Alcohol Use Disorder: Symptoms, Causes, Effects and Treatment

Alcohol Use Disorder (AUD), known as alcoholism or alcohol abuse disorder, is a chronic condition that makes individuals lose control over alcohol consumption despite facing negative effects and consequences.

Symptoms of alcohol use disorder include mood swings, intense cravings for alcohol, compulsive drinking, an inability to stop drinking once started, physical health problems, withdrawal symptoms when not drinking, and prioritizing alcohol over responsibilities.

There are different causes of alcoholism, including genetics, environmental factors, social factors, neurochemical problems, and psychological issues such as stress, trauma, or depression.

The physical effects of alcohol abuse disorder include liver disease, heart problems, and cancer. The mental health effects include anxiety, depression, and cognitive decline. 
Treatment options for AUD include detoxification, medications, behavioral therapies like cognitive behavioral therapy (CBT), support groups such as Alcoholics Anonymous, psychotherapy, and residential treatment. 

What is Alcohol Use Disorder?

Alcohol Use Disorder (AUD) is a chronic relapsing brain disorder that involves a combination of physical dependence, psychological cravings, and behavioral disruptions, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The organization described AUD as a medical condition characterized by an impaired ability to stop or control alcohol use despite negative social, occupational, or health consequences. Research published in The Lancet also classifies AUD as a major public health issue, contributing significantly to the global disease burdens.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines Alcohol Use Disorder as a problematic and compulsive pattern of consuming alcohol, leading to major impairment and distress. The DSM-5 lists 11 diagnostic criteria, including increased tolerance, withdrawal symptoms, and unsuccessful efforts to cut down on drinking. Meeting two or more of these criteria within 12 months qualifies for an AUD diagnosis, ranging from mild to severe.

The high rate of alcoholism is slowly becoming a significant concern in the US. According to the 2023 National Survey on Drug Use and Health (NSDUH), approximately 28.9 million individuals aged 12 and older, representing 10.2% of this age group, experienced Alcohol Use Disorder (AUD) within the past year in the United States. Among them, 757,000 youth aged 12 to 17 were affected by AUD. Additionally, 28.1 million adults aged 18 also reported having AUD during the same period.

Alcohol Use Disorder is responsible for over 85,000 deaths each year in the United States and more than 1,500 deaths annually in New Jersey, according to Bolaji Yoade and Oluwafemi Akinbode in their study “Alcohol Use Disorder (AUD) in New Jersey (NJ): Disparity in Treatment.” Understanding the factors contributing to AUD, especially in areas like New Jersey, is essential for developing effective interventions.

What are the Signs and Symptoms of Alcoholism?

The signs and symptoms of alcoholism are mood swings, compulsive drinking, loss of control, intense cravings, neglecting responsibilities, behavioral changes, physical health issues, and cognitive impairments.

These signs and symptoms of AUD are listed below.

• Mood Swings: Mood swings refer to frequent and severe changes in mood, including psychological signs like irritability, anxiety, depression, or euphoria. Mood disturbances are often linked to the neurochemical imbalances caused by chronic alcohol use, according to the National Institutes of Health.
• Compulsive Drinking: Compulsive drinking refers to an uncontrollable urge to consume alcohol, even when it leads to negative consequences. This behavior is one of the most significant signs of alcoholism, according to the DSM-5 diagnosis criteria.
• Loss of Control: Individuals with alcohol use disorder face difficulty in limiting alcohol intake while drinking more than intended. This loss of control is related to changes in impulse regulation and decision-making processes in the brain, according to Sara M. Nehring and Richard J. Chen, in their study “Alcohol Use Disorder.”
• Intense Cravings: Individuals with AUD can experience intense or persistent cravings for alcohol when they aren’t able to consume it. These cravings are due to the neurobiological factors and psychological dependencies that develop over time.
• Neglecting Responsibilities: Individuals with alcohol use disorder fail to meet work, school, or family responsibilities. All their time is occupied by alcohol consumption, and the drowsiness doesn’t let them focus on anything else.
• Behavioral Changes: Behavioral changes, such as secrecy, aggression, and avoiding friends and social activities, are major signs of AUD. These behavioral changes result from the impact of alcohol on mood and social interactions, according to the American Journal of Drug and Alcohol Abuse.
• Physical Health Issues:  Chronic alcohol use can lead to a range of physical health problems, including liver disease, cardiovascular issues, and gastrointestinal disorders, highlighted by P. V. AshaRani and Mohamed Zakir Karuvetil in their research “Prevalence and Correlates of Physical Comorbidities in Alcohol Use Disorder (AUD): a Pilot Study in Treatment-Seeking Population.”
• Cognitive Impairments: Compulsive and chronic alcohol consumption can lead to cognitive impairments, such as problems with memory, decision-making, and concentration, according to Ge Wang and Daniel Y Li in their research “Alcohol Use Disorder as a Risk Factor for Cognitive Impairment.”
• Rare Complications: On rare occasions, severe complications like alcoholic hallucinosis may occur. Eyer F, Schuster T, Felgenhauer N, Pfab R, Strubel T, Saugel B. Risk assessment of moderate to severe alcohol withdrawal–predictors for seizures and delirium tremens in the course of withdrawal. Alcohol Alcohol. 2011 This condition involves auditory hallucinations where individuals might hear threatening voices, posing significant mental health risks (Bhat et al., 2012).

