Alcohol Use Disorder: Signs, Withdrawal, and When to Get Help

Alcohol use disorder (AUD) is a common medical condition that can happen to anyone, not a choice or a character flaw, and most people who have it recover or markedly improve [1]. Treatment and support are available to help people cut down or stop drinking [2].

What Is Alcohol Use Disorder?

AUD means drinking alcohol in a way that is harmful [2]. It is a medical condition in which the ability to stop or control drinking is impaired, even when drinking is causing social, work or health problems [3]. The term covers what people have called alcohol abuse, alcohol dependence, alcohol addiction and alcoholism [3], although some people find some of these words stigmatising [4]. AUD is considered a brain disorder, and it can be mild, moderate or severe [3]. You do not have to drink a certain amount, or drink all the time, to be dependent on alcohol [4].

Heavy Drinking Is Not Always AUD

In the US, the CDC counts binge drinking, heavy drinking, and any drinking during pregnancy or by people younger than 21 as excessive drinking [5]. Binge drinking means four or more drinks on one occasion for women, or five or more for men, and heavy drinking means eight or more drinks a week for women, or 15 or more for men [5]. One beverage might contain more than one standard drink of alcohol [5].

Most people who drink excessively do not have AUD [5], and many of them can lower their drinking without specialized medical treatment [5][6]. The NHS warns: "It can be very dangerous to stop drinking suddenly if you're dependent on alcohol. If you get withdrawal symptoms, get medical help before you try to stop drinking." [2]

How Common Is Alcohol Use Disorder?

Worldwide, an estimated 400 million people aged 15 and older, 7% of that age group, lived with alcohol use disorders in 2019, and 209 million people, 3.7% of the adult world population, lived with alcohol dependence [7]. In the UK, around 1 in 100 adults are dependent on alcohol [4]. In the US, national surveys show that millions of Americans have AUD [3].

Access to treatment for alcohol use disorders remains very low [7]. In countries where data are available, the share of people with alcohol use disorders in contact with treatment services ranges from less than 1% to no more than 14% [7].

Signs of Alcohol Use Disorder

The main signs are:

• regularly drinking more than you mean to [2]
• difficulty stopping or cutting down, even if you want to [2], and struggling to control how much you drink [4]
• a strong urge to drink [4], such as craving a drink when you wake up in the morning [2]
• carrying on drinking even when it is causing problems for your health, work or relationships [2][4]
• needing more, or stronger, alcohol to get the same effect [2][4]
• getting withdrawal symptoms when you stop or cut down [2][4]
• feeling guilty or remorseful after drinking [2]
• people you know being concerned about your drinking [2]

Warning Signs That Are Easy to Miss

Not getting hangovers is not necessarily a good thing. It can be a sign that your body has got used to you drinking a lot, and might mean that you have become dependent on alcohol [4]. A blackout, when you cannot remember what happened while you were drunk, is a warning that you are drinking too much, and an early sign that alcohol is damaging your brain and that you might be dependent [4].

Questions a Health Professional May Ask

In the US, a health care provider might ask whether, in the past year, you have [3]:

• ended up drinking more, or for longer, than you intended
• more than once wanted or tried to cut down or stop, but could not
• spent a lot of time drinking, being sick from drinking, or getting over the aftereffects
• wanted a drink so badly that you could not think of anything else
• found that drinking, or being sick from drinking, often got in the way of looking after your home or family, your job, or school
• kept drinking even though it was causing trouble with family or friends
• given up or cut back on activities that mattered to you so that you could drink
• more than once got into situations while or after drinking that made you more likely to get hurt, such as driving or swimming
• kept drinking even though it made you feel depressed or anxious, added to another health problem, or followed a memory blackout
• needed much more alcohol to get the effect you want, or found your usual amount had much less effect
• had withdrawal symptoms as the alcohol wore off, such as trouble sleeping, shakiness, restlessness, nausea, sweating or a racing heart, or sensed things that were not there

Severity is based on how many of these apply: two to three is mild, four to five is moderate and six or more is severe [3]. Any of them may be a cause for concern, and the more there are, the more urgent the need for change [1][3]. A health care provider can look at the number, pattern and severity of symptoms to see whether AUD is present [1].

Who Is More Likely to Develop It?

