Alcohol use disorder
Alcohol use disorder (which includes a level that's sometimes called alcoholism) is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, or having withdrawal symptoms when you rapidly decrease or stop drinking.
Unhealthy alcohol use includes any alcohol use that puts your health or safety at risk or causes other alcohol-related problems. It also includes binge drinking — a pattern of drinking where a male consumes five or more drinks within two hours or a female downs at least four drinks within two hours. Binge drinking causes significant health and safety risks.
If your pattern of drinking results in repeated significant distress and problems functioning in your daily life, you likely have alcohol use disorder. It can range from mild to severe. However, even a mild disorder can escalate and lead to serious problems, so early treatment is important.
Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms you experience. Signs and symptoms 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
- Spending a lot of time drinking, getting alcohol or recovering from alcohol use
- Feeling a strong craving or urge to drink alcohol
- Failing to fulfill major obligations at work, school or home due to repeated alcohol use
- Continuing to drink alcohol even though you know it's causing physical, social or interpersonal problems
- Giving up or reducing social and work activities and hobbies
- Using alcohol in situations where it's not safe, such as when driving or swimming
- Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount
- Experiencing withdrawal symptoms — such as nausea, sweating and shaking — when you don't drink, or drinking to avoid these symptoms
Alcohol use disorder can include periods of alcohol intoxication and symptoms of withdrawal.
- Alcohol intoxication results as the amount of alcohol in your blood stream increases. The higher the blood alcohol concentration is, the more impaired you become. Alcohol intoxication causes behavior problems and mental changes. These may include inappropriate behavior, unstable moods, impaired judgment, slurred speech, impaired attention or memory, and poor coordination. You can also have periods called "blackouts," where you don't remember events. Very high blood alcohol levels can lead to coma or even death.
- Alcohol withdrawal can occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to four or five days later. Symptoms include sweating, rapid heartbeat, hand tremors, problems sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms can be severe enough to impair your ability to function at work or in social situations.
The National Institute on Alcohol Abuse and Alcoholism defines one standard drink as any one of these:
- 12 ounces (355 milliliters) of regular beer (about 5 percent alcohol)
- 8 to 9 ounces (237 to 266 milliliters) of malt liquor (about 7 percent alcohol)
- 5 ounces (148 milliliters) of unfortified wine (about 12 percent alcohol)
- 1.5 ounces (44 milliliters) of 80-proof hard liquor (about 40 percent alcohol)
If you feel that you sometimes drink too much alcohol, or it's causing problems, or your family is concerned about your drinking, talk with your doctor. Other ways to get help include talking with a mental health provider or seeking help from a support group such as Alcoholics Anonymous or a similar type of self-help group.
Because denial is common, you may not feel like you have a problem with drinking. You might not recognize how much you drink or how many problems in your life are related to alcohol use. Listen to relatives, friends or co-workers when they ask you to examine your drinking habits or to seek help. Consider talking with someone who has had a problem drinking, but has stopped.
Many people with alcohol use disorder hesitate to get treatment because they don't recognize they have a problem. An intervention from loved ones can help some people recognize and accept that they need professional help. If you're concerned about someone who drinks too much, ask a professional experienced in alcohol treatment for advice on how to approach that person.
Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder.
Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones.
Risk factors for alcohol use disorder include:
- Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-related problems or alcohol use disorder.
- Age. People who begin drinking at an early age, and especially in a binge fashion, are at a higher risk of alcohol use disorder. Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s. However, it can begin at any age.
- Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems with alcohol. This may be influenced by genetic factors.
- Depression and other mental health problems. It's common for people with a mental health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances.
- Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it's OK to drink too much. For young people, the influence of parents, peers and other role models can impact risk.
Alcohol depresses your central nervous system. In some people, the initial reaction may be stimulation. But as you continue to drink, you become sedated.
Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you're taking certain medications that also depress the brain's function.
Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including:
- Motor vehicle accidents and other types of accidental injury, such as drowning
- Relationship problems
- Poor performance at work or school
- Increased likelihood of committing violent crimes or being the victim of a crime
- Legal problems or problems with employment or finances
- Problems with other substance use
- Engaging in risky, unprotected sex, or becoming the victim of sexual abuse or date rape
- Increased risk of attempted or completed suicide
Drinking too much alcohol on a single occasion or over time can cause health problems, including:
- Liver disease. Heavy drinking can cause increased fat in the liver (hepatic steatosis), inflammation of the liver (alcoholic hepatitis), and over time, irreversible destruction and scarring of liver tissue (cirrhosis).
- Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It also can interfere with absorption of B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis).
- Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause a serious heart arrhythmia called atrial fibrillation.
- Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level.
- Sexual function and menstruation issues. Excessive drinking can cause erectile dysfunction in men. In women, it can interrupt menstruation.
- Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamine). A thiamine deficiency also can be associated with other brain changes, such as irreversible dementia, if not promptly treated.
- Birth defects. Alcohol use during pregnancy may cause miscarriage. It also may cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems that last a lifetime.
- Bone damage. Alcohol may interfere with the production of new bone. This bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding.
- Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss.
- Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia.
- Increased risk of cancer. Long-term excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, colon and breast cancer. Even moderate drinking can increase the risk of breast cancer.
- Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
Consider your drinking habits, taking an honest look at how often and how much you drink. Be prepared to discuss any problems that alcohol may be causing. You may want to take a family member or friend along, if possible.
Before your appointment, make a list of:
- Any symptoms you've had, including any that may seem unrelated to your drinking
- Key personal information, including any major stresses or recent life changes
- All medications, vitamins or other supplements that you're taking, and their doses
- Questions to ask your doctor
Some questions to ask include:
- Do you think I drink too much or show signs of problem drinking?
