healthy man after sub-acute medical detox

Alcohol Use Disorder:

Definition, Health Effects, and Treatment

What is Alcohol Use Disorder?

The number of people diagnosed with alcohol use disorder (AUD) hasn’t changed much in recent years. Nonetheless, more US adults are drinking now compared to a few years ago, especially women aged 20 to 40.

Alcohol (ethanol) is the most frequently abused substance in the US. The next two substances are tobacco and marijuana. About 1 out of every 2 people aged 12 years or older used alcohol in the past 30 days. During the same period, 1 out of 5 used tobacco products.1 Alcohol abuse can lead to inpatient treatment and therapy at a rehab facility.

In the US, the legal drinking age is 21 years. Yet, about 70% of high school students have drunk at least once in their lifetime.2 Problematic use is most prevalent among young adults between the ages of 18 and 25.

Number of AUD Cases

In 2017, 14.5 million people had an alcohol use disorder.3 These numbers marginally increased to 14.8 million in 2018.1 Despite the increase from 2017 to 2018, AUD diagnoses have actually decreased when compared to 2015 when there were 15.1 million AUD diagnoses among people aged 18 and older.4 About 1 in 5 college students meet the criteria for AUD.5

That said, these results should be interpreted with caution because the number of AUD diagnoses does not accurately reflect the actual scenario of drinking and its devastating effects. Each year, excessive alcohol use kills 88,000 people in the US.5 Furthermore, in 2014, 9,967 road traffic deaths involved alcohol, which is almost one-third of all driving fatalities.5

Alcohol Use Disorder: A new Diagnosis for Excessive Alcohol Use

AUD is a long-term brain disease that often relapses. The symptoms of alcohol use disorder include:

Abuse: reduced ability to stop/control drinking even if doing so has caused problems with health, relationships, and work. 

Tolerance: requiring more to get the effects that previously occurred with lower amounts

Dependence: inability to feel good when drinking is stopped or intake is reduced

The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) classified alcohol abuse and alcohol dependence as two distinct disorders. The fifth edition (DSM-5) introduced the term “alcohol use disorder,” which combined both alcohol abuse and dependence. More information about the DSM-5 criteria for AUD is available online.

According to the DSM-5, there are three types of alcohol use disorder. They are:

Mild: meeting 2 to 3 of the 11 DSM5 criteria

Moderate: meeting 4 to 5 criteria

Severe: meeting 6 or more criteria 

Common Questions

Is Alcohol Use Disorder the Same as Alcoholism?

Many people use the terms AUD and alcoholism interchangeably, yet these are not the same. Alcoholism describes the problematic use of alcohol but does not specify the diagnostic criteria. Alcoholism is not a diagnosis; rather, it is a behavior associated with excessive drinking. In contrast, AUD is a disorder with a full set of criteria for a precise diagnosis.

Is Alcohol Use Disorder a Mental Illness?

Alcohol use disorder is a mental illness. Prolonged abuse can cause changes in various areas of the brain. These areas regulate memory, behavior, and cognition. Heavy drinkers are more likely to have depression, anxiety, and mood disorders. Developing a dependency causes a 3-fold increase in the risk of developing mood disorders.6

Is Alcohol Use Disorder Curable?

To date, alcohol use disorder remains a chronic disorder. That said, certain medications and behavioral therapies can help with recovery. Of people recovering from AUD, 4 out of 10 people who have not used alcohol for two years start drinking again. Such a high relapse rate makes AUD treatment difficult.

Is Alcohol Use Disorder Genetic?

Two major risk factors are genetic factors and environmental factors. Genetics account for about half of AUD risk. Children born to parents with AUD are 50% more likely to develop the disorder compared to those born to parents without AUD. The other 50% risk is associated with environmental factors. These can include stress, a history of abuse, and domestic violence.7

How Alcohol Works

It is no exaggeration to say that alcohol is a legal drug. Like other drugs, it affects how the brain works. It is a depressant with many psychotropic effects, including enhanced feelings of pleasure, satisfaction, and relaxation.

Within minutes after an alcoholic drink enters the body, alcohol reaches the bloodstream and then enters the brain. Once inside the brain, it alters the activity of several brain chemicals (neurotransmitters). Neurotransmitters help brain cells (neurons) communicate with each other.

The following neurotransmitters are stimulated:

Gamma-aminobutyric acid (GABA): GABA stimulation causes sedation, disinhibition, and relaxation.

Dopamine: Dopamine stimulation enhances feelings of pleasure and satisfaction. It also increases cravings and is involved in addiction.

Serotonin: Serotonin stimulation elevates mood and enhances feelings of wellbeing.

Some neurotransmitters are blocked or experience reduced activity:

Glutamate: Reduced glutamate activity impairs memory, alertness, and sleep. It can also cause blackouts.

Endocannabinoids: Endocannabinoids act on the same brain areas as the chemicals in marijuana. Reduced endocannabinoid activity impairs posture, movement, gait, and logical thinking.

How Much is Too Much?

Binge drinking

For women: consuming at least 4 drinks at a time.
For men: consuming at least 5 drinks at a time.

