Alcohol Addiction

Alcohol addiction is a common substance use disorder. While drinking is often considered socially acceptable (or even expected), too many people struggle to control how much or how often they drink. An evidence-based treatment plan can help you regain control.

Alcohol use disorder (AUD) is characterized by an impaired ability to control or stop alcohol intake, even when drinking causes social, occupational, or health problems. AUD is considered a brain disorder, as lasting changes caused by drinking perpetuate the situation and make relapse more likely. [2]

Key Information About Alcohol Use Disorder

Is Alcohol Addiction Considered a Disease?

The American Society of Addiction Medicine defines addiction as a treatable, chronic medical disease.[19] People who abuse substances for long periods have altered brain chemistry and can engage in compulsive behaviors as a result.

AUD comes by many names, including alcohol abuse, alcohol dependence, and alcoholism. It’s considered a brain disorder that can be mild, moderate, or severe.[1]

How Many People Are Affected by Alcohol Use Disorder?

Per the 2021 National Survey on Drug Use and Health, 29.5 million Americans 12 and older have AUD. People of all races and ethnicities can develop AUD, but the problem is most common in American Indian or Alaska Native populations. Among people 12 and older, 15.6% of people in this group had an AUD.[4]

Top Reasons People Start Drinking Alcohol 

Alcoholism begins with the decision to drink. For some people, that introduction is enough to trigger a lifetime of struggle to control how much—and how often—they consume alcohol.

These are common reasons people start drinking alcohol:

Experimentation 

Three-quarters of Americans started drinking alcohol before reaching age 21. Most took the first sip in a party situation.[8]

Alcohol-fueled parties are common on college campuses and at university functions. And some high school students throw rowdy parties when their parents are away. If alcohol is free and everyone else is drinking, it’s hard to say no. 

Stress Relief

Alcohol is a sedating drug capable of slowing electrical activity within the brain. People under stress from work, school, relationships, or parenting may reach for alcohol to slow their thoughts and relax. Drinking is a common coping strategy for stress, and the more stressed people are, the more they tend to drink.[21]

Break From Reality 

People who drink may have an out-of-body experience in which their daily worries no longer matter, and their future isn’t worth fighting for. Drinking heavily can bring about this state. 

Pleasure

Alcohol works directly on parts of your brain that help you feel happy, relaxed, and connected.[22] While you’re drinking, you may feel tingling happiness that stems directly from the drug’s effects on your brain.

Trauma

Surviving trauma can lead to alcohol use problems. Researchers say up to a third of people who live through accidents, illnesses, or disasters report drinking problems later in life. Drinking can ease the impact of difficult memories.[9]

Self-medication

People with mood and anxiety disorders often treat their conditions with alcohol.[23] The drug can help them feel happy and relaxed while they’re intoxicated, but uncomfortable mental health symptoms can return when the high wears off.

Loneliness

During COVID-19 lockdowns, researchers identified a link between loneliness and increased alcohol consumption. In particular, people who once had strong social connections and lost them are more likely to drink more than they did before.[10]

Emotional Management 

Researchers say people often use alcohol to ease “negative affective states.” In other words, they drink to reduce feelings of shame, inadequacy, fear, shyness, or depression. Unfortunately, people like this often feel even worse when alcohol wears off, so the cycle repeats.[11]

Causes of Alcohol Addiction

AUD is personal, and everyone who develops the problem faces unique problems, triggers, and challenges. These are some of the issues that could increase AUD risks: 

Biological Factors 

Alcohol use disorders tend to run in families. Alcohol abuse and genetics can intertwine in interesting ways. 

Some genes make alcohol more rewarding, so you’re likely to drink more. And some genes work in the opposite manner, helping to ensure people don’t drink frequently. 

Environmental Factors 

Easy access to alcohol can make AUD more likely. If you grow up in a home where parents both keep alcohol and drink often, you may start drinking earlier in life. And you may find it’s easy to steal alcohol for personal consumption. 

Social Factors 

Spending time with people who drink can normalize alcohol abuse. Similarly, attending many parties fueled by alcohol can allow for binge drinking. If your peers don’t drink or host alcohol-fueled parties, you may be less likely to drink. 

Psychological Factors 

Every life is filled with challenges, and some people lean on alcohol to solve them. Underlying conditions like depression and anxiety can make using alcohol even more dangerous and lead to an AUD in time. 

Recognizing Drinking Habits & Alcohol Abuse

The World Health Organization uses a 10-item questionnaire (the alcohol use disorders identification test or AUDIT) to help doctors screen for AUD. It contains questions such as the following:[12]

• Have you or someone else been injured because of your drinking?
• How often do you have six or more drinks on one occasion? 
• How many alcoholic beverages do you have on a typical drinking day?
• How often do you drink alcohol?
• How often have you felt guilt or remorse after drinking?

Reviewing all of the questions on AUDIT could help you recognize signs of a drinking problem in yourself or someone else. 