What are the Causes of Alcohol Abuse Disorder?

The causes of Alcohol Abuse Disorder include genetics, environmental factors, psychological factors, social and cultural factors, neurochemical factors, early exposure, peer pressure, and availability.

These common factors of AUD are listed below.

• Genetics: Genetics are usually the number one cause of AUD cases in the US.  Individuals with a family history of alcoholism are up to 60% more likely to develop AUD due to inherited genetic vulnerabilities, according to Elisabeth A. Tawa, Samuel D. Hall, and Falk W. Lohoff in their study “Overview of the Genetics of Alcohol Use Disorder.”
• Environmental Factors: Environmental factors, such as exposure to stressful environments, traumatic experiences, or growing up in households where alcohol use is common can increase the likelihood of developing AUD. Additionally, childhood trauma and stress are strongly correlated with higher rates of alcohol abuse in adulthood, according to the National Library of Medicine.
• Psychological Factors: Psychological factors and mental health issues such as anxiety, depression, and trauma-related disorders are often linked to alcohol abuse as individuals use alcohol as a form of self-medication, according to the Journal of Alcoholism and Drug Dependence.
• Social and Cultural Factors: Social and cultural factors that promote heavy drinking, such as the acceptance of alcohol consumption or living in communities with high alcohol use, can significantly influence the development of AUD. The social drinking culture in gatherings and parties can also normalize excessive alcohol consumption.
• Neurochemical Factors: Alcohol’s effect on brain chemistry, particularly on neurotransmitters like dopamine and GABA, plays a crucial role in addiction. These neurochemical changes enhance the pleasurable effects of alcohol, reinforcing addiction over time, according to the study “Alcohol: Effects on Neurobehavioral Functions and the Brain.”
• Early Exposure: Drinking alcohol at a young age increases the chances of developing AUD later in life. Early exposure disrupts brain development, making teenagers more vulnerable to addictive behaviors as adults.
• Peer Pressure: Friends or acquaintances that encourage excessive drinking, especially among young adults, can lead to the development of unhealthy drinking habits. Peer pressure can make it difficult to say no and normalize heavy alcohol use.
• Availability:  Easy access to alcohol, especially living in communities where alcohol is widely available, can increase the risk of Alcohol Use Disorder. When alcohol is easily accessible, individuals start consuming it in larger quantities and more frequently.

What are the Effects of Alcoholism?

The common effects of alcoholism include damage to physical health, liver damage, cirrhosis, cancer, mental health problems, strained relationships, financial problems, legal issues, social isolation, and accidents or injuries.

These common effects are described below.

