Alcohol Use Disorder

What alcohol use disorder is

Alcohol use disorder changes the brain's reward, stress and self-control systems. With repeated heavy drinking, the brain adapts: more alcohol is needed for the same effect (tolerance), and stopping causes withdrawal. Drinking shifts from being pleasurable to being driven by craving and relief of discomfort. These changes help explain why willpower alone is often not enough, and why AUD is treated as a medical condition rather than a moral failing.

In the US, about 1 in 10 people aged 12 and older had AUD in the past year according to national surveys, and alcohol contributes to roughly 178,000 deaths each year according to the CDC.

Signs of alcohol use disorder

The DSM-5 lists 11 criteria. In the past 12 months, have you:

1. Drunk more, or for longer, than you intended?
2. Wanted to cut down or stop but could not?
3. Spent a lot of time drinking, being sick, or recovering?
4. Experienced cravings, a strong urge to drink?
5. Found that drinking interfered with home, family, work or school?
6. Continued drinking despite problems with family or friends?
7. Given up activities you enjoyed in order to drink?
8. Got into risky situations while or after drinking, such as driving or unsafe sex?
9. Continued drinking despite depression, anxiety or another health problem, or after memory blackouts?
10. Needed more alcohol to feel the effect (tolerance)?
11. Had withdrawal symptoms such as shakiness, sweating, nausea, insomnia, anxiety or racing heart when alcohol wore off?

Risky drinking levels

In the US, a standard drink contains 14 g of pure alcohol: about 355 ml (12 oz) of regular beer, 148 ml (5 oz) of wine or 44 ml (1.5 oz) of spirits. The NIAAA defines heavy drinking as more than 4 drinks on any day or 14 per week for men, and more than 3 drinks on any day or 7 per week for women. Binge drinking is reaching a blood alcohol level of 0.08%, usually 5 drinks for men or 4 for women in about 2 hours.

Causes and risk factors

• Genetics: about half of the risk is inherited. Having a parent with AUD increases risk.
• Starting young: drinking before age 15 is strongly linked to later AUD.
• Mental health conditions: depression, anxiety, PTSD, ADHD and bipolar disorder.
• Trauma and adverse childhood experiences.
• Social and environmental factors: easy access, peer drinking, stress, isolation.

Health effects

Alcohol withdrawal

People who drink heavily every day can develop alcohol withdrawal within 6 to 24 hours of their last drink: tremor, sweating, anxiety, nausea, fast heartbeat and insomnia. Seizures can occur at 12 to 48 hours. Delirium tremens, with confusion, hallucinations, fever and dangerous changes in heart rate and blood pressure, usually begins 48 to 96 hours after stopping and can be fatal.

Anyone who drinks heavily every day should not stop abruptly without medical advice. Medically supervised withdrawal (detox) uses benzodiazepines to prevent seizures and thiamine (vitamin B1) to prevent brain damage. It can often be done at home with daily checks for milder cases, or in hospital for severe dependence or a history of seizures or DTs.

Diagnosis

Doctors ask about drinking using screening tools such as the AUDIT or AUDIT-C questionnaires and the single question "How many times in the past year have you had 5 (men) or 4 (women) or more drinks in a day?". The USPSTF recommends screening all adults in primary care. A full assessment covers the 11 criteria, withdrawal history, mental health, and physical examination. Blood tests (liver enzymes including GGT, blood count showing large red cells, and sometimes phosphatidylethanol) can support the history and track progress.

Treatment

Treatment is tailored to severity and goals. Some people aim for abstinence; others start by cutting down.

Medicines

• Naltrexone: reduces cravings and the rewarding effect of alcohol; available as a daily tablet or monthly injection. Not used with opioid medicines or in severe liver failure.
• Acamprosate: helps maintain abstinence by reducing post-withdrawal discomfort; dose adjusted in kidney disease.
• Disulfiram: causes flushing, nausea and palpitations if alcohol is consumed; works best with supervision.
• Off-label options: topiramate and gabapentin have evidence in some people.

These medicines are underused, though they reduce relapse and can be prescribed by a primary care doctor.

Behavioral treatments

• Cognitive behavioral therapy (CBT): identifies triggers and builds coping skills.
• Motivational enhancement therapy: strengthens motivation to change.
• Contingency management: rewards for verified abstinence.
• Couples and family therapy.
• Brief interventions by primary care doctors for mild AUD.

Mutual-help groups

Alcoholics Anonymous (AA), SMART Recovery and other groups provide peer support. Combining groups with professional treatment improves outcomes.

Treating co-occurring conditions

Depression, anxiety, PTSD and other substance use often occur alongside AUD and need treating together.

Recovery and outlook

Recovery is common. Many people with AUD eventually stop or reduce drinking substantially, and liver, heart and brain health improve after stopping. Relapse is part of many people's recovery and is a signal to adjust treatment, not a failure. Free, confidential help is available through the SAMHSA National Helpline at 1-800-662-4357.

Frequently asked questions

What are the signs of alcohol use disorder?

Signs include drinking more or longer than intended, being unable to cut down, cravings, drinking interfering with work or relationships, giving up activities, drinking in risky situations, needing more to feel the effect, and withdrawal symptoms such as shaking, sweating or anxiety when alcohol wears off.

Is alcohol use disorder the same as alcoholism?

Mostly. Alcohol use disorder is the current medical term that replaced alcohol abuse and alcohol dependence. Alcoholism is an older, informal term that usually refers to moderate or severe AUD. The newer term reflects that problem drinking exists on a spectrum.

Is it dangerous to stop drinking suddenly?

It can be. People who drink heavily every day can develop withdrawal seizures or delirium tremens, which can be fatal. Speak to a doctor before stopping. Medically supervised withdrawal with medicines and thiamine makes it much safer.

What medicines help with alcohol use disorder?

Naltrexone, acamprosate and disulfiram are FDA-approved. Naltrexone reduces cravings and heavy drinking, acamprosate helps maintain abstinence, and disulfiram makes drinking unpleasant. Topiramate and gabapentin are sometimes used. They work best combined with counseling or support groups.

How can I help someone with alcohol use disorder?

Express concern calmly when they are sober, focusing on specific behaviors and your feelings rather than labels. Offer to help them find treatment, and look after your own wellbeing through groups such as Al-Anon. Call 911 or your local emergency number if they are unresponsive or having seizures.