Alcohol use disorder is characterized by the inability to control or stop alcohol consumption, despite the negative impact it has on various aspects of one’s life, such as relationships, work, physical and mental health.
In the United States, a significant number of people are affected by alcohol use disorder. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in 2019, around 5.6% of adults aged 18 and above (which is approximately 14.1 million individuals) were diagnosed with this condition.
In addition to affecting adults, alcohol use disorder also impacts many young people. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that in 2019, approximately 1.7% of individuals aged 12 to 17 in the United States, or 414,000 adolescents, had alcohol use disorder.
The severity of alcohol use disorder can range from mild to severe, and even mild cases can have significant negative impacts on a person’s personal and professional life. However, the good news is that there is support and treatment available for those struggling with alcohol use disorder.
What is alcohol use disorder?
Having alcohol use disorder can make it hard to control or regulate your alcohol consumption, which can have adverse impacts on your health, work, and relationships with your loved ones.
Alcohol use disorder is a multifaceted condition that influences various brain systems, such as the mesolimbic dopaminergic system, among other areas.
People have used different terms to refer to alcohol use disorder, such as alcohol abuse, alcohol addiction, alcohol dependence, and alcoholism. However, the preferred term today is alcohol use disorder.
Symptoms
Healthcare professionals diagnose alcohol use disorder using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Although alcohol use disorder can vary from person to person, there are some common symptoms and warning signs to be aware of.
According to the NIAAA, if you have experienced at least two of the 11 criteria within the past year, a healthcare professional may diagnose you with alcohol use disorder.
- You drank more or longer than you meant to on some occasions.
- You tried to cut back more than once but weren’t able to.
- Drinking took up a lot of your time, or you spent a lot of time getting over the aftereffects.
- You had a persistent, distracting desire to have a drink.
- Drinking or hangovers affected your obligations at home, with your family, at work, or at school.
- Your drinking has affected relationships with family or friends.
- You avoided other important or pleasurable activities in your life so that you could drink.
- You engaged in high risk behaviors more than once while drinking that increased the chances you’d get hurt. Risk-taking could include driving, swimming, or having sex without barrier protection while intoxicated.
- Your drinking has negatively affected your health or contributed to , , or memory blackouts.
- You drank more in one sitting to get the same effect as in the past. Each drink has less of an effect than it used to.
- You experienced withdrawal symptoms when the effects of alcohol were wearing off. These might have included , restlessness, shakiness, nausea, a racing heart, sweating, or a seizure. You may have even perceived things that were not there, known as hallucinations.
The number of the above criteria you match determines the severity of alcohol use disorder.
- Mild: You match two to three criteria.
- Moderate: You match four to five criteria.
- Severe: You match six or more criteria.
Language matters
While this article uses the terms “women” and “men” to refer to gender, it is important to note that individuals may identify differently. It is recommended to consult with a healthcare provider to better understand how the information provided applies to your specific situation, including diagnosis, symptoms, and treatment.
What counts as heavy, moderate, and binge drinking?
According to the American Psychological Association (APA), moderate drinking of alcohol is defined as two drinks per day for men and one drink per day for women and older people. A standard drink is equivalent to 1.5 oz. (44 mL) of spirits, 12 oz. (355 mL) of beer, or 5 oz. (148 mL) of wine.
According to a 2018 study, drinking within the limits considered “safe” by governments can still lead to harm.
In contrast, the NIAAA defines heavy alcohol use as:
- In men: drinking more than four alcoholic beverages in one sitting or more than 14 per week
- In women: drinking more than three alcoholic beverages in one sitting or more than seven per week
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), binge drinking refers to consuming five or more alcoholic drinks for men or four or more alcoholic drinks for women on the same occasion.
Warning signs
Even if your alcohol use disorder isn’t severe, it can still have a significant impact on your health, relationships, work, and overall life.