• Damage to Physical Health: Chronic alcohol consumption leads to various health issues, including high blood pressure, heart disease, and digestive problems. Additionally, excessive drinking significantly increases the risk of cardiovascular diseases, according to Chieh Sung and Chi-Hsiang Chung in their study “Risk of cardiovascular disease in patients with alcohol use disorder: A population-based retrospective cohort study.”
• Liver Damage: The liver is one of the most affected organs, as it metabolizes alcohol. Long-term alcohol abuse leads to liver inflammation and scarring, according to research published in the National Library of Medicine.
• Cirrhosis: Cirrhosis is severe scarring of the liver and is one of the most advanced stages of liver damage caused by alcoholism. Research in the National Library of Medicine shows that cirrhosis develops after years of heavy drinking and results in irreversible liver failure.
• Cancer: Alcoholism increases the risk of various cancers, including those of the mouth, throat, liver, and breast. The International Agency for Research on Cancer classifies alcohol as a Group 1 carcinogen, meaning it is a known cancer-causing substance, especially when combined with smoking.
• Mental Health Problems: Alcoholism can trigger mental health issues such as anxiety, depression, and mood disorders, as alcohol impairs brain function and disrupts mood regulation.
• Strained Relationships: The behavior of alcoholics often leads to broken or strained relationships with family and friends. AUD can cause conflict, lack of communication, and trust issues, leading to emotional distance.
• Financial Problems: Alcoholism often leads to job loss, reduced productivity, and high spending on alcohol, resulting in severe financial instability. 
• Legal Issues: Drinking alcohol excessively can result in legal problems such as arrests for drunk driving, public intoxication, or domestic violence.
• Social Isolation: Many individuals with AUD withdraw from social interactions, either because of shame or conflict with loved ones. This isolation further develops feelings of loneliness and depression.
• Accidents or Injuries: Alcohol impairs judgment, coordination, and reaction times, increasing the risk of accidents and injuries. In 2018, alcohol-impaired driving (AID) crashes caused 10,511 deaths in the U.S., making up 29% of all motor vehicle-related fatalities, according to the study “Alcohol-impaired driving among adults—USA, 2014–2018.”

What Does Excessive Alcohol Use Do To the Brain?

Below is a breakdown of how alcohol affects the brain according to Dr Michael Olla:

• Depressant Effect: Alcohol is a central nervous system depressant, slowing down brain activity. It inhibits the transmission of signals between nerve cells, leading to reduced brain function.
• Neurotransmitter Modulation: Alcohol increases the activity of inhibitory neurotransmitters like GABA while suppressing excitatory neurotransmitters like glutamate. This shift in neurotransmitter balance results in sedation and reduced brain stimulation.
• Dopamine Release: Alcohol prompts the release of dopamine, a neurotransmitter associated with pleasure and reward. This release creates feelings of euphoria and reinforces the desire to drink more.
• Impaired Cognitive Function: Alcohol impairs cognitive functions such as judgment, decision-making, and memory, directly affecting an individual’s ability to think clearly and make rational choices.
• Motor Skills and Coordination: Alcohol impairs motor skills and coordination, leading to observable symptoms like slurred speech, impaired balance, and reduced motor control.
• Memory Formation: Excessive alcohol consumption can interfere with forming new memories, resulting in blackouts or memory lapses.
• Structural Changes: Long-term, heavy alcohol use can lead to structural changes in the brain, including brain shrinkage, particularly in regions associated with memory and cognition. 

A team of Harvard researchers led by Dr. Kenneth J. Mukamal in discovered in 2001 that brain volume decreases relative to alcohol intake. Surprisingly, even light and moderate drinkers exhibited more atrophy (shrinkage) compared to those who abstained from alcohol.

What are the Types of Alcoholics?

The types of alcoholics, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), are young adult subtype, young antisocial subtype, functional subtype, intermediate familial subtype, and chronic severe subtype.

These types of alcoholics are listed below.

• Young Adult Subtype: The young adult subtype consists of individuals in their late teens or early 20s who drink heavily but do not have a history of addiction or mental health issues. They tend to binge drink and rarely seek help for their drinking.
• Young Antisocial Subtype: The young antisocial subtype consists of individuals in their mid-20s with a history of criminal behavior, mental health disorders, and early stages of alcohol dependence. This group may also abuse other substances and is more likely to seek help than the young adult subtype.
• Functional Subtype: Functional alcoholics maintain successful careers, relationships, and family lives despite their heavy drinking. Most in this subtype are middle-aged, well-educated, and can mask their dependence. They often appear normal in social settings.
• Intermediate Familial Subtype: The intermediate familial subtype has a strong family history of alcoholism, with many members struggling with alcohol use disorder. Most are in their late 30s or early 40s and experience mental health issues such as depression or anxiety.
• Chronic Severe Subtype: The chronic severe subtype is the smallest and most severe group. These individuals have a long history of alcohol abuse, often beginning in teenage. They frequently struggle with other addictions and mental health issues, and most in this group have significant health and legal problems. They are also the most likely to seek treatment.

