Alcohol consumption is as old as time. In cultures all over the world, alcohol is used in celebration and sadness, ritual and remedy. But it doesn’t come without its dangers. Alcohol use is linked to chronic disease like cancer and diabetes, mental health disorders like depression and anxiety, and risky behaviors like drunk driving and unprotected sex.

With an estimated 88,000 people dying from alcohol-related causes annually, alcohol is the third-leading preventable cause of death in the United States. While it often seems that alcohol is the answer to all life’s problems, the reality is it’s often the cause. What’s clear is that, for some people, just one drink is one too many.

“A lot of us will say, ‘Everybody drinks,’ but the truth is that 8 percent of Americans consume 50 percent of the alcohol in America,” explains Donnie Sansom, DO, associate medical director and director of addictions at Sierra Tucson, a leading residential and outpatient treatment center for substance abuse disorders, trauma-related issues, chronic pain, mood and anxiety, and other co-occurring disorders, located in Tucson, Arizona. “Not everyone is really engaged in it.”

What Is Alcohol Use Disorder?

“Alcohol use disorder is the term we use instead of alcoholism,” explains Dr. Sansom. “We do this because we know there’s a stigma in the terms alcoholic and alcoholism. In the treatment world, we find it’s kinder on the ears, with less shame and stigma, and it covers all bases with regard to alcohol dependence.”

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol use disorder (AUD) is “a chronic relapsing brain disorder characterized by an impaired ability to stop or control use despite adverse social, occupational, or health hazards.” It affects an estimated 15 million adults in the United States–or 5.8 percent of the population. A diagnosis outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), AUD is identified by 11 criteria.

“The DSM-5 criteria provide a scale that is used to determine the severity of AUD,” says Dr. Sansom. “It takes into consideration tolerance, withdrawal, time spent to recover, cravings, and more, all of which harken to a change in the brain’s limbic system. This is what we need for survival and reward, and it is important for decision making and rational thinking. Over time, overuse of a psychoactive substance like alcohol affects this system and people become addicted.”

Signs Of Alcohol Use Disorder

In order to be diagnosed with AUD, you must meet any two of the following 11 criteria within a 12-month period. Have you:

  • Had times when you ended up drinking more, or longer than you intended?
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  • Spent a lot of time drinking? Or being sick or getting over the aftereffects?
  • Experienced craving—a strong need, or urge, to drink?
  • Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  • Continued to drink even though it was causing trouble with your family or friends?
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
  • Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
  • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

Mild AUD is classified as the presence of two to three symptoms; moderate, four to five symptoms; and severe, six or more symptoms.

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Causes of Alcohol Use Disorder

Just as there are many symptoms of AUD, there are also many causes.

“We get here a lot of different ways,” says Dr. Sansom. “One is early use. The earlier a person uses alcohol, the higher the likelihood they’ll develop the disorder.

Another is genetics. There are at least 30 to 40 genes that relate to substance abuse disorder, some specifically to alcohol. Some indicate a prediction of AUD, others a vulnerability.

Other factors are environmental–you grew up in a house where everyone drank, all of your friends drink, etc.

Others yet are co-existing conditions like anxiety, depression and untreated ADHD–which could account for as much as 50 percent of AUD cases–and childhood abuse and trauma. In fact, people with a high occurrence of childhood trauma are 70 percent more likely to have a substance abuse disorder.”

Treatments For Alcohol Use Disorder

Treating AUD can be just as individualized as treating the causes themselves. Depending on the severity of the disorder, treatment can range from a brief intervention to individual or group counseling, an outpatient program or an inpatient stay at a rehabilitation center. It can involve a medically managed detox and withdrawal, psychological counseling, psychiatric treatment with medication, ongoing therapy, and a wide variety of lifestyle changes.

No matter what treatment is right for the individual, all treatments for AUD have one thing in common:

“It takes time and a day-by-day understanding,” Dr. Sansom concludes. “For people who have a problem with alcohol, there’s not an on-off switch. It’s a continual problem that requires a continual life change.”

Last Updated: Oct 9, 2020