It’s important to assess whether your alcohol consumption is negatively affecting your family, job, or social life, regardless of the amount.
If you find that you cannot control your drinking despite adverse effects, it may be a sign of alcohol use disorder and seeking help might be necessary.
The APA has identified several warning signs that may indicate the presence of an alcohol use disorder, including:
- Drinking more or for a longer period than intended.
- Difficulty cutting down or controlling alcohol consumption.
- Spending a lot of time drinking, being sick from drinking, or recovering from its effects.
- Cravings for alcohol.
- Continuing to drink despite negative consequences to one’s health, work, or relationships.
- Giving up activities or hobbies in favor of drinking.
- Developing a tolerance to alcohol, requiring more to achieve the desired effect.
- Experiencing withdrawal symptoms when not drinking, such as shakiness, sweating, nausea, or anxiety.
If you are experiencing any of these warning signs, it’s important to speak with a healthcare professional or addiction specialist for an assessment and possible treatment options.
Causes and risk factors
Alcohol use disorder can be influenced by a variety of factors, including environmental, social, biological, and genetic factors.
Environmental factors such as living in a culture where alcohol is readily available or being surrounded by heavy drinkers can increase the likelihood of developing an alcohol use disorder. Social factors, such as peer pressure or social norms that encourage heavy drinking, can also play a role.
Biological factors, such as imbalances in brain chemicals or the presence of co-occurring mental health disorders, can increase the risk of developing an alcohol use disorder.
Genetic factors can also play a role, as certain genes have been linked to an increased susceptibility to alcoholism.
It’s important to understand that alcohol use disorder is a complex and multifaceted condition that can be influenced by a range of factors.
A comprehensive treatment approach that addresses these various factors is often necessary for successful recovery.
Several factors have been associated with an increased risk of developing alcohol use disorder. These include:
- Family history: Having a family member with alcohol use disorder increases the risk of developing the condition.
- Age of onset: Starting to drink at a young age or drinking heavily during adolescence can increase the risk of developing alcohol use disorder.
- Mental health: Having a co-occurring mental health disorder, such as depression or anxiety, increases the risk of developing alcohol use disorder.
- Trauma: Experiencing physical or emotional trauma, such as abuse or neglect, can increase the risk of developing alcohol use disorder.
- Stress: High levels of stress, such as those experienced in a demanding job or personal life, can increase the risk of developing alcohol use disorder.
- Social and cultural factors: Social and cultural factors, such as peer pressure, social norms that encourage heavy drinking, or living in a culture where alcohol is readily available, can increase the risk of developing alcohol use disorder.
It’s important to remember that having one or more of these risk factors does not necessarily mean that someone will develop alcohol use disorder, and that recovery is possible with appropriate treatment and support.
When to seek help
Asking for help with an alcohol use disorder can be a difficult and scary process. For many people, alcohol use is part of a larger coping mechanism used to deal with stress, anxiety, or other difficult emotions. It’s common to worry about how you will cope without alcohol, and to feel afraid of the unknown.
However, it’s important to remember that seeking help for an alcohol use disorder is a courageous and positive step towards a healthier, happier life. Treatment options are available that can help you learn new coping skills and strategies for managing difficult emotions. With the right support, it is possible to overcome an alcohol use disorder and lead a fulfilling life without relying on alcohol.
If you are struggling with an alcohol use disorder, it’s important to reach out to a healthcare professional or addiction specialist for help. They can provide guidance and support throughout the recovery process, and help you build a new, healthier way of coping with life’s challenges.
A 2014 review article identified several significant obstacles to recovery from alcohol use disorder. These included:
- Denial of the problem, either by the person experiencing the disorder or by their friends and family members.
- Limited support from family members or community resources.
- Lack of understanding about the nature of alcohol use disorder and its symptoms.
