Alcohol Use Disorder
What is alcohol use disorder?
Alcohol use disorder (AUD) is a medical condition in which a person continues to drink alcohol even in the face of health problems or undesired complications at work, at home, or in relationships. A diagnosis of alcohol use disorder includes the spectrum of conditions known as alcohol abuse, alcohol dependence, and alcoholism.
AUD is a common condition, affecting approximately 15% of adults in the United States. An estimated 623,000 teens between ages 12 and 17 abuse alcohol.
The causes of alcohol use disorder are not known, although some risk factors have been identified. For example, people who start drinking alcohol at age 14 or younger tend to have more troubles with alcohol than those who start at age 21 or older. Alcohol problems are most common between the ages of 18 and 29; people age 65 or older are the least likely to have alcohol problems. Alcohol problems are more common in men than in women.
Alcohol affects all your body’s organs and can cause long-term health effects. Alcohol’s effects on your brain account for many of the symptoms of intoxication, including an increased risk of accidents and impaired judgment. Long-term alcohol abuse can lead to liver disease, pancreatitis, gastroesophageal reflux disease (GERD), high blood pressure, heart disease, malnutrition, brain damage, and certain cancers. Excessive alcohol consumption is the third leading preventable cause of death in the U.S.
Some people are not aware of the troubles alcohol is causing in their lives; honesty and compassion can help them recognize the problems they are having and assist them in setting personal goals for the future. Treatment of alcohol use disorder can involve supervised withdrawal and detoxification, recovery programs, support groups, cognitive behavioral therapy, and certain medications. Although treatments have varying rates of success, many people are able to remain abstinent.
Alcohol use disorder can have serious, even life-threatening, complications, such as injury, acute alcohol poisoning, and significant medical illness. Seek immediate medical care (call 911) for serious symptoms, such as thoughts of suicide or self-harm, persistent vomiting, seizure, slow breathing or not breathing, trauma, vomiting blood, or bloody stool.
Seek prompt medical care if you think you might have a problem with alcohol.
What are the different types of alcohol abuse?
There are several terms that are seemingly synonymous when describing overuse of alcohol, but there are important distinctions in how these phrases are used in the context of a medical diagnosis:
Alcohol abuse was previously its own diagnosis in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), defined as meeting at least one of the outlined criteria. These included drinking that affects work or school, increased risk of injury due to alcohol, and continuing to drink even when it causes problems with family and friends. DSM-V, the most recent edition, now integrates alcohol abuse under the diagnosis of alcohol use disorder.
Alcohol use disorder (AUD) is a medical condition in which a person continues to drink even when their alcohol consumption causes harm. AUD is considered a brain disorder in which alcohol causes lasting changes in a person’s brain, including a physical addiction. An AUD diagnosis can range from mild to severe, based on the number of diagnostic criteria met.
Alcohol dependence was another previously used diagnosis in the DSM-IV, in which a person met at least three of the criteria listed. Today, alcohol dependence is part of the DSM-V’s diagnosis of alcohol use disorder.
- Alcoholism is the term most commonly associated with alcohol use disorder, though it is not a medical diagnosis. It is often used to describe the most severe level of alcohol use disorder, in which a person becomes physically addicted to alcohol.
People colloquially use the word “alcoholic” to describe anyone who may drink to excess, though not everyone who drinks heavily has AUD. An accurate diagnosis of alcohol use disorder can only be made by a medical professional using the diagnostic criteria outlined in the DSM-V.
What are the symptoms of alcohol use disorder?
Symptoms of alcohol use disorder include those of alcohol intoxication and those related to unfulfilled responsibilities and the social consequences of drinking.
Common general symptoms of alcohol use disorder
Alcohol abuse can cause problems in interpersonal relationships, at home, on the job, and with the law. General symptoms of alcohol abuse related to these problems include:
- Alcohol-related legal problems
- Deterioration of work performance
- Difficulty holding a job due to alcohol-related problems
- Drinking alcohol before or during activities where safety is a concern
- Drinking more alcohol or drinking for longer than you planned
- Drop in school performance
- Experiencing symptoms of withdrawal when not drinking
- Inability to cut back or stop drinking alcohol
- Not fulfilling responsibilities
- Memory blackouts due to alcohol
- Weakening or loss of relationships
- Withdrawing from hobbies or social activities
Common symptoms of alcohol intoxication
Alcohol consumption can lead to symptoms of intoxication including:
- Balance problems, difficulty walking, and falls
- Changes in behavior or personality
- Diminished reflexes
- Impaired judgment
- Impaired memory
- Impaired peripheral vision
- Slurred speech
Symptoms of alcohol withdrawal
One sign of alcohol use disorder involves feeling symptoms of withdrawal during times between alcohol consumption, or as the effects of alcohol begin to wear off.
