The Evidence on Alcohol Use Disorder, Without the Hype

Key takeaways

• US standard drink: 14 grams of alcohol: 12 fl oz of regular beer, 5 fl oz of wine or 1.5 fl oz of distilled spirits
• Heavy drinking, men: 5 or more drinks on any day or 15 or more a week
• Most useful single change: Talk to your doctor, who can screen for alcohol problems and discuss treatment.
• Commonest mistake: Stopping suddenly after long-term heavy drinking without medical advice, since withdrawal can be dangerous.
• See a doctor if any of the signs under "When to speak to a doctor" below apply to you.

What it is

A medical condition in which a person has trouble controlling or stopping drinking despite harm to their health, work or relationships. It sits within Substance Use. The figures below are the ones published guidance uses, rather than the ones that circulate.

The numbers, in one place

What helps

Here is what the evidence supports doing. Some of it will already be familiar.

• Talk to your doctor, who can screen for alcohol problems and discuss treatment
• Ask whether a medicine to reduce cravings or prevent relapse is right for you
• Use the NIAAA Alcohol Treatment Navigator to find quality care
• Call the SAMHSA National Helpline at 1-800-662-4357 for free, confidential referrals

What to avoid

These come up often, and several of them sound like good ideas.

• Stopping suddenly after long-term heavy drinking without medical advice, since withdrawal can be dangerous
• Drinking and driving, or riding with a driver who has been drinking
• Mixing alcohol with opioids, sleep medicines or anxiety medicines

In depth

Alcohol use disorder is diagnosed when drinking causes clinically significant problems or distress, and a person has trouble controlling it. It ranges from mild to severe, based on how many of a set of symptoms someone has in the past year. Many people with mild alcohol use disorder hold down jobs and look fine from the outside, which is one reason the condition often goes unrecognized.

Over time, heavy drinking changes how the brain responds to reward, stress and self-control. The brain adapts to regular alcohol, so stopping suddenly can cause withdrawal, and cues such as certain places, people or moods can trigger strong cravings. These changes help explain why willpower alone is often not enough, and why treatments that address the brain, behavior and environment all have a role.

Alcohol affects nearly every organ. Heavy use is linked to liver disease, high blood pressure, heart rhythm problems, pancreatitis, several cancers, depression, anxiety, sleep problems and injuries. The US Surgeon General has highlighted that alcohol raises the risk of several cancers, including breast cancer, even at lower levels. Cutting down or stopping reduces many of these risks, and the body often begins to recover within weeks.

Signs and symptoms

• Drinking more or for longer than you intended
• Wanting to cut down but being unable to
• Spending a lot of time drinking or recovering from drinking
• Strong cravings, or needing more alcohol for the same effect
• Continuing to drink despite problems at home, work or with health
• Withdrawal symptoms such as shakiness, sweating, nausea, anxiety or trouble sleeping when you stop

Causes and risk factors

• Family history, since genes play a substantial role
• Starting to drink at a young age
• Mental health conditions such as depression, anxiety or PTSD
• Stress, trauma or major life changes
• Social and work settings where heavy drinking is common
• Easy access to alcohol and drinking to cope with feelings

How it is checked

The USPSTF recommends that primary care providers screen adults for unhealthy alcohol use and offer brief counseling when needed. Screening usually starts with a short questionnaire, such as asking how many times in the past year you have had a heavy drinking day. If the answers suggest a problem, your clinician asks more questions to see whether you meet the criteria for alcohol use disorder and how severe it is.

Your clinician may also check your blood pressure and order blood tests to look at your liver and blood counts, since heavy drinking can affect both. They will ask about other substances, mood and sleep. Being honest about how much you drink helps them recommend the right level of care, including whether you need medical support to stop safely.

Treatment and support options

Medicines

Naltrexone can reduce cravings and the rewarding effects of alcohol. It should not be used by people taking opioids. Acamprosate can help maintain abstinence after you stop drinking. Disulfiram causes unpleasant reactions if you drink, which deters drinking for some people. Your doctor can explain which might suit you; these medicines work best alongside counseling or support.

Behavioral therapies

Approaches such as cognitive behavioral therapy, motivational enhancement therapy and couples or family therapy help people change drinking patterns, handle triggers and build coping skills. They can be delivered one-on-one, in groups or online. Brief interventions in primary care can also help people who drink heavily cut down, even if they do not have a severe disorder.

Medically supervised withdrawal

People who drink heavily every day may need medical care to stop safely. Withdrawal can cause seizures or delirium tremens, a dangerous state of confusion and agitation. Clinicians can use medicines to ease withdrawal and prevent complications, often as an outpatient but sometimes in a hospital or residential setting.

