Alcohol Use Disorder (Alcoholism)

Alcohol use disorder is considered a brain disorder, a mental health condition, and a substance use disorder. It’s a common condition that involves drinking too much alcohol despite negative consequences. AUD can be mild, moderate, or severe and may include drinking heavily or frequently. The condition often results in strained relationships, problems at work or school, and worsened physical and mental health.

How much alcohol is too much? 

The Centers for Disease Control and Prevention (CDC) advises people of legal drinking age (21 years old in the U.S.) to avoid alcohol or to drink it only in moderation. The definition of moderate drinking varies by sex assigned at birth:

• Men and people assigned male at birth (AMAB) should limit their alcohol consumption to two drinks per day.
• Women and people assigned female at birth (AFAB) should limit their alcohol consumption to one drink per day.

One drink is defined as:

• 12 ounces of beer (assuming the drink consists of 5 percent alcohol)
• 8 ounces of malt liquor, including malt-based seltzers (assuming 7 percent alcohol)
• 5 ounces of wine (assuming 12 percent alcohol)
• 1.5 ounces of distilled spirits such as tequila, vodka, rum, whiskey, gin, and brandy (assuming 40 percent alcohol)

Note that different types of alcoholic beverages may have different concentrations of alcohol.

Alcohol use disorder often begins as alcohol misuse, which is marked by heavy alcohol use and binge drinking.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy drinking as:

• Consuming five or more drinks in one day or 15 or more drinks in a week (for men and people AMAB)
• Consuming four or more drinks in one day or eight or more drinks in a week (for women and people AFAB)

Binge drinking is a pattern of drinking that raises a person’s blood alcohol concentration (BAC) to 0.08 percent or higher. BAC refers to how much alcohol is in the bloodstream. Having a BAC of 0.08 percent means your blood is 0.08 percent alcohol by volume.  

An adult man or person AMAB usually reaches a BAC of 0.08 percent if they consume five or more drinks in two hours. For an adult woman or person AFAB, a BAC of 0.08 percent is typically reached after consuming four or more drinks in two hours.  

The 2023 National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), found that 45 percent of participants reported binge drinking in the previous month.

In the U.S., driving or operating a vehicle with a BAC higher than 0.08 percent is illegal. 

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The signs and symptoms of alcohol use disorder generally include:

• A strong urge to drink and intense cravings for alcohol
• An inability to stop or limit drinking after starting
• Feelings of irritability and anxiety when not drinking   

Someone with alcohol use disorder may often display alcohol intoxication (drunkenness) due to an elevated BAC. Signs of drunkenness include slurred speech, reduced coordination, poor judgement, unpredictable behavior, and unstable moods. Drinking too much can also cause a person to “black out,” or fail to remember events that occurred when they were drunk.  

Alcohol withdrawal may happen if a person who drinks heavily stops or significantly reduces their drinking. The signs of alcohol withdrawal can occur a few hours or days after a person has their last drink. They may include:

• Sweating
• Trouble sleeping
• Shaky hands
• Rapid heartbeat
• Hallucinations (sensing things that aren’t there)
• Seizures (in severe cases)  

Some people occasionally drink until they feel “buzzed” or drunk. This doesn’t mean they have alcohol use disorder. More than 80 percent of people who drink alcohol never develop AUD.

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Healthcare providers (HCPs) generally follow the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) when evaluating a person for alcohol use disorder. This is a large catalogue and description of mental health issues published by the American Psychiatric Association. A physical exam and psychological evaluation may be performed to check for physical or emotional signs of alcohol abuse.

According to the DSM-5-TR, someone with alcohol use disorder can answer “yes” to two or more of the following questions.

In the past year, have you:

• Had moments where you ended up drinking longer or more than you intended to?
• Spent a considerable amount of time drinking or getting over the aftereffects of drinking (for example, feeling nauseated or hungover)? 
• Tried to stop or reduce your drinking more than once, but couldn’t?
• Wanted to drink alcohol so intensely that you couldn’t focus on anything else?
• Found that drinking or dealing with the effects of alcohol interfered with your ability to take care of your family, pets, or home, or caused issues at work or school?
• Given up hobbies that you once enjoyed or were important to you just so you could drink?
• Continued to drink despite the fact it made you feel anxious or depressed or contributed to another health problem?
• Continued to drink following a memory blackout?
• Continued to drink even though it was causing issues with your friends or family?
• More than once found yourself in situations during or after drinking that increased your chances of getting hurt (for example, engaging in unprotected sex, driving, swimming, walking in a dangerous area, or using machinery while intoxicated)?
• Had to drink much more than you once did to feel buzzed or drunk? Or found that your usual number of drinks had less of an effect than before? 
• Experienced alcohol withdrawal symptoms?

