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Alcohol use disorder

Alcohol dependence; Alcohol abuse; Problem drinking; Drinking problem; Alcohol addiction; Alcoholism - alcohol use; Substance use - alcohol

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Alcohol use disorder is when your drinking causes serious problems in your life, yet you keep drinking. You may also need more and more alcohol to feel drunk. Stopping suddenly may cause withdrawal symptoms.

Causes

No one knows what causes problems with alcohol. Health experts think that it may be a combination of a person's:

  • Genes
  • Environment
  • Psychology, such as being impulsive or having low self-esteem

Long-term risks of drinking an excessive amount of alcohol are more likely if:

  • You are a man who has more than 2 drinks per day, or 15 or more drinks a week, or often have 5 or more drinks at a time
  • You are a woman who has more than 1 drink per day, or 8 or more drinks a week, or often have 4 or more drinks at a time

One drink is defined as 12 ounces or 360 milliliters (mL) of beer (5% alcohol content), 5 ounces or 150 mL of wine (12% alcohol content), or a 1.5-ounce or 45-mL shot of liquor (80 proof, or 40% alcohol content).

If you have a parent with alcohol use disorder, you are more at risk for alcohol problems.

You also may be more likely to have problems with alcohol if you:

  • Are a young adult under peer pressure
  • Have depression, bipolar disorder, anxiety disorders, post-traumatic stress disorder (PTSD), or schizophrenia
  • Can easily obtain alcohol
  • Have low self-esteem
  • Have problems with relationships
  • Live a stressful lifestyle

If you are concerned about your drinking, it may help to take a careful look at your alcohol use.

Symptoms

Health care providers have developed a list of symptoms that a person has to have in the past year to be diagnosed with alcohol use disorder.

Symptoms may include:

  • Times when you drink more or longer than you planned to.
  • Wanted to, or tried to, cut down or stop drinking, but could not.
  • Spend a lot of time and effort to get alcohol, use it, or recover from its effects.
  • Crave alcohol or have a strong urge to use it.
  • Alcohol use is causing you to miss work or school, or you do not perform as well because of drinking.
  • Continue to drink, even when relationships with family and friends are being harmed.
  • Stop taking part in activities that you used to enjoy.
  • While or after drinking, you get into situations that can cause you to get hurt, such as driving, using machinery, or having unsafe sex.
  • Keep drinking, even though you know it is making a health problem caused by alcohol worse.
  • Need more and more alcohol to feel its effects or to get drunk.
  • You get withdrawal symptoms when the effects of alcohol wear off.

Exams and Tests

Your provider will:

  • Examine you
  • Ask about your medical and family history
  • Ask about your alcohol use, and if you have any of the symptoms listed above

Your provider may order tests to check for health problems that are common in people who use alcohol. These tests may include:

Treatment

Many people with an alcohol problem need to completely stop using alcohol. This is called abstinence. Having strong social and family support can help make it easier to quit drinking.

Some people are able to just cut back on their drinking. So even if you do not give up alcohol altogether, you may be able to drink less. This can improve your health and relationships with others. It can also help you perform better at work or school.

However, many people who drink too much find they can't just cut back. Abstinence may be the only way to manage a drinking problem.

DECIDING TO QUIT

Like many people with an alcohol problem, you may not recognize that your drinking has gotten out of your control. An important first step is to be aware of how much you drink. It also helps to understand the health risks of alcohol.

If you decide to quit drinking, talk with your provider. Treatment involves helping you realize how much your alcohol use is harming your life and the lives those around you.

Depending on how much and how long you have been drinking, you may be at risk for alcohol withdrawal. Withdrawal can be very uncomfortable and even life threatening. If you have been drinking a lot, you should cut back or stop drinking only under the care of a provider. Talk with your provider about how to stop using alcohol.

LONG-TERM SUPPORT

Alcohol recovery or support programs can help you stop drinking completely. These programs usually offer:

  • Education about alcohol use and its effects
  • Counseling and therapy to discuss how to control your thoughts and behaviors
  • Physical health care

For the best chance of success, you should live with people who support your efforts to avoid alcohol. Some programs offer housing options for people with alcohol problems. Depending on your needs and the programs that are available:

  • You may be treated in a special recovery center (inpatient)
  • You may attend a program while you live at home (outpatient)

You may be prescribed medicines to help you quit. They are often used with long-term counseling or support groups. These medicines make it less likely that you will drink again or help limit the amount you drink.

Drinking may mask depression or other mood or anxiety disorders. If you have a mood disorder, it may become more noticeable when you stop drinking. Your provider will treat any mental disorders in addition to your alcohol treatment.

Support Groups

Support groups help many people who are dealing with alcohol use. Talk to your provider about a support group that might be right for you.

Outlook (Prognosis)

How well a person does depends on whether they can successfully cut back or stop drinking.

