300,000 deaths from communicable diseases^[5]. The alcohol-related death rate was heaviest among men, accounting for 2 million deaths compared to 600,000 deaths among women in 2019^[5].

An estimated 400 million people, or 7% of the world’s population aged 15 years and older, lived with alcohol use disorders. Of this number, 209 million people (3.7% of the adult world population) lived with alcohol dependence^[5]. About 178,000 people die from excessive alcohol use each year in the United States^[3].

What Increases the Risk?

A person’s risk for developing AUD depends partly on how much, how often, and how quickly they consume alcohol. Alcohol misuse—defined as drinking in a manner, situation, amount, or frequency that could cause harm to the person who drinks or to those around them—over time increases the risk of AUD. Alcohol misuse includes binge drinking and heavy alcohol use^[1].

Binge drinking means four or more drinks for women, or five or more drinks for men during a single occasion. Heavy drinking means eight or more drinks for women, or 15 or more drinks for men during a week^[3].

Several other factors also increase the risk of developing AUD. Drinking at an early age is one important factor. 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 than 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 of alcohol problems play a significant role. Genetics account for approximately 60% of the risk. However, like other chronic health conditions, AUD risk is influenced by the interaction between a person’s genes and their environment. Parents’ drinking patterns may also influence the likelihood that a child will one day develop AUD^[1]. Studies show people with a family history of alcohol use disorder have an increased risk of developing it^[11].

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

Signs and Symptoms

Health care professionals diagnose AUD when a person has two or more specific symptoms. AUD can be mild (the presence of two to three symptoms), moderate (the presence of four to five symptoms), or severe (the presence of six or more symptoms)^[1].

Signs and symptoms of alcohol use disorder may include being unable to limit the amount of alcohol you drink, wanting to cut down on how much you drink or making unsuccessful attempts to do so, and spending a lot of time drinking, getting alcohol, or recovering from alcohol use^[2].

Other symptoms include feeling a strong craving or urge to drink alcohol, failing to fulfill major obligations at work, school, or home due to repeated alcohol use, and continuing to drink alcohol even though you know it’s causing physical, social, or relationship problems^[2].

People with this condition may drink despite the damage it does to their relationships or plan their life around their next drink. Additional symptoms include craving beverages containing alcohol, drinking more than intended or for longer than intended, and spending lots of time obtaining and drinking these beverages or recovering from hangovers caused by drinking^[11].

Repeatedly trying to reduce how much you drink but repeatedly failing to meet work or family obligations because you’re drinking are also signs. Giving up important social, work, or recreational activities because of alcohol, using alcohol in physically hazardous situations, and continuing to drink when you have a medical condition or mental disorder that gets worse when you drink are additional indicators^[11].

Having a high tolerance for beverages containing alcohol and having alcohol withdrawal symptoms or drinking to avoid withdrawal symptoms are further signs of the disorder^[11].

Effects on Your Health

Using alcohol excessively on a single occasion or over time can have immediate and long-term health effects. Drinking excessively on an occasion can lead to injuries such as motor vehicle crashes, falls, drownings, and burns. It can also lead to violence including homicide, suicide, sexual violence, and intimate partner violence^[3].

Immediate effects include alcohol poisoning, which causes high blood alcohol levels that affect body functions like breathing and heart rate. Overdose from alcohol use with other drugs, such as opioids, is also possible. Excessive drinking can lead to sexually transmitted infections or unplanned pregnancy from sex without protection, and it can cause miscarriage, stillbirth, or fetal alcohol spectrum disorder (FASD) from alcohol use during pregnancy^[3].

Over time, drinking alcohol can cause serious long-term health problems. Heavy drinking can increase the risk for certain cancers, especially those of the liver, esophagus, throat, and larynx (voice box). Drinking any alcoholic beverages, including red and white wine, beer, and liquor, is linked with cancer. The risk of some cancers increases with the amount of alcohol consumed^[4][3].

Heavy drinking can also cause liver cirrhosis, immune system problems, brain damage, and harm to the fetus during pregnancy. In addition, drinking increases the risk of death from automobile crashes as well as recreational and on-the-job injuries. Furthermore, both homicides and suicides are more likely to be committed by persons who have been drinking^[4].