What are the types of alcohol use disorder?

The questions from the DSM-5-TR criteria can also help determine the severity, or type, of alcohol use disorder.

• Mild alcohol use disorder is indicated by answering yes to two or three questions.
• Moderate alcohol use disorder is indicated by answering yes to four or five questions. 
• Severe alcohol use disorder is indicated by answering yes to six or more questions.

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Consider speaking with an HCP if you answer “yes” to two or more of the above questions. Even if you don’t meet the criteria for AUD, an HCP can suggest ways to help you cut back on drinking alcohol and improve your physical and mental health.

What to do if you or a loved one need help

If you or a loved one needs assistance with alcohol misuse or alcohol use disorder, reach out to an HCP or contact SAMHSA’s National Helpline. This free and confidential service provides referrals to local support groups, treatment facilities, and community-based resources. It’s available 24 hours a day, 365 days a year.   

You may find that a loved one is resistant to getting help or treatment because they don’t believe they have a problem. Denial of a problem is a common hurdle among people with substance use disorders. Ask your HCP or mental health provider about ways you can gently approach this situation and encourage the person to seek help.

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A complex combination of genetic, environmental, and psychological factors can lead to alcohol use disorder. Each person’s road to AUD is unique and is shaped by varying factors.

Alcohol is an addictive substance that stimulates the brain’s reward processing system. (This is the part of the brain that generates feelings of satisfaction in response to certain experiences or forms of stimulus.) Alcohol also reduces activity in the brain’s stress system, which manages stress, emotional pain, and anxiety.

Over time, drinking alcohol gradually changes the structure of a person’s brain, compromising its function and making the person more likely to regularly use alcohol. Having one or more AUD risk factors also makes a person more vulnerable to the condition.

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Several factors can increase a person’s risk of alcohol use disorder, including:

Alcohol misuse: Someone who misuses alcohol is more likely to develop alcohol use disorder. Misuse refers to drinking alcohol in an amount, situation, frequency, or manner that could endanger the person who is drinking or those around them. Alcohol misuse involves heavy drinking and binge drinking.

Family history and genetics: Alcohol use disorder is three to four times more common in people who have close relatives with AUD, according to the American Psychiatric Association. The NIAAA notes that genetics (which involve the traits that you inherit from your parents) play a role in around 60 percent of AUD cases.

Genetics and environmental factors (such as living with family members who frequently drink) can interact to make a person more likely to develop alcohol use disorder. A child who simply witnesses unhealthy drinking patterns in a parent may also have an increased risk of AUD when they’re older. Around one in 10 children in the U.S. resides with a parent who has AUD.  

Social factors: Just as being around family members who drink can influence the risk of developing alcohol use disorder, so can spending time with friends and peers who drink. Being surrounded by a culture that celebrates and encourages drinking can reinforce the myth that misusing alcohol is acceptable and not dangerous.

Drinking at a young age: A national SAMHSA survey conducted in 2022 found that people who started drinking alcohol before age 15 were more than three times more likely to report an alcohol use disorder than people who waited to drink alcohol until age 21 or older.

Mental health conditions and trauma: Various mental health conditions may occur alongside alcohol use disorder or increase the risk of AUD. These include major depressive disorder, attention deficit hyperactivity disorder (ADHD), bipolar disorder, and post-traumatic stress disorder (PTSD), among others. AUD shares many causes and risk factors with other mental health conditions. Alcohol is often used as an unhealthy coping mechanism for feelings of depression and anxiety.

Childhood trauma is also closely linked to alcohol use disorder and other substance use disorders. One 2023 review of studies published in Substance Use: Research and Treatment found that having multiple adverse childhood experiences was a strong risk factor for use of alcohol, cannabis, and other drugs among young adults.

An adverse childhood experience (ACE) is a potentially traumatic experience that occurs before age 18. Examples of ACEs include:

• Experiencing neglect, violence, or abuse
• Having a family member die by suicide or attempt suicide
• Living in an unstable household due to issues such as substance use, parental divorce or separation, mental illness, or a jailed family member
• Witnessing violence at or near home 

According to the CDC, around 64 percent of adults in the U.S. report having experienced at least one type of ACE.

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Alcohol addiction generally refers to moderate or severe alcohol use disorder. It can be viewed as a repeating cycle with three main stages:

Binge/intoxication stage: The effects of alcohol that some people consider pleasant (such as elation, a perception of easier social interactions, lowered anxiety) take hold in this stage. The more someone enjoys these temporary “rewards,” the greater the likelihood they will continue using alcohol. This may ultimately lead to alcohol dependence (another name for alcohol use disorder).