Mutual support

Groups such as Alcoholics Anonymous, SMART Recovery and others offer peer support, structure and a community of people in recovery. They are free and widely available in person and online. Many people combine mutual support with medicine and therapy. Try a few groups to find one that feels right.

Prevention

• Know what a US standard drink is and count your drinks
• Plan alcohol-free days each week
• Avoid drinking to cope with stress, anxiety or sleep problems
• Delay a young person's first drink as long as possible
• Ask for help early if drinking starts to cause problems

Day to day

Recovery from alcohol use disorder is often a gradual process with ups and downs. Many people find it helps to change routines that revolved around drinking, find new ways to relax, and spend time with people who support their goals. Keeping alcohol out of the house, planning what to say when offered a drink and having a plan for high-risk situations can make day-to-day life easier.

Slips are common and do not mean treatment has failed. They are a chance to learn what triggered the drink and adjust your plan. Staying in touch with your doctor, counselor or support group helps you catch problems early. Treating related problems such as depression, anxiety or sleep difficulties also makes recovery more stable.

For specific groups

Women

Women tend to reach higher blood alcohol levels than men after the same amount of alcohol, and they may develop alcohol-related liver and heart damage sooner. Alcohol also raises breast cancer risk. Pregnant people should avoid alcohol completely.

Older adults

As people age, the body handles alcohol differently, and alcohol interacts with many common medicines. It also raises the risk of falls. Older adults may need to drink less than younger adults, or not at all, especially if they take certain medicines.

Teens and young adults

The brain continues to develop into the mid-20s, and drinking during this time can affect memory and learning and raises the risk of later alcohol problems. Binge drinking is common among young adults and can lead to injury and alcohol poisoning.

Questions to ask your doctor

• Is my drinking affecting my health or my medicines?
• Do I need medical help to stop or cut down safely?
• Would naltrexone, acamprosate or another medicine help me?
• Can you refer me to counseling or a treatment program?
• Should I have tests for my liver or other organs?
• How can I manage sleep, anxiety or mood without alcohol?

More questions, answered

Can I cut down instead of quitting completely?

For some people with mild problems, cutting down with clear limits can work. For people with moderate or severe alcohol use disorder, or with health problems made worse by alcohol, stopping completely is usually safer. Talk with your doctor about which goal fits your situation.

Is alcohol use disorder the same as alcoholism?

"Alcoholism" is an older term. Clinicians now use alcohol use disorder, which covers a range from mild to severe. The newer term reflects that problems with alcohol exist on a spectrum and that treatment can help at any level, not only when drinking has become severe.

How long do alcohol cravings last after stopping?

Cravings are often strongest in the first weeks and months after stopping, but they can return at times of stress or around cues linked to drinking. Over time, they usually become less frequent and less intense. Medicines, therapy and support groups can help you manage them.

Does my insurance cover alcohol treatment?

Most health plans, including Medicaid and Medicare, cover treatment for alcohol use disorder. Federal parity law requires many plans to cover substance use treatment on terms similar to other medical care. Call your plan or check its website to learn what is covered and which providers are in network.

What is alcohol poisoning?

Alcohol poisoning happens when a person drinks so much that brain areas controlling breathing, heart rate and temperature begin to shut down. Signs include confusion, vomiting, seizures, slow or irregular breathing, blue-tinged skin and being hard to wake. Call 911 and do not leave the person alone.

Does alcohol use disorder run in families?

Genes account for a substantial part of the risk, and children of parents with alcohol problems are at higher risk. Environment matters too. Having a family history does not mean you will develop alcohol use disorder, but it is a good reason to be careful about drinking.

Related topics

• Alcohol Reduction: What the Evidence Actually Says (Preventive Care)
• What the Guidance Really Says About Alcohol and Mental Health (Mental Health)
• Alcohol-Related Liver Disease: What Published Guidance Supports (Liver Health)
• The Evidence on Alcohol and the Heart, Without the Hype (Heart Health)

Where to go next

• Popular Beliefs About Alcohol Use Disorder, and What Is Actually Published
• Alcohol Use Disorder: A Beginner-Friendly Start
• Alcohol Use Disorder — the reference entry
• Substance Use: The Complete Guide
• The Evidence on Cannabis Use, Without the Hype
• What the Guidance Really Says About Vaping and E-Cigarettes

When to speak to a doctor

Seek medical help before stopping if you drink heavily every day. Call 911 for seizures, confusion, hallucinations, vomiting with confusion, slow or irregular breathing or someone who cannot be woken after drinking.

Where this comes from

• National Institute on Alcohol Abuse and Alcoholism — Understanding Alcohol Use Disorder
• National Institute on Alcohol Abuse and Alcoholism — What Is A Standard Drink?
• SAMHSA — National Helpline

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.