Alcoholism is the lay term for alcohol use disorder (AUD), which is a brain disorder affecting nearly 15 million people aged 12 and older in 2019, according to a national survey. Some people may also know it as alcohol abuse, alcohol addiction, or alcohol dependence. AUD ranges from mild to moderate to severe. No matter the severity, the key characteristic in people who have AUD is an impaired ability to control their alcohol use despite consequences.
This article will discuss the causes of AUD, its symptoms, how it’s diagnosed and treated, and tips for living with AUD. It will also share some information on what you can do if you have a loved one who is experiencing AUD.
Causes and Risk Factors of Alcohol Use Disorder
Factors that can contribute to the development of AUD include:
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- Steady drinking over time: Steady drinking over time increases a person’s tolerance. Tolerance means needing increasing amounts of alcohol to experience the same or similar effects to earlier drinking days.
- Starting young: People who start drinking earlier than others are at heightened risk of developing alcohol-related problems like alcoholism.
- Family history: Genetic factors make some people more vulnerable to developing alcoholism or problem drinking.5Parents’ drinking behaviors are also influencing factors.
- Depression and other mental illnesses: Alcoholism may worsen depression and people with depression may drink alcohol in an attempt to relieve feelings of depression. While treating AUD can help relieve depression, treating depression does not resolve alcohol use disorder.
- Trauma: People may use alcohol to cope with trauma. Traumatic events interfere with your body’s production of endorphins (the brain’s natural painkillers).
- Social and cultural factors: Peer pressure and easy access to alcohol at home, along with financial insecurity or poverty and physical or sexual abuse, also increase the odds of developing alcohol dependence. Those factors may fall under the category of trauma for people.
The Neurobiology of Alcoholism
The effects of alcohol on brain chemistry are like those of other drugs—toxic to brain messaging channels (neurotransmitter pathways) associated with learning and memory. And as drinking continues, these changes negatively affect systems responsible for your body and brain’s stress response.
Reward System
Drinking alcohol changes a person’s brain chemistry. Over time it impairs many brain chemicals including those associated with motivational processes, including arousal, reward, and stress.
For example, dopamine (reward/motivation), opioid peptides (pain relief), GABA (stress/anxiety), and serotonin (mood/energy/appetite) are all affected by alcohol use and misuse. These neurotransmitters are all associated with a person’s mental health. Over time drinking can lead to persistent deficits in these brain chemicals.
Mental Obsession
A mental obsession is a thought that plays over and over again in your head, distracting from other thoughts and priorities.9 Mental obsession examples include planning or scheduling activities around alcohol consumption or the effects of alcohol consumption (e.g., hangovers) and increased thinking about alcohol.
Alcohol and Linked Behaviors
Certain behaviors or traits can prompt inappropriate drinking or lead to alcohol-related disorders. These include:
- Impulsiveness
- Low self-esteem
- A need for approval
Heavy drinkers and those who have lost control over responsible alcohol consumption also markedly increase their chances of dying from automobile accidents, homicide, and suicide.
People may use alcohol in the short-term to experience feelings of pain relief. But over time alcohol use disrupts the relationship between pleasure and pain.5
The Cycle of Addiction
As tolerance increases, a person may continue drinking to avoid the adverse effects of stopping or to avoid discomfort. Increased cravings for alcohol to provide desired feelings like calmness or emotional numbing make it all the more difficult to stop the cycle.5
Signs and Symptoms of Alcohol Use Disorder
Physical signs of alcohol use disorder can vary between people. Someone may show some, all, or you may see no signs of AUD. It can depend on how high-functioning the person with the disorder is and how long they’ve been in the cycle of addiction.
Physical signs include:
- Dry skin and brittle hair and nails from the dehydrating effects of alcohol (over time leads to increased appearance of aging and wrinkles)
- Poor hygiene
- Broken capillaries on your face and nose
- The frequent smell of alcohol on the breath, which can continue for hours after heavy drinking
- Weight loss due to the neglect of eating in favor of drinking
- Yellow eyes and skin due to liver damage
- Experiencing symptoms of alcohol withdrawal
Like signs of AUD, symptoms can also vary. These are the things a person or their loved one may report to their healthcare provider:
- A pattern of binge drinking or heavy drinking or consuming more alcohol than planned
- Frequent intoxication
- Drinking in dangerous situations, such as when driving
- Mental obsession with alcohol
- Denying drinking has become a problem
- Drinking first thing after waking
- Experiencing mood swings and personality changes
Symptoms of Withdrawal
Alcohol withdrawal ranges from mild to severe and in some cases can be life-threatening. Alcohol withdrawal symptoms worsen as the detox process continues. This means how you feel on day one or two of not drinking may not be a good indicator of your risk of serious withdrawal.
Alcohol withdrawal symptoms usually start within eight hours after the last drink, but they can still occur days later. Symptoms usually peak by 24 to 72 hours, but may go on for weeks.