Negative affect/withdrawal stage: If someone with an alcohol addiction stops drinking, they may experience alcohol withdrawal symptoms and negative feelings like anxiety, irritability, and emotional distress. The brain’s reward system shuts down while the stress system increases its activity. Someone in this stage may drink to try to ease their pain rather than to experience pleasant feelings.

Preoccupation/anticipation stage: This stage involves craving alcohol after a period of time without drinking. Someone may focus intently on when they can drink again and eagerly look forward to occasions involving alcohol. A person’s ability to make sound decisions, manage their time, and organize their thoughts may be compromised.  

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The main goals of treatment for alcohol use disorder are to:

• Reduce alcohol consumption or achieve sobriety (a state of not using alcohol)
• Lessen the urge to drink
• Learn how to resist alcohol cravings

Visiting a primary care provider is a good first step if you or a loved one is considering treatment for alcohol use disorder. This HCP can evaluate a person’s overall health, outline a treatment plan, determine if medication is appropriate, and refer them to appropriate specialists for further care.

Alcohol use disorder causes changes in the brain that can make it difficult to quit drinking without assistance. Treatment for AUD will be personalized to the individual and may involve attending therapy sessions, taking medication, joining a support group, or a combination of these approaches. Inpatient therapy at an alcohol treatment center can be beneficial for those with more severe addictions.

Therapy and counseling

Alcohol use disorder treatment often begins with talk therapy, sometimes referred to as alcohol counseling. These treatments are provided by licensed mental health providers, such as psychologists, psychiatrists, clinical social workers, and counselors. The goal is to change drinking behaviors.

Alcohol counseling helps patients:

• Learn skills to reduce or stop their drinking
• Identify and set attainable goals (such as developing healthy coping mechanisms or achieving an alcohol-free home)
• Develop a strong, positive support system
• Understand how to avoid and deal with alcohol triggers

Multiple forms of talk therapy may be used to assist people with alcohol use disorder. Some of the most common include:

• Cognitive behavioral therapy: Cognitive behavioral therapy (CBT) involves identifying and addressing detrimental thinking patterns and behaviors that contribute to alcohol abuse.
• Motivational enhancement therapy: This method helps boost motivation by identifying the pros and cons of drinking, establishing a plan for changing behavior, and learning skills to stick to that plan.
• Couples and family counseling: This approach helps partners and other family members of patients improve strained relationships and learn how to support their loved one through recovery.
• Acceptance- and mindfulness-based interventions: These modes of therapy increase awareness and acceptance of the present moment and encourage healthy, flexible responses to alcohol triggers.
• Contingency management approaches: Healthy behaviors are reinforced by rewarding patients for reaching specific, measurable goals.  
• Brief interventions: Short sessions of therapy can be used to discuss a patient’s drinking patterns, drinking risks, and possible treatments.

Therapies for co-existing mental health issues, such as depression or anxiety, may also be discussed or provided during alcohol counseling.

Medication

There are three nonaddictive oral medications approved by the U.S. Food and Drug Administration (FDA) to help people stop or reduce alcohol use:

• Acamprosate eases alcohol cravings and the negative emotions that can occur after stopping drinking. This makes it easier to maintain sobriety. 
• Disulfiram discourages drinking by producing side effects such as nausea and headaches when alcohol is consumed.
• Naltrexone helps prevent heavy drinking and reduces the urge to drink by blocking the temporary euphoric feelings alcohol can cause. 

Vivitrol—an injectable version of naltrexone that’s administered monthly by an HCP—is also used to help relieve the urge to drink alcohol.

Support groups

Mutual support groups provide peer support for people with alcohol use disorders. These group meetings allow people who face similar challenges to share experiences and offer encouragement. When combined with therapy and medication, support groups can help prevent relapses and facilitate lasting change.

Many support group organizations, such as Alcoholics Anonymous, use a 12-step program that focuses on acknowledging the reality of addiction and invoking the healing possibilities of a higher power. This power may be your community or family, or your conception of God, the universe, or another type of spirituality. These programs are largely successful and help participants feel supported and better equipped to reach their goals.

Alcohol use disorder support groups are available in person and online. To learn more, talk to your HCP about the options that may be best for you. You can also check out support groups hosted by organizations such as:

• Alcoholics Anonymous (AA)
• Moderation Management  
• National Alliance on Mental Illness

Residential treatment programs

Residential treatment programs involve temporarily living in a facility that provides 24-hour treatment. They may be appropriate for people with more severe alcohol use disorders. Also known as inpatient care, inpatient rehabilitation, or simply “rehab,” residential treatment facilities are typically staffed by HCPs and mental health providers who specialize in helping people overcome addictions.