It may take several tries to stop drinking for good. If you are struggling to quit, do not give up hope. Getting treatment, if needed, along with support and encouragement from support groups and those around you can help you remain sober.

Possible Complications

Alcohol use disorder can increase your risk of many health problems, including:

Alcohol use also increases your risk for violence.

Drinking alcohol while you are pregnant can lead to severe birth defects in the baby. This is called fetal alcohol syndrome. Drinking alcohol while you are breastfeeding can also cause problems for your baby.

When to Contact a Medical Professional

Talk with your provider if you or someone you know may have an alcohol problem.

Seek immediate medical care or call your local emergency number (such as 911) if you or someone you know has an alcohol problem and develops severe confusion, seizures, or bleeding.

Prevention

The National Institute on Alcohol Abuse and Alcoholism recommends:

  • Women should not drink more than 1 drink per day
  • Men should not drink more than 2 drinks per day

References

American Psychiatric Association. Substance-related and addictive disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013:481-590.

Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion. CDC vital signs: alcohol screening and counseling. www.cdc.gov/vitalsigns/alcohol-screening-counseling. Updated January 7, 2014. Accessed April 15, 2019.

Reus VI, Fochtmann LJ, Bukstein O, et al. The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. Am J Psychiatry. 2018;175(1):86-90. PMID: 29301420 www.ncbi.nlm.nih.gov/pubmed/29301420.

Sherin K, Seikel S, Hale S. Alcohol use disorders. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 48.

US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(18):1899-1909. PMID: 30422199 www.ncbi.nlm.nih.gov/pubmed/30422199.

  • Alcoholic liver disease

    Animation

  •  

    Alcoholic liver disease - Animation

    Long-term alcohol abuse can lead to dangerous damage called alcoholic liver disease. Let's talk today about alcoholic liver disease. Alcoholic liver disease usually occurs after years of drinking too much. The longer you've abused alcohol, and the more alcohol you've consumed, the greater likelihood you will develop liver disease. Alcohol may cause swelling and inflammation in your liver, or something called hepatitis. Over time, this can lead to scarring and cirrhosis of the liver, which is the final phase of alcoholic liver disease. The damage caused by cirrhosis is unfortunately irreversible. To determine if you have alcoholic liver disease your doctor will probably test your blood, take a biopsy of the liver, and do a liver function test. You should also have other tests to rule out other diseases that could be causing your symptoms. Your symptoms may vary depending upon the severity of your disease. Usually, symptoms are worse after a recent period of heavy drinking. In fact, you may not even have symptoms until the disease is pretty advanced. Generally, symptoms of alcoholic liver disease include abdominal pain and tenderness, dry mouth and increased thirst, fatigue, jaundice (which is yellowing of the skin), loss of appetite, and nausea. Your skin may look abnormally dark or light. Your feet or hands may look red. You may notice small, red, spider-like blood vessels on your skin. You may have abnormal bleeding. Your stools might be dark, bloody, black, or tarry. You may have frequent nosebleeds or bleeding gums. You may vomit blood or material that looks like coffee grounds. Alcoholic liver disease also can affect your brain and nervous system. Symptoms include agitation, changing mood, confusion, and pain, numbness, or a tingling sensation in your arms or legs. The most important part of treatment is to stop drinking alcohol completely. If you don't have liver cirrhosis yet, your liver can actually heal itself, that is, if you stop drinking alcohol. You may need an alcohol rehabilitation program or counseling to break free from alcohol. Vitamins, especially B-complex vitamins and folic acid, can help reverse malnutrition. If cirrhosis develops, you will need to manage the problems it can cause. It may even lead to needing a liver transplant.

  • Liver cirrhosis - CT scan

    Liver cirrhosis - CT scan - illustration

    A CT scan of the upper abdomen showing cirrhosis of the liver.

    Liver cirrhosis - CT scan

    illustration

  • Fatty liver - CT scan

    Fatty liver - CT scan - illustration

    A CT scan of the upper abdomen showing a fatty liver (steatosis of the liver). Note the liver enlargement and dark color compared with the spleen (gray body in lower right).

    Fatty liver - CT scan

    illustration

  • Liver with disproportional fattening - CT scan

    Liver with disproportional fattening - CT scan - illustration

    A CT scan of the upper abdomen showing disproportional steatosis (fattening) of the liver.

    Liver with disproportional fattening - CT scan

    illustration

  • Alcoholism

    Alcoholism - illustration

    Alcoholism is a chronic illness marked by dependence on alcohol consumption that interferes with physical or mental health, and social, family or job responsibilities. This addiction can lead to liver, circulatory and neurological problems. Pregnant women who drink alcohol in any amount may harm the fetus.

    Alcoholism

    illustration

  • Alcohol use disorder

    Alcohol use disorder - illustration

    Alcohol use disorder is a chronic illness marked by alcohol consumption that interferes with physical or mental health, and social, family or job responsibilities. Over time this use can lead to liver, circulatory, and neurological problems. Pregnant women who drink alcohol in any amount may harm the fetus.

