Understanding Alcohol Use Disorder: The Basics

Alcohol Use Disorder Causes

AUD is a complex brain disorder, the cause of which remains unknown. So far, experts believe that it's caused by a combination of the genes you inherited from your parents and your environment. Your personality traits — for instance, how secure you feel about yourself or whether you're prone to acting on impulse — can also play a part.

Over time, drinking excess alcohol can change areas of your brain, including one that senses pleasure and another that helps with self-control. Because your brain stops functioning properly, you may crave alcohol even more.

Risk Factors for Alcohol Use Disorder

Many different factors can make you prone to problem drinking. They include:

A family history. Your risk of having AUD is three to four times greater if a parent has it, although many people who have a parent with a drinking issue don't develop one as well.

Drinking at a young age. If you began drinking alcohol before the age of 15, you may be more likely to have AUD, especially if you're assigned female at birth.

Your environment. This can include stress in your life, whether an overwhelming event or a bunch of smaller stressors that build up over time. Trauma, especially in childhood, can also raise your risk.

Mental health issues. Some conditions raise your risk of drinking too much. Among them are

• Depression
• Attention deficit hyperactivity disorder (ADHD)
• Anxiety
• Bipolar disorder
• Posttraumatic stress disorder (PTSD)
• Schizophrenia

Alcohol Use Disorder Symptoms

The immediate physical effects of drinking alcohol range from mild mood changes to loss of coordination, balance, and speech. You may even find it hard to see. Any of these signs can signal that you're drunk or what's officially called "acute alcohol intoxication." They usually wear off in a few hours after you stop drinking.

If you have an alcohol issue, it's common to:

• Crave more alcohol
• Drink more than you mean to
• Feel like you need to keep drinking larger amounts of alcohol to feel good
• Spend more time drinking than you mean to
• Lose time because you're recovering from hangovers
• Keep drinking even though it's harming your personal or work life
• Try with little or no success to cut back on alcohol
• Drink in a situation that puts you or someone else in harm's way (such as drinking and driving)
• Choose alcohol over your family, friends, or work obligations
• Continue to drink alcohol although it worsens a physical or mental health condition you have
• Feel unwell (have withdrawal symptoms) when you don't drink alcohol regularly

Alcohol Use Disorder Stages

Problem drinking doesn't happen in an instant. it's a progressive condition, which means that it gets more severe over time. Experts first realized this back in the 1950s. The stages of AUD include:

At-risk stage

You might also hear this called "pre-alcoholic." At this stage, you might drink to escape something going on in your life or to relax and feel better about yourself. Drinking may become a regular part of your life, although it may not seem like anything to worry about.

Early alcohol use disorder

This is also referred to as the "early alcoholic" stage. Drinking is starting to impact you and your life. For instance, you may start drinking so much that you black out (lose consciousness). You could also be thinking about alcohol and craving your next drink. If loved ones question you, you may lie about how much you're drinking.

Mid-stage alcohol use disorder

At this point, AUD symptoms start to interfere with your personal and work life. They're also more noticeable to others. For instance, you might miss important family events or meetings with co-workers because you've been drinking. Physical symptoms such as weight gain (or loss) usually show up in this mid-stage, too.

Alcohol Use Disorder Test

There's no medical test that proves you have a drinking problem. Instead, experts follow the criteria for alcohol use disorder that are listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). It's a list of questions about your drinking habits, and how alcohol use affects your daily life and relationships. Your answers can help a doctor understand if you have AUD, and whether it's mild, moderate, or severe.

To gather more information about how alcohol is affecting your physical and mental health, your doctor could also:

• Do a physical exam
• Order blood tests or imaging tests (for instance, to check your liver function)
• Ask questions to evaluate you for depression or anxiety

If your doctor thinks you need more support to stop drinking, they'll likely refer you to a mental health provider, such as a counselor or therapist.

Alcohol Use Disorder Treatment

The main focus of AUD treatment is to help you stop drinking and realize that getting sober can improve your well-being and quality of life.

That can be a challenge. It's common to be in denial about how much you drink. Or feel too guilty to admit what's going on. Another barrier to receiving care is that doctors screen only about 15% of their primary care patients for AUD.

