Alcoholism: Symptoms and Signs

Content Overview


Alcohol is a legal drug, but one that carries a significant risk of addiction.
Some of the most common physical, psychological, and behavioral signs and symptoms of alcohol abuse are:

  • Poor coordination
  • Slurred speech
  • Impaired thinking
  • Memory impairment
  • Wanting to stop drinking but not managing to do so
  • Diverting energy from work, family, and social life in order to drink
  • Being secretive about the extent of the alcohol abuse in order to protect it
  • Engaging in risky behavior, such as drunk driving
  • Being in denial about the extent of the alcohol abuse problem
  • Becoming distressed at the prospect of not having access to alcohol

When a person who regularly abuses alcohol stops drinking or significantly reduces the amount of intake, withdrawal symptoms will emerge. Such symptoms can begin as soon as two hours after the last drink and continue for weeks. Symptoms can include shaking, anxiety, and the desire for a drink. Delirium tremens (DTs), a severe withdrawal symptom, can include confusion, fever, and rapid heartbeat. There is a general advisement that alcohol withdrawal should occur under the care of a doctor specialized in addiction treatment, as some withdrawal symptoms can be life-threatening.

The term alcoholism is clinically ambiguous and out of use. Per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), the new term is alcohol use disorder, which is explained in the Substance-Related and Addictive Disorders section of the book. In order to be diagnosed with an alcohol use disorder, a person must meet the specific criteria delineated in the DSM-5.

alcoholism A mental health professional must find that a person has at least two of the delineated 11 criteria during the same 12-month period of time. Depending on the number of criteria met, the individual will be diagnosed with a mild, moderate, or severe alcohol use disorder. The more criteria present, the more severe the grading of the disorder.

WebMD explains the 11 criteria, or symptoms, in the DSM-5 in an easy-to-understand list:

  • Feeling powerless to control one’s level of alcohol use
  • Declining to engage in social activities or hobbies that used to be of interest
  • Having a desire to stop or decrease drinking but being unable to do so
  • Using alcohol in high-risk situations, such as while swimming or driving
  • Devoting significant time and resources to drinking
  • Developing a tolerance for alcohol (i.e., needing more alcohol over time to match the feelings from earlier use)
  • Experiencing cravings for alcohol when not drinking
  • Experiencing withdrawal symptoms when not drinking (e.g., cravings, sweating, shaking, and nausea)
  • Facing problems at work, home, or school because of alcohol use
  • In reaction to the discomfort associated with withdrawal, having to drink to feel better
  • Continuing to use alcohol even when it is leading to social, physical, relationship, and personal problems

Alcohol use disorders are more common than may be imagined. Notes Psychology Today, studies have revealed that 29.1 percent of the US population (or 68.5 million) has experienced an alcohol use disorder (of varying grades) at some point in their lifetime. Within a 12-month period, approximately 13.9 percent (32.6 percent) of the US population experiences an alcohol use disorder. About 19.8 percent of the adults who have experienced an alcohol use disorder in their lifetime seek treatment or ask for help at some point.

As Psychology Today points out, about 75 percent of the alcohol that Americans drink occurs in the form of binge drinking. The symptoms of binge drinking include blackouts and memory lapses. Over time, a chronic binge drinker can develop serious liver damage and/or brain damage.

A lesser-known but just as severe consequence is cardiovascular disease. This disease can arise because a high volume of alcohol causes stress on the heart, leading to heart attack or stroke.

Alcohol has immediate effects, as the American public clearly knows. The immediate impact of alcohol use on the body includes but is not limited to:

  • Slowed reaction times
  • Blackouts (again, usually in binge drinking episodes)
  • Trouble with motor coordination or an inability to walk properly
  • Impaired judgment and risk-taking without full consideration of the consequences (such as drunk driving)
  • Memory impairment or memory lapses
  • Slurred speech

An alcohol use disorder, especially at the more severe end of the spectrum, can lead to permanent and debilitating health conditions that may require care for a lifetime. Some of the most acute problems relate to the indirect problems that an alcohol use disorder causes.

A tipoff that a person’s behavior has progressed to an alcohol use disorder concerns their nutritional habits. As alcohol abuse takes firmer root, people often neglect their nutritional health. The person may show signs of malnutrition, such as a gaunt appearance, hair loss or thinning, and dark circles under the eyes. These may be symptoms of a general condition known as thiamine deficiency. The brain and all the tissue in the body need thiamine (B1) for healthy functioning. Individuals with an alcohol use disorder may be suffering from a thiamine deficiency, among other nutritional deficits.

The psychological effects of alcohol are immediately recognizable after a person drinks. Individuals may repeat themselves (due in part to memory lapse) and not show their familiar level of good judgment. Over time, individuals may develop sleep troubles and/or mental health disorders such as depression or anxiety. Cognitive problems include a diminished attention span and problems with motor coordination, such as asterixis, a condition that causes a person to involuntarily flap or shake their hands. In severe cases, hepatic encephalopathy can develop and, for some, cause them to slip into a fatal hepatic coma.

As the National Council on Alcoholism and Drug Dependence explains, the behavioral signs of an alcohol use disorder will usually be apparent. People who experience alcohol abuse may become increasingly secretive about their activities because they may not want to hear people’s concerns or get advice to stop. The individual may also drink in secret, either in a private place or out in public but away from concerned friends and family.

As a result of drinking, people may become more prone to accidents and show signs of injury, which they may try to cover up. An individual who is experiencing an alcohol use disorder may also hide alcohol around the house or at work. A person may become fearful of running out of alcohol, which in turn means that they keep a ready supply nearby.

Alcohol abuse can also lead people to show a diminished level of care for their hygiene and physical appearance. As alcohol abuse progresses, the individual may look increasingly as if they have not been showering, have stopped shaving, and are no longer washing or changing their clothes. Alcohol abuse often leads to problems in the person’s relationships across the full spectrum of life. A person who has a rather calm affect when sober may shift into moodiness, depression, or irritability when intoxicated.

Additional behavioral signs of alcohol abuse include:

  • Increasing legal troubles, such as assault, domestic abuse, or drunk driving
  • Showing up intoxicated at work, a family function, or a meeting
  • Yo-yoing: drinking and then stopping in a repeated pattern over time
  • Overreacting to any perceived criticism levelled against their drinking
  • Experiencing increasing financial problems
  • Uncharacteristically taking loans, liquidating any assets, and depleting cash accounts
  • Stealing and likely lying about it
  • Engaging in risky activities, such as unprotected sex

One of the most troubling behavioral signs of an alcohol use disorder is drunk driving. The well-known nonprofit organization Mothers Against Drunk Driving publishes reliable statistics on drunk driving.

  • In 2013, 28.7 million Americans reported that they drove after drinking.
  • In 2014, 9,967 Americans died in car crashes that involved alcohol. This statistic translates to a fatal car crash every 53 minutes in the US. That’s about 27 fatalities each day.
  • In 2014, about 290,000 Americans were injured in a car accident that involved drinking. This statistic translates to a car accident injury every two minutes.
  • On average, a person will drive drunk 80 times before being arrested for the first time.
treatmentMost individuals with an alcohol use disorder who experience brain or cognitive troubles will recover with treatment within a year of sobriety. In some instances, it can take much longer. The outcome of recovery and sustained sobriety depends on a host of medical, personal, and physiological factors. The first step in recovery from an alcohol use disorder is seeking treatment from a rehab center that offers exemplary clinical services and compassionate care.

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