What Is Alcohol Use Disorder? Symptoms, Causes, Diagnosis, Treatment, and Prevention
While many people may enjoy a glass of wine with dinner or a celebratory cocktail, drinking too much has the potential to cause physical and psychological distress. When someone can’t control their drinking and suffers professional, social, or health consequences because of it, they may be diagnosed with a condition known as alcohol use disorder (AUD).
The more familiar term “alcoholism” may be used to describe a severe form of AUD, but physicians, researchers, and others in the medical community tend not to use the word.
Alcohol use disorder is diagnosed on the basis of criteria defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM is a guide that describes and classifies mental disorders, published and updated regularly by the American Psychiatric Association and used as a tool by medical professionals.
According to the DSM-5, in order to be diagnosed with AUD, you must experience at least 2 of the following 11 symptoms within a year:
Having to drink more than normal to get the desired effect (to feel “buzzed” or drunk)
Experiencing withdrawal symptoms after the effects of alcohol wear off
Having occasions when you drink more or longer than intended
Trying and failing to cut down on — or stop — drinking more than once
Wanting to drink so much you can’t think about anything else
Spending a lot of time drinking and experiencing the after-effects of drinking
Noticing that drinking or the after-effects of drinking caused problems at home, work, or school
Giving up on other activities you enjoy to drink instead
Continuing to drink even after experiencing psychological or physical health problems (like anxiety or depression symptoms), or after having a memory blackout
Continuing to drink even if it’s causing problems with your family and friends
Getting into situations more than once where alcohol could have increased your risk of getting hurt (driving while under the influence, having unprotected sex, etc.)
What’s Considered Excessive Alcohol Use?
Excessive drinking includes binge drinking and heavy drinking. The Centers for Disease Control and Prevention (CDC) defines those two types of excessive drinking this way:
Binge Drinking is having 4 or more drinks during a single occasion for women and 5 or more drinks for men (see below for the definition of a drink)
Heavy Drinking is having 8 or more drinks per week for women and 15 or more drinks per week for men
Moderate alcohol use is considered no more than one drink a day for women and up to two drinks a day for men. Drinking less is better for health than drinking more. Pregnant women or those younger than age 21 should not drink at all.
The following servings constitute what’s considered a standard drink:
12 ounces of beer
8 ounces of malt liquor
5 ounces of wine (this is about one glass)
1.5 ounces (one shot) of 80-proof distilled spirits or liquor, such as gin, rum, vodka, or whiskey
Excessive drinking can be harmful to your health over time. But excessive alcohol use does not necessarily indicate AUD. According to the CDC, 9 in 10 people who binge drink do not have AUD.
Genetic, psychological, social, and environmental factors all play a role in a person’s risk for alcohol abuse.
Genes may account for as much as half of the risk for AUDs, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
Other factors that may play a role in the development of AUD include:
History of emotional or other trauma
Mental illnesses and mood disorders, including anxiety, depression, bipolar disorder, or schizophrenia
Social and cultural pressure, including having a partner who drinks regularly (or a parent who does, for adolescents)
Starting to drink — especially to binge drink — at an early age
Regularly drinking too much over a long period of time
As mentioned above, the DSM-5 says an AUD diagnosis requires at least 2 of the 11 symptoms of alcoholism listed above to have occurred within the previous 12 months.
The severity of the condition depends on the number of AUD symptoms you experience.
Mild AUD 2 to 3 symptoms
Moderate AUD 4 to 5 symptoms
Severe AUD 6 or more symptoms
Prognosis of Alcohol Use Disorder
Alcohol can affect nearly every organ in the body. In many organs, the effects of alcohol increase over time, and the damage becomes apparent only after years of abuse.
The brain experiences the effects of alcohol right away, resulting in changes in mood, behavior, and judgment. The more alcohol you drink, the higher your blood alcohol levels and the greater your level of alcohol intoxication.
