Alcohol Use Disorder (AUD)

According to the National Institute on Alcohol Abuse and Alcoholism, in 2023, 28.1 million adults ages 18 and older had an alcohol use disorder, a medical condition that can adversely impact their physical and mental health, relationships, and more. The good news is that regardless of how severe the problem may be, evidence-based treatment that combines behavioral therapies, mutual-help groups, and/or medications, can help you find lasting recovery.¹

What is an Alcohol Use Disorder (AUD)?

Alcohol use disorder is a chronic, relapsing medical condition characterized by an inability to stop or control alcohol use despite the negative consequences it has on all areas of your life.^1,2 The severity of the condition can range from mild to severe, with addiction often referring to the more severe end of the spectrum.²

Healthcare professionals use a set of 11 criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5) to diagnose an alcohol use disorder at various levels of severity.³ While not all criteria need to be met for a diagnosis to be made, the more criteria that are met indicate a more severe disorder as well as a potential need for relatively more intensive treatment measures.¹

What is Considered 1 Drink?

Obviously not every person who consumes alcohol has an alcohol use disorder, but many might be surprised to learn what counts as a drink and how many drinks constitute binge drinking or heavy drinking—both considered problematic drinking patterns.

The National Institute on Alcohol Abuse and Alcoholism states that one alcoholic drink in the United States contains roughly 14 grams of pure alcohol, which is found in:⁴

• 12 ounces of regular beer, which is usually about 5% alcohol.
• 5 ounces of wine, which is typically about 12% alcohol.
• 1.5 ounces of distilled spirits, which is about 40% alcohol.

What is Binge Drinking?

Binge drinking involves a pattern of drinking that brings the blood alcohol concentration (BAC) to 0.08% or more. For a typical adult male, this generally involves consuming 5 or more drinks in a 2-hour period, for women, it involves having 4 or more drinks in the same short time frame.⁵

The National Institute on Alcohol Abuse and Alcoholism defines heavy drinking as consuming 5 or more drinks on any day or 15 drinks in a week for men. For women, heavy drinking is defined as having 4 or more drinks on any day or 8 or more drinks in a week.⁵

Similarly, the Substance Abuse and Mental Health Services Administration (SAMHSA) defines heavy alcohol use as binge drinking on 5 or more days in a month.⁵

What Causes Alcohol Use Disorder?

An individual’s risk for developing an AUD is influenced by how much, how often, and how quickly they consume alcohol. Alcohol misuse—defined as drinking in a manner, situation, amount, or frequency that could cause harm to the individual or those around them—can increase the risk of developing an AUD. However, other factors impact an individual’s risk, including:¹

• Genetics.
• A family history of problematic alcohol use or alcohol use disorder.
• Parental drinking patterns.
• Exposure to trauma and stress during childhood.
• Drinking alcohol at an early age. Scientists have found that people who began drinking at age 15 or younger were 5 times more likely to develop an AUD than those who started drinking at age 21 or older. In addition, the risk for women among this group is higher than for men.
• Having a mental health condition, such as depression, anxiety, post-traumatic stress disorder (PTSD), or attention-deficit hyperactivity disorder (ADHD).

Certain psychiatric disorders, like those mentioned above as well as bipolar disorder or personality disorder are commonly associated with alcohol use disorder. However, it can be difficult to distinguish whether these co-occurring mental health disorders are a result of alcohol use disorder or contributed to the development of an alcohol use disorder. Some studies indicate that the relationship between psychiatric disorders—such as schizophrenia, mood disorders, and personality disorders—and AUDs suggests that psychiatric disorders may increase the risk of alcohol use and exacerbate other risk factors for AUDs.⁶

Signs and Symptoms of Alcohol Use Disorder

As previously mentioned, clinicians use the DSM-5 list of 11 diagnostic criteria to assess the probability and severity of an alcohol use disorder. It can be helpful to know the signs of alcohol use disorder, colloquially referred to as alcohol addiction, which include:³

