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Alcohol use disorder (AUD)

Reviewed by Susan Radzilowski, MSW, LMSW, ACSW

Image of alcohol lined up behind a bar

Alcohol use disorder (AUD, informally known as “alcoholism”) is chronic, problematic drinking that continues despite its harmful effects on a person’s life. It’s both an addiction and a chronic illness with both genetic and environmental causes. People with AUD frequently keep drinking even as it damages their romantic relationships, families, friendships, and livelihood.

Although AUD is the most well-known drinking issue, it’s not the only one. Many people have problems with alcohol, such as binge drinking and heavy drinking, that fall short of alcohol use disorder but still interfere with their daily lives.

“Alcoholism” and “alcohol addiction” both refer to having symptoms of addiction (cravings, withdrawal, and so on) in your relationship with alcohol. 

However, you won’t find “alcoholism” or “alcohol addiction” as diagnoses in the American Psychiatric Association’s diagnostic manual, the DSM-5. Instead, both terms fall under the diagnosis of “alcohol use disorder.” AUD includes a variety of alcohol-related conditions, including alcohol abuse and alcohol dependence. “Alcohol dependence” is another way to refer to alcohol addiction.

Is AUD a substance addiction or a behavioral addiction?

Contrary to popular belief, alcohol dependence isn’t only a substance addiction—it’s also a behavioral addiction. In social settings, someone with AUD may feel compelled to drink because drinking is so strongly associated with gatherings and socializing. Just like substance addictions, behavioral addictions can have large, negative consequences in your life.

If you have a substance addiction, you can’t control your use of either drugs or alcohol because you get some form of pleasure from it. With a behavioral addiction, you get the same kind of pleasure from repeating patterns of behavior that become destructive. Addiction—whether it’s to a behavior or to a substance—has many characteristics, most notably tolerance and withdrawal symptoms.

Some common behavioral addictions include gambling, sex, shopping, playing video games, working, and eating. When these types of behaviors become destructive and you struggle to manage them, it’s an addiction.

Excessive drinking vs. normal drinking

Drinking in moderation can be perfectly healthy and normal. A lot of us can have a beer or glass of wine with dinner, or enjoy an occasional cocktail. But many people struggle to drink in moderation, or they have a relationship with alcohol that’s defined by unhealthy choices.

When we drink more than recommended, we can develop an “excessive drinking” pattern. There are two types of excessive drinking: binge drinking and heavy drinking.1 Both of these kinds of alcohol abuse can have negative health consequences.

Binge drinking

Binge drinking is consuming a large number of drinks in a short period of time. It often happens in social settings: parties, bars or clubs, and weddings or other big events. The Centers for Disease Control and Prevention (CDC) defines binge drinking as having either four or more or five or more drinks on a single occasion, depending on your gender.2

The goal of binge drinking is usually intoxication. This isn’t a sign of AUD by itself, but it can be a sign that you’re beginning to have a problem that could escalate to the level of dependence.

While celebrations often play a role in binge drinking, some people engage in it to self-medicate mental health disorders. People with depression, anxiety, or other common conditions may find a brief sense of relief in alcohol or other drugs, but it’s an unhealthy way of coping that usually leads to more problems.

In 2021, 23.3% of Americans age 18 or older reported binge drinking in the past month—and among young people ages 12 to 20, over 90% of alcohol use qualified as bingeing.3, 4

What’s considered a normal amount of drinking?

To make healthy choices, it helps to understand the amount of alcohol in a standard drink. One serving of alcohol means 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor. These standard servings have a roughly equal amount of alcohol. However, it’s important to note that some kinds of beer, wine, and liquor contain much more alcohol than others.

Based on these standard servings, the CDC defines moderate drinking as one drink or less each day for women, and two drinks or less each day for men.5

Different cultures have a range of attitudes toward drinking. Some cultures abstain from alcohol altogether. Others embrace and encourage it during celebrations, dinner, or other gatherings. A person’s culture can strongly influence their feelings about drinking and what they consider normal. Your family of origin may also play a role in your relationship with alcohol. These outside influences can be both positive and negative. 