Detox for alcohol use disorder

Treatment for AUD can differ from person to person but sometimes starts with detoxification (detox). For anywhere from 2 days to a week, a doctor keeps a close eye on you while alcohol fully leaves your system. Because you could have withdrawal symptoms, medication that makes you sleep a lot is often part of detox.

Naltrexone for alcohol use disorder

This FDA-approved medication isn't a cure for AUD. (No cure currently exists.) But naltrexone can block you from feeling some of the effects of alcohol if you decide to start drinking again. When you take naltrexone, you won't feel relaxed or get a euphoric "high" from drinking. This drug binds to your body's endorphin ("feel-good" chemical) receptors so alcohol can't interact with them.

Other alcohol use disorder treatments

Behavioral treatment, also known as alcohol counseling or talk therapy, is usually a big part of managing AUD. With the help of a licensed therapist, you could learn important skills such as:

• How to identify triggers that cause you to drink
• Ways to handle a craving for alcohol
• Strategies to deal better with stress and negative moods
• How to improve your relationships and self-esteem
• How to manage other mental health issues, such as depression or anxiety

You can choose from different types of therapy such as alcohol counseling, cognitive behavioral therapy, mindfulness-based therapy, or couples or family therapy.

Alcohol Use Disorder Harm Reduction

AUD treatment is usually centered on abstinence — getting you to completely give up alcohol. But some research now shows that cutting back on heavy drinking, or what's known as harm reduction treatment, can be useful.

That's because a lot of people with AUD don't want to quit drinking or find it really hard to stay sober. You might even avoid seeking treatment or admitting that you have an issue because of that.

Reducing the amount you drink may feel more doable. It can still benefit your physical health and quality of life.

Some tips to help you do that:

• Aim to drink no more than 10 drinks a week, and not more than four in 1 day. 
• Drink on a full stomach. This will slow down how fast the alcohol gets into your system. If you can, snack on foods while you drink, too.
• Sip a glass of water in between every alcoholic drink.
• Try to do another activity while you're drinking. If you're dancing, playing a video game, or chatting with friends, you're likely to drink more slowly.
• Don't use any other drug while you're drinking. That includes prescription drugs, as well as club drugs, street drugs, or marijuana.

If you're younger than 18, pregnant, or nursing, harm reduction isn't a good option. It's really important for you to abstain from all alcohol.

Alcohol Withdrawal

Once you stop or cut back on the amount of alcohol you drink, you'll likely have withdrawal symptoms. These can range from mild to severe and include:

• Headache
• Feeling irritated 
• Anxiety
• Upset stomach
• Racing heart
• Heavy sweating
• Trouble sleeping (insomnia)
• Shaking (for instance, shaking hands)
• Increased blood pressure 
• Hallucination (seeing things that aren't there)
• Confusion
• Seizures

About half of all people with AUD have withdrawal symptoms. 

Mild symptoms usually start within 6 hours after you stop drinking as much alcohol as your body has become used to. 

Symptoms often get worse about 24-72 hours after your last drink. But some people have symptoms that linger for weeks or months. You're more likely to have withdrawal symptoms if:

• You're used to drinking heavy amounts of alcohol every day.
• You're 65 or older.
• You have other health conditions (such as an issue with your liver or brain).
• You don't drink enough water.
• You've had severe alcohol withdrawal symptoms in the past.

When to Get Emergency Help

Many law enforcement agencies consider a .08 percentage of alcohol in your bloodstream as evidence of intoxication. Higher levels of blood alcohol can impair your brain function and eventually cause you to lose consciousness (pass out). Drinking an extreme amount of alcohol, also known as alcohol poisoning, can be fatal.

Signs of alcohol poisoning include:

• Feeling confused
• Trouble staying awake
• Breathing very slowly (eight breaths a minute or less)
• Irregular breathing (pausing 10 seconds between each breath)
• Pale, gray, or blue skin
• Throwing up
• Seizures

You don't need to have every one of these signs to have alcohol poisoning. It affects people differently but can become life-threatening very quickly. Let your loved ones know that if they see any of these symptoms, they should call 911 or get you to a hospital right away.

