Alcohol use disorder
Alcohol dependence; Alcohol abuse; Problem drinking; Drinking problem; Alcohol addiction; Alcoholism - alcohol use; Substance use - alcohol
Alcohol use disorder is when your drinking causes serious problems in your life, yet you keep drinking. You may also need more and more alcohol to feel drunk. Stopping suddenly may cause withdrawal symptoms.
No one knows what causes problems with alcohol. Health experts think that it may be a combination of a person's:
- Psychology, such as being impulsive or having low self-esteem
Long-term risks of drinking an excessive amount of alcohol are more likely if:
- You are a man who has more than 2 drinks per day, or 15 or more drinks a week, or often have 5 or more drinks at a time
- You are a woman who has more than 1 drink per day, or 8 or more drinks a week, or often have 4 or more drinks at a time
One drink is defined as 12 ounces or 360 milliliters (mL) of beer (5% alcohol content), 5 ounces or 150 mL of wine (12% alcohol content), or a 1.5-ounce or 45-mL shot of liquor (80 proof, or 40% alcohol content).
If you have a parent with alcohol use disorder, you are more at risk for alcohol problems.
You also may be more likely to have problems with alcohol if you:
- Are a young adult under peer pressure
- Have depression, bipolar disorder, anxiety disorders, post-traumatic stress disorder (PTSD), or schizophrenia
- Can easily obtain alcohol
- Have low self-esteem
- Have problems with relationships
- Live a stressful lifestyle
If you are concerned about your drinking, it may help to take a careful look at your alcohol use.
Health care providers have developed a list of symptoms that a person has to have in the past year to be diagnosed with alcohol use disorder.
Symptoms may include:
- Times when you drink more or longer than you planned to.
- Wanted to, or tried to, cut down or stop drinking, but could not.
- Spend a lot of time and effort to get alcohol, use it, or recover from its effects.
- Crave alcohol or have a strong urge to use it.
- Alcohol use is causing you to miss work or school, or you do not perform as well because of drinking.
- Continue to drink, even when relationships with family and friends are being harmed.
- Stop taking part in activities that you used to enjoy.
- While or after drinking, you get into situations that can cause you to get hurt, such as driving, using machinery, or having unsafe sex.
- Keep drinking, even though you know it is making a health problem caused by alcohol worse.
- Need more and more alcohol to feel its effects or to get drunk.
- You get withdrawal symptoms when the effects of alcohol wear off.
Exams and Tests
Your provider will:
- Examine you
- Ask about your medical and family history
- Ask about your alcohol use, and if you have any of the symptoms listed above
Your provider may order tests to check for health problems that are common in people who use alcohol. These tests may include:
Many people with an alcohol problem need to completely stop using alcohol. This is called abstinence. Having strong social and family support can help make it easier to quit drinking.
Some people are able to just cut back on their drinking. So even if you do not totally give up alcohol, you may be able to drink less. This can improve your health and relationships with others. It can also help you perform better at work or school.
However, many people who drink too much find they can't just cut back. Abstinence may be the only way to manage a drinking problem.
DECIDING TO QUIT
Like many people with an alcohol problem, you may not recognize that your drinking has gotten out of your control. An important first step is to be aware of how much you drink. It also helps to understand the health risks of alcohol.
If you decide to quit drinking, talk with your provider. Treatment involves helping you realize how much your alcohol use is harming your life and the lives those around you.
Depending on how much and how long you have been drinking, you may be at risk for alcohol withdrawal. Withdrawal can be very uncomfortable and even life threatening. If you have been drinking a lot, you should cut back or stop drinking only under the care of a provider. Talk with your provider about how to stop using alcohol.
Alcohol recovery or support programs can help you stop drinking completely. These programs usually offer:
- Education about alcohol use and its effects
- Counseling and therapy to discuss how to control your thoughts and behaviors
- Physical health care
For the best chance of success, you should live with people who support your efforts to avoid alcohol. Some programs offer housing options for people with alcohol problems. Depending on your needs and the programs that are available:
- You may be treated in a special recovery center (inpatient)
- You may attend a program while you live at home (outpatient)
You may be prescribed medicines along with counseling and behavioral therapy to help you quit. This is called medication-assisted treatment (MAT). While MAT doesn't work for everyone, it is another option in treating the disorder.
- Acamprosate helps reduce cravings and dependence on alcohol in people who have recently stopped drinking.
- Disulfiram should only be used after you stop drinking. It causes a very bad reaction when you drink, which helps prevent you from drinking.
- Naltrexone blocks pleasurable feelings of intoxication, which may help you cut back or stop drinking.
It's a common misconception that taking medicine to treat alcohol use disorder is trading one addiction for another. However, these medicines are not addictive. They can help some people manage the disorder, just as people with diabetes or heart disease take medicine to treat their condition.
Drinking may mask depression or other mood or anxiety disorders. If you have a mood disorder, it may become more noticeable when you stop drinking. Your provider will treat any mental disorders in addition to your alcohol treatment.
Support groups help many people who are dealing with alcohol use. Talk to your provider about a support group that might be right for you.
How well a person does depends on whether they can successfully cut back or stop drinking.
It may take several tries to stop drinking for good. If you are struggling to quit, do not give up hope. Getting treatment, if needed, along with support and encouragement from support groups and those around you can help you remain sober.
Alcohol use disorder can increase your risk of many health problems, including:
- Bleeding in the digestive tract
- Brain cell damage
- A brain disorder called Wernicke-Korsakoff syndrome
- Cancer of the esophagus, liver, colon, breast, and other areas
- Changes in the menstrual cycle
- Delirium tremens (DTs)
- Dementia and memory loss
- Depression and suicide
- Erectile dysfunction
- Heart damage
- High blood pressure
- Inflammation of the pancreas (pancreatitis)
- Liver disease, including cirrhosis
- Nerve and brain damage
- Poor nutrition
- Sleeping problems (insomnia)
- Sexually transmitted infections (STIs)
Alcohol use also increases your risk for violence.
Drinking alcohol while you are pregnant can lead to severe birth defects in your baby. This is called fetal alcohol syndrome. Drinking alcohol while you are breastfeeding can also cause problems for your baby.
When to Contact a Medical Professional
Talk with your provider if you or someone you know may have an alcohol problem.
Seek immediate medical care or call your local emergency number (such as 911) if you or someone you know has an alcohol problem and develops severe confusion, seizures, or bleeding.
The National Institute on Alcohol Abuse and Alcoholism recommends:
- Women should not drink more than 1 drink per day
- Men should not drink more than 2 drinks per day
American Psychiatric Association. Substance-related and addictive disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013:481-590.
Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion. CDC vital signs: alcohol screening and counseling.
Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. Am J Psychiatry. 2018;175(1):86-90. PMID: 29301420
Sherin K, Seikel S, Hale S. Alcohol use disorders. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 48.
US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(18):1899-1909. PMID: 30422199
Witkiewitz K, Litten RZ, Leggio L. Advances in the science and treatment of alcohol use disorder. Sci Adv. 2019;5(9):eaax4043. Published 2019 Sep 25. PMID: 31579824
Last reviewed on: 5/10/2020
Reviewed by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.