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Alcohol Use Disorder

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Medically reviewed by
Last updated April 27, 2022

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Care Plan

1

First steps to consider

  • Discuss your drinking habits with people you trust to help you identify problematic drinking patterns.
  • Check online for a validated screening test for alcohol use disorder like AUDIT-C.
2

When you may need a provider

  • You screen positive for alcohol use disorder.
  • You or people in your life are concerned that your drinking pattern is problematic.
  • You feel in-person support and treatment may help you.

Emergency Care

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Go to the ER if you have any of these symptoms of a more serious condition:

  • Alcohol withdrawal, including visual hallucinations, seizures, severe confusion with agitation, racing heartbeat, elevated blood pressure, fever, and excessive sweating.
  • If you over consume alcohol to the point of having slurred speech, confusion, loss of consciousness, memory impairment, or difficulty walking, you are at risk for acute alcohol intoxication and should go to the ER.

Alcohol use disorder is when you have problems controlling how much alcohol you drink, you think about drinking often, and the drinking has affected your mental health, relationships, or work.

What is alcohol use disorder?

Alcohol use disorder is having a problematic relationship with alcohol. It includes drinking too much and being preoccupied with drinking. It can also harm your mental health and other areas of your life. It can affect your relationships, your mood, your school, and your work. Drinking too much alcohol can also harm your body over time.

Alcohol use disorder is also known as alcoholism or alcohol abuse. It is the most common substance use disorder, with as many as 30% of adults having it at some point in their lifetime, according to a study in JAMA Psychiatry.

There is a wide range of treatments for alcohol abuse including therapy, support groups, medications, and in-patient rehabilitation programs.

Dr. Rx

Since alcohol is legal, it isn’t seen as being as harmful as other recreational substances. But each year, nearly 100,000 people die of alcohol-related deaths in the U.S.—far more than all other substance-related deaths combined. It also shortens lives by an average of 29 years.  —Dr. Nikhil Nadkarni

Symptoms

Drinking too much can cause physical, mental, emotional, and behavioral symptoms.

  • Depression, anxiety, and suicidal thoughts
  • Changes in your behavior and relationships
  • Lowered inhibitions, which lead to risky activities or behaviors that you wouldn’t normally do if you weren’t drinking
  • Harmful patterns of drinking, such as often drinking more than intended and struggling to control alcohol use
  • Cravings for alcohol that are so strong that they get in the way of social, family, or work responsibilities
  • Increasing tolerance to the effects of alcohol, requiring more drinking in order to feel the same effects
  • Stopping alcohol use leads to withdrawal symptoms like shakiness, anxiety, changes to blood pressure and heart rate, and even seizures.
  • Over the long term, heavy drinking can damage your liver and your digestive, cardiovascular, and nervous systems, causing a range of symptoms.

Pro Tip

Sobriety is hard and you don’t have to do it alone. There are genetic factors, social factors, psychological factors, and biological factors, all of which contribute to difficulties with alcohol. It can feel overwhelming to try to overcome this by yourself, but there are doctors, groups, therapists, counselors, and programs, which are all devoted to helping you with this problem, often at no cost or low cost to you. —Dr. Nadkarni

Criteria for alcohol use disorder

There are three levels of alcohol use disorder, based on the number of symptoms you have over a 12-month period. If you have 2–3 symptoms, it’s considered mild, 4–5 is moderate, and 6 or more is severe.