These barriers can prevent individuals from seeking help or being able to access appropriate treatment options. It is important to address these obstacles in order to improve the chances of successful recovery from alcohol use disorder. This may involve education and outreach efforts to increase awareness and understanding of the disorder, as well as providing adequate resources and support to those affected by it.
In addition to the barriers mentioned earlier, there are several other significant obstacles that can hinder recovery from alcohol use disorder. Some of these barriers include:
- Stigma: There is still a significant stigma associated with alcohol use disorder, which can prevent individuals from seeking help due to fear of judgment or discrimination.
- Lack of access to care: Access to treatment for alcohol use disorder can be limited by a variety of factors, including financial barriers, geographic barriers, and shortages of trained healthcare providers.
- Co-occurring disorders: Alcohol use disorder often co-occurs with other mental health disorders, such as depression or anxiety, which can make treatment more complex and difficult.
- Relapse: Recovery from alcohol use disorder is often characterized by periods of relapse, which can be discouraging and lead to a sense of hopelessness.
Overcoming these barriers requires a comprehensive approach that addresses the individual’s unique needs and circumstances. This may involve a combination of medical treatment, counseling and therapy, social support, and lifestyle changes. With the right support and resources, recovery from alcohol use disorder is possible.
If you believe that you are struggling with alcohol use disorder or meet the diagnostic criteria for the condition, it is important to seek help from a healthcare professional as soon as possible. A healthcare professional, such as a doctor or addiction specialist, can provide a comprehensive assessment of your condition and recommend appropriate treatment options.
Treatment for alcohol use disorder may include a combination of medical, psychological, and social interventions tailored to your individual needs. This may include medication-assisted treatment, counseling and therapy, support groups, and lifestyle changes.
The first step in recovery is often the hardest, but it is important to remember that you are not alone. With the right support and treatment, it is possible to overcome alcohol use disorder and lead a fulfilling, healthy life.
How to seek help
Many individuals with alcohol use disorder find it challenging to quit drinking without the aid of medication or therapy. Research has shown that repeated returns to drinking are linked to brain systems that are not fully under conscious control.
These systems involve a complex interplay of neurotransmitters, hormones, and brain structures that regulate mood, stress, and reward. Over time, heavy alcohol use can disrupt these systems, leading to physical dependence and intense cravings for alcohol.
Medication-assisted treatment can help to manage these symptoms by reducing cravings and withdrawal symptoms, making it easier for individuals to quit drinking and stay sober. Behavioral therapies, such as cognitive-behavioral therapy (CBT), can also help to address underlying psychological factors that contribute to alcohol use disorder, such as stress, anxiety, or trauma.
It is important to remember that recovery is a process and that it may take time to find the right combination of treatments for your individual needs. With the right support and resources, however, it is possible to overcome alcohol use disorder and achieve long-term sobriety.
It is essential to seek help and support when dealing with alcohol use disorder. You do not need to face this challenge on your own.
There are various ways to seek help for alcohol use disorder. Here are a few options to consider:
- Talk to your primary care physician: Your primary care physician can provide you with a referral to a specialist in addiction medicine or connect you with other resources in your area.
- Contact a local treatment center: Treatment centers specialize in helping individuals with alcohol use disorder and can provide a range of services, including medical detox, therapy, and support groups.
- Reach out to a support group: Support groups, such as Alcoholics Anonymous (AA), offer a safe and supportive environment to share experiences, gain insight, and receive encouragement from others in recovery.
- Use an online resource: There are many online resources available that can provide information on alcohol use disorder, treatment options, and support services.
Remember, seeking help is a courageous step towards recovery. There are many resources available to help you on your journey to sobriety.
Treatments
Research suggests that medications, behavioral therapy, and support groups can be effective in treating alcohol use disorder. If you suspect you may have this condition, your healthcare professional may recommend one or a combination of these treatments based on your unique needs and circumstances.
