What is alcohol use disorder?

Alcohol use disorder can develop very quickly or happen gradually over years.

In the beginning, your drinking might not seem to be any different from the way other people drink. You may drink only with friends or at parties. It may stay like this, or you may start to drink more. Your drinking might become a way for you to feel normal or to cope with life's problems.

You might think that you can quit drinking at any time. Many people who have alcohol use disorder quit for days, weeks, or even months before they start to drink again. But unless you can consistently keep your drinking under control and not fall back into unhealthy patterns, you need help.

The physical signs of alcohol use disorder can be vague in the early stages of the disease. Some early symptoms include:

• Blackouts, which cause you to not remember what happened when you were drinking. Blackouts aren't the same as passing out. Passing out means that you lose consciousness. You don't pass out when you have an alcohol blackout. But you do lose your memories of the event.
• Accidents and illnesses you can't explain. You might have new physical problems, such as stomach cramps. Or another health problem may get worse.

As alcohol use disorder gets worse, physical symptoms of long-term heavy drinking can develop. You may:

• Not feel hungry, not eat well, and lose weight.
• Notice tiny blood vessels on your skin that look like spider webs (spider angiomas).
• See swelling or redness of the palms of your hands.
• Have redness on your face, especially your nose and cheeks.
• Keep getting infections and skin sores (abscesses).
• Have less interest in sex. You might also notice shrinkage of the testicles and impotence.
• Have a sore or upset stomach (gastritis).
• Feel numbness and tingling in your feet or hands.
• Be unsteady when on your feet.
• Have liver problems, such as cirrhosis.

Getting help is up to you. But you don't have to do it alone. There are many people and kinds of treatments that can help.

Treatment for alcohol use disorder can include:

• Group therapy, one or more types of counseling, and alcohol education.
• Medicines that help to:
  • Reduce withdrawal symptoms and help you safely stop drinking.
  • Reduce cravings for alcohol.
• Support groups. These groups include Alcoholics Anonymous and SMART Recovery (Self-Management and Recovery Training).

Some people are able to stop or cut back on drinking with help from a counselor. People who have moderate to severe alcohol use disorder may need medical treatment. They may need to stay in a hospital or treatment center.

You may have a treatment team to help you. This team may include a psychologist or psychiatrist, counselors, doctors, social workers, nurses, and a case manager. A case manager helps plan and manage your treatment.

There are a few types of treatment programs for alcohol use disorder. They are:

• Outpatient treatment. You regularly go to a mental health clinic, counselor's office, hospital clinic, or local health department for treatment.
• Inpatient treatment. You stay at a facility and have treatment during the day or evening. This usually lasts several weeks. You most likely will then go to outpatient treatment.
• Residential treatment. You live at the facility while you recover. These programs may last for months. This may be a good option if you have a long history of alcohol or drug use, have a difficult home situation, or have limited social support.

Your doctor can help you decide which program is best for you.

Alcohol use disorder may be diagnosed at a routine doctor visit or when you see your doctor for another problem.

Your doctor will ask questions about your symptoms and past health and will do a physical exam. Your doctor also may ask questions or do tests to look for health problems linked to alcohol, such as cirrhosis.

People who drink too much also may have mental health conditions. These may include depression, anxiety disorders, or post-traumatic stress disorder (PTSD). If you have alcohol use disorder and a mental health condition, it's called a dual diagnosis. A dual diagnosis can make treatment for alcohol use disorder harder.

If your doctor thinks you have a mental health condition, your doctor may do a mental health assessment.

Medicines can help treat alcohol use disorder.

Some medicines reduce withdrawal symptoms during detoxification. These include:

• Antianxiety medicines (benzodiazepines such as diazepam). They treat withdrawal symptoms such as delirium tremens (DTs).
• Seizure medicines. They reduce or stop severe withdrawal symptoms.

Other medicines help you stay sober during recovery. These include:

• Naltrexone. It interferes with the pleasure you get from drinking.
• Acamprosate. It may reduce your craving for alcohol.
• Disulfiram. It makes you sick to your stomach when you drink.
• Topiramate. It may help treat alcohol use disorder.

Along with medicine, you might need vitamins and supplements. Alcohol use can cause your body to become low in certain vitamins and minerals, especially thiamine (vitamin B1). You might need to take thiamine supplements to improve your nutrition during recovery. Thiamine helps prevent Wernicke-Korsakoff syndrome, which causes brain damage. You also might need supplements to help replace fluids and electrolytes.