How is Alcohol Use Disorder Diagnosed?

Alcohol Use Disorder (AUD) is diagnosed by a healthcare professional through an in-depth evaluation of a person’s drinking habits and their impact on their life. Doctors look for specific signs, like the inability to control drinking, intense cravings, or continuing to drink even when it causes problems. They often follow guidelines from the DSM-5, which lists 11 symptoms that help determine how severe the disorder is, including mild, moderate, or severe, depending on how many symptoms are present (Christopher S. Martin and Ken C. Winters in “Diagnosis and Assessment of Alcohol Use Disorders Among Adolescents”). Screening tests, like the Alcohol Use Disorders Identification Test (AUDIT), and blood work may be used to check for heavy drinking or liver issues. Additionally, a detailed conversation about the person’s health, behavior, and social life is also important to confirm the diagnosis.

What are the Treatment Options for Alcohol Use Disorder?

The treatment options for Alcohol Use Disorder include detoxification, medication-assisted treatment, behavioral therapies, support groups, counseling and psychotherapy, and residential treatment.

These treatment options are listed below.

• Detoxification: Detoxification is the first step in treating Alcohol Use Disorder (AUD) to help individuals safely manage withdrawal symptoms, according to Motoi Hayashida in their study “An Overview of Outpatient and Inpatient Detoxification.” This process typically lasts 3-7 days under medical supervision. It cleanses the body of alcohol, but it can be uncomfortable and, in severe cases, dangerous without professional support.
• Medication-Assisted Treatment:  Medications such as naltrexone, acamprosate, and disulfiram are highly effective alongside therapy to reduce cravings and prevent AUD relapse, according to the American Academy of Family Physicians. Recovery time varies depending on individual progress, but MAT is usually part of a long-term treatment plan. However, medications can cause side effects like nausea or headaches.
• Behavioral Therapies: Behavioral therapies, such as  Cognitive Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET), help individuals change harmful drinking behaviors, according to Sigurd Krogh Hammerum and Daniel Thaysen-Petersen in their study “Virtual reality-assisted cognitive behavioral therapy for patients with alcohol use disorder: a randomized feasibility study.” Therapy duration can range from several weeks to months. The advantage is that these therapies address the underlying triggers of alcohol use, though they require consistent participation and may not show immediate results.
• Support Groups: Support groups like Alcoholics Anonymous (AA) feature a group of people going through similar struggles and conditions. Recovery through support groups is a long-term process, with participants attending meetings regularly. Support groups offer a sense of community. However, they may not suit everyone, and success relies on active involvement.
• Counseling and Psychotherapy: Individual or group counseling helps individuals explore emotional and psychological factors contributing to their drinking. Sessions can last for months or even years, depending on the individual. Counseling helps build coping strategies, but it can take time to see improvement and requires commitment.
• Residential Treatment: Residential treatment programs offer 24/7 care, usually lasting 30, 60, or 90 days, depending on severity. These programs are highly effective in providing the best psychological and physical care for individuals with AUD, according to J W Finney, A C Hahn, and R H Moos in their study “The effectiveness of inpatient and outpatient treatment for alcohol abuse: the need to focus on mediators and moderators of setting effects.” However, it can be costly, and re-entry into daily life after treatment may be challenging.

What are the Withdrawal Symptoms of Alcoholism?

The withdrawal symptoms of alcoholism include anxiety, insomnia, mood swings, hallucinations, tremors, sweating, nausea and vomiting, and seizures.

These withdrawal symptoms are listed below.