Most residential treatment programs last a few weeks or months and include services such as:

• Alcohol counseling, which may be one-on-one or involve family members
• Support groups
• Education sessions
• Complementary therapies (more on this below)

Before treatment begins, many people who participate in residential programs must go through a process called alcohol detoxification, also known as “detox.” During this period, the body and mind are trained to readjust to functioning without alcohol.

Alcohol detox at a residential treatment center is medically supervised and usually lasts between two and seven days. HCPs can provide sedating medicines and other forms of care to help manage or prevent accompanying alcohol withdrawal symptoms. The detoxification process may also be completed in a hospital.

Complementary therapies

Complementary therapies are typically natural, drug-free approaches that augment and support standard medical treatments. They aren’t a substitute for conventional alcohol counseling or medication, but they may help some people with alcohol use disorder cope with the ups and downs of treatment and reach their recovery goals. 

Examples of complementary approaches for substance use disorders include:

• Yoga and other Eastern mind-body practices
• Traditional exercise, including taking simple walks outside
• Acupuncture
• Meditation  
• Art and music therapy

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Alcohol use disorder damages the brain and body and increases the risk of many short- and long-term health complications. These include, but are not limited to:

Injuries, accidents, and fatalities

Alcohol hampers areas of the brain that control balance and judgment. As a result, the risk of serious injury and death is higher among people who drink alcohol.

According to the NIAAA, alcohol plays a role in approximately:

• 31 percent of motor vehicle traffic fatalities 
• 40 percent of fatal burn injuries
• 50 percent of fatal drownings
• 50 percent of homicides
• 65 percent of fatal falls

Alcohol use is also a factor in a significant number of sexual assaults and roughly one-third of injuries treated at trauma centers.

Moreover, alcohol-related deaths are on the rise in the U.S. The CDC notes that excessive alcohol use was responsible for about 178,000 deaths each year in the U.S. in 2020 and 2021. (That’s around 20 deaths every hour.) This figure is a 29 percent increase from 2016 and 2017, when alcohol caused roughly 138,000 deaths per year.

Medical conditions

Alcohol use can cause, contribute to, or worsen a wide range of medical conditions, many of which are life-threatening. For instance, alcohol is responsible for around 50 percent of liver disease deaths. Drinking alcohol—even in moderation—raises a person’s risk of breast cancer by as much as 15 percent. Clouded judgment and decision-making from alcohol misuse is associated with a greater likelihood of sexually transmitted infections and unwanted pregnancies.

Research also links alcohol misuse to an increased risk of:

• Stomach bleeding and peptic ulcers
• Heart disease
• Liver disease and liver cancer
• Head and neck cancers
• Esophageal cancer
• Colorectal cancer

Additionally, alcohol misuse makes it more difficult to manage issues like high blood pressure, sleep disorders, diabetes, and chronic pain. Evidence also suggests that women and people AFAB have an increased risk of adverse health effects from alcohol because their bodies process alcohol differently than those of men and people AMAB.

Mental health issues

Mental health issues such as anxiety and depression are more common among people with alcohol use disorder than in people who do not abuse alcohol. Research shows that long-term alcohol use and use in adolescence may increase the risk of mental health issues. AUD and mental health conditions often occur together. When they do, they may worsen each other, making both issues more difficult to treat.

In particular, alcohol use disorder is closely associated with:

• Anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder
• Mood disorders, such as major depressive disorder and bipolar disorder
• Psychotic disorders, such as schizophrenia and schizoaffective disorder  
• Other substance use disorders involving legal substances (such as tobacco) and illegal substances (such as heroin)

Alcohol is also a factor in around 25 percent of suicides. Reach out to an HCP or trusted loved one right away if you or someone you know has thoughts of self-harm. For immediate assistance, contact the 988 Suicide and Crisis Lifeline by calling or texting 988. This is a free service that’s confidential and available 24/7.

Congenital differences

Drinking any amount of alcohol during pregnancy increases the risk of brain damage and other congenital differences in babies. These alcohol-related complications, known as fetal alcohol spectrum disorders (FASD), can include varying degrees of lifelong learning, physical, cognitive, and behavioral disabilities. Fetal alcohol syndrome refers to a severe type of FASD.

Alcohol overdose

Alcohol overdose, also called alcohol poisoning, occurs when a person continues to drink despite being significantly intoxicated. During an overdose, the bloodstream contains so much alcohol that life-supporting areas of the brain begin to shut down. 