Symptoms of alcohol withdrawal include:
- Fast heart rate
- Hand tremors, associated with delirium tremens or “DTs”
- Insomnia or problems sleeping
Serious symptoms that might indicate a life-threatening condition
In some cases, alcohol overuse can be life-threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:
- Being a danger to oneself or others, including threatening, irrational or suicidal behavior
- Change in level of consciousness or alertness, such as passing out or unresponsiveness
- Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions
- Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, slow breathing, not breathing, or choking
- Severe and persistent vomiting
- Trauma, such as bone deformity, burns, eye injuries, and other injuries
- Vomiting blood, rectal bleeding, or bloody stool
What causes alcohol use disorder?
The cause of alcohol use disorder is not known, nor is it understood why some people can drink alcohol without it ever causing problems and other people cannot. AUD does tend to run in families, and research suggests there might be genes that increase the risk. Other risk factors related to environment and some psychiatric conditions seem to increase the risk of alcohol overuse.
Researchers have identified multiple biologic factors (neurotransmitters and brain cell receptors) and candidate genes that may, going forward, unlock the mystery of alcohol addiction.
What are the risk factors for alcohol use disorder?
A number of factors increase a person’s risk of abusing alcohol. Not all people with risk factors will abuse alcohol. Risk factors for alcohol use disorder include:
Age between 18 and 29 years
Alcohol use starting at a young age (14 years old or younger)
Anxiety disorders or depression
Cultural acceptance of alcohol use and easy access to alcohol
Parents who abuse alcohol. Children of adults with AUD are four times more likely to develop AUD themselves.
Peer pressure to drink alcohol
How do you prevent alcohol use disorder?
Because the exact causes of alcohol use disorder are not known, it is not possible to definitively prevent the development of AUD. However, the U.S. Preventive Services Task Force has made recommendations for how communities and individuals can work to reduce excess consumption of alcohol, including routine screening by primary care physicians for signs of alcohol abuse.
You can take personal action to prevent excessive alcohol use by:
Following dietary guidelines for alcohol consumption, outlined as no more than one drink per day for women and no more than two drinks per day for men. (One drink is defined as 12 oz of beer, 8 oz of malt liquor, 5 oz of wine, or 1.5 oz of hard liquor.)
Never drinking alcohol if pregnant or potentially pregnant, under the legal drinking age, living with chronic medical conditions, or taking certain medications
Not serving or providing alcohol to anyone underage, pregnant, or who has already consumed large amounts of alcohol
- Talking with your doctor or healthcare practitioner if you have concerns about your alcohol use
How are diet and nutrition linked to alcohol use disorder?
Excessive consumption of alcohol affects many functions in the body, including how it processes food. Chronic alcohol abuse causes harm to the gastrointestinal tract and the liver, making it more difficult for the digestive system to absorb nutrients from food. Even if someone with AUD eats a healthy diet, the damage caused by alcohol can still result in nutritional deficiencies.
Alcohol itself contains significant calories, and many alcoholic drinks are high in sugar. For people who abuse alcohol, these “empty” calories often replace healthier foods. Problem drinkers are also more likely to eat a diet high in fat and sugar, and are less likely to exercise. In women particularly, obesity and heavy alcohol use are often linked.
The combination of alcohol abuse and poor diet can lead to serious complications, including fatty liver disease, cirrhosis (permanent scarring of liver tissue), and liver failure. If you are concerned about your alcohol use, or if you drink heavily and have symptoms, such as abdominal pain, dark urine, diarrhea, jaundice (yellowing of eyes and skin), loss of appetite, or pale stools, seek prompt care from your doctor. Early diagnosis of possible liver disease improves your likelihood of successful treatment.
What are some conditions related to alcohol use disorder?
People with alcohol use disorder are more likely to abuse other substances, including illicit drugs. Studies show that in people with combined dependencies or addictions, each separate issue becomes more severe. One large-scale survey by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that people who abuse drugs were more likely to also have alcohol use disorder, more so than people with AUD were likely to have drug abuse disorder. Young adults ages 18 to 24 have the highest rates of abusing both alcohol and drugs.
Research also suggests similar risk factors exist for both alcohol use disorder and drug use disorder. Children of parents who abuse drugs and/or alcohol are more likely to have similar dependencies themselves. There is some evidence this link may be genetic, but studies have not been definitive so far.
Separately, people with emotional and mental conditions, such as anxiety, depression or personality disorders are more likely to engage in excessive drug and alcohol use. This can be an effect of symptoms like impaired judgment and risky behavior, as well as a coping mechanism for psychiatric symptoms. Researchers also believe the same genetic factors that might influence mental disorders could also increase the risk for drug and alcohol use disorders.
How do doctors diagnose alcohol use disorder?
