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Alcohol use disorder

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 .

Alternative Names

Alcohol dependence; Alcohol abuse; Problem drinking; Drinking problem; Alcohol addiction

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

Drinking a lot of alcohol can put you at risk for alcohol problems if:

  • You are a man who has 15 or more drinks a week, or often have 5 or more drinks at a time
  • You are a woman who has 12 or more drinks a week, or often have 4 or more drinks at a time

One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.

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:

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

Symptoms

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

Symptoms 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 health care 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 cannot 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 hand. 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 health care 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 doctor. Talk with your health care 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 health care 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.

ALCOHOLICS ANONYMOUS (AA)

Alcoholics Anonymous is a self-help group of persons recovering from alcohol use. Meetings offer emotional support and specific steps toward recovery. The program is commonly called a "12-step" approach. There are local chapters throughout the U.S. AA offers help 24 hours a day.

AL-ANON

Family members of a person with an alcohol problem often benefit from talking with others. Al-Anon is a support group for people who are affected by another person's drinking problem.

Alateen provides support for teenage children of people with alcohol use disorder.

OTHER SUPPORT GROUPS

Several other support groups are available.

  • SMART recovery teaches ways to change thoughts and behaviors to help people recover from alcohol use disorder.
  • LifeRing recovery and Secular Organizations for Sobriety (SOS ) are two non-religious programs that offer support for people with alcohol use disorder.
  • Women for Sobriety is a self-help group just for women.
  • Moderation Management is a program for those who want to reduce how much they drink. It recommends abstinence for people who cannot do this.

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:

  • Bleeding in the digestive tract
  • Brain cell damage
  • A brain disorder called Wernicke-Korsakoff syndrome
  • Cancer of the esophagus, liver, colon, and other areas
  • Changes in the menstrual cycle
  • Delirium tremens (DTs)
  • Dementia and memory loss
  • Depression and suicide
  • Erectile dysfunction
  • Heart damage
  • High blood pressure
  • Inflammation of the pancreas (pancreatitis )
  • Liver disease, including cirrhosis
  • Nerve damage
  • Poor nutrition
  • Sleeping problems (insomnia)
  • Sexually transmitted infections (STIs)

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 .

When to Contact a Medical Professional

Talk with your doctor 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. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013.

Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. CDC Vital Signs: Alcohol Screening and Counseling. January 2014. Available at http://www.cdc.gov/vitalsigns/pdf/2014-01-vitalsigns.pdf . Accessed November 11, 2014.

National Institute on Alcohol Abuse and Alcoholism. Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5. November 2013. Available at  http://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf . Accessed November 11, 2014.

National Institute on Alcohol Abuse and Alcoholism. Alcohol Use Disorder. Available at http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders . Accessed November 11, 2014.

O'Connor PG. Alcohol abuse and dependence. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 32.

Sherin K, Seikel S. Alcohol use disorders. Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 49.

U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Available at http://www.uspreventiveservicestaskforce.org/uspstf12/alcmisuse/alcmisuserfinalrs.htm . Accessed November 11, 2014.

Updated: 2/9/2013

David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team. Editorial update 11/11/2014.


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