Signs of alcohol use disorder

Some signs of alcohol dependence are obvious, while others are much more subtle. The most common signs include:

  • Spending more money on alcohol than you should
  • Being unable to control how frequently or how much you drink
  • Acting differently after you drink
  • Craving alcohol
  • Prioritizing drinking over responsibilities

Symptoms of alcohol use disorder

According to a 2021 survey by the CDC, 29.5 million Americans ages 12 and older had AUD in the past year.6 The DSM-5 uses the following symptoms to diagnose all alcohol use disorders, including alcohol dependence:

  • Drinking more than you mean to
  • Being unable to stop or decrease your drinking
  • Spending a lot of time drinking or recovering from hangovers
  • Being unable to think of anything else due to alcohol cravings
  • Continuing to drink despite your personal relationships suffering
  • Skipping out on hobbies and activities to drink instead
  • Getting involved in situations or activities that put your health at risk or cause you injury during or after drinking
  • Experiencing depression, anxiety, or worsening health conditions, and continuing to drink anyway
  • Having an increased tolerance to alcohol that leads to drinking more to achieve the same effect
  • Suffering withdrawal symptoms when sobering up

Identifying with any of these criteria may be a sign that alcohol has become a problem in your life. Speaking with a medical or mental health professional can help. Browse our directory to find a licensed therapist near you.

If you’re in crisis, help is available now: Call 988 for the 988 Crisis Lifeline, available 24/7.

Effects of alcohol use disorder

Common short-term effects of alcohol dependence include:

  • Injuries from drunk driving, drowning, or other accidents influenced by drinking
  • Violent outbursts, assault, homicide, or suicide
  • High-risk sexual behavior
  • Alcohol poisoning
  • Pregnancy loss or fetal harm

While the short-term effects above can lead to longer-lasting health consequences (whether from injuries or other complications), alcohol abuse in and of itself can also have long-term health effects. They include:

  • High blood pressure
  • Heart disease
  • Stroke
  • Liver disease
  • Cancer
  • Dementia and other memory issues
  • Psychosis
  • Depression
  • Anxiety

Why do people get addicted to alcohol?

Alcohol dependence happens for many different reasons. People with a family history of AUD, an addiction to another substance or behavior, or a history of trauma are more likely to develop it.

People often drink in order to cope with mental, emotional, or physical health issues. Resulting problems with drinking can begin in childhood or as a person gets older. Self-medicating mental health disorders, escaping the emotional pain of a dysfunctional home environment, or coping with stress are common reasons people begin drinking. Hereditary alcohol dependence increases the risk that this self-medicating behavior will evolve into AUD.

Alcohol and mental health: How they affect each other

Mental health and alcohol dependence are directly related, especially when depression and anxiety are involved.7, 8 Disorders like those can cause people to abuse alcohol.9

At the same time, alcohol dependence can cause or worsen mental health disorders.10 As a result, people who abuse alcohol can find themselves caught in a vicious cycle, with their mental health struggles worsening their problem drinking and vice versa. 

Treatment for alcohol use disorder

Most people consider AUD a lifelong condition. That said, recovery is possible. It usually takes a combination of professional therapy, determination, and a strong support system.

Many people who’ve successfully overcome alcohol dependence participate in rehabilitation programs. These can be inpatient or outpatient, but in all cases they include work with a therapist. A therapist’s role in a person’s recovery is to help them identify the reasons for their drinking, as well as develop better coping mechanisms in order to endure withdrawal symptoms and avoid relapsing.

Therapy can be done one-on-one, but a lot of people in recovery find group therapy beneficial. Group members help hold each other accountable and serve as a support system. 

Whether you or a loved one are ready to enter a rehab program or you’re still exploring options, talking with a therapist can help. In addition, Alcoholics Anonymous (AA) offers free group support meetings across the globe. You can search for one in your area and just show up.

If you need immediate help, call 988 for the 988 Crisis Lifeline, available 24/7. To talk with someone who can connect you to local support, call the SAMHSA National Helpline at 1-800-662-HELP (4357), also available 24/7.

About the author

The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.

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