Alcohol overdose is a medical emergency. Call 911 immediately if someone around you experiences signs of an alcohol overdose, which can include:

• Loss of consciousness or difficulty staying conscious
• Vomiting 
• An absent or delayed gag reflex, which could lead to choking on vomit
• Slow breathing and heart rate
• Confusion
• Cold, clammy skin
• Bluish skin around the fingernails and lips
• Very low body temperature
• Seizure

An alcohol overdose may result in brain damage or death without immediate treatment.

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Alcohol use disorder can be prevented. Genetic and environmental factors make some people more susceptible to AUD than others, but the disorder is avoidable.

For some people, avoiding alcohol altogether is the best way to prevent alcohol use disorder. Others can lower their risk by cutting back on drinking and staying within the CDC’s alcohol guidelines for moderate intake (two or fewer drinks per day for men and people AMAB and one or fewer drinks for women and people AFAB).

Using these strategies can help ensure you don’t drink too much alcohol:

Establish limits. Map out your week and when you plan on drinking, if you drink. For example, you might have one drink at a birthday party on Saturday and another at a football game on Sunday. Schedule as many alcohol-free days per week as possible.

Track your drinks. Count how many drinks you have per week in your planner, journal, or phone. Keep in mind that “one” drink poured at a bar or restaurant often exceeds standard drink sizes.  

Alternate beverages. If you are having an alcoholic drink, precede or follow up your drink with something nonalcoholic, like water or seltzer with a twist of citrus. This can help satisfy the urge to drink while helping you feel full.

Find a support system. Share your goals with your HCP and loved ones. They can offer support and help keep you accountable if you’re tempted to overindulge. 

Be mindful of temptations. If you have strong cravings for a certain type of alcohol, keep it out of your home. If you want to avoid drinking, suggest meeting friends for a lunch date instead of a happy hour. Encourage alcohol-free outings, such as a nature hike or breakfast with coffee.   

Remember your motivation. If you’re cutting back on alcohol to be more present as a parent, set your phone background to your favorite picture of your kids. Write reminders of your motivation on sticky notes and place them around your home. Schedule alerts on your phone with inspiring messages at times when you may need encouragement, such as a Friday or Saturday night.

Underage drinking and alcohol use disorder 

Kids and teenagers who drink alcohol are more vulnerable to developing alcohol use disorder later in life. Teaching your child or children to avoid underage drinking may lower their risk of AUD and related health issues when they’re older.

You can help prevent underage drinking in your family by:

• Setting a positive example with your own drinking habits
• Establishing clear rules and expectations regarding drinking and communicating the consequences of breaking these rules
• Having open discussions about alcohol with your child and staying involved in their life

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Many people recover successfully from alcohol use disorders. But the path to recovery isn’t always easy. Challenges and setbacks are common as people learn to cope with triggers and to change long-standing habits. Treatments like alcohol counseling, medication, and support groups can help ensure positive outcomes.

Meanwhile, a growing body of evidence suggests that changes in the brain caused by heavy drinking (and the accompanying changes in thinking and behavior) may be improved or reversed after several months of sobriety. It is possible to heal—both physically and mentally—from alcohol use disorder.

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Alcohol use disorder is not a sign of weakness or a lack of self-control. Rather, AUD is a medical condition with complex biological and environmental causes and clear risk factors. If you’re coping with AUD, remember that you’re one of hundreds of millions globally. Seeking treatment is the first step toward a healthier life.

As you work with your healthcare team to recover from alcohol use disorder, it’s important to lay the foundation for a successful recovery. This means you’ll want to:

Incorporate healthy habits into your daily routine. Learn how to cope with stress in healthy ways by practicing stress management techniques. Prioritize getting enough sleep (most adults need 7 to 9 hours daily), be physically active, and eat a well-balanced, nutritious diet.

Find alcohol-free activities you enjoy. Explore hobbies that don’t involve alcohol. This can include pastimes like cooking, yoga, or painting. If you previously enjoyed crafting cocktails, try creating your own mocktails. Many people who are recovering from addictions also find it helpful to volunteer in their community.

Evaluate your social circle. Let your friends and family know that you’re cutting back or quitting alcohol. Spend time with people who support you and your decision to change your habits. If you find that someone is detrimental to your recovery, consider taking a break from spending time with them.

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Reach out to an HCP to learn more about alcohol use disorder, its signs and symptoms, or how you can help a loved one or yourself. You can also browse these helpful AUD treatment resources: 

• NIAAA Alcohol Treatment Navigator
• Rethinking Drinking
• SMART Recovery

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