Only a healthcare professional can make a medical diagnosis of alcohol use disorder. Someone who drinks heavily does not necessarily have AUD, nor can they be self-diagnosed as an “alcoholic.”
When evaluating a person’s alcohol use, doctors look at symptoms and behaviors in the context of diagnostic criteria listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
In order to receive a medical diagnosis of alcohol use disorder, a person must meet at least two of the following criteria over the past 12 months:
Had times when you ended up drinking more, and for longer, than intended
More than once have tried to or wanted to cut down or stop drinking, but couldn’t
Spent a lot of time drinking, or recovering from the aftereffects
Wanted a drink so badly you couldn’t think of anything else
Found that drinking or its effects interfered with your home, family, school or work life
Continued drinking even when it was causing problems with family and friends
Reduced or gave up activities and interests you enjoy in order to drink
More than once have been in situations when drinking caused you to engage in high-risk behavior, such as driving drunk, operating heavy machinery, or having unsafe sex
Continued to drink after having a memory blackout, or even though drinking made you feel anxious or depressed
Have found you need to drink a higher number of drinks to get the same effect you once did
- Have experienced symptoms of withdrawal, including hallucinations, nausea, racing heart, seizure, sweating, tremors, or trouble sleeping, when the effects of alcohol begin to wear off
The severity of a person’s AUD is determined by the number of diagnostic criteria met:
Mild: Meets 2 to 3 criteria
Moderate: Meets 4 to 5 criteria
- Severe: Meets 6 or more criteria
Your doctor will explain your AUD diagnosis in the context of your symptoms and your individual medical history, then work with you to determine an effective treatment plan.
How is alcohol use disorder treated?
Treatment of alcohol use disorder begins with seeking regular medical care throughout your life. Regular medical care allows a healthcare professional to provide early screening tests. Routine physicals also provide an opportunity for your healthcare professional to promptly evaluate symptoms and your risks for developing AUD, along with any complications.
The goal of treatment is often to achieve abstinence from alcohol use, although some people are able to turn their problems around by reducing their alcohol intake. For some, it takes another person to point out that they are having problems related to their alcohol abuse, while others may seek treatment on their own or at the advice of a healthcare professional.
Supervised alcohol withdrawal is often recommended, and allows an opportunity to identify coexisting health problems and watch for alcohol withdrawal complications. Whatever route is taken, coexistent behavioral conditions like depression and anxiety must also be addressed in order to achieve a healthy recovery.
Treatment for alcohol abuse may include rehabilitation, cognitive behavioral therapy, and medications. Support groups can be helpful initially and in maintaining sobriety.
Medications that may be used to treat alcohol abuse
Doctors sometimes prescribe medication in the treatment of alcohol abuse and alcoholism and to help prevent relapse. These medications include:
- Acamprosate (Campral) to lower the risk of relapse
- Disulfiram (Antabuse), which lasts two weeks and causes unpleasant side effects if alcohol is consumed during that time
- Naltrexone (Vivitrol) to decrease cravings
- Topiramate (Topamax) to chemically mute the pleasure of drinking alcohol
How does alcohol use disorder affect quality of life?
By definition, alcohol use disorder has a significant negative impact on a person’s life, and the lives of those around them. People with AUD can have difficulty caring for loved ones, completing school work, or maintaining a job. They may also isolate themselves socially as they withdraw from activities and events they previously enjoyed in favor of drinking alcohol.
Because severe alcohol use disorder is associated with engaging in risky behavior, people who drink heavily can put themselves and others in danger of serious injury or even death. About 10,000 people each year die in car accidents related to drunk driving. On average, 40% of people incarcerated for violent crimes were under the influence of alcohol when they committed their offense.
Alcohol use disorder also puts people at home in potential harm. Friends and family members may find it emotionally devastating to watch a loved one struggle with the symptoms of AUD, particularly in how they may damage or even destroy close relationships. Alcohol use disorder carries physical risk for household members as well: Nearly 70% of alcohol-related violence happens at home.
If you are concerned about your own alcohol use or that of a loved one, help is available. Talk with your doctor about first steps toward receiving an AUD diagnosis and putting together an effective treatment plan that lets you take control of your life back from alcohol addiction.
What are the potential complications of alcohol abuse?
Complications of untreated alcohol abuse can be serious, even life-threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you.
Complications of alcohol abuse include:
Cancer of the mouth, throat, larynx, esophagus, liver, stomach, colon or breast
Delirium tremens (tremors and confusion associated with severe alcohol withdrawal)
Head and neck cancers
High blood pressure
- Stupor or coma
Studies have linked alcohol use disorder to an increased risk of suicide. If you or you someone you know is expressing suicidal thoughts or actions, help is available through the National Suicide Prevention Lifeline at 1-800-273-8255 or the Crisis Text Line by texting HOME to 741741.