Common symptoms include:
- Anxiety or depression
- Nervousness and irritability
- Jumpiness or shakiness
- Tiredness/fatigue
- Mood swings
- Nightmares
- Impaired thinking (not thinking clearly)
Signs of Delirium Tremens
Serious withdrawal symptoms are known as the DTs, or delirium tremens. Signs of emergency include:
- Agitation
- Fever
- Seeing or feeling things that aren’t there (hallucinations)
- Seizures
- Severe confusion
Stages of Alcohol Use Disorder
Alcohol use disorder is known as a progressive disease, meaning that without proper treatment, it will continue to get worse. There is no set time frame for when a person typically moves through each stage.
- At-risk: Drinking is social, alcohol is beginning to be used to cope with stress, and tolerance to alcohol increases.
- Early: Drinking alone, experiencing blackouts, and mental obsession with alcohol begin.
- Middle: Drinking is out of control, causing problems with daily life, and organ damage can be seen on lab tests and scans.
- End-stage: Drinking is now the main focus of life and serious health complications due to organ damage develop. This is a life-threatening stage.
Complications of Alcohol Use Disorder
Possible complications of alcohol use disorder include:
- Birth defects: Drinking during pregnancy is the cause of fetal alcohol syndrome (FAS), a range of birth defects including physical and mental disabilities.
- Bone damage: Chronic alcohol consumption is associated with compromised bone health and increased osteoporosis risk.
- Diabetes: Alcohol consumption is a risk for diabetes. People with diabetes need to closely monitor their alcohol intake to prevent low blood sugar.
- Digestive problems: Large amounts of alcohol are known to cause gastrointestinal inflammation and damage your digestive tract. This inflammation promotes organ damage.
- Eye problems: Alcohol impairs eye performance (pupil reaction slower, blurred vision) and may trigger migraines.
- Heart problems: Long-term heavy alcohol use can damage your heart, even changing its shape over time, and increase your risk of heart disease and stroke.
- Increased cancer risk: There’s growing evidence that alcohol is related to several cancers including head and neck, throat, liver, and breast cancer.
- Liver disease: Inflammation caused by alcohol leads to liver swelling (alcoholic hepatitis) in about 35% of heavy drinkers. Liver cirrhosis is the most serious as it replaces healthy liver tissues with scar tissue.
- Neurological complications: These include memory loss, hallucinations, and various conditions such as polyneuropathy, cerebellar degeneration, dementia, Wernicke-Korsakoff syndrome, and Marchiafava-Bignami disease.2
- Sexual function and menstrual issues: Alcohol interferes with sexual functioning, including the ability to become erect and climax; it also interferes with the menstrual cycle, causing irregularities or even cessation.
- Weakened immune system: Metabolizing alcohol will take priority over fighting viruses, leaving you more vulnerable to sickness.
SAMHSA Helpline
If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.
Diagnosis
Alcohol use disorder is diagnosed based on criteria as outlined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). A person must meet at least 2 of the 11 criteria during the same 12-month period.23 Additional lab tests including screening for nutritional deficiencies and blood markers of inflammation can also be useful to determine the illness stage.
How Is Alcohol Use Disorder Treated?
AUD is usually treated with multiple methods, including behavioral therapies, medications, and support groups.
Behavioral Therapies Psychotherapies can help a person learn to cope with everyday stress without alcohol.
These include:
- Cognitive behavioral therapy: This type of therapy helps a person identify drinking triggers and replace them with healthier coping strategies for everyday stressors.
- Family therapy: This type of therapy aims to enhance communication between family members to better support the person in recovery and work on healing the family unit.
- Motivation enhancement therapy: This therapy is geared toward maintaining motivation to stay sober and reach new goals.
Medications
Medications may be used to help reduce symptoms of withdrawal and cravings for alcohol. These include:
- Revia, Vivitrol, or Vivitrol injectable (naltrexone)
- Campral (acamprosate)
- Topamax (topiramate)25
- Neurontin (gabapentin)26
Prevention
The Centers for Disease Control and Prevention recommends avoiding excessive alcohol consumption. If you do choose to drink alcohol, follow the Dietary Guidelines for Americans on moderate alcohol consumption (no more than one drink per day for women and no more than two drinks per day for men).28 They also suggest talking to your healthcare provider and seeking counseling if you have concerns about your drinking.
How to Support Someone With Alcohol Use Disorder
Supporting someone with AUD means encouraging them to seek help and stay in recovery (continue with their treatment plan which includes staying sober from alcohol). You can also help by:
- Recognizing efforts made to cut back and slow down or stop drinking (acknowledgment and recognition go a long way)
- Remembering that relapse is a part of recovery for many with AUD (practicing patience is key)
- Considering support for yourself at support groups for family members of alcoholics or addicts (e.g., Al-Anon)
People with drinking problems are most likely to relapse during periods of stress or when exposed to people or places associated with past drinking.
Who Do I Call for Help?
The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a hotline, 24/7, 365 days a year. Call 1-800-662-HELP (4357).