• Using alcohol more frequently or in higher amounts than intended.
• Making repeated unsuccessful attempts to cut back or control alcohol use despite a persistent desire to do so.
• Spending a great deal of time on activities needed to obtain alcohol, consume it, or recover from alcohol use.
• Craving alcohol.
• Failing to fulfill role obligations at work, home, or school because of recurrent alcohol use.
• Using alcohol in dangerous or hazardous situations such as drinking and driving.
• Continuing to use alcohol despite persistent or recurrent social or interpersonal relationship problems caused or exacerbated by it.
• Giving up work, social, and recreational activities because of alcohol use.
• Continuing to use alcohol despite the knowledge of having persistent or recurrent physical or psychological problems that are likely caused or exacerbated by it.
• Experiencing tolerance means it takes more alcohol to produce the desired effects or the same amount of alcohol no longer produces the same effects.
• Experiencing withdrawal symptoms when trying to stop or cut back on drinking, such as shakiness, restlessness, nausea, sweating, racing heart, seizures, or hallucinations (seeing or sensing things that aren’t there).

Despite the negative effects continued alcohol use can have, some people may overlook or downplay these symptoms of alcohol use disorder as they develop, even as they begin to impact physical and mental well-being. Thus, these issues are best evaluated by a doctor or other mental health professional, who may more systematically run through the full list of 11 criteria to make an official diagnosis and help you get the help you need.

Mental Health and Alcohol Use

As previously mentioned, alcohol use and mental health disorders commonly occur together—either simultaneously or sequentially.⁷ According to the 2023 National Survey on Drug Use and Health (NSDUH), 20.4 million adults aged 18 and older had both a substance use disorder and a co-occurring mental health disorder.⁸

Alcohol use disorder commonly co-occurs and may have significant overlap with several other mental health conditions, including anxiety disorders, depressive disorders, trauma- and stress-related disorders, other substance use disorders, sleep disorders, and psychotic disorders. Some may use alcohol in an attempt to relieve certain mental health issues such as anxiety. However, using alcohol in this way may actually worsen both the mental health condition and the maladaptive drinking.⁷

What are the Dangers of Alcohol Misuse and Addiction?

Heavy alcohol use doesn’t just complicate mental health issues, it can lead to personal injury and other, serious harms to oneself—alcohol use disorder contributes to 1 in 4 suicide deaths, according to the Centers for Disease Control and Prevention (CDC). It can also contribute to harming others. Alcohol-impaired driving fatalities accounted for over 13,000 deaths or 32% of all driving fatalities in the United States in 2022.⁹

Additionally, alcohol can take a toll on your physical health, contributing to potentially severe health issues, including:^10-12

• Memory and coordination issues, brain changes, and other neurological conditions, including Wernicke-Korsakoff syndrome.
• Cardiovascular issues such as an irregular heartbeat, high blood pressure, and cardiomyopathy, which includes a weakening and stretching of the heart muscle over time.
• Liver damage, such as fatty liver, fibrosis, hepatitis, and cirrhosis. Liver diseases can also make you more susceptible to rarer conditions like alcoholic ketoacidosis.
• Pancreatitis and other chronic gastrointestinal inflammation and digestive tract issues.
• Diabetes.
• An increased risk of certain cancers.
• A weakened immune system, which can make you more prone to contracting certain diseases like pneumonia and tuberculosis.
• Muscle weakness caused by skeletal muscle dysfunction.
• An increased risk of alcohol poisoning and overdose.

Impact of Alcohol Addiction on Relationships

While evidence illustrates the destructive effect that alcohol has on your mental and physical health, it can also negatively impact your relationships with family—including your partner, spouse, and children—and friends.

Admitting that you need help controlling your alcohol use can be difficult. In fact, denial is a common experience for those with alcohol use disorder.¹³ So it can be a challenge to convince yourself—or someone you love—to get help.

