Alcohol Use Disorder (AUD)

What is an Alcohol Use Disorder?

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

Recognizing an Alcohol Use Disorder

As a subset of the 11 diagnostic criteria mentioned above, some of the signs of alcohol use disorder, colloquially referred to as alcohol addiction, include:³

• 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.
• Failing to fulfill role obligations at work, home, or school because of recurrent alcohol use.
• Continuing to use alcohol despite persistent or recurrent social or interpersonal relationship problems caused or exacerbated by it.
• Continuing to use alcohol despite the knowledge of having persistent or recurrent physical or psychological problems that are likely caused or exacerbated by it.

Despite the negative effects continued alcohol use can have on your life, 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

Alcohol use and mental health disorders commonly occur together—either simultaneously or sequentially.⁴ According to the 2021 National Survey on Drug Use and Health, 19.4 million adults ages 18 and older had both a substance use disorder and a co-occurring mental health disorder.⁵

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.⁴

Health Complications from 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 31% of all driving fatalities in the United States in 2021.⁶

Additionally, alcohol can take a toll on your physical health, contributing to potentially severe health issues, including:^7-9

• 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.

While the above health issues are real concerns for anyone who misuses alcohol, there are other groups of people or populations who may encounter additional problems. Women who drink while pregnant, for instance, risk experiencing pregnancy and birth complications and having an infant with fetal alcohol spectrum disorder (FASD).¹⁰ And older adults tend to have an increased sensitivity to alcohol as they age, which can raise the likelihood that they experience alcohol-related injuries, memory-problems, sleep issues, and overall mortality.¹¹

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.¹² 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.

Legal Implications of Alcohol Misuse and Addiction

While alcohol consumption in the United States is legal for individuals who are at least 21 years of age, alcohol can cause legal woes for some. It interferes with the brain’s communication pathways and can cause changes in your mental state, including emotional processing and rational thinking, which can make behaviors done under the influence of alcohol unpredictable and even dangerous. Alcohol use has been linked to crimes ranging from misdemeanors to felonies—including driving under the influence (DUI), robbery, domestic violence, sexual abuse, and homicide.^7,13

Alcohol Addiction Treatment

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 your needs and the treatment center. 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.

Regardless of the program, medical detoxification 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 withdrawal and to keep you as comfortable as possible.

After detox, you will likely transition to an inpatient or residential treatment program or an outpatient program, depending on your individual circumstances and needs. The services provided by each will likely include behavioral therapies such as cognitive-behavioral therapy (CBT), individual and group counseling, support groups, and medications. 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.

If your loved one seeks treatment, you can support them in rehab and throughout recovery, which is a lifelong process. You can engage in enjoyable activities with them that don’t involve drinking, you can refrain from keeping alcohol in your home, and you can encourage counseling or attend a group meeting with them.¹⁵

 Alcohol use disorder requires a long-term commitment, but the benefits of hard work and dedication to sobriety can mean improved physical and mental health, stronger relationships, and a more optimistic future.¹⁶