Alcohol Use Disorder

Overview

What is alcohol use disorder?

Alcohol use disorder is a medical condition involving frequent or heavy alcohol use. People with alcohol use disorder can’t stop drinking, even when it causes problems, emotional distress or physical harm to themselves or others.

Is alcohol use disorder a disease?

Alcohol use disorder is a medical condition. It’s a disease of brain function and requires medical and psychological treatments to control it.

Alcohol use disorder can be mild, moderate or severe. It can develop quickly or over a long period of time. It’s also called alcohol dependence, alcohol addiction or alcohol abuse.

How common is alcohol use disorder?

14.5 million Americans 12 years or older have an alcohol use disorder.

How can drinking too much affect me?

Drinking too much alcohol can damage your health. It’s associated with:

  • Brain damage, including dementia.
  • Despair, depression and suicide.
  • Cancers of the breast, liver, colon and mouth.
  • Fetal alcohol syndrome (if exposed to alcohol before birth).
  • Accidents (like falls or burns) and injuries (like fractures or drowning).
  • Liver problems, such as cirrhosis, hepatitis and fatty liver.
  • Blackouts, assaults, DUIs and even homicide.

Frequent or heavy drinking can also lead to personal problems, such as trouble with:

  • Money.
  • Personal relationships.
  • Work.

Symptoms and Causes

What causes alcohol use disorder?

Scientists are still trying to understand what causes alcohol use disorder. It appears to be a combination of one or more of the following:

  • Genetics.
  • Early childhood events.
  • Attempts to relieve emotional pain.

People are more likely to become an alcoholic if they:

  • Consume alcohol often, in large amounts or start early in life.
  • Experienced trauma, such as physical or sexual abuse.
  • Have a family history of alcohol problems.
  • Have mental health issues, such as grief, anxiety, depression, eating disorders and post-traumatic stress disorder.
  • Have had stomach bypass surgery (Roux-en-y) for weight issues.

What are the symptoms of alcohol use disorder?

Signs of alcohol use disorder include:

  • Blacking out or not remembering things that happened.
  • Continuing to drink even if it causes distress or harm to you or others.
  • Drinking more or longer than you planned.
  • Feeling irritable or cranky when you’re not drinking.
  • Frequent hangovers.
  • Getting into dangerous situations when you’re drinking (for example, driving, having unsafe sex or falling).
  • Giving up activities so you can drink.
  • Having cravings for alcohol.
  • Having repeated problems with work, school, relationships or the law because of drinking.
  • Needing to drink more and more to get the same effect.
  • Not being able to stop drinking once you’ve started.
  • Spending a lot of time drinking or recovering from drinking.
  • Wanting to cut back but not being able to.
  • Obsessing over alcohol.

A person who is alcohol dependent also might experience symptoms of withdrawal when they cut back or stop drinking, such as:

  • Anxiety.
  • Depression.
  • Irritability.
  • Nausea, dry heaves.
  • Racing heart.
  • Restlessness.
  • Shakiness.
  • Sweating.
  • Trouble sleeping.
  • Seizures.
  • Seeing things that aren’t there (hallucinations).
  • Delirium tremens.
  • Coma and death.

What are the stages of alcohol use disorder?

Alcohol use that turns into a use disorder develops in stages.

  • At-risk stage: This is when you drink socially or drink to relieve stress or to feel better. You may start to develop a tolerance for alcohol.
  • Early alcohol use disorder: In this stage, you have progressed to blackouts, drinking alone or in secret and thinking about alcohol a lot.
  • Mid-stage alcohol use disorder: Your alcohol use is now out of control and causes problems with daily life (work, family, financial, physical and mental health). Organ damage can be seen on lab tests and scans.
  • End-stage alcohol use disorder: Drinking is now the main focus of your life, to the exclusion of food, intimacy, health and happiness. Despair, complications of organ damage and death are now close.

Diagnosis and Tests

How is alcohol use disorder diagnosed?

There’s no single lab test for alcohol use disorder. Diagnosis is based on a conversation with your healthcare provider. The diagnosis is made when drinking interferes with your life or affects your health.

Management and Treatment

How is alcohol use disorder treated?

Treatment may include a combination of:

  • Behavioral therapies: Counseling, or talk therapy, with a healthcare provider like a psychologist or mental health counselor can teach you ways to change your behavior. Motivational, cognitive-behavioral, contingency and 12-step facilitation are the most commonly used techniques.
  • Medications: The U.S. Food & Drug Administration has approved naltrexone and acamprosate for the treatment of alcohol use disorder. Topiramate and gabapentin can also decrease cravings in some people. An older medication — disulfiram — is now used only rarely. These medications seem to help decrease the background obsessional thinking around alcohol.
  • Support groups: Group meetings with other alcoholics can help you stay sober. Alcoholics Anonymous (AA) meetings are usually free and are available in most communities. Other styles of recovery groups include: Celebrate! Recovery (Christian focus), Rational Recovery (non-spiritual) and Recovery Dharma (mindfulness/Buddhist focus).

Your treatment setting will depend on your stage of recovery and the severity of your illness. You may need inpatient medical (hospital), residential rehabilitation (rehab), outpatient intensive therapy or outpatient maintenance.

Prevention

How can I prevent alcohol use disorder?

To prevent alcohol problems, avoid high-risk drinking:

  • For women: No more than four or more drinks in one day or eight or more drinks per week.
  • For men: No more than five or more drinks in one day or 15 or more drinks per week.

If you drink more alcohol than that, consider cutting back or quitting. Talk to your healthcare provider about proven strategies.

Outlook / Prognosis

What is the outlook for people with alcohol use disorder?

Your outlook depends on many factors. Milder cases may only be problematic for a period of time. Severe cases are often a lifelong struggle.

The sooner you recognize there may be a problem and talk to your healthcare provider, the better your recovery chances.

Living With

Who can I call for help with alcoholism?

The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a hotline, 24/7, 365 days a year. Call 1-800-662-HELP (4357).

Alcoholics Anonymous is available almost everywhere and provides a place to openly and non-judgmentally discuss alcohol problems with others who have suffered from alcohol.

A note from Cleveland Clinic

No matter how hopeless alcohol use disorder may seem, treatment can help. If you think you might have a problem with alcohol, call SAMHSA or talk to your healthcare provider. They can help you cope, make a treatment plan, prescribe medications and refer you to support programs.

Last reviewed by a Cleveland Clinic medical professional on 06/02/2021.

References

  • National Institute on Alcohol Abuse and Alcoholism. Alcohol Use Disorder. (https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-use-disorder) Accessed 7/16/2021.
  • National Institute on Alcohol Abuse and Alcoholism. Treatment for Alcohol Problems: Finding and Getting Help. (https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help) Accessed 7/16/2021.
  • Substance Abuse and Mental Health Services Administration. Find Help: ATOD. (https://www.samhsa.gov/find-help/atod) Accessed 7/16/2021.
  • U.S. Department of Health and Human Services. Dietary Guidelines for Americans. (https://health.gov/sites/default/files/2019-09/2015-2020_Dietary_Guidelines.pdf) Accessed 7/16/2021.
  • U.S. National Library of Medicine. Alcohol Use Disorder (AUD). (https://medlineplus.gov/alcoholusedisorderaud.html) Accessed 5/17/2021.

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