In the short term, alcohol intoxication can cause:
Blurred vision
Reduced inhibitions
Unstable moods
Inappropriate behavior
Poor coordination
Memory loss or blackouts (where you don’t remember events)
Alcohol withdrawal after periods of excessive drinking can cause debilitating symptoms hours to days later. According to the NIAAA, symptoms may include trouble sleeping, restlessness, nausea, sweating, a racing heart, increased blood pressure, tremor (or shakiness), anxiety, feeling low, or just a general sense of malaise. Moderate and severe withdrawal syndromes can include hallucinations, seizures, or delirium tremens; the latter two can be life-threatening.
Over the long term, alcoholism can weaken your immune system and increase the risk of a variety of health issues, including cardiovascular problems, liver problems, cancer, and infections like pneumonia.
Excessive drinking or an alcohol use disorder can be successfully managed with treatments, such as therapy and medication, to help you to modify your behaviors and help your brain adapt to the absence of alcohol.
Between 40 and 60 percent of people with a substance abuse problem relapse, or return to alcohol, after attempting to stop.
Relapsing doesn’t mean that treatment has failed, though — it takes time to change behavior. You can work with a health professional to try new treatments that may work better for you.
Receiving treatment improves your chances of recovering from AUD.
There are several treatment options available for AUD, and there’s no one-size-fits-all solution.
If you think you need help with alcohol use, talk to your doctor. They can assess whether you have a risky drinking pattern, evaluate your overall health, help create a treatment plan, and refer you to programs or other healthcare providers if necessary.
Support Groups and Rehabilitation Programs
Mutual-support groups like Alcoholics Anonymous (AA) and inpatient rehabilitation are common treatments for alcohol problems.
Mutual-support groups teach you tactics to help you overcome your compulsion to drink alcohol. AA is a 12-step program that provides peer support and applies 12 spirituality-based principles. The NIAA offers a list of a number of these support groups, including secular options.
A 2020 review of studies found that AA and other 12-step programs may be even more effective than other treatments, including cognitive behavioral therapy, in encouraging abstinence from alcohol for at least three years. The authors found these programs are also at least as effective in reducing the amount of alcohol people drink and the consequences of drinking they experience.
Rehab is usually a month-long treatment program in a facility that removes you from situations and circumstances that perpetuate substance abuse.
Counseling
Counseling can help you identify and change behaviors that lead to drinking, build a stronger support system, develop attainable goals, learn healthy coping skills, and handle triggers that lead to relapses.
Treatment may involve standard therapies used to treat other mental illnesses, including cognitive behavioral therapy (CBT), which is commonly used to treat depression, among other disorders.
In addition to CBT, another type of therapy called Motivational Interviewing, which focuses on empowering the subject to identify their issues and take action, has also demonstrated effectiveness, according to research from 2020.
Medications
Several medications may help you curb your drinking. Drugs for alcohol dependence approved by the U.S. Food and Drug Administration (FDA) include:
Naltrexone (Vivitrol)helps people stop heavy drinking by blocking the euphoric effects and feelings of intoxication.
Disulfiram (Antabuse) helps you avoid drinking alcohol by blocking the metabolism of alcohol in your body. If you do drink, it causes nausea, skin flushing, and other unpleasant symptoms.
Acamprosate (Campral) can help you continue to abstain from drinking and is thought to work by restoring brain chemical imbalances caused by heavy drinking.
Prevention of Alcohol Use Disorder
Research suggests that if a person drinks alcohol before the age of 15 they may be 5 times more likely to develop AUD at some point in life.
Adolescents are also likely to binge drink, which can lead to serious consequences, including injury and death.
It’s essential to take action if you think your teen is using alcohol. Watch out for signs of alcohol use in your child, including slurred speech, defensive behavior, frequent mood changes, and problems at school.
You can help prevent alcohol abuse in your children by setting a good example and using alcohol responsibly, talking openly with them and being involved in their lives, and setting expectations and consequences for their behavior.
Drinking heavily over long periods of time may lead to changes in how the brain functions, from memory slips to more debilitating conditions. The impact depends on when a person started drinking, how long they’ve been drinking, and how often and how much they drink.
Other neurological issues from long-term alcohol abuse can include short-term memory loss, disordered thinking, and dementia. In a five-year longitudinal French study of more than 31 million people, published in 2018, researchers found that 56.6 percent of individuals with dementia had an alcohol use disorder noted in their medical history.