• Anxiety: Anxiety refers to individuals experiencing intense feelings of nervousness and fear during alcohol withdrawal. This anxiety can last for several days, and in severe cases, it may lead to panic attacks or heightened stress levels.
• Insomnia: Insomnia refers to difficulty sleeping during alcohol withdrawal. Individuals find falling or staying asleep hard, leading to fatigue and irritability. This symptom can persist for several weeks as the body adjusts.
• Mood Swings: Mood swings refer to sudden changes in mood, ranging from irritability to depression, which are frequent during withdrawal. The body’s attempt to rebalance chemicals affected by alcohol use leads to emotional instability, which can last for several weeks.
• Hallucinations: Hallucinations refers to seeing or hearing things that aren’t there. This occurs in more severe cases of alcohol withdrawal and can be a sign of delirium tremens (DTs), a dangerous complication, according to Bethany R. Canver, Richard K. Newman, and Anna E. Gomez in their research “Alcohol Withdrawal Syndrome.”
• Tremors: Many people develop hand tremors or uncontrollable shaking during withdrawal. This is one of the most noticeable physical symptoms and typically occurs within the first 24 to 48 hours after the last drink.
• Sweating: Extreme sweating, even when not physically active, is common in the early stages of withdrawal. It is a sign that the body is trying to detox and regulate itself after prolonged alcohol use.
• Nausea and Vomiting: Nausea and vomiting are frequent and common digestive issues during alcohol withdrawal. This symptom is the body’s response to the absence of alcohol, which it has become dependent on for normal functioning.
• Seizures: Seizures are sudden, uncontrolled electrical disturbances in the brain that can cause changes in behavior, movements, feelings, or consciousness. According to research by the National Institutes of Health, seizures are a serious symptom, particularly in individuals with long-term heavy drinking histories.

How is Alcohol Addiction Different from Other Addictions?

Alcohol addiction is different from other addictions like gambling, drug use, or food addiction because alcohol is legal and socially accepted. While gambling and drug addictions often involve illegal activities or financial stakes, alcohol is widely available and part of many social events, making it hard to avoid. Unlike food addiction, which centers on an essential need (eating), alcohol isn’t necessary for survival. Alcohol addiction also causes physical withdrawal symptoms, while behavioral addictions, like gambling, affect mental health but don’t cause physical dependence.

What is the difference between alcohol addiction and drug addiction?

Alcohol addiction is a dependence on alcohol, where people feel compelled to drink despite the harm it causes, often leading to physical withdrawal symptoms. On the other hand, drug addiction involves a dependency on substances like opioids or stimulants, which can affect the brain in different ways. The key difference is that alcohol is legal and socially accepted, while many drugs are illegal or controlled. Alcohol addiction usually develops more slowly, and drug withdrawal, especially from substances like opioids, can be much more severe and dangerous.

What is the difference between alcohol addiction and food addiction?

Alcohol addiction involves the compulsive use of alcohol. On the other hand, food addiction is a compulsion to eat certain foods, especially those high in sugar, fat, or salt, even when it’s unhealthy. While alcohol addiction creates a physical need to drink, food addiction is mostly psychological since we need food to live but don’t need unhealthy food. Alcohol addiction tends to result in more severe withdrawal symptoms, while food addiction can cause emotional struggles and unhealthy eating habits.

What is the difference between alcohol addiction and nicotine addiction?

Alcohol addiction means being physically and mentally dependent on alcohol, with serious withdrawal symptoms when a person tries to quit. However, nicotine addiction involves a craving for nicotine, usually from cigarettes or vaping. The difference lies in the substances: alcohol is a depressant that slows down the body’s functions, while nicotine is a stimulant that temporarily boosts energy and alertness. Nicotine addiction can develop quickly, but it usually doesn’t lead to the intense physical withdrawal that alcohol causes. Both addictions are hard to quit because they affect the brain’s reward system.

What is the difference between alcohol addiction and prescription drug addiction?

Alcohol addiction is a dependence on alcohol characterized by compulsive drinking and difficulty controlling alcohol use despite negative consequences. Prescription drug addiction involves the misuse of medications prescribed by a healthcare provider, such as opioids, sedatives, or stimulants, leading to physical and psychological dependence. The key difference lies in the substances involved: alcohol is a legal, widely available substance, while prescription drugs are intended for medical use but can be misused or taken without a prescription. Both addictions can lead to serious health issues and withdrawal symptoms, but the specific effects and risks may vary depending on the substance involved.