    Alcohol use disorder

    illustration

  • Alcohol and diet

    Alcohol and diet - illustration

    Alcohol is considered a macronutrient in that it provides energy (about 7 calories per gram). The equivalent of a 1-ounce shot of liquor is approximately 80 to 90 calories.

    Alcohol and diet

    illustration

  • Liver anatomy

    Liver anatomy - illustration

    The liver serves a wide variety of body functions, including detoxifying blood and producing bile that aids in digestion.

    Liver anatomy

    illustration

  • Alcoholic liver disease

    Animation

  •  

    Alcoholic liver disease - Animation

    Long-term alcohol abuse can lead to dangerous damage called alcoholic liver disease. Let's talk today about alcoholic liver disease. Alcoholic liver disease usually occurs after years of drinking too much. The longer you've abused alcohol, and the more alcohol you've consumed, the greater likelihood you will develop liver disease. Alcohol may cause swelling and inflammation in your liver, or something called hepatitis. Over time, this can lead to scarring and cirrhosis of the liver, which is the final phase of alcoholic liver disease. The damage caused by cirrhosis is unfortunately irreversible. To determine if you have alcoholic liver disease your doctor will probably test your blood, take a biopsy of the liver, and do a liver function test. You should also have other tests to rule out other diseases that could be causing your symptoms. Your symptoms may vary depending upon the severity of your disease. Usually, symptoms are worse after a recent period of heavy drinking. In fact, you may not even have symptoms until the disease is pretty advanced. Generally, symptoms of alcoholic liver disease include abdominal pain and tenderness, dry mouth and increased thirst, fatigue, jaundice (which is yellowing of the skin), loss of appetite, and nausea. Your skin may look abnormally dark or light. Your feet or hands may look red. You may notice small, red, spider-like blood vessels on your skin. You may have abnormal bleeding. Your stools might be dark, bloody, black, or tarry. You may have frequent nosebleeds or bleeding gums. You may vomit blood or material that looks like coffee grounds. Alcoholic liver disease also can affect your brain and nervous system. Symptoms include agitation, changing mood, confusion, and pain, numbness, or a tingling sensation in your arms or legs. The most important part of treatment is to stop drinking alcohol completely. If you don't have liver cirrhosis yet, your liver can actually heal itself, that is, if you stop drinking alcohol. You may need an alcohol rehabilitation program or counseling to break free from alcohol. Vitamins, especially B-complex vitamins and folic acid, can help reverse malnutrition. If cirrhosis develops, you will need to manage the problems it can cause. It may even lead to needing a liver transplant.

  • Liver cirrhosis - CT scan

    Liver cirrhosis - CT scan - illustration

    A CT scan of the upper abdomen showing cirrhosis of the liver.

    Liver cirrhosis - CT scan

    illustration

  • Fatty liver - CT scan

    Fatty liver - CT scan - illustration

    A CT scan of the upper abdomen showing a fatty liver (steatosis of the liver). Note the liver enlargement and dark color compared with the spleen (gray body in lower right).

    Fatty liver - CT scan

    illustration

  • Liver with disproportional fattening - CT scan

    Liver with disproportional fattening - CT scan - illustration

    A CT scan of the upper abdomen showing disproportional steatosis (fattening) of the liver.

    Liver with disproportional fattening - CT scan

    illustration

  • Alcoholism

    Alcoholism - illustration

    Alcoholism is a chronic illness marked by dependence on alcohol consumption that interferes with physical or mental health, and social, family or job responsibilities. This addiction can lead to liver, circulatory and neurological problems. Pregnant women who drink alcohol in any amount may harm the fetus.

    Alcoholism

    illustration

  • Alcohol use disorder

    Alcohol use disorder - illustration

    Alcohol use disorder is a chronic illness marked by alcohol consumption that interferes with physical or mental health, and social, family or job responsibilities. Over time this use can lead to liver, circulatory, and neurological problems. Pregnant women who drink alcohol in any amount may harm the fetus.

    Alcohol use disorder

    illustration

  • Alcohol and diet

    Alcohol and diet - illustration

    Alcohol is considered a macronutrient in that it provides energy (about 7 calories per gram). The equivalent of a 1-ounce shot of liquor is approximately 80 to 90 calories.

    Alcohol and diet

    illustration

  • Liver anatomy

    Liver anatomy - illustration

    The liver serves a wide variety of body functions, including detoxifying blood and producing bile that aids in digestion.

    Liver anatomy

    illustration

A Closer Look

 

Self Care

 
 

Review Date: 4/8/2018

Reviewed By: Ryan James Kimmel, MD, Medical Director of Hospital Psychiatry at the University of Washington Medical Center, Seattle, WA. Internal review and update on 04/15/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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