  1. Drinking more alcohol than intended
  2. Often wanting to or trying to quit drinking but not being able to stop
  3. A lot of time is spent getting alcohol, drinking alcohol, and recovering from drinking
  4. Strong desires or cravings to drink alcohol
  5. Repeated drinking interferes with work, school, or home
  6. Continuing to drink even when problems become worse when you drink
  7. Important activities are given up or not done as often because of drinking
  8. Alcohol is drunk while knowing it puts you in dangerous situations, like needing to drive
  9. Alcohol use continues even when it is causing or worsening physical or mental health problems
  10. Tolerance is developed, either due to:
    a. Needing more alcohol to feel its effects
    b. No longer feel the effects as much from the same amount of alcohol
  11. Need to drink alcohol to relieve withdrawal symptoms

Alcohol use disorder vs. alcoholism

Both alcohol use disorder and alcoholism are ways to describe unhealthy patterns of drinking. Alcohol use disorder is more of a medical diagnosis that includes both alcohol dependence and alcohol abuse. While alcoholism is not a true diagnostic term, it usually refers to someone with a severe alcohol dependence.

What causes alcohol use disorder?

A number of risk factors contribute to alcohol abuse. It often runs in families, and several genes have been found to increase the risk. But other factors also play an important role in whether you develop it. Untreated mental health problems like depression, anxiety, ADHD, and post-traumatic stress disorder (PTSD), are all risk factors.

Pro Tip

When talking to a doctor about drinking, it is common for people to feel ashamed and underreport the amount or the frequency that they drink. They may make comparisons to other people who drink heavily and try to show how their own pattern of drinking is different. It can be uncomfortable to talk about, but it is important to be as honest as possible. —Dr. Nadkarni

Treatment

Treatment typically requires a combination of therapy and medical treatments. Some people can manage it on their own, while others need to go into a rehabilitation program.

It’s important to talk to a doctor if you’re planning to stop drinking. A doctor can prescribe medications that can help with withdrawal symptoms and improve your chance of being able to stop drinking.

It may also help to talk to a therapist. You are more likely to stop drinking alcohol if you understand why you want to stop. A therapist can help you figure out your reasons.

Stop drinking

The first step is to completely stop drinking alcohol. You will need to watch for symptoms of withdrawal, which can be severe.

A doctor may prescribe benzodiazepines (such as lorazepam or diazepam). These help with withdrawal symptoms by mimicking the effects of alcohol on the brain. Your doctor will slowly lower the dosage of the drug as symptoms lessen.

Get support

People with mild alcohol use disorder may be able to stop drinking on their own using various approaches. These may include therapy, counseling interventions, or support groups like Alcoholics Anonymous.

There are several types of therapies that can help treat alcohol use disorder.

  • Cognitive behavioral therapy (CBT) helps change negative thought patterns and behaviors.
  • Motivational interviewing focuses on your motivation to stop drinking.
  • Mutual help group therapies (like Alcoholics Anonymous) provide support and accountability from peers.
  • Combined behavioral intervention uses components of CBT, motivational interviewing, and group support.
  • Family or couples therapy can also help since alcohol use disorder affects your relationships.

Medications

People with moderate or severe alcohol use disorder may have more success staying sober (not drinking alcohol) if they take a prescription medication. There are different types of medications. Some reduce the feel-good effects of alcohol, and some can reduce cravings. Medications should be combined with other approaches, such as behavioral therapy and support groups.

  • Naltrexone (taken as a daily pill or a monthly injection) blocks the feel-good effects of alcohol. It can also reduce cravings for alcohol.
  • Acamprosate helps reduce cravings for alcohol after you quit drinking. 

Rehabilitation programs

People with a serious alcohol problem who are not able to stay sober with therapy, support groups, and medication, may need to enroll in a rehabilitation program.

These programs can provide intensive therapy and support, and offer a greater chance at long-term sobriety.

Rehabilitation programs are live-in facilities. Programs can be for weeks or months. Treatments include different types of individual therapy, group programs, family therapy, and medication. They are similar to the out-patient approaches, but the program is more structured and intensive. They also monitor behavior to prevent relapsing.

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I am interested in the intersection of technology and mental health for people of all ages. I am a UCLA-trained board certified Adult Psychiatrist and will be board eligible in Child & Adolescent Psychiatry in June 2021 upon completion of my fellowship. I am currently licensed to practice in California and Florida and work part time as a Clinical Team Lead for a company called healthPiper, which p...
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