Alcohol Abuse: Warning Signs and When to Get Help

How much is too much

In the US, one standard drink contains 14 grams of pure alcohol. That is about:

• 12 oz (355 ml) of regular beer at 5% alcohol
• 5 oz (148 ml) of wine at 12%
• 1.5 oz (44 ml) of spirits at 40% (80 proof)

Many restaurant pours and craft beers contain 1.5 to 2 standard drinks.

No amount of alcohol is entirely risk-free, especially for cancer risk. Pregnant people, people under 21, people taking interacting medicines and people with liver disease should not drink.

Warning signs of alcohol abuse

Signs you might notice in yourself

• drinking more, or for longer, than you planned
• wanting to cut down but not managing it
• spending a lot of time drinking or recovering from it
• strong cravings or urges to drink
• needing more alcohol to get the same effect (tolerance)
• shakiness, sweating, nausea, anxiety or poor sleep when the alcohol wears off, relieved by another drink
• drinking in the morning to steady your nerves
• missing work, school or family duties because of drinking
• continuing to drink despite arguments, health problems or low mood
• giving up activities you used to enjoy
• drinking in risky situations such as before driving
• memory blackouts

Signs others might notice

• smelling of alcohol, or using mints and mouthwash to hide it
• hidden bottles, or drinking alone or in secret
• mood swings, irritability, or defensiveness when drinking is mentioned
• unexplained injuries, falls or bruises
• declining work performance or money problems
• red face, puffiness, weight change or poor self-care

Physical signs of long-term heavy drinking

High blood pressure, frequent heartburn and stomach upsets, poor sleep, low mood and anxiety, memory problems, numb or burning feet from nerve damage, and later yellowing of the skin and eyes from alcoholic liver disease.

A quick self-check

The AUDIT-C, a short screening tool from the World Health Organization's AUDIT, asks three questions:

1. How often do you have a drink containing alcohol?
2. How many drinks do you have on a typical day when you are drinking?
3. How often do you have 6 or more drinks on one occasion?

If you drink more than the limits above, binge drink at least monthly, or answered yes to two or more of the warning signs, talk to a doctor. The NIAAA "Rethinking Drinking" website has a full self-assessment.

Alcohol abuse vs alcohol use disorder

"Alcohol abuse" was the older term for harmful drinking. Doctors now use alcohol use disorder, diagnosed when at least 2 of 11 criteria are present over a year, graded mild, moderate or severe. Severe alcohol use disorder is what most people call alcoholism. Our alcohol abuse condition page explains the diagnosis, health effects and treatment in detail.

Do not stop suddenly if you drink heavily every day

The body adapts to regular heavy drinking. Stopping abruptly can cause alcohol withdrawal:

• 6 to 24 hours: tremor, sweating, anxiety, nausea, fast pulse, poor sleep
• 12 to 48 hours: risk of withdrawal seizures
• 48 to 72 hours: risk of delirium tremens, with confusion, hallucinations, fever and a racing heart, which can be fatal

A doctor can arrange a safe detox at home or in hospital, usually with a short course of medicine and thiamine (vitamin B1).

How to cut down or get help

• Talk to your primary care doctor. They can check your liver, blood pressure and mood, and offer medicines and referral.
• Medicines such as naltrexone, acamprosate and disulfiram reduce cravings or relapse risk. They are underused and effective.
• Talking therapies: motivational interviewing, cognitive behavioral therapy and couples or family therapy.
• Mutual-help groups: Alcoholics Anonymous, SMART Recovery and others.
• Practical steps if you drink within safer limits but want to cut back: set drink-free days, count drinks, alternate with water, avoid keeping alcohol at home, and plan for triggers.
• Call the SAMHSA National Helpline at 1-800-662-4357 (US, free, 24 hours) for treatment referral.

Helping someone else

Choose a calm, sober moment. Describe specific behaviors you have seen and how they affect you, without labels such as "alcoholic". Offer to help them see a doctor. Groups such as Al-Anon support family members. Look after your own safety if drinking leads to aggression.

Frequently asked questions

What are the signs of alcohol abuse?

Common signs include drinking more than intended, failing to cut down, cravings, needing more to feel the effect, withdrawal symptoms such as shakes or sweats, morning drinking, blackouts, neglecting responsibilities, and continuing to drink despite health, relationship or legal problems.

How many drinks a day is considered alcohol abuse?

There is no single cutoff, because abuse is about harm and control. However, NIAAA defines heavy drinking as more than 4 drinks a day or 14 a week for men, and more than 3 a day or 7 a week for women. Regularly drinking above this sharply raises the risk of alcohol use disorder.

Is it dangerous to stop drinking suddenly?

It can be. People who drink heavily every day can develop withdrawal seizures or delirium tremens within 1 to 3 days of stopping. Speak to a doctor before stopping; a medically supervised detox with medicine is safe and effective.

What is the difference between alcohol abuse and alcoholism?

Both are now covered by the diagnosis of alcohol use disorder, graded mild, moderate or severe. "Alcohol abuse" usually refers to harmful drinking, while "alcoholism" usually refers to the severe form with dependence, cravings and withdrawal.

Where can I get help for alcohol abuse?

Start with your primary care doctor. In the US, the SAMHSA National Helpline (1-800-662-4357) is free, confidential and open 24 hours. Treatment options include counseling, medicines that reduce cravings, and mutual-help groups such as AA or SMART Recovery.