- Do you think I need to cut back or quit drinking?
- Do you think alcohol could be causing or worsening my other health problems?
- What's the best course of action?
- What are the alternatives to the approach that you're suggesting?
- Do I need any medical tests for underlying physical problems?
- Are there any brochures or other printed material that I can have? What websites do you recommend?
- Would it be helpful for me to meet with a professional experienced in alcohol treatment?
Don't hesitate to ask any other questions.
Be ready to answer questions from your doctor, which may include:
- How often and how much do you drink?
- Do you have any family members with alcohol problems?
- Do you sometimes drink more than you intend to drink?
- Have relatives, friends or co-workers ever suggested you need to cut back or quit drinking?
- Do you feel like you need to drink more than you previously did to get the same effect?
- Have you tried to stop drinking? If so, was it difficult and did you have any withdrawal symptoms?
- Have you had problems at school, at work or in your relationships that may be related to alcohol use?
- Have there been times that you behaved in a dangerous, harmful or violent way when you were drinking?
- Do you have any physical health problems, such as liver disease or diabetes?
- Do you have any mental health issues, such as depression or anxiety?
- Do you use recreational drugs?
You're likely to start by seeing your primary care doctor. If your doctor suspects you have a problem with alcohol, he or she may refer you to a mental health provider.
To assess your problem with alcohol, your health care provider will likely:
- Ask you several questions related to your drinking habits. The health care provider may ask for permission to speak with family members or friends. However, confidentiality laws prevent your health care provider from giving out any information about you without your consent.
- Perform a physical exam. 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.
- Lab tests and imaging tests. While there are no specific tests to diagnose alcohol use disorder, certain patterns of lab test abnormalities may strongly suggest it. And 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.
- Complete a psychological evaluation. This evaluation includes questions about your symptoms, thoughts, feelings and behavior patterns. You may need to fill out a questionnaire to help answer these questions.
- Use the DSM-5 criteria. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, is often used by mental health providers to diagnose mental health conditions and by insurance companies to reimburse for treatment.
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 the use of alcohol to improve quality of life is the main treatment goal.
Treatment for alcohol use disorder may include:
- Detox and withdrawal. Treatment may begin with a program of detoxification or detox — withdrawal that's medically managed — which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital.
- Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center.
- Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcohol use. You may benefit from couples or family therapy — family support can be an important part of the recovery process.
- Oral medications. A drug called disulfiram (Antabuse) may help to prevent you from drinking, although it won't cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help you combat alcohol cravings once you stop drinking. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick after taking a drink.
- Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol use disorder to use consistently.
- Continuing support. Aftercare programs and support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group.
- Treatment for psychological problems. Alcohol use disorder commonly occurs along with other mental health disorders. If you have depression, anxiety or another mental health condition, you may need talk therapy (psychotherapy), medications or other treatment.
- Medical treatment for health conditions. Many alcohol-related health problems improve significantly once you stop drinking. But some health conditions may warrant continued treatment and follow-up.
- Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcohol use disorder or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery.
For a serious alcohol problem, you may need a stay at a residential treatment facility. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement and activity therapy.
Residential treatment programs typically include licensed alcohol and drug counselors, social workers, nurses, doctors and others with expertise and experience in treating alcohol use disorder.
You'll need to focus on changing your habits and making different lifestyle choices.
- Consider your social situation. Make it clear to your friends and family that you're not drinking alcohol. Develop a support system of friends and family who can support your recovery. You may need to distance yourself from friends and social situations that impair your recovery.
- Develop healthy habits. For example, good sleep, regular physical activity, managing stress more effectively and eating well all can make it easier for you to recover from alcohol use disorder.
- Do things that don't involve alcohol. You may find that many of your activities involve drinking. Replace them with hobbies or activities that are not centered around alcohol.
Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. But if used in addition to your treatment plan when recovering from alcohol use disorder, these techniques may be helpful:
- Yoga. Yoga's series of postures and controlled breathing exercises may help you relax and manage stress.
- Meditation. During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress.
- Acupuncture. With acupuncture, hair-thin needles are inserted under the skin. Acupuncture may help reduce anxiety and depression.
Many people with alcohol problems and their family members find that participating in support groups is an essential part of coping with the disease, preventing or dealing with relapses, and staying sober. Your doctor or counselor can suggest a support group. These groups are also often listed on the Web and sometimes in the phone book.
Here are a few examples:
- Alcoholics Anonymous. Alcoholics Anonymous (AA) is a self-help group of people recovering from alcoholism that offers a sober peer group built around 12 steps as an effective model for achieving total abstinence.
- Women for Sobriety. Women for Sobriety is a nonprofit organization offering a self-help group program for women who want to overcome alcoholism and other addictions. It focuses on developing coping skills related to emotional and spiritual growth, self-esteem and a healthy lifestyle.
- Al-Anon and Alateen. Al-Anon is designed for people who are affected by someone else's alcoholism. Alateen groups are available for teenage children of those with alcoholism. In sharing their stories, family members gain a greater understanding of how the disease affects the entire family.
Early intervention can prevent alcohol-related problems in teens. If you have a teenager, be alert to signs and symptoms that may indicate a problem with alcohol:
- Loss of interest in activities and hobbies and in personal appearance
- Bloodshot eyes, slurred speech, problems with coordination and memory lapses
- Difficulties or changes in relationships with friends, such as joining a new crowd
- Declining grades and problems in school
- Frequent mood changes and defensive behavior
You can help prevent teenage alcohol use:
- Set a good example with your own alcohol use.
- Talk openly with your child, spend quality time together and become actively involved in your child's life.
- Let your child know what behavior you expect — and what the consequences will be if he or she doesn't follow the rules.