The risk depends partly on how much, how often and how quickly a person drinks [3]. Other things that raise the risk include [3]:

• Starting young. Among people aged 26 and older, those who began drinking before age 15 were more likely to report AUD in the past year than those who waited until 21 or later.
• Genes and family. Genetics play a role, with heritability accounting for approximately 60%, but the risk is shaped by the interplay between a person's genes and their environment. Parents' drinking patterns may also influence whether a child later develops AUD.
• Mental health and trauma. Conditions such as depression, post-traumatic stress disorder and attention deficit hyperactivity disorder occur alongside AUD and are linked with a higher risk of it. People with a history of childhood trauma are also vulnerable.

Alcohol, Depression, Anxiety and Suicide Risk

Drinking is linked with mental health conditions such as depression and anxiety [2][5][7]. Alcohol affects the chemistry of the brain, raising the risk of depression, panic disorder and impulsive behaviour, and it can increase the risk of self-harm and suicide [4]. If you already have a mental health problem or a diagnosed mental illness, drinking can make it much worse [4]. People with a mental health problem might drink to try to feel better, but this can have the opposite effect [4].

Cutting down or stopping generally has a positive effect on mental health. If drinking has been making you feel bad, you might start to feel better physically and mentally after a few weeks without alcohol, although the relationship between alcohol and mental health is complicated, especially for people who have been through trauma [4]. If you have struggled to stop, or alcohol is making your mental health worse, talk to your GP [4].

Other Effects on Health and Daily Life

Drinking too much on one occasion can lead to serious accidents or injuries and to alcohol poisoning [2][5]. Over time, harmful drinking can bring family and relationship problems and trouble at work [5][7], as well as financial problems and unemployment [7]. No level of drinking is completely free of risk [4][7].

Heavy drinking can also damage the brain [2][4]. Studies suggest that as many as 3 in 10 people who are dependent on alcohol could have alcohol-related brain damage [4].

Alcohol Withdrawal: Why Stopping Suddenly Can Be Dangerous

Withdrawal symptoms after stopping or cutting down are a sign that the body has become dependent on alcohol [2]. They can include anxiety, difficulty sleeping, feeling or being sick, a racing heartbeat, sweating, shaking and seizures [2][4], as well as confusion and seeing, hearing or feeling things that are not there [2].

Timing estimates differ. The NHS says symptoms begin within 6 to 12 hours of the last drink and usually last 3 to 7 days, but some can last for a few months, especially in people who drink heavily [2]. RCPsych says alcohol withdrawal syndrome usually starts within one or two days of stopping and lasts for up to three days [4].

When someone who has been drinking heavily for a prolonged period of time suddenly stops, withdrawal can be potentially life-threatening [1][3]. Stopping quickly can be very dangerous for people who drink daily at high levels or have been drinking for a long time [4]. Delirium tremens (DTs) is a serious and dangerous complication of withdrawal, and there is always a risk that someone with it can die [4].

Getting medical help to plan a safe recovery is advised [1], and this help can be given at home or in hospital [2]. For more serious dependence, alcohol support services should assess whether you can stop drinking at home or should come into a specialist alcohol treatment centre [4].

Getting Help

In the UK, see a GP or an alcohol addiction support service if [2]:

• you are worried about your drinking
• you want help to stop drinking
• you get symptoms such as anxiety, difficulty sleeping, sweating or feeling and being sick when you try to stop
• you are worried about someone else's drinking

You can also refer yourself to a local alcohol service without a GP referral [4].

In the US, talking with a health care provider is an important first step if you have concerns about your drinking or are thinking about treatment [1][6]. A primary care provider can look at your drinking pattern, help put together a treatment plan and check your overall health [1]. CDC also points to a national helpline [6]:

• Use the Substance Abuse and Mental Health Services Administration (SAMHSA)'s National Helpline by calling 1-800-662-HELP (4357) to find help near you.

How It Is Diagnosed

A GP or alcohol service will ask about your drinking and how it is affecting your life [2]. A GP should ask how much and how often you drink, your history with alcohol, any other substance use disorders, and any other mental or physical health problems [4]. You may be asked to fill in a questionnaire about your symptoms, and you may be offered blood tests to check whether drinking is affecting your health [2].

Treatment and Support

One size does not fit all, and treatment can be outpatient, inpatient or both [3]. The aim is usually to stop drinking completely, especially for people who are dependent, but if you are not ready to stop, or just want to cut down, you will be supported to reduce your drinking to a safer level [2].

