Alcohol Use Disorder

alcohol abuse, alcohol dependence, alcohol addiction, alcoholism

Alcohol use disorder is a medical condition that affects millions of people, making it difficult or impossible to control drinking even when it causes serious harm to health, relationships, and daily life. The good news is that treatment works, and most people can reduce their drinking or stop entirely with the right support.

Table of contents

• What is Alcohol Use Disorder?
• What Increases the Risk for Developing This Condition?
• Recognizing the Signs and Symptoms
• Understanding Harmful Drinking Patterns
• Effects on Health and Well-being
• How the Condition is Diagnosed
• Available Treatments
• Recovery and Outlook

What is Alcohol Use Disorder?

Alcohol use disorder (AUD) is a medical condition in which a person has difficulty stopping or controlling their alcohol use despite serious problems it causes in their life^[1]. This condition affects how a person thinks, feels, and behaves around alcohol. When someone has AUD, they cannot stop drinking even when it harms their health, puts their safety at risk, or damages their relationships with family and friends^[4].

AUD is considered a brain disorder because alcohol misuse causes lasting changes in the brain^[1]. These changes make the condition continue over time and make people vulnerable to drinking again even after they stop. The condition can range from mild to severe, depending on how many symptoms a person experiences^[1].

National surveys show that millions of Americans have AUD^[1]. Worldwide, an estimated 400 million people aged 15 years and older live with alcohol use disorders, with approximately 209 million people living with alcohol dependence^[6]. In 2019, alcohol caused approximately 2.6 million deaths globally^[6].

What Increases the Risk for Developing This Condition?

A person’s risk for developing AUD depends partly on how much, how often, and how quickly they drink alcohol^[1]. Alcohol misuse—which means drinking in a way, situation, amount, or frequency that could cause harm—increases the risk of AUD over time. This includes binge drinking and heavy alcohol use^[1].

Starting to drink at an early age significantly increases risk. Research shows that people who began drinking before age 15 were more likely to develop AUD later in life compared to those who waited until age 21 or later to start drinking. The risk is especially high for females who start drinking early^[1].

Genetics and family history play an important role. Studies show that genes account for approximately 60% of a person’s risk for developing AUD^[1][4]. However, like other chronic health conditions, AUD risk comes from a combination of genetic factors and environmental influences. If your parents have drinking problems, this may also influence your likelihood of developing AUD^[1].

Mental health conditions also increase risk. People with depression, post-traumatic stress disorder (PTSD), or attention deficit hyperactivity disorder (ADHD) have higher chances of developing AUD^[1][4]. People who experienced trauma during childhood are also more vulnerable^[1].

Recognizing the Signs and Symptoms

Healthcare providers diagnose AUD when a person has two or more specific symptoms within a year^[1]. The condition is considered mild when two to three symptoms are present, moderate with four to five symptoms, and severe when six or more symptoms occur^[1].

Common symptoms include having strong cravings or urges to drink alcohol^[4]. People with AUD continue drinking even though it affects their relationships with family, friends, and colleagues^[4]. They often drink more than they intended or for longer periods than they planned^[4].

Spending lots of time obtaining alcohol, drinking, or recovering from hangovers is another warning sign^[4]. People with AUD repeatedly try to reduce how much they drink but fail. They may repeatedly miss work or family obligations because of drinking^[4].

As the condition progresses, people give up important social, work, or recreational activities to drink instead^[4]. They may use alcohol in physically dangerous situations. Some continue to drink even when they have a medical condition or mental health problem that gets worse with alcohol^[4].

Physical signs include developing a high tolerance, meaning they need to drink more to feel the same effects^[4]. When they stop drinking, they experience withdrawal symptoms such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, and sweating. In severe cases, withdrawal can cause fever, seizures, or hallucinations^[7].

Understanding Harmful Drinking Patterns

The American Medical Association recommends that men limit drinking to two drinks or less per day, while women should limit drinking to one drink or less per day^[4]. Drinking less is better for health than drinking more^[2].

Binge drinking is a particularly risky pattern. It means drinking enough alcohol to bring blood alcohol concentration to 0.08% or higher. For typical adults, this corresponds to consuming five or more drinks for males, or four or more drinks for females, in about two hours^[2].

Heavy drinking for men means five or more drinks in one day or 15 or more drinks in a week. For women, heavy drinking is four or more drinks in a day or eight drinks in a week^[4]. High-intensity drinking means consuming two or more times these binge drinking amounts—10 or more drinks for males and eight or more for females^[2].

Any amount of drinking can be associated with harm, and as the amount of alcohol consumed increases, the level of harm increases^[2]. Excessive drinking on a single occasion can lead to injuries, violence, alcohol poisoning, and risky sexual behavior^[3]. Over time, regular excessive drinking increases the risk of developing AUD^[1].

Effects on Health and Well-being

Alcohol affects the body in both immediate and long-term ways. In the short term, excessive drinking can cause injuries from motor vehicle crashes, falls, drownings, and burns^[3]. It can lead to violence including homicide, suicide, sexual violence, and intimate partner violence^[3]. Alcohol poisoning occurs when blood alcohol levels become so high they affect basic body functions like breathing and heart rate^[3].