Health professionals who diagnose and treat alcohol use disorder include:

• Family medicine doctors.
• General practitioners.
• Nurse practitioners.
• Physician assistants.
• Internists.
• Psychiatrists.
• Psychologists.

Other health professionals who can help with recovery include:

• Addiction psychiatrists, or other doctors who specialize in addiction medicine.
• Licensed mental health counselors.
• Social workers.

Certain things make alcohol use disorder more likely. These are called risk factors.

Risk factors that make you more likely to drink harmful amounts of alcohol include:

• Genes. There is often a family history of alcohol use disorder.
• Early use. The younger you were when you first started drinking alcohol, the higher your risk for alcohol use disorder later as an adult.
• Having a mental health condition or conditions. This could include depression, post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenia, and anxiety disorders.
• Use of other substances. This could include the use of tobacco or drugs or the misuse of prescription medicines.
• Environment. You may live in an area where alcohol is easy to get, people drink a lot, or heavy drinking is accepted as part of life.
• Friends. Your friends may influence you to drink by directly urging you to or by drinking when you're around them.
• Problems with others. You may be more likely to drink heavily when you are having problems in your family or with friends.
• Not having purpose or satisfaction in your life. If you have no activities that give you a sense of purpose, you may be more likely to drink too much.

Just because you have risk factors doesn't mean you'll develop alcohol use disorder. A person who has many risk factors won't always develop alcohol use disorder. And a person who has no risk factors can have alcohol use disorder.

Treatment for alcohol use disorder usually involves one or more types of counseling. These include:

• Individual and group therapy. This is where you talk about your recovery with a counselor or with other people who are trying to quit. You can get support from others who have struggled with alcohol.
• Cognitive behavioral therapy (CBT). You learn to change thoughts and actions that make you more likely to use alcohol. A counselor teaches you ways to deal with cravings and avoid going back to alcohol.
• Motivational interviewing (MI). You resolve mixed feelings about quitting and getting treatment. A counselor helps you find personal motivation to change.
• Motivational enhancement therapy (MET). It uses motivational interviewing to help you find motivation to quit. It usually lasts for 2 to 4 sessions.
• Brief intervention therapy. This provides feedback, advice, and goal-setting in very short counseling sessions.
• Couples and family therapy. It can help you become and stay sober and keep good relationships within your family.

You probably will feel relief and happiness when a person with alcohol use disorder decides to get help. But treatment and recovery mean changes in your life too. Your emotions may become more complicated. You may:

• Resent what the person did to you in the past.
• Not trust the person. You may not want to give the person the house key, the car key, or money. You also may feel guilty about not trusting the person.
• Find it hard to give up or share your family role. For example, if you took over child-rearing when your partner was drinking, you may resent your partner's becoming involved again. If you managed money, you may resent having to make shared decisions on how to spend money.
• Resent that the person is spending more time at meetings or with others in recovery than with you.
• Worry so much about relapse that you avoid anything that you think may upset the person. You also may resent this feeling.

It's okay to have these feelings. You've been through a difficult period of your life, and what happened isn't easy to forget. And it's not easy to forgive your loved one. Keep in mind that recovery is the road to a better life. And you can help your loved one get there.

You may find that talking to people who also have loved ones with alcohol use disorder helps your own recovery. Al-Anon and similar programs are for people with family members or friends with alcohol use disorder. Other support groups are specially designed for certain age groups, such as Alateen for teens.

These programs help you recover from the effects of being around someone who has alcohol use disorder. You also may try family therapy.

It's not clear why some people develop alcohol use disorder and others don't. It often runs in families (genetic). But drinking habits also are influenced by your environment and life situations, such as friends or stress levels.

Alcohol use disorder means that a person drinks alcohol even though it causes harm to themselves or others. It can range from mild to severe. The more symptoms of this disorder you have, the more severe it may be. People who have it may find it hard to control their use of alcohol.

People who have this disorder may argue with others about how much they're drinking. Their job may be affected because of drinking. They may drink when it's dangerous or illegal, such as when they drive. They also may have a strong need, or craving, to drink. They may feel like they must drink just to get by. Their drinking may increase their risk of getting hurt or being in a car crash.

Over time, drinking too much alcohol may cause health problems. These may include high blood pressure, liver problems, or problems with digestion.