Symptoms of Alcohol Addiction 

AUD causes problems in almost every part of your life. Common symptoms can be split into the following categories: 

Physical 

Alcohol is a sedative drug. When people are intoxicated, and those with AUD often are, these symptoms are common:

• Floppy muscles
• Lack of coordination 
• Slurred speech 
• Vomiting (at high doses)
• Slowed breathing (at high doses) 

Between doses, people with AUD can develop signs of withdrawal. Their hands and feet may shake, and the symptoms may only fade when people drink again. 

Mental 

Alcohol slows electrical activity within the brain. When it wears off, that electrical impulse can return and intensify. Some people develop anxiety and nervousness when they’re sober. 

Deep cravings for alcohol are also part of AUD. People may struggle with overwhelming urges to drink when they’re faced with triggers like the sound of ice in a glass or a bottle opening. 

Behavioral 

While alcohol is a legal substance, excess drinking can lead to significant problems. People with AUD may face legal action if they drink while driving or engage in alcohol-fueled outbursts in public. 

AUD can also impair a person’s ability to hold down a job, maintain a relationship, or raise children. 

Comparing Symptoms of AUD by Type

How Addictive Is Alcohol?

Alcohol is a powerful drug that produces pleasurable feelings and reduces negative thoughts. This combination of changes, caused by alcohol’s qualities, can make people keep drinking even when they don’t want to do so. [1]

“Heavy drinking can cause physiological changes that make more drinking the only way to avoid discomfort. Individuals with alcohol dependence may drink partly to reduce or avoid withdrawal symptoms.”[13]

Understanding the Typical Stages of Alcohol Addiction

AUD begins with the choice to drink, and it progresses through a series of understandable and predictable steps. Understanding what they are can help you appreciate how it works and the associated dangers. 

Testing & Social Drinking

Consider this the first stage of alcohol addiction. People make the choice to pick up and drink the first alcoholic substance of their lives. Some repeat the action right away, while others need months or even years of regular drinking to progress to the next step. 

Tolerance

Alcohol tolerance means people can drink more alcohol without feeling inebriated. Experts say tolerance encourages excessive alcohol consumption, leading to organ damage and increased negative consequences (like job loss). [13]

Dependence

People with alcohol dependence cannot stop drinking, or reduce how much they drink, without experiencing negative consequences like shaking, hallucinations, or deep cravings. People at this stage may want to stop drinking, but they feel so unwell when they try that they have no choice. 

Addiction

Alcohol addiction involves a combination of physical and mental symptoms. People at this stage are dependent, so they can’t quit without feeling sick. But they have routines and schedules developed around alcohol, so they may feel like they have their drinking under control.

Withdrawal 

People with AUD may attempt to quit drinking and develop alcohol withdrawal syndrome. This is a life-threatening complication involving seizures, hallucinations, and cardiac problems. Alcohol withdrawal timelines can vary, but most people experience issues for several days. Medical help is needed to safely stop drinking at this stage.

Health Impact of Alcohol Abuse 

Alcohol is hard on almost every system. Alcohol’s effect on the body can be split into short-term and long-term impacts. Know that alcohol’s impact on your health can’t always be reversed. 

Short-Term Impact

Short-term problems may include the following:

• Alcohol poisoning, which can lead to hospitalization or death
• Increased symptoms of mental illness, including depression and anxiety
• Stomach and digestive discomfort
• Weight gain and increased risk of diabetes
• Increased susceptibility to trauma, including from accidents or assaults.
• Possible allergic reactions to drinking alcohol

Long-Term Impact

Problems with excessive drinking over a long time can cause long-term health effects like these:

• Liver damage: Alcohol is filtered through the liver, which can cause alcoholic liver disease. Various forms of damage to this organ include fatty liver disease, fibrosis, liver cancer, cirrhosis, and alcoholic hepatitis.
• Heart problems: Excessive alcohol consumption damages the heart and circulatory system. This can cause cardiomyopathy (disease of the heart muscle), irregular heartbeat, high blood pressure, high cholesterol, and increased risk of blood clots, leading to stroke or pulmonary embolism.
• Cancer: Alcohol abuse increases the risk of cancer in the liver, mouth, throat, larynx, esophagus, colon, and rectum. AUD increases the risk of breast cancer in women. Alcohol and cancer are closely linked. 
• Brain: Alcohol has a toxic effect on the central nervous system. Drinking too much can increase the risk of mental health problems, and it can also cause acquired brain injury or alcohol-related brain impairment (ARBI). Alcohol-related brain damage can lead to Wernicke-Korsakoff syndrome (sometimes called wet brain syndrome). 

Alcohol Abuse & Mixing Other Substances 

Many people combine alcohol with other substances, mixing them and taking them at the same time. Combining drugs in this manner is incredibly dangerous, especially when alcohol is used with other sedating drugs. 