Medication
Medication treatment for alcohol use disorder involves using medications to help manage withdrawal symptoms, reduce alcohol cravings, and support long-term sobriety. Some examples of medications used in the treatment of alcohol use disorder include benzodiazepines, naltrexone, acamprosate, and disulfiram. The specific medication or combination of medications recommended will depend on an individual’s specific needs and circumstances, and should only be prescribed and monitored by a healthcare professional.
Healthcare professionals can also prescribe non-FDA medication options, including:
- gabapentin
- topiramate
Behavioral therapy
Behavioral therapy is a type of treatment for alcohol use disorder that focuses on changing unhealthy behaviors and thought patterns related to drinking. Different types of behavioral therapies may be used, such as cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), and contingency management. CBT can help individuals identify and change negative thought patterns and behaviors that contribute to alcohol use, while MET can increase motivation to change and improve self-esteem. Contingency management uses rewards to encourage positive behaviors and sobriety. Behavioral therapy can be delivered in individual or group settings, and may be used in combination with medication treatment for optimal results.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests that therapists may use a range of therapeutic approaches to help individuals with alcohol use disorder, including cognitive-behavioral therapy, motivational enhancement therapy, marital and family counseling, and brief interventions.
Cognitive-behavioral therapy can help individuals identify and change negative thought patterns and behaviors related to drinking, while motivational enhancement therapy can increase motivation to change and improve self-esteem.
Marital and family counseling can address relationship issues that may contribute to alcohol use, and brief interventions can help individuals reduce their alcohol consumption. It is important to discuss with your therapist which approach may work best for your individual needs and circumstances.
Support groups
There are many low-cost or free mutual support groups available to individuals seeking help for alcohol use disorder.
Alcoholics Anonymous (AA) is a well-known 12-step program that provides peer support for individuals in recovery. Other mutual support groups, such as SMART Recovery and Women for Sobriety, may also be helpful.
Your healthcare professional may be able to recommend a support group or you can search for one using the resources available online. Many support groups now offer online meetings, in addition to in-person meetings, for added convenience.
Managing alcohol withdrawal
Managing alcohol withdrawal is an important part of recovering from alcohol use disorder. Withdrawal symptoms can range from mild to severe and can include anxiety, tremors, seizures, and delirium tremens (DTs). In some cases, withdrawal symptoms can be life-threatening, so it is important to seek medical attention if you are experiencing severe symptoms.
Medications may be used to manage withdrawal symptoms, such as benzodiazepines to reduce anxiety and prevent seizures. Medical professionals may also use other medications, such as beta-blockers or antipsychotics, to manage symptoms such as tremors or hallucinations.
It is also important to stay hydrated and eat a nutritious diet during the withdrawal process. Getting enough sleep and engaging in gentle exercise, such as walking, can also be helpful.
It is recommended to seek medical assistance when managing alcohol withdrawal to ensure safe and effective management of symptoms.
Alcohol withdrawal symptoms can vary in severity, depending on the individual’s level of alcohol consumption and other factors. Some common symptoms of alcohol withdrawal include:
- Anxiety or nervousness
- Irritability
- Shakiness or tremors
- Sweating
- Nausea or vomiting
- Insomnia or other sleep disturbances
- Headache
- Elevated heart rate or blood pressure
- Delirium tremens (DTs), which can cause confusion, hallucinations, seizures, and other severe symptoms
It’s important to seek medical attention if you are experiencing severe withdrawal symptoms or DTs, as these can be life-threatening.
If you have been drinking heavily for a long time, it’s important to seek medical advice before attempting to quit drinking.
Suddenly stopping alcohol consumption can lead to serious withdrawal symptoms, including seizures and delirium tremens. A healthcare professional can help you safely manage your withdrawal symptoms and provide support throughout the detoxification process.
Yes, seeking medical advice before quitting alcohol can help you safely manage withdrawal symptoms and increase the chances of successfully quitting.