Taking a break from drinking, even for a month, allows the body to recover. People often experience improved sleep quality, as alcohol disrupts normal sleep patterns. Other benefits include lowered blood pressure, weight loss, healthier skin, better mental clarity, improved mood, reduced anxiety, and better liver function^[16].

Long-term excessive drinking takes a serious toll on health. Alcohol is a chemical that can cause cancer. Heavy, long-term drinking increases the risk of several types of cancer, including esophageal cancer^[4]. Drinking any alcoholic beverages—including red and white wine, beer, and liquor—is linked with cancer, and the risk increases with the amount consumed^[3].

Other serious complications include alcohol-induced cardiomyopathy (damage to the heart muscle), alcohol-induced hepatitis (liver inflammation), cirrhosis of the liver (permanent liver scarring), and brain damage called cerebellar degeneration^[4]. Alcohol also increases the risk of heart disease, stroke, high blood pressure, and other liver diseases^[3].

Alcohol affects mental health as well. It is a depressant that disrupts the balance of chemical messengers in the brain, affecting feelings, thoughts, and behavior^[22]. Regular heavy drinking is linked to symptoms of depression and anxiety. While alcohol may provide a brief feeling of relaxation, these effects wear off quickly, and the chemical changes in the brain can lead to more negative feelings like anger, depression, or anxiety^[22].

About 178,000 people die from excessive alcohol use each year in the United States^[3]. Deaths from alcohol misuse occur from both immediate dangers and long-term health complications. Younger adults aged 20-39 years are disproportionately affected, with the highest proportion of alcohol-related deaths occurring in this age group^[6].

How the Condition is Diagnosed

Diagnosis typically begins with a visit to a primary healthcare provider^[10][17]. If the provider suspects an alcohol problem, they may refer the person to a mental health provider for further evaluation.

The healthcare provider will ask questions about drinking habits and may request permission to speak with family members or friends^[10][17]. They will perform a physical examination and ask questions about general health, looking for physical signs that indicate complications from alcohol use^[4][10].

While there are no specific tests to diagnose AUD, certain patterns of lab test results may strongly suggest it^[10][17]. Tests may be ordered to identify health problems linked to alcohol use, and damage to organs may show up on these tests^[10][17].

A psychological evaluation includes questions about symptoms, thoughts, feelings, and behavior patterns^[10][17]. A questionnaire may be used to help answer these questions. Healthcare providers use criteria from the Diagnostic and Statistical Manual to make the diagnosis^[4].

Available Treatments

The good news is that no matter how severe the problem seems, most people with AUD can benefit from treatment^[1][11]. Evidence-based treatment with behavioral therapies, mutual-support groups, and medications can help people achieve and maintain recovery^[1]. For many people, using both medications and behavioral therapies gives the best results^[13].

Treatment can vary depending on individual needs and may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay^[10][17]. Some people may need intensive treatment at a residential center for rehabilitation, which offers highly structured care with several types of behavioral therapies and medications^[13].

Three medications are approved to treat AUD^[13]. Disulfiram causes unpleasant symptoms such as nausea and skin flushing whenever alcohol is consumed, which can help people stay away from drinking. Naltrexone blocks the receptors in the brain that create good feelings when drinking, and it can reduce cravings for alcohol. Acamprosate helps people avoid alcohol after they have quit drinking by working on multiple brain systems to reduce cravings, especially just after quitting^[13]. These medications are not addictive and can help manage AUD like medications manage other chronic diseases^[13].

Behavioral therapies, also called alcohol counseling, involve working with a healthcare professional to identify and change behaviors that lead to heavy drinking^[13]. Cognitive-behavioral therapy (CBT) helps identify feelings and situations that lead to heavy drinking and teaches coping skills including stress management. It can be done one-on-one or in small groups^[13].

Motivational enhancement therapy helps build and strengthen motivation to change drinking behavior through about four sessions over a short time. The therapy starts by identifying pros and cons of seeking treatment, then works on forming a plan for change and building confidence^[13].

Marital and family counseling includes spouses and other family members and can help repair and improve family relationships. Strong family support through family therapy may help people stay away from drinking^[13]. Brief interventions are short counseling sessions that provide information about drinking patterns and risks, help set goals, and provide ideas for making changes^[13].

Support groups like Alcoholics Anonymous (AA) can also be helpful for people getting treatment for AUD^[13]. Treatment may begin with a program for detox and withdrawal, which helps manage withdrawal symptoms safely^[10][17].

Recovery and Outlook

Change is possible, and most people who have AUD recover or markedly improve^[11][14]. While people with this condition may start drinking again, studies show that with treatment, most people are able to reduce how much they drink or stop drinking entirely^[4][12].

It’s important to know that AUD is not a choice or character flaw—it is a common medical condition that can happen to anyone^[11][14]. People with AUD can feel isolated and rejected due to negative attitudes and false beliefs they have heard from others. However, evidence-based treatment is available, and seeking help is a sign of strength^[11][14].

There has been progress globally. From 2010 to 2019, the number of alcohol-related deaths per 100,000 people decreased by 20.2% worldwide^[6]. Many people substantially reduce their drinking and report fewer alcohol-related problems with treatment^[11][14].

Making even small changes can make a big difference to health and well-being^[19]. By drinking less, people can improve their health in both the short and long term. Benefits may include better sleep, increased energy, improved concentration, better relationships, improved work performance, and better overall physical health^[16].