Alcohol Abuse and Alcohol Use Disorder

What alcohol use disorder is

Repeated heavy drinking changes how the brain's reward, stress and self-control circuits work. Over time, alcohol becomes the main way to feel normal, cravings intensify, and stopping causes withdrawal. This is why willpower alone often fails and why AUD is treated as a medical condition.

For a practical checklist of warning signs and how much is too much, see the signs of alcohol abuse symptom page.

How alcohol use disorder is diagnosed

Doctors use the DSM-5 criteria. In the past 12 months, has the person:

1. drunk more or for longer than intended
2. wanted or tried to cut down without success
3. spent a lot of time drinking or recovering
4. had cravings
5. failed to meet obligations at work, school or home because of drinking
6. kept drinking despite relationship problems it caused
7. given up important activities
8. drunk in physically dangerous situations
9. kept drinking despite health or psychological problems
10. developed tolerance
11. had withdrawal symptoms, or drunk to avoid them

Doctors also use screening questionnaires such as the AUDIT, and blood tests (liver enzymes such as GGT, red cell size, and sometimes phosphatidylethanol) to assess harm.

Causes and risk factors

• Genetics: heritability is estimated at around 50%. Having a parent with AUD raises risk several-fold.
• Starting young: people who start drinking before age 15 are much more likely to develop AUD than those who start at 21 or later.
• Mental health: depression, anxiety, post-traumatic stress disorder, ADHD and bipolar disorder often co-occur.
• Trauma and stress, including childhood adversity.
• Social and environmental factors: heavy-drinking peer groups, easy access, low price and drinking cultures.

Effects of alcohol abuse on the body

Alcohol also causes harm beyond the drinker: road crashes, violence, and financial and family strain.

Treatment

Treatment is tailored to severity, goals and other health problems. Both stopping completely and cutting down are valid goals for some people with mild AUD. Severe AUD, liver disease or pregnancy usually call for abstinence.

Withdrawal management (detox)

People who drink heavily every day need medical advice before stopping. Alcohol withdrawal is treated with a short, tapering course of a benzodiazepine (or alternatives) and thiamine (vitamin B1) to prevent brain damage. Mild cases can be managed at home with daily checks; severe cases, or those with a history of seizures or delirium tremens, need hospital care.

Medicines

• Naltrexone: reduces cravings and the rewarding effect of alcohol; daily tablet or monthly injection. Not used with opioids or in severe liver failure.
• Acamprosate: helps maintain abstinence after stopping; dose is adjusted for kidney function.
• Disulfiram: causes an unpleasant reaction (flushing, nausea, palpitations) if alcohol is drunk; works best with supervision.
• Others used off-label: topiramate and gabapentin.

These medicines roughly double the chance of success for many people but are prescribed to only a small minority.

Talking therapies

Cognitive behavioral therapy, motivational enhancement therapy, contingency management, and couples or family therapy are all effective. Treatment for co-existing depression, anxiety or PTSD improves outcomes.

Support and aftercare

Mutual-help groups such as Alcoholics Anonymous and SMART Recovery, sober living, and regular follow-up with a doctor or counselor. Residential treatment helps people with severe AUD or unstable home environments.

Complications of stopping and relapse

Relapse is common and is part of the course of a chronic condition, not a failure of treatment. Many people need several attempts. Long-term outcomes are good: most people with AUD eventually reduce drinking or stop, and liver, heart and brain function often improve substantially within months of stopping.

Prevention

Delaying the age of first drinking, limiting alcohol at home, treating depression and anxiety early, and screening in primary care all reduce AUD. Adults who drink can keep within the moderate-drinking limits and have alcohol-free days.

Frequently asked questions

Is alcohol abuse the same as alcoholism?

Not exactly. Both terms are now replaced by alcohol use disorder, graded mild, moderate or severe. "Alcohol abuse" historically meant harmful drinking without dependence, while "alcoholism" usually means the severe form, with cravings, tolerance and withdrawal.

What are the long-term effects of alcohol abuse?

Long-term heavy drinking can cause liver disease and cirrhosis, pancreatitis, high blood pressure, heart rhythm problems, several cancers, memory loss and dementia, nerve damage, depression and anxiety. Many of these improve after stopping, especially if caught early.

Can alcohol use disorder be cured?

AUD is best thought of as a chronic condition that can go into long-term remission. Many people stop or drink at low-risk levels for good. Medicines, therapy and peer support all improve the chances of lasting recovery, and relapses can be treated.

What medicines help with alcohol abuse?

Naltrexone reduces cravings and the pleasure from drinking. Acamprosate helps people stay alcohol-free after stopping. Disulfiram makes drinking unpleasant. A doctor will choose based on your goals, liver and kidney function and other medicines.

How do I help a family member with alcohol abuse?

Talk calmly when they are sober, describe specific concerns, and offer to help them see a doctor. Avoid covering for them. Support groups such as Al-Anon help families cope. In the US, the SAMHSA National Helpline (1-800-662-4357) offers free, confidential referral.