A healthcare professional can provide personalized advice and may recommend medication to help ease withdrawal symptoms. Additionally, they can refer you to appropriate resources and support to help you maintain sobriety and manage any underlying issues related to alcohol use disorder.
Who is advised to avoid alcohol?
The NIAAA advises that some people should avoid drinking alcohol entirely, including individuals who:
- are unable to limit their drinking to moderate levels
- have a history of alcohol use disorder or other substance use disorders
- are taking medications that interact with alcohol
- have certain medical conditions, such as liver disease, pancreatitis, or certain cancers
- are pregnant or trying to become pregnant
- plan to drive, operate machinery, or engage in other activities that require attention, coordination, or skill
It’s important to note that even moderate alcohol consumption can have negative health consequences for some people, and that the decision to drink should be made on an individual basis after considering personal health factors and risks.
Managing alcohol use disorder
While relapse is a common occurrence for those with alcohol use disorder, it’s important to remember that it’s not a sign of failure. Recovery is a lifelong process, and setbacks can happen. It’s important to not give up and to seek help if you find yourself returning to drinking.
Talking to a healthcare professional or a support group can be helpful in addressing the underlying causes of the relapse and developing a plan to prevent it from happening again. It’s important to continue seeking support and treatment as needed to maintain sobriety and achieve long-term recovery.
According to a 2019 review, medications have been found to be effective in treating alcohol use disorder. Additionally, a 2014 review found that seeking counseling from a therapist and attending support groups have been associated with lower rates of relapse and returning to drinking.
I completely agree. Seeking help from a healthcare professional is crucial for developing an effective plan for recovery from alcohol use disorder. Recovery is a journey that requires commitment and perseverance, and it’s important to remember that setbacks can happen. However, with the right support and resources, it’s possible to overcome alcohol use disorder and maintain sobriety. It’s important to take it one step at a time and keep moving forward.
What’s next
If you suspect that you or someone you know is suffering from alcohol use disorder, there are several actions you can take to get help and support.
If you are interested in learning more about alcohol use disorder and how to reduce your alcohol consumption, you can visit the NIAAA Rethinking Drinking website.
This site provides information about what constitutes a standard drink, how much drinking might be costing you financially, and other resources to help you cut back on your drinking. Additionally, the NIAAA Alcohol Treatment Navigator can help you locate treatment options in your local area.
Consulting with a healthcare professional is also beneficial. They can provide guidance on how to obtain the necessary treatment to make progress and achieve favorable outcomes.
The SAMHSA National Helpline
1-800-662-HELP (4357)
If you are struggling with alcohol use disorder and don’t know where to begin seeking help, you could try contacting the SAMHSA National Helpline.
This helpline is designed for individuals dealing with mental health issues or substance abuse disorders, and it offers confidential support in both English and Spanish.
Additionally, the helpline is always available and completely free of charge.
11 sources
- Alcohol use and burden for 195 countries and territories, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. (2018).
com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext - Alcohol use disorder: A comparison between DSM-IV and DSM-5. (2021).
nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm - Alcohol use disorder. (n.d.).
nih.gov/alcohols-effects-health/alcohol-use-disorder - Bringing down binge drinking. (n.d.).
gov/sites/default/files/programs_campaigns/nation_prevention_week/data-binge-drinking.pdf - Carter J, et al. (2014). The management of alcohol use disorders: The impact of pharmacologic, affective, behavioral, and cognitive approaches.
nlm.nih.gov/pmc/articles/PMC4318665/ - Drinking levels defined. (n.d.).
nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking - Medications development program. (2019).
nih.gov/medications-development-program - Treatment for alcohol problems: Finding and getting help. (2021).
nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help - Understanding alcohol use disorder. (2021).
nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder - Understanding alcohol use disorders and their treatment. (2012).
org/topics/alcohol-disorders - Witkiewitz K, et al. (2019). Advances in the science and treatment of alcohol use disorder.
nlm.nih.gov/pmc/articles/PMC6760932/