Heavy drinking

For women: consuming at least 8 drinks per week.
For men: consuming at least 15 drinks per week.

For pregnant women and people younger than 21 years, consuming any amount of alcohol is considered excessive drinking.

How Much is One Standard Drink in the US?

One standard drink in the US is equal to:

  • 12-ounces of regular beer (5% alcohol content or alc)
  • 8-ounces of malt liquor (7% alc)
  • 5-ounces of wine (12% alc)
  • 1.5-ounces of distilled spirits or liquor (40% alc), such as gin, rum, vodka, or whiskey

Health Risks of Alcohol Use

Binge drinking and heavy drinking have detrimental health effects, both in the short term and long term. Alcohol affects every major organ in the body. It also increases the risk of some cancers.

Short-term Effects

Increased risk of road traffic injuries, injuries from falls, and burns

Increased likelihood of engaging in violent activities (examples: homicide, suicide, sexual assault, and domestic violence)

Overdose or poisoning (poisoning occurs when there is excessive consumption over a short time. In 2017, alcohol-induced causes, including alcohol poisoning, led to 35,823 deaths)8

Engaging in high-risk sexual behaviors (examples: unprotected intercourse or sex with more than one partner. These behaviors increase the odds of unplanned pregnancy and contracting sexually transmitted infections, HIV, and hepatitis.)

Pregnancy loss or irreversible damage to the baby due to substance use during pregnancy

Long-Term Effects

Prolonged use of alcohol can increase the risk of many long-term diseases/conditions, such as:

High blood pressure

Abnormal heart rhythms


Liver disease (death rates involving alcohol-induced liver disease increased by over 40% from 4.1 per 100,000 in 2006 to 5.9 per 100,000 in 2016.9 In 2015, almost half of all 78,529 liver disease deaths among individuals ages 12 and older involved alcohol.5

Pancreatitis (inflamation of the pancreas)

Digestive disorders

Cancer of the breast, mouth, throat, food pipe, liver, and intestines

Problems remembering or learning things



Weakened immune systems

Social problems

Over time, excessive use can cause tolerance and physical dependence. However, it is important to note that heavy/binge drinking is not considered an AUD.

Alcohol Withdrawal

Withdrawal causes many undesirable symptoms. These symptoms typically appear six hours after the last drink.

The signs and symptoms of withdrawal can include:10

Raised blood pressure

Rapid heart rate

Elevated body temperature 


Shaking hands

Increased pupil size

Mental confusion

Increased alertness



Inability to fall or stay asleep 



Increased irritability 

A false belief that someone is going to harm you

Delirium Tremens (DT)

Heavy and long-term drinking may result in seizures 6 to 48 hours after the last drink. There may be up to six seizure episodes within 6 hours. People with multiple seizures are at a higher risk of having delirium tremens (DT). DT is a potentially fatal form of alcohol withdrawal. It is common among people who have drunk heavily for ten or more years. The symptoms of DT usually appear 2 to 4 days after the last drink and include:

Severe confusion 



Sleep that can last longer than a day


Rapid mood changes


Increased sensitivity to light, sound, and touch


Excessive sleepiness

People experiencing DT require emergency medical care. Treatments can include large doses of sedative and (sometimes) the use of anesthetics to put the person to sleep.

Minor withdrawal symptoms such as sweating, digestive problems, and shaking can last for up to 48 hours. Most notably, some people may hallucinate within 12 to 24 hours after the last drink. Hallucinations cause a person to feel things that are not there. They usually last 24 hours to 6 days, but can (rarely) be experienced for over a month.

Is It Possible to Overdose on Alcohol?

An overdose or alcohol poisoning is a potentially fatal condition. It kills 6 people each day and 2,200 people each year in the US.11

An overdose occurs when the blood levels of alcohol become very high. Overdose is most likely when there is an excessive amount consumed over a short time. The risk of an overdose increases when mixed with opioids, sleeping pills, or illicit substances.

The symptoms of an overdose include:

  • Confusion
  • Fainting
  • Vomiting
  • Seizure
  • Slowed or irregular breathing
  • Slowed heart rate
  • Sweaty skin
  • Slowed or delayed responsess

The symptoms of severe poisoning can include:

  • Stopped breathing
  • A heart attack
  • Low body temperature
  • Choking
  • Lung infection if vomit enters the breathing tube
  • Severe dehydration
  • Pale or bluish skin color
  • Dangerously low blood glucose levels
  • Coma
  • Death

If an overdose has occurred, call a local emergency number or 911.

What is Alcohol Detox Like?

Detox or detoxification is the first stage of addiction treatment. It involves removing alcohol from the system. The body may experience mild to severe withdrawal symptoms during detox. The symptoms tend to be more severe if usage has been in large quantities over a long period of time.

Detox helps manage physical withdrawal symptoms. People who experience severe withdrawal symptoms require medical detoxification.

For mild to moderate withdrawal, doctors prefer treatment at an outpatient facility. A doctor first checks if a person has other co-occurring conditions, such as heart problems or bleeding in the digestive tract.

Treatment comprises injectable fluids and salts to maintain hydration. In people with severe brain disorders due to the lack of vitamin B1 (thiamin), a doctor may give multivitamins with glucose.

