At Discovery Institute, our professionals have been helping people and their families to understand and overcome this medical condition for over 50 years, and we understand that recognizing the problem and asking for help are the first, and often hardest, steps.
What Is Alcohol Use Disorder?
Alcohol use disorder (AUD) is a chronic medical condition defined by a person showing a pattern of abusing alcohol that results in considerable distress or impairment and meets the criteria outlined in the DSM-5.[1] AUD can be classified on a spectrum from mild to severe and is diagnosed if a person meets two or more of the eleven criteria defined.[2] This includes signs such as the inability to cut back on alcohol use, continuing to drink despite negative consequences, tolerance, and withdrawal symptoms if drinking stops.
According to the National Institute on Alcoholism and Alcohol Abuse (NIAAA), there were approximately 21.5 million people in the United States who qualified as “binge drinkers” as of 2021.[3] Alcohol use disorder is significantly underdiagnosed because many people who suffer from it do not recognize the signs or do not believe that their drinking habits have crossed the line into alcoholism.
Alcohol Addiction and Abuse
Alcohol is such an addictive substance because of how continued use changes the brain’s reward system. Each time a person drinks alcohol, dopamine is released into the brain, creating feelings of relaxation, euphoria, or relief from stress. With continued use, the brain adjusts its natural production of dopamine and alters the sensitivity of its dopamine receptors.[4] This ultimately results in someone requiring larger quantities of alcohol to produce the same effects than they required when they started drinking. This is how tolerance develops.
As alcohol usage progresses, someone might experience withdrawal symptoms when they are not drinking. This drives them to continue drinking, not just to feel “good,” but to feel “normal.” Binge drinking and drinking heavily create the greatest risk factors for developing an alcohol use disorder, although people who do not drink daily may develop an alcohol use disorder as well.[5] In addition, if a person has a significant family history of alcohol use disorder, started drinking at a young age, has a history of trauma, or has mental health issues like depression or anxiety, this also increases the likelihood of developing an alcohol use disorder.[6]
Signs and Symptoms of Alcoholism
Symptoms of alcoholism may not always be obvious, especially during the initial stages. Many people with alcohol use disorder can manage to hold down jobs, maintain personal relationships, and function in society, while their alcohol consumption quietly escalates. Knowing how to identify warning signs in yourself or a loved one is key to getting help before developing long-term problems.
Common behavioral symptoms of AUD include:
- Drinking more or for a longer period than intended.
- Making multiple failed attempts to reduce or stop alcohol consumption altogether.
- Consuming excessive amounts of time in drinking or recovering from its effects.
- Choosing to forego previously enjoyable activities, hobbies, or obligations in order to continue drinking.
- Continuing to consume alcohol despite the negative effects it has caused to your job, relationships, or health.
- Consuming alcohol in unsafe situations, such as drinking and driving.
- Consistent, strong cravings to drink that are difficult to restrain.
- Developing a need to consume larger amounts of alcohol in order to achieve the same effects.
Physical signs of alcoholism include:
- Having blackouts or memory gaps after drinking
- Tremors or shaking, especially when waking up or when alcohol is not available
- Flushed skin and broken capillaries, especially around the face
- Unexplained changes in body weight or continual poor nutrition.
- Bloodshot or glassy eyes.
- Poor hygiene or personal appearance, such as a lack of grooming or clean clothing.
- Lack of coordination and decreased reflexes.
- Mood swings, irritability, or anxiety, and suddenly improving those feelings once alcohol is consumed.
Alcohol withdrawal is one of the most serious medical complications of alcohol dependence. Unlike withdrawal from most other substances, alcohol withdrawal can be life-threatening.[7] Symptoms range from anxiety, sweating, and insomnia in mild withdrawal cases to seizures and delirium tremens in severe cases. Medically supervised withdrawal is vital to preventing life-threatening complications.
Characteristics of Alcoholism
In addition to meeting the clinical diagnostic criteria, there are some common patterns of thought and behavior characteristic of people diagnosed with AUD. Below are a few:
- Denial: Refusing to believe they have a drinking problem, even with evidence contrary to their belief
- Minimizing: Downplaying either the amount consumed or the frequency of their drinking when confronted
- Secretive Behavior: Drinking alone or secretly to avoid scrutiny from others
- Broken Promises: Promising to reduce consumption and not keeping those promises
- Coping: Using alcohol as the primary method of coping with stress or negative emotions
- Preoccupation: Anxiety or restlessness when alcohol is not available
- Prioritization: Putting alcohol above personal values, responsibilities, or relationships
- Shame: Feeling guilt or shame about their drinking, yet being unable to stop
These identified characteristics are a result of the neurobiological impact that alcohol has on a person’s behavior and thought patterns, not a moral failing or character flaw. Addiction is a medical condition that deserves the right treatment, not judgment.
Why Do Some People Become Alcoholics?
People drink for many reasons, including relieving stress, socializing with friends, numbing anxiety, or simply because alcohol is part of their daily routine.
But whether or not a person becomes addicted to alcohol is influenced by many factors that they have no control over. The NIAAA reports that approximately 60% of the risk for developing an alcohol use disorder is attributed to genetic predisposition.[8] If you have a parent or sibling with an AUD, your chance of struggling with alcoholism increases significantly.
Mental health disorders, namely depression, anxiety, post-traumatic stress disorder (PTSD), and past trauma, are also common and often found in conjunction with alcohol use disorder since many people drink to temporarily alleviate symptoms from these undiagnosed or undertreated conditions. The age at which you first start drinking also plays a role. If you start drinking at an early age, you will have a significantly higher chance of becoming addicted to alcohol later in life.[9]
The Stages of Alcoholism
Alcoholism typically develops gradually, with patterns worsening over time, though the progression of the condition and the symptoms presented will vary from person to person.[10] Below is a description of what each stage might look like:
- Early Stages: This is when a person develops tolerance and begins drinking more frequently and in increasing amounts, often using alcohol to relax or manage stress. At this point, the consequences are not as severe, and the person usually does not see their drinking as a problem.
- Middle Stage: This stage is marked by the deepening of physical and psychological dependence. Withdrawal symptoms may appear, drinking starts to interfere with work and relationships, and attempts to stop are unsuccessful.
- Late Stage: Alcohol becomes necessary to function. There is a marked increase in the severity of physical consequences, including liver damage, cardiovascular problems, and neurological impairment. Employment and relationships are significantly affected. Withdrawal is riskiest at this stage.
- Recovery Stage: Recovery is possible at any stage of alcoholism, with better outcomes the earlier treatment is started. Even the most severe cases see improvement with the right treatment plan and support.
Alcohol Addiction Treatment at Discovery Institute
Discovery Institute offers comprehensive alcohol-related addiction treatment that is customized for each person who walks through our doors. Our programs address the physical dependence on alcohol while also addressing any underlying mental health conditions, history of trauma, and other behavioral issues that drive alcohol use.