Treatment and support can include:

• Talking therapies. Options include cognitive behavioural therapy (CBT) [2][4] and social behaviour and network therapy [4], which help you understand why you drink and how drinking affects your behaviour and social life [4]. Behavioural treatments, also known as alcohol counselling or talk therapy, aim to change drinking behaviour [3].
• Mutual-support groups. These offer peer support for stopping or reducing drinking [3], and include Alcoholics Anonymous and SMART Recovery [1][2].
• Help with the rest of life. Support can cover relationships, employment and housing [2].

A doctor can also explain other treatment options.

Recovery and Setbacks

People with AUD can feel too embarrassed to talk about it, think they should be strong enough to handle it alone, or be concerned that others might think badly of them [1]. Yet research shows that most people who have alcohol problems are able to reduce their drinking or quit entirely [1].

Setbacks are common [1][4], including among people in treatment [3], and a return to drinking can be seen as a temporary setback on the way to full recovery rather than a failure [1].

Supporting Someone Who Drinks

If someone you know is dependent on alcohol, consider these steps [4]:

• Find out more about alcohol dependence, so you better understand the person and what you are both going through.
• Set your expectations. A return to drinking does not mean that they or you have failed, or that they will not be able to stop again in the future.
• Understand what you can and cannot do. The person has to want to stop or reduce their drinking, and there is only so much you can do to help them make that choice.
• Get support for yourself. Your GP can put you in touch with local organisations, and some groups support families and friends specifically.
• Stay safe. If someone else's drinking is putting you or someone you know in danger, speak to someone you trust.

While you help someone else, it is important to take care of yourself too, and to think about professional help for yourself if you develop symptoms of depression or anxiety [1]. Support for families and friends is available in the UK from Al-Anon UK, the SMART Recovery family and friends programme and Adfam [2], and in the US from Al-Anon Family Groups and SMART Recovery Family & Friends [1].

When to Get Urgent Help

In the UK

For severe withdrawal symptoms, the NHS says [2]:

Call 999 or go to A&E if:

You or someone else has severe withdrawal symptoms after stopping drinking alcohol, such as:

• shaking visibly
• being unusually restless, irritable or upset
• confusion (for example, not knowing what day it is)
• seeing, hearing, or feeling things that are not there
• having a seizure

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance [2].

For alcohol poisoning, the NHS says [8]:

Call 999 if:

• you think someone has alcohol poisoning
• you or someone else has had a seizure or fit
• someone has lost consciousness
• someone has stopped breathing

Do not drive yourself to A&E [8].

RCPsych gives these emergency lines [4]:

• If you think you or someone you know has alcohol poisoning, call 999 immediately.
• Delirium tremens is a medical emergency.
• Call 999 if you are in immediate danger
• If you or someone you know is showing signs of Wernicke's Encephalopathy, call 999 immediately.

Wernicke's encephalopathy is a type of alcohol-related brain damage [4]. RCPsych describes the signs [4]:

If you have Wernicke's Encephalopathy, one or more of the following three things might happen suddenly:

• you will become confused and disorientated, e.g not knowing where you are or what time it is
• you will become unsteady on your feet
• your eyes will move quickly from side to side (called 'nystagmus')

For urgent mental health help, the NHS says [9]:

Get advice from 111 or ask for an urgent GP appointment if:

• you need urgent help for your mental health

The NHS also lists a free listening service [9]:

• call 116 123 to talk to Samaritans

For a mental health emergency, the NHS says [9]:

Call 999 or go to A&E now if:

• someone's life is at risk - for example, they have seriously injured themselves or taken an overdose
• you do not feel you can keep yourself or someone else safe

In the US

For thoughts of suicide or emotional support, NIAAA lists [1]:

• 988 Suicide & Crisis Lifeline | Call or Text 988
• For TTY Users: Use your preferred relay service or dial 711, then 988.
• If you're thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States. Services are also available in Spanish.

Conclusion

Alcohol use disorder is a medical condition, not a personal failing, and treatment and support are available. If some of the signs sound familiar, for you or for someone close to you, a conversation with a GP or health care provider is a practical place to start, and if your body may have come to depend on alcohol, that conversation should come before you stop drinking.

Medical Disclaimer

This article is for general information and does not replace advice from a qualified health professional. If you think you need urgent medical care, get emergency help straight away.