Learn more about the dangers of mixing alcohol with other substances through these resources:

• Mixing Alcohol & Weed
• Mixing Alcohol & Caffeine
• Mixing Alcohol & Ambien
• Mixing Alcohol & Klonopin
• Mixing Alcohol & Ativan

What to Do When Someone Needs Help

Alcoholism is a lonely disease. People may want to quit drinking but don’t know how to get started. You could provide help and support at a crucial time and help the person to get help.

Follow this advice from the National Institute on Aging to get started:[20]

1. Talk to the person when they are sober.
2. Express your concerns about drinking, including facts about the dangers of alcohol.
3. Offer your help in finding a treatment center.
4. If the person won’t go to treatment, consider suggesting a support group meeting.
5. Be persistent, as the first conversation may not be enough to prompt the person to make changes.

Caring for someone with alcoholism can be challenging, so don’t forget to care for yourself. Eat right, exercise, get enough sleep, and reach out to your support system. Your self-care routine will ensure you’re strong enough to help the person you love when the time is right.

Evidence-based Treatment for Alcohol Addiction 

You cannot overcome alcohol addiction alone. Fortunately, medical science has developed an effective approach to treating substance use disorders like AUD. Alcohol treatment options can help you get sober safely. 

Here is what you can expect from an evidence-based recovery program:

Medical Detox 

The first step to overcoming AUD is detoxing from alcohol. If you struggle with mild or moderate alcohol addiction, the program you enter may support your mental health and offer complementary treatments as you go through withdrawal, which can take a little over a week.

Once you have safely overcome withdrawal with therapeutic support, you may receive a prescription for either acamprosate or naltrexone. These medications can reduce your cravings for alcohol. If you relapse and drink, the medications will also reduce the effectiveness of alcohol, so you will not receive the same pleasure from drinking. These maintenance medications can help you move into the next step in treatment.

If you have severe AUD, you might be at risk of developing a severe type of withdrawal syndrome called delirium tremens, so a doctor may prescribe regulated doses of a benzodiazepine like Valium to help with detox. 

Benzodiazepines work in a similar part of the brain as alcohol. When a doctor monitors your symptoms to taper the dose, many people avoid seizures, hallucinations, high fever, and other symptoms of DTs.

Due to this risk, the dangers of quitting cold turkey are severe. No one should try this method. Always consult a medical professional before you attempt to stop drinking.

Rehabilitation

Every good rehabilitation program is built on talk therapy. Modern programs typically offer cognitive behavioral therapy (CBT) sessions in group and individual forms. You may also attend dialectical behavior therapy (DBT), which is related to CBT in addition to art therapy, nutritional therapy, physical and occupational therapy, family therapy, and motivational enhancement therapy (MET). 

Talking through potential triggers for substance abuse, like work stress or family trauma, can help you understand when these issues arise. You can then find new approaches to safely manage these feelings. You can also find new hobbies that can replace alcohol use.

You can use residential rehab or outpatient treatment to complete this step. 

Aftercare

Once you complete your rehabilitation program, you will be encouraged to develop an aftercare plan, which can support your ongoing recovery and health. This may include a list of people to call if you are worried about relapsing, a daily list of activities, information on support groups in your area, and other resources.

Once you leave the protective setting of a rehabilitation program, you are more likely to encounter triggers to begin drinking again. Developing a support system for yourself can help you stay focused on your recovery.

Although people who struggle with substance use disorders, including alcohol addiction, are at risk of relapsing, many people overcome AUD and live in sobriety for the rest of their lives. A combination of medication, mutual support groups, therapy, and supportive friends and family can help you return to a balanced, healthy life.

Support Resources for Alcohol Addiction

Several organizations offer advice and support for people hoping to learn more about AUD recovery:

• Alcoholics Anonymous: You can learn from peers who are also dealing with AUD in these free meetings. 
• Al-Anon: This group is focused on providing support to people whose loved ones are dealing with AUD. 
• American Society of Addiction Medicine: This organization conducts research on how alcoholism develops and how it can be addressed. 
• National Institute on Drug Abuse: Tap into research on how addictions work and are treated. 
• National Institutes of Mental Health: Read studies about how addictions develop and how they can co-exist with mental health issues like depression. 
• National Institute on Alcohol Abuse and Alcoholism: This organization supports alcohol research and publishes the results in commonsense language. 
• Secular Organization for Sobriety: Like Alcoholics Anonymous, Secular Organizations for Sobriety offers support groups for people hoping to find a life in recovery. It doesn’t have a religious foundation, like AA does. 
• SMART Recovery: This secular support group for people with addiction can help you understand what a life in recovery might look like. 
• Substance Abuse and Mental Health Services Administration: Use this free tool to find treatment centers in your area. 
• Women for Sobriety: This organization offers support group meetings for women struggling with addiction, including alcoholism. 

Frequently Asked Questions About Alcoholism 

We’ve compiled some of the most common questions about alcohol addiction. 

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More