What to Know About Alcohol Use Disorder

If you have alcohol use disorder, you may have difficulty stopping or managing your alcohol use. It may negatively affect your health and work and relationships with family and friends.

Alcohol use disorder is a complex disorder that affects several brain systems, including the mesolimbic dopaminergic system of the brain, among other areas.

People may also refer to alcohol use disorder as alcohol abuse, alcohol addiction, alcohol dependence, and alcoholism. But alcohol use disorder is the preferred term today.

Alcohol use disorder doesn’t look the same in everyone. However, there are a few key symptoms and warning signs to look out for.

Healthcare professionals diagnose alcohol use disorder using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5).

If you meet any two of the following 11 criteria in the past year, a healthcare professional may diagnose you with alcohol use disorder, according to the NIAAA:

• 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 depression, anxiety, 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 problems sleeping, 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.

What counts as heavy, moderate, and binge drinking?

Drinking alcohol in moderation is defined as two drinks per day for men and one per day for women and older people. A standard drink is 1.5 oz. (44 mL) of spirits, or 12 oz. (355 mL) of beer, or 5 oz. (148 mL) of wine, the American Psychological Association (APA) notes.

However, according to research from 2018, even drinking within governmental “safe” limits, scientifically, still results in 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

Binge drinking is when you have five or more alcoholic drinks for men, or four or more alcoholic drinks for women, on the same occasion, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

Alcohol use disorder doesn’t need to be severe to seriously affect your life, work, relationships, and health.

If you drink alcohol regularly, no matter how much, consider whether you can manage your intake and whether it’s negatively affecting other areas of your life, like your family, job, and social life.

Inability to manage your alcohol intake despite negative consequences is a key sign you may have alcohol use disorder and may want to consider seeking help.

Here are some other warning signs to consider, according to the APA:

• You need a morning drink to relieve a hangover.
• Friends or family members have expressed concern about your drinking.
• You feel irritated when people criticize or comment on your drinking habits.

Environmental, social, biological, and genetic influences can all play a role in alcohol use disorder.

The following factors are associated with an increased risk of developing this condition:

• heavy drinking, which includes binge drinking and heavy alcohol use, both of which are defined above
• a parent or other family member has alcohol use disorder
• if you experienced trauma during childhood
• if you’re living with a mental health condition, such as depression or post-traumatic stress disorder (PTSD), or a neurodevelopmental disorder, such as attention deficit hyperactivity disorder (ADHD)
• if you started drinking before you were 15, though this is a stronger risk factor for women than men

Asking for help can be very difficult, especially because alcohol is usually one part of a complex coping mechanism, and it can feel very difficult, even scary, to think about living without this coping method.

According to one review article from 2014, major barriers to recovery include:

• denying that there is a problem
• people around you, like friends and family, denying that there is a problem
• having limited help from your family and community
• not understanding alcohol use disorder or recognizing that you have symptoms

Other major barriers include:

• social stigma, or the idea that people with substance use disorders are less worthy of medical care
• a lack of education, which leads people to believe that those with substance use disorders just need to “snap out of it” or “make better life choices” when, in reality, they need treatment for a chronic health condition that has resulted in physical changes to their body and brain

If you think you may have alcohol use disorder, or you match the diagnostic criteria listed above, the first step to recovery is often reaching out to a healthcare professional. They can help you find the right combination of treatments for your specific situation.

Many people with alcohol use disorder find it very difficult to quit without medication or therapy. In fact, some research suggests that repeated return to drinking is influenced by systems in the brain that are not under conscious control.

That’s why it’s critical to receive help and support. You don’t have to do it all alone.

Healthcare professionals can help you get medical and psychological help to deal with withdrawal symptoms and underlying issues that may be influencing you to use alcohol.

There are many ways to start looking for help. For example, you can try one of the following:

• Confide in a trusted friend about what you’re experiencing and, hopefully, get their support to help you in your journey to recovery.
• Reach out to a primary care doctor or a mental health professional.
• Read the NIAAA guide to finding and getting help for alcohol use disorder.
• Call the SAMHSA National Helpline on 1-800-662-HELP (4357), a free helpline for people and families dealing with mental health disorders or substance use disorders.