If you’re struggling with alcohol use, talk to a close family member or friend. It’s likely that they already recognize the problem and want to help you get treatment. Support and encouragement from family and friends can play a pivotal role in your lasting recovery.

If someone you love struggles with alcohol use disorder, you should express your concerns objectively and compassionately without judgement or blame—as you would do with any serious chronic disease.

Before discussing a loved one’s alcohol use with them, however, you should educate yourself about addiction, note some key points you’d like to make, and plan to talk to them when they’re sober and you have ample time to talk.

You should be prepared that you may not convince them to seek treatment the first time you try. Even if they recognize that their alcohol use has become problematic, your loved one may waver between agreeing that they need professional help and feeling like they can handle their alcohol use issues on their own. Revisit the topic. Your persistence and support may give them the encouraging nudge they need to get treatment, stabilize their life, and live fully in recovery.

What are the Types of Treatment for Alcohol Use Disorder?

Alcohol addiction is treatable. Effective alcohol addiction treatment that’s tailored to your specific needs and combines several therapeutic approaches—such as medication, behavioral therapy, and mutual-help groups—can help promote recovery.¹ The setting and intensity of the program depends on your needs and the treatment center.

Regardless of the program, treatment for alcohol use disorder may involve:

Medical detoxification. Medically managed detox is often the first step in a more comprehensive treatment plan. It’s the process in which your body works to clear itself of alcohol.¹⁴ It’s done under the supervision of healthcare professionals, who can keep you safe and prescribe medications to medically manage alcohol withdrawal and to keep you as comfortable as possible. After alcohol detox, you will likely transition to an inpatient or outpatient program.

Inpatient or residential treatment program. Depending on your individual circumstances and needs, you may receive treatment in an inpatient facility, where you reside for the duration of treatment. The services provided likely include behavioral therapies, individual and group counseling, support groups, and medications.

Outpatient programs. Outpatient programs vary in intensity, but you live at home or in a sober living facility and attend therapy and counseling sessions at the treatment center. Some individuals may transition to an outpatient program after completing an inpatient program. Others may enter the continuum of care in an outpatient program.

Medication for addiction treatment. Some of the anti-alcohol misuse medications you may receive in the care of an inpatient or outpatient treatment provider can help curb alcohol cravings and deter drinking and may include:¹⁴

• Naltrexone, which can help reduce the urge to drink and prevent relapse. Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and craving alcohol.
• Acamprosate, which has been shown to help dependent drinkers maintain abstinence by decreasing cravings and urges to consume alcohol.
• Disulfiram, which blocks the metabolism of alcohol in the body, and in turn, produces an unpleasant reaction if you drink, including flushing, nausea, and palpitations.

Behavioral therapies. Inpatient and outpatient programs provide various types of therapies. One behavioral therapy commonly used to treat AUDs is cognitive-behavioral therapy (CBT), which helps you identify and change unhelpful, negative thoughts and behaviors that led to or contributed to the addiction. CBT helps you learn coping skills to help you manage triggers and prevent relapse.

Mutual-help groups. Mutual-help groups, such as 12-Step programs like Alcoholics Anonymous (AA) or 12-Step alternatives like SMART Recovery help you connect with other individuals who may have faced many similar situations in their recoveries. These groups help provide support and encouragement and can continue beyond the formal treatment period.

Finding the Right Treatment for You

It’s important to find the best fit for you and your needs when it comes to treatment for alcohol addiction. You want to find a treatment center that offers the level of care that’s appropriate for you and offers the amenities you want. Some individuals, such as Veterans, women, and members of the LGBTQIA+ community, may also benefit from finding specialized treatment programs designed to address their specific group’s unique needs as well as the addiction.

American Addiction Centers (AAC) offers the complete continuum of care, evidence-based therapies, specialized treatment tracks, and lots of amenities at facilities located throughout the country. Call to speak to a knowledgeable admissions navigator, who will listen to your needs, answer your questions, explain your options, and help you begin your recovery.

Frequently Asked Questions About Alcohol Use Disorder