Other potential complications include alcohol-induced cardiomyopathy, alcohol-induced hepatitis, alcohol poisoning, cerebellar degeneration, cirrhosis of the liver, and delirium tremens^[11].

How Is It Diagnosed?

You’re likely to start by seeing your primary health care provider. If your provider suspects that you have a problem with alcohol, you may be referred to a mental health provider. To assess your problem with alcohol, your provider will likely ask you some questions related to your drinking habits. The provider may ask for permission to speak with family members or friends^[10].

Your health care provider may do a physical exam and ask questions about your health. There are many physical signs that indicate complications of alcohol use. While there are no specific tests to diagnose alcohol use disorder, certain patterns of lab test results may strongly suggest it. You may need tests to identify health problems that may be linked to your alcohol use. Damage to your organs may be seen on tests^[10].

You may also be asked to complete a psychological evaluation. This evaluation includes questions about your symptoms, thoughts, feelings, and behavior patterns. You may be asked to complete a questionnaire to help answer these questions^[10].

Your alcohol intake may be assessed using tests such as the Alcohol Use Disorders Identification Test, a widely used screening test that can help determine whether you need to change your drinking habits^[7].

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. Many others substantially reduce their drinking and report fewer alcohol-related problems^[9].

Treatment for alcohol use disorder can vary depending on your needs. Treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay. Working to stop alcohol use to improve quality of life is the main treatment goal^[10].

Medical treatments include medicines and behavioral therapies. For many people, using both types gives them the best results^[13]. Treatment may begin with a program of detoxification and withdrawal, where medication helps manage withdrawal symptoms^[10].

If you’re dependent on alcohol to function, it’s recommended you seek medical advice to manage your withdrawal. Some people may be prescribed medication to help achieve abstinence. You may also choose to attend self-help groups, receive extended counseling, or use a talking therapy such as cognitive behavioral therapy (CBT)^[12].

Three medicines are approved to treat AUD. Disulfiram causes unpleasant symptoms such as nausea and skin flushing whenever you drink alcohol. Knowing that drinking will cause these unpleasant effects may help you stay away from alcohol. Naltrexone blocks the receptors in your brain that make you feel good when you drink alcohol and can also reduce your craving for alcohol. Acamprosate helps you avoid alcohol after you have quit drinking by working on multiple brain systems to reduce your cravings^[13].

Behavioral therapies, also called alcohol counseling, involve working with a health care professional to identify and help change the behaviors that lead to heavy drinking. Cognitive-behavioral therapy helps you identify the feelings and situations that can lead to heavy drinking and teaches you coping skills. Motivational enhancement therapy helps you build and strengthen the motivation to change your drinking behavior. Marital and family counseling includes spouses and other family members and can help repair and improve family relationships^[13].

People who are getting treatment for AUD may also find it helpful to go to a support group such as Alcoholics Anonymous. If you have an AUD and a mental illness, it is important to get treatment for both^[13].

Can People Recover?

Evidence-based AUD treatment is available, change is possible, and most people who have AUD recover or markedly improve^[9]. Studies show most people can reduce how much they drink or stop drinking entirely^[11].

However, AUD is a chronic relapsing disorder associated with compulsive alcohol drinking, the loss of control over intake, and the emergence of a negative emotional state when alcohol is no longer available. Changes in the brain can endure long after a person stops consuming alcohol and can contribute to relapse in drinking^[6].

Taking a break from drinking, even for a month, allows your body to recover from the effects of alcohol. Improved sleep quality is a notable outcome, as alcohol disrupts normal sleep patterns. Other benefits include lowered blood pressure, weight loss, a healthier complexion, enhanced mental clarity, improved mood, reduced anxiety, and better liver function^[18].

One study found an association between participation in Dry January (a pledge to abstain from alcohol for the entire month) and reductions in drinking days and number of drinks as well as greater confidence in the ability to refuse drinks^[18].

AUD is not a choice or character flaw and is a common medical condition that can happen to anyone^[9]. With the right support and treatment, recovery is achievable for most people struggling with alcohol abuse.