Also called: Alcohol Abuse, Alcohol dependence, Alcoholism
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 bloodstream 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. Signs and 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 cause of alcohol use disorder is still unknown. Alcohol use disorder develops when you drink so much that chemical changes in the brain occur. These changes increase the pleasurable feelings you get when you drink alcohol. This makes you want to drink more often, even if it causes harm.
Eventually, the pleasurable feelings associated with alcohol use go away and the person with alcohol use disorder will engage in drinking to prevent withdrawal symptoms. These withdrawal symptoms can be quite unpleasant and even dangerous.
Alcohol use disorder typically develops gradually over time. It’s also known to run in families.
Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s, though it can start at any age.
- 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.
- Starting at an early age. People who begin drinking — especially binge drinking — at an early age are at a higher risk of alcohol use disorder.
- 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.
- History of trauma. People with a history of emotional or other trauma are at increased risk of alcohol use disorder.
- Having bariatric surgery. Some research studies indicate that having bariatric surgery may increase the risk of developing alcohol use disorder or of relapsing after recovering from alcohol use disorder.
- 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.
Your doctor or healthcare provider can diagnose alcohol use disorder. They’ll do a physical exam and ask you questions about your drinking habits.
Your doctor may ask if you:
- drive when you’re drunk
- have missed work or have lost a job as a result of your drinking
- need more alcohol to feel “drunk” when you drink
- have experienced blackouts as a result of your drinking
- have tried to cut back on your drinking but couldn’t
Your doctor may also use a questionnaire that assesses alcohol use disorder to help diagnose your condition.
Typically, a diagnosis of alcohol use disorder doesn’t require any other type of diagnostic test. There’s a chance your doctor may order blood work to check your liver function if you show signs or symptoms of liver disease.
Alcohol use disorder can cause serious and lasting damage to your liver. Your liver is responsible for removing toxins from your blood. When you drink too much, your liver has a harder time filtering the alcohol and other toxins from your bloodstream. This can lead to liver disease and other complications.
When to see a doctor
If you feel that you sometimes drink too much alcohol, or your drinking is 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 professional 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.
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.
Impact on your safety
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 experiencing sexual abuse or date rape
- Increased risk of attempted or completed suicide
Impact on your health
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 can also 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 (thiamin). A thiamin deficiency can also be associated with other brain changes, such as irreversible dementia, if not promptly treated.
- Birth defects. Alcohol use during pregnancy may cause miscarriage. It may also 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, esophagus, colon and breast cancers. 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.
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
- Red 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.
Treating AUD can be just as individualized as treating the causes themselves. Depending on the severity of the disorder, treatment can range from a brief intervention to individual or group counseling, an outpatient program or an inpatient stay at a rehabilitation center. It can involve a medically managed detox and withdrawal, psychological counseling, psychiatric treatment with medication, ongoing therapy, and a wide variety of lifestyle changes.
No matter what treatment is right for the individual, all treatments for AUD have one thing in common:
“It takes time and a day-by-day understanding,” Dr. Sansom concludes. “For people who have a problem with alcohol, there’s not an on-off switch. It’s a continual problem that requires a continual life change.”
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