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Alcohol use disorder (AUD) involves frequent or heavy alcohol drinking that becomes difficult to control and leads to problems such as in relationships, work, school, family, or other areas.

AUD is common and often goes untreated. There are treatments that work, including medication, therapies, and support/self-help groups.

AUD is common and often goes untreated.

There are treatments that work.

People can seek treatment and make
changes at any point in their journey.

People can seek treatment and make changes at any point in their journey — they don’t have to wait until alcohol has completely changed their life. They can also work toward a range of goals, from reducing drinking to complete abstinence.

Prevalence

• Alcohol use is common, 84% of adults ages 18 and older report drinking alcohol at some point in their lives. ¹
• Among adults aged 18 and over, approximately 11% had AUD in the past year.¹
• Among adults aged 18-25, approximately 15% had AUD in the past year; including 14% of full-time college students.²
• An estimated 3% of youth aged 12 to 17 had AUD in the past year.¹
• One in 10 children live with a parent with AUD.³
• The rate of AUD is three to four times higher in close relatives of individuals with AUD.
• While most people who drink alcohol occasionally feel “drunk,” only a minority (less than 20%) ever develop alcohol use disorder.

Alcohol use disorder involves a problematic pattern of alcohol use that leads to significant distress or problems functioning. Symptoms of AUD include:

• Drinking more alcohol or over a longer period than originally intended.
• Unsuccessfully trying to cut down or control alcohol use.
• Craving, or a strong desire or urge to use alcohol. (Wanting a drink so much it’s difficult to think of anything else)
• Drinking that interferes with responsibilities at home, at work, or at school.
• Continuing to use alcohol even when it causes problems with family and friends.
• Giving up important social, occupational, or recreational activities because of alcohol use.
• Repeatedly using alcohol in physically hazardous situations.
• Developing a tolerance to alcohol (needing more alcohol to get the same effect).
• Experiencing withdrawal symptoms such as shakiness, restlessness, nausea, or sweating after stopping or reducing drinking.

Having two or more of these symptoms in the last year could signal an alcohol use disorder.

Drinking, even small amounts daily and occasional intoxication do not by themselves make a diagnosis of alcohol use disorder.

Health impacts and consequences of alcohol use

• AUD is the 4th leading preventable cause of death in the U.S.⁴
• Repeatedly consuming large amounts of alcohol can affect nearly every organ system, especially the digestive system, cardiovascular system, and central and peripheral nervous systems.
• Gastrointestinal effects include “acid reflux/heartburn,” gastritis, and stomach ulcers. In about 15% of individuals who drink alcohol heavily, this can lead to liver cirrhosis and/or pancreatitis.
• AUD is associated with a significant increase in the risk of accidents and violence.⁵
• AUD is a contributor to suicide risk.
• Heavy drinking can also impact a person’s mood and may make depression harder to treat.

It is estimated that 40% of individuals in the United States experience an alcohol-related adverse event at some time in their lives. Alcohol accounts for up to 55% of fatal driving events.⁶

Binge drinking can also be problematic. Though definitions vary somewhat, binge drinking typically refers to when women have four or more drinks and men have five or more drinks within a couple of hours. (See more in NIAAA Glossary). Binge drinking is highest among young adults — about 29% of individuals ages 18 to 25 reported binge drinking in the past month.²

Less than 5% of individuals in the U.S. with a diagnosis of alcohol use disorder receive any treatment.¹

Evidence-based treatments including behavioral treatments (therapy/counseling), medication, and mutual support programs can play a major role in treating AUD.

Talking with a primary care doctor or other health care clinician can be a great place to start.

• Recovery is unique to every individual. Some may choose to stop drinking altogether, while others may focus on reducing their drinking or limiting it in certain situations.
• Recovery is a process and may involve periods of remission and relapse.
• Support from family and friends is crucial for a person beginning a recovery journey.
• Forming a treatment plan with your doctor and tracking progress on that plan can greatly increase your chances of successfully recovering.

Medication

Medications are often used to treat AUD. There are three FDA-approved medications for AUD.

• Naltrexone - helps people reduce heavy drinking.
• Acamprosate - makes it easier to maintain abstinence.
• Disulfiram - helps people avoid drinking and maintain abstinence. When a person taking disulfiram drinks alcohol, they experience unpleasant physical symptoms. These medications are not addictive and can be used alone or in combination with therapy.

Behavioral treatments

Behavioral treatments, therapy or counseling, can help people understand and change behaviors that lead to heavy drinking. Counseling can involve:

• Developing skills to help stop or reduce drinking.
• Helping to build a strong social support system.
• Working to set reachable goals.
• Learning to cope with or avoid triggers that might lead to relapse.

Behavioral treatments can include therapies such as cognitive behavioral therapy, motivational enhancement therapy, marital and family counseling, brief interventions, and others. (See more on psychotherapy.)

Mutual Support

Community-based peer support groups such as Alcoholics Anonymous and other 12-step programs are helpful for many people but are not a substitute for medication and therapy

NAMI (National Alliance on Mental Illness) offers a variety of resources, support phone lines, support groups, and more for individuals and for family members.

SMART Recovery (Self-Management and Recovery Training) helps people learn the skills needed to overcome their addictions and change their lives. It provides mutual support meetings, offered online and in-person, and has specialized meetings and resources for a variety of communities, including family/friends, veterans, and more.

Moderation Management™ provides a non-judgmental, compassionate peer-support community for anyone who concerned about their drinking and wants to make positive lifestyle change.

Finding Treatment

The NIAAA Alcohol Treatment Navigator® helps adults find alcohol treatment for themselves or an adult loved one. The Navigator can help find programs, therapists, and doctors. It offers guidance on questions to ask and how to choose quality care.

For help finding treatment for adolescents, NIAAA recommends the resources available from the Partnership for Drug-Free Kids.

Note: If someone who has been drinking heavily for a long time stops suddenly, they can experience alcohol withdrawal. This can be dangerous and even life-threatening. Doctors can help make the process safer with medications to treat withdrawal symptoms. (NIAAA)

Support for Family and Friends

• Al-Anon and Al-Ateen – Support for people who are worried about someone with a drinking problem.
• Adult Children of Alcoholics/Dysfunctional Families - A Twelve Step, Twelve Tradition program of people who grew up in dysfunctional homes.
• NAMI (National Alliance on Mental Illness) – NAMI offers a variety of resources, support phone lines, support groups, and more for individuals and for family members.
• CRAFT: Community Reinforcement and Family Training
  CRAFT teaches family and friends effective strategies for helping their loved one to change and to feel better themselves. CRAFT works to affect the loved one’s behavior by changing the way the family interacts with him or her. It is a skills-based program that impacts families in multiple areas of their lives, including self-care, pleasurable activities, problem-solving, and goal setting. At the same time, CRAFT addresses their loved one’s resistance to change. More information: Center for Motivation and Change: https://the20minuteguide.com/; National Center for PTSD: Video about CRAFT.

Many people with AUD often hesitate to get treatment because they don't recognize that they have a problem and don’t know effective treatments are available. If you're concerned about someone’s drinking, ask your primary care health care professional or a professional experienced in alcohol treatment for advice on how to approach that person.

Physician Review

Smita Das, M.D.
Chair, APA Council on Addiction Psychiatry

Jeremy Kidd, M.D.
Member, APA Council on Addiction Psychiatry

November 2023

  References