According to the NIAAA, up to 80 percent of people with AUD have a deficiency in thiamine, which can cause Wernicke-Korsakoff syndrome.
Wernicke-Korsakoff syndrome is a degenerative brain disorder that causes mental confusion, vision problems, lack of coordination, and memory problems, among other symptoms.
Beyond brain issues, AUD can cause:
Cardiovascular problems,such as arrhythmias, stroke, high blood pressure, or cardiomyopathy (impaired function of the heart)
Liver problems, including steatosis (fatty liver), hepatitis, and or cirrhosis (scarring of and permanent damage to the liver)
Bone damage,including osteoporosis, as alcohol can interfere in new bone production
Birth defects in your baby, if you drink while pregnant, due to fetal alcohol syndrome (this applies to anyone who drinks alcohol while pregnant, and not just those with AUD)
According to the National Cancer Institute, the link between alcohol use and breast cancer is well-established, and research suggests that even lighter drinking (meaning one alcoholic drink per day) may lead to a slightly increased risk of breast cancer.
In a study of 88,000 women, Nurses’ Health Study researchers found that for nonsmoking women, drinking up to one alcoholic drink per day was associated with a 1.13-fold increase in cancers, particularly breast cancer.
Excessive drinking and alcohol use disorder is also linked to mental health problems, such as depression and anxiety, as well as problems with relationships and work.
In the United States, 14.5 million people ages 12 and older — 9 million men and 5.5 million women — suffer from AUD, according to the 2019 National Survey on Drug Use and Health (NSDUH), with youths (ages 12 to 17) accounting for 414,000 of the total.
And the NIAAA also has noted, based on a 2017 analysis, that heavy alcohol use and binge drinking have been increasing over the past two decades in people age 60 and older.
Some research shows AUD is even more common than estimates suggest.
A study from 2015 found that 29.1 percent of American adults misuse alcohol — and meet the DSM-5’s diagnostic criteria for AUD — at some point in their lives. The authors estimated that in a given year, 13.9 percent of American adults have AUD.
A number of studies have looked at alcohol use among specific racial and ethnic populations, including Black, Indigenous, and People of Color (BIPOC) communities.
A 2017 review that included large U.S. surveys found that Native Americans were significantly more likely to experience AUD than other populations, and that the rates of AUD were similar among white, Black, and Hispanic individuals. According to data from one of those surveys, 43.4 percent of Native Americans experienced an AUD in their lifetime, compared with 22.9 percent of Hispanic Americans, 22 percent of Black Americans, and 32.6 percent of white Americans. Fifteen percent of Asian Americans and Pacific Islanders experienced an AUD in their lifetime.
Another review of large U.S. surveys from 2016came to similar conclusions and noted that Native Americans are most likely to experience health consequences because of excessive alcohol use.
Women — particularly Black women — may be especially susceptible to the effects of alcohol. Women are more likely than men to experience negative impacts of excessive drinking on their physical and functional health, according to a 2017 study.
The researchers looked at data on AUD in women age 25 and older and found that while Black and white women had similar rates of AUD, Black women were significantly more likely to experience health problems linked to AUD, even when other potential contributing factors, such as education, income, and body mass index, were taken into consideration.
The authors suggested the findings may be linked to systemic racism and the stress resulting from it, as well as differences in the body’s inflammatory response to alcohol use.
According to the NIAAA, alcohol use is the sole contributing factor behind more than 25 chronic health conditions, including several liver conditions (such as alcoholic hepatitis and alcoholic cirrhosis of the liver), fetal alcohol syndrome (which occurs when alcohol is consumed by pregnant women), and alcohol-induced chronic pancreatitis.
As mentioned above, long-term overconsumption of alcohol has also been linked to many conditions, including cardiovascular disease; several types of cancer; neurological disorders (including Alzheimer’s disease); and stroke.
Psychological disorders including anxiety, depression, schizophrenia, and bipolar disease have been associated with AUD. They may be a contributing factor to AUD, and alcohol use itself may worsen the symptoms of these conditions.
AUD may also be associated with sleep problems, including disrupted sleep and poor sleep quality, and it may worsen sleep apnea, according to a meta-analysis from 2018.
