Alcoholism, now known as alcohol use disorder, is a condition in which a person has a desire or physical need to consume alcohol. Treatment can include counseling, medications, residential programs, and support groups.

The National Institutes of Health (NIH) states that in 2022, 29.5 million Americans ages 12 years and older had alcohol use disorder (AUD).

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes AUD as “an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.”

This article explains what to know about AUD.

Symptoms of alcohol use disorder

A person with AUD does not know when or how to stop drinking. They spend a lot of time thinking about alcohol and cannot control how much they consume, even if it is causing serious problems financially and at home or work.

Excessive or inappropriate consumption of alcohol is not necessarily the same as alcohol dependence.

Moderate alcohol consumption does not generally cause any psychological or physical harm. However, if someone who enjoys moderate drinking increases their consumption or regularly consumes more than the recommended quantity, AUD may eventually develop.

A person who drinks excessive alcohol may not be the first to realize it is a problem.

Someone with AUD may do the following:

• drink alone or in secret
• be unable to limit how much alcohol they consume
• black out and be unable to remember chunks of time
• have rituals and show irritation if someone else comments on these rituals, such as drinking before, during, or after meals or after work
• lose interest in hobbies they previously enjoyed
• feel the urge to drink
• feel irritable when drinking times approach, especially if alcohol may not be available
• store alcohol in unusual places
• gulp down drinks
• have problems with relationships, the law, finances, or work that stem from drinking
• need more alcohol to feel its effect
• experience nausea, sweating, or shaking when not drinking

Alcohol consumption becomes a problem when it takes precedence over all other activities.

The problems relating to alcohol dependence are extensive, and its effects can be physical, psychological, and social.

What causes alcohol use disorder?

Alcohol dependence develops over time and can disrupt the balance of gamma-aminobutyric acid (GABA) in the brain and glutamate. GABA controls impulsiveness, while glutamate stimulates the nervous system.

In the brain, levels of the neurotransmitter dopamine rise after consuming alcohol. These heightened dopamine levels may make the drinking experience more gratifying.

Over the long or medium term, excessive drinking can significantly alter the levels of these brain chemicals. This causes the body to crave alcohol to feel good and avoid feeling bad.

Possible risk factors

Some risk factors may also contribute to AUD, including:

• Genes: According to the NIH, genetic factors account for around half the risk of AUD. Environmental factors and interaction between genes and the environment account for the remaining risk.
• The age of the first alcoholic drink: People who start drinking alcohol before the age of 15 years may be 3 times as likely to develop AUD as people who begin drinking at the age of 21 years or older.
• Stress: Some stress hormones may have links to alcohol misuse. If stress and anxiety levels are high, a person may consume alcohol in an attempt to blank out the upheaval.
• Peer drinking: People whose friends drink regularly or excessively are more likely to drink too much. This can eventually lead to alcohol-related problems.
• Low self-esteem: People with low self-esteem are more likely to consume too much.
• Depression: People with depression may use alcohol as self-treatment. On the other hand, consuming excess alcohol may increase the risk of depression rather than reducing it.
• How the body processes or metabolizes alcohol: People who need comparatively more alcohol to achieve an effect have a higher risk of eventually developing health problems related to alcohol.

How do doctors diagnose alcohol use disorder?

To diagnose AUD, people must meet at least 2 of 11 criteria described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) in the past 12 months.

According to the number of criteria a person meets, doctors diagnose AUD as mild, moderate, or severe.

The criteria include having a pattern of consumption that leads to considerable impairment or distress.

Frequently asked questions

Below are answers to common questions about alcohol use disorder.

Does drinking three beers a day make me an alcoholic?

If someone feels compelled to drink 3 drinks or more every day and is uncomfortable when alcohol is unavailable, they may have an alcohol dependency problem. The Dietary Guidelines for Americans 2020-2025 states that moderate drinking equates to 2 drinks or less per day for males and 1 drink per day or less for females.

According to the NIH, “heavy drinking” equates to:

• For females: 4 or more drinks on any day or 8 or more per week
• For males: 5 or more drinks on any day or 15 or more per week

Are alcohol abuse and alcoholism the same thing?

Alcohol abuse and alcoholism both describe drinking that causes negative consequences for the drinker. Alcoholism often describes a person’s chemical dependency on alcohol and their inclination to prioritize drinking in their lives.

Alcohol abuse could encompass both occasional problematic drinking and alcohol dependency. Professionals now use the term alcohol use disorder to describe the spectrum of alcohol use problems.

Summary

People with alcohol use disorder (AUD) cannot control how much they need and desire alcohol and, as a result, consume it in amounts that can lead to severe health issues. Genetics may make some individuals more susceptible, but a person’s environment plays an important part.

AUD can impair daily functioning and lead to various complications. Long-term health effects include liver and heart disease.

Treatment for AUD may be lifelong and include counseling, support groups, residential programs, and medications.

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