If you think you might have alcohol use disorder, medications, behavioral therapy, and support groups can help, according to research.

Your healthcare professional might recommend one or a combination of the following approaches, depending on what they think might work best based on your specific situation and needs.

Medication

Various medications are available to help with alcohol use disorder recovery. They may help you stop drinking or reduce your drinking, and can help prevent relapse.

According to the NIAAA, the Food and Drug Administration (FDA) has approved all of these, and none are habit-forming:

• naltrexone, which you can take by mouth or long-acting injection
• acamprosate
• disulfiram

Healthcare professionals can also prescribe non-FDA medication options, including:

• gabapentin
• topiramate

Behavioral therapy

A specialized, licensed therapist can provide talk therapy known as alcohol counseling. This is a type of psychosocial treatment for alcohol use disorder.

This professional could be a psychologist, counselor, or specialized alcohol counselor. In addition, general practitioners and psychiatrists may provide behavioral treatment and can also prescribe medication.

In therapy sessions, you’ll work one-on-one with your therapist to explore and deal with underlying causes, and you’ll learn coping techniques and other skills to help prevent relapse.

According to the NIAAA, your therapist might use a range of therapeutic approaches to help you do this, including:

• cognitive behavioral therapy
• motivational enhancement therapy
• marital and family counseling
• brief interventions

Ask your therapist what approach they think might work best for you.

Support groups

Whether you’d like to meet in person or would prefer to meet online, there’s a low cost or free alcohol mutual support group available to help you.

Alcoholics Anonymous or another 12-step program can provide peer support to help you recover.

You can ask your healthcare professional to recommend a support group, or search for one yourself using the resources at the bottom of this article.

Managing alcohol withdrawal

You may experience the following symptoms if going through alcohol withdrawal:

• nausea
• sweating
• restlessness
• irritability
• tremors
• hallucinations
• convulsions

If you’re living with alcohol use disorder, you might be tempted to quit “cold turkey,” or immediately. However, if you’ve been drinking alcohol heavily for a long time, experts advise that you do not stop drinking suddenly.

If you have severe alcohol use disorder and you stop drinking completely all at once, you could experience serious withdrawal symptoms, such as seizures. In some cases, these can be life-threatening.

If you’re considering quitting alcohol, there are many benefits to consulting your healthcare professional about how to do so safely. They may also recommend medication that can help ease withdrawal symptoms.

You can read more about treatments for alcohol use disorder here.

Who is advised to avoid alcohol?

The NIAAA advises that some people avoid drinking alcohol entirely, including individuals who:

• drive or operate machinery, or participate in activities that require alertness and responsiveness
• take particular medications
• live with certain medical conditions
• have difficulty managing how much alcohol you drink
• are pregnant or attempting to get pregnant

Return to drinking after a period of abstinence is a possibility for those with alcohol use disorder. This disorder makes changes in the brain that can make drinking very hard to give up. If you have alcohol use disorder, you might feel very discouraged if you return to drinking.

However, recovery is possible.

Talking with a trusted friend is a useful first step. If you feel you can confide in a friend and gain their support, they may be able to help you with the next stages of your recovery.

A 2019 review reports that medications are effective in treating alcohol use disorder, and a 2014 review notes that getting counseling from a therapist and going to a support group are associated with lower rates of returning to drinking.

Experts advise speaking with a healthcare professional to determine the best course of action. They can help you develop a game plan to work through alcohol use disorder and learn skills to prevent or recover from returning to drinking in the future.

Recovery is an ongoing process, and it’s normal and understandable to experience setbacks along the way. What matters is that you keep making an effort to move toward recovery.

If you think you or someone you care about has alcohol use disorder, here are some next steps you can take.

You can visit the NIAAA Rethinking Drinking website to learn more about alcohol use disorder, including what a “standard” drink actually looks like and how much drinking may be costing you in dollars. You can also explore other tools to help you reduce your alcohol consumption.

The NIAAA Alcohol Treatment Navigator is another useful tool you can use to find treatment options in your community.

It’s also helpful to speak with a healthcare professional. They can help you get the treatment you need to move forward and make positive changes.