Make sure your friends and family know to seek help even if you aren't old enough to be legally drinking (under 21). The consequences of not getting medical assistance could be fatal.

Until an ambulance arrives or you get to an ER, it's crucial to ensure that someone with alcohol poisoning:

• Is sitting up or lying on their side so that they don't choke on their vomit and stop breathing
• Isn't left alone. There's no way to sleep off alcohol poisoning.

Delirium tremens

Although it may seem counterintuitive, suddenly cutting yourself off from all alcohol when you're a heavy drinker can also become a medical emergency. If your AUD is moderate or severe, you're at risk of developing delirium tremens (DT), a life-threatening form of alcohol withdrawal. Check with your doctor about the safest way to cut back if you're used to regularly drinking large amounts of alcohol.

Alcohol Use Disorder Complications

Alcohol use is a factor in over 200 health conditions. It's responsible for about 178,000 deaths in the U.S. each year. Half of those are due to heavy drinking, while the other half result from accidents caused by drinking.

How to Deal With Alcohol Use Disorder

Getting support from others is often extremely helpful in getting and staying sober. You have many options to choose from, including Alcoholics Anonymous (AA).

If you join this well-known group, which offers free meetings around the world, other members will guide you through AA's 12 steps to recovery. The first step is accepting that it's hard for you to control your drinking. The last step is helping others become and stay sober.

One analysis of 27 studies and over 10,000 participants showed that AA/12-step programs are the most effective ways to abstain from alcohol.

AA isn't religious-based. You can join no matter what belief system you have, or if you don't have one at all. But spiritual themes and references to "God" may come up at meetings. If you try AA and it doesn't feel like the right fit for you, there are other support groups you can try.

Some groups recommended by the National Council on Alcoholism and Drug Dependence (NCADD) include:

Women for Sobriety. Tailored for women with substance abuse issues, this support group meets either in-person or online.

SMART Recovery. Using cognitive-behavioral therapy methods, you'll learn to manage cravings for alcohol and better manage your thoughts and behaviors.

Secular Organizations for Society (SOS). This science-based group focuses on helping you become more self-reliant.

Young People in Recovery. If you're under 30, this grassroots organization, which offers life skills, community chapters, and an opportunity to reduce the stigma around abuse issues, could be a good fit.

Alcohol Use Disorder Intervention

If you're worried about a loved one's drinking habits, you may want to think about doing an intervention. This is a face-to-face talk where you'll lay out examples of their harmful behavior and suggest a specific treatment plan. You, and everyone else who's present, will also share what you'll do if the person refuses to get treatment.

Working with an addiction or intervention specialist can often be helpful, but some people arrange interventions on their own without professional help.

To do that:

Gather information. How severe is your loved one's alcohol usage? What parts of their life are being harmed? What type of treatment could help?

Choose four to six people to be part of the intervention. They don't all have to be relatives. But they should be people your loved one respects and likes.

Plan out what you'll say. Everyone should prepare to speak candidly about how your loved one's drinking has become harmful to them or others. Some people may focus on facts. Others may want to share emotional stories. It can help to write things down ahead of time.

Takeaways

If you have an alcohol addiction, treatment can help protect your health, improve your quality of life, and save your relationships with loved ones. There's no one-size-fits-all treatment. Be open with others about what you're experiencing so they can support you as you work to become sober.

Alcohol Use Disorder FAQs

What are the 4 types of drinkers?

Researchers at the University of Missouri found that people who drink often fall into one of these four categories:

Hemingway. Named after the famous writer Ernest Hemingway, you might not act drunk even if you've had a lot to drink. Alcohol won't have a large effect on your general personality.

Mary Poppins. Alcohol can increase how agreeable, friendly, and outgoing you are when you're sober. 

Mr Hyde. After drinking, you'll become less responsible, less agreeable, and less able to think clearly. You're also more likely to experience negative consequences, such as being arrested, when you drink alcohol.

The Nutty Professor. If you fall into this group, alcohol causes a dramatic shift in your personality. Although you usually feel shy or quiet when sober, alcohol makes you much more extroverted, like the life of the party.