Severe withdrawal requires the use of injectable benzodiazepines, such as diazepam (Valium) or lorazepam (Ativan). Consultation with a toxicologist may be necessary if a person needs higher doses of benzodiazepines.

Other drugs that may be used to control seizures are propofol (Diprivan), ketamine (Ketalar), or dexmedetomidine (Precedex). Propofol is also used to treat recurrent delirium tremens. If a person is experiencing muscle spasms, a doctor may administer baclofen.

Detox usually lasts one week or longer, depending on the severity of the symptoms.

How to Stop Drinking

Recovering from alcohol addiction has a myriad of health and other benefits. However, many people who want to stop drinking do not know where to start. The journey to sobriety depends on many factors. For example,

Length of drinking history 

Amount of usage

Presence of co-occurring medical conditions

Abruptly stopping use can cause severe withdrawal in people who drink heavily. Thus, it is important to first talk to a doctor if there have been large amounts of use. A doctor will check for the presence of alcohol use disorders. If an AUD is diagnosed, medications will be administered to cope with withdrawal.

If a person drinks occasionally and wishes to quit, there are ways to reduce intake. The following tips can help.

Write it down: Find the reason for quitting, and write it down on paper.

Know the limits: Consume no more than 1 drink per day (for women) and 2 drinks per day (for men).

Celebrate alcohol-free days: Abstaining helps support understanding of the body’s relationship with substances. It is helpful to observe any thoughts and feelings during the dry days.

Identify triggers: Temptations are hard to resist. However, with regular practice, it may be possible to overcome temptations. Remember, quitting is a journey, and relapses are a part of it.

Seek help: Seeking help from people, such as family members, friends, doctors, or therapists, may help.

How to Test for AUD

Many screening tools for alcohol use disorder are available. A doctor, nurse, psychiatrist, or other healthcare professional can use these tools.

The three most commonly used tools are:


The CAGE uses 4 questions to help identify potential alcohol abuse.
C: Have you ever felt you should CUT DOWN on your drinking?
A: Have people ANNOYED you by criticizing your drinking?
G: Have you ever felt bad or GUILTY about your drinking?
E: EYE OPENER: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Two positive answers mean a positive result that requires further tests to confirm the diagnosis.


The TACE is designed to identify drinking problems in pregnant women.
T: TOLERANCE: How many drinks does it take to make you feel high?
A: Have people ANNOYED you by criticizing your drinking?
C: Have you ever felt you ought to CUT DOWN on your drinking?
E: EYE OPENER: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

The T question carries two points, while the remaining questions carry 1 point each. A score of 2 or more indicates a positive result.

Alcohol Use Disorders Identification Test (Audit)

The AUDIT helps identify problematic alcohol use in the past year.

The AUDIT consists of 10 questions. A score of 8+ indicates a drinking problem. The entire content of the AUDIT can be found online.

Treatments for Alcohol Use Disorder

Many treatments for alcohol use disorder are available. These include medications and talk therapies. Evidence suggests that a combination might be the best in most cases.

FDA-Approved Medications for AUD

Treatments involving FDA-approved medications last at least three months. The duration may vary depending on how the body responds. Nonetheless, most experts do not recommend drug treatments lasting longer than a year.

Disulfiram: Disulfiram (Antabuse tablet) blocks the breakdown of alcohol in the body. If a person drinks while taking disulfiram, they experience flushing, nausea, and heart palpitations. Each tablet contains 250 mg of disulfiram. The usual dose is two tablets at a time each day.

Naltrexone: Naltrexone blocks activity in specific brain areas. These areas regulate the rewarding effects associated with alcohol use. That way, naltrexone also reduces cravings. Two forms of the drug are available: oral tablets (Depade, ReVia) and injections (Vivitrol).

Acamprosate: Acamprosate (Campral) helps restore the healthy balance of GABA and glutamate in the body. That way, it helps relieve sleep problems, anxiety, and agitation. It is available in the form of oral tablets.

Non-FDA-Approved Medications

The effectiveness of other drugs, including baclofen for alcohol use disorder, is not well documented. If there are any queries about these drugs, talk to a doctor. Some of the non-FDA-approved medications used in AUD are nalmefene, topiramate, and gabapentin.

Non-Drug Therapies

These include talk therapies. They may be used alone or combined with medications. Some effective talk therapies for alcohol use disorder are:

Cognitive-behavioral therapy (CBT): CBT helps the client identify negative thought patterns associated with substance abuse. By recognizing and modifying these patterns, it may be possible to curb consumption. Some CBT approaches can help reduce the risk of relapses.

Motivational enhancement therapy (MET): MET aims to motivate a person to stick to treatment. There are 1 to 4 sessions with each session lasting about an hour. Studies show that MET can help support sobriety for a longer duration.

Alcohol behavioral couple therapy (ABCT): ABCT assumes that drinking behavior and intimate relationships are closely linked. The ABCT therapist helps a person identify their partner’s behaviors that may trigger drinking. The therapist also facilitates communication between the client and their partner. The couple attends a weekly session on an outpatient basis for 12 to 20 weeks.

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