Alcohol Use Disorder

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When Drinking Becomes Hard to Control

If you keep drinking more than you planned or cannot cut back despite the problems it causes, you deserve help without blame. Alcohol use disorder (AUD) is a treatable condition involving difficulty controlling drinking despite harm. An assessment can help you understand what is happening and compare medication, counseling, and support.^[1][2]

Seek medical help before suddenly stopping after prolonged heavy drinking. Alcohol withdrawal can be life-threatening, but treatment can ease symptoms and help prevent complications. Care may include medicines and monitoring. Mild to moderate withdrawal can often be treated outside a hospital, with someone staying with you and usually daily medical visits until you are stable.^[3]

A seizure, severe confusion, hallucinations, fever, or an irregular heartbeat during possible withdrawal needs emergency care. Call 911 or go to an emergency department.^[3]

Recognizing Alcohol Use Disorder Symptoms

AUD is diagnosed when at least two of 11 symptoms occur within the same 12-month period and form a problematic pattern that causes clinically significant distress or impairment.^[1]

The symptoms ask whether, during the past year, a person has:

1. Drunk more or for longer than intended.
2. Wanted or tried to cut down or stop but could not.
3. Spent substantial time drinking, recovering from drinking, or dealing with its aftereffects.
4. Experienced a strong craving or urge to drink.
5. Had drinking or its aftereffects interfere with home, family, work, or school responsibilities.
6. Continued drinking despite repeated conflict with family or friends.
7. Given up or reduced important, enjoyable, or interesting activities in order to drink.
8. Repeatedly used alcohol in situations that increased the chance of injury.
9. Continued drinking despite knowing it was worsening a physical or mental health problem.
10. Developed tolerance, meaning more alcohol was needed to produce the previous effect or the same amount had less effect.
11. Experienced withdrawal symptoms when the effects of alcohol were wearing off.^[2]

Withdrawal symptoms listed in diagnostic guidance include sleep difficulty, shakiness, restlessness, nausea, sweating, a racing heart, feeling uneasy or generally unwell, low mood, seizures, or sensing things that are not present.^[2]

Mild, Moderate, and Severe AUD

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), describes severity by the number of symptoms present during the same year.^[1][2]

The symptom count is important, but assessment also considers the pattern, intensity, consequences, medical risks, and the person’s circumstances. Two people with the same number of symptoms may need different levels or types of support.^[2][4]

Drinking Patterns and Diagnosis in Practice

Picture two people. One drinks heavily every Saturday but reports no loss of control, craving, repeated consequences, tolerance, withdrawal, or other diagnostic symptoms. Those nights can still carry substantial injury risk. The information given does not establish AUD; a fuller assessment would be needed.

The other drinks less but repeatedly cannot stop as intended, lets responsibilities slide, gives up things they care about, and keeps drinking despite worsening depression. That pattern may meet AUD criteria even if no single episode looks like a binge. These imagined situations show why the pattern matters, not just the amount.^[1][5]

Alcohol Screening and a Full Assessment

Screening is a first check that can prompt a fuller assessment. After a person screens positive for heavy drinking, a healthcare professional can use a checklist based on the 11 diagnostic criteria to review the number, pattern, and severity of symptoms and determine whether AUD is present and how severe it is.^[1][2]

A screening result is therefore a starting point rather than an AUD diagnosis. Assessment of possible withdrawal is also important because withdrawal symptoms can have other explanations and can occur after alcohol is reduced as well as stopped.^[6]

Guidance for withdrawal assessment considers six broad areas: current intoxication or withdrawal potential; physical health; emotional, behavioral, or cognitive conditions; readiness to change; the possibility of continued use or recurring problems; and the recovery or living environment. These areas help determine treatment needs and the appropriate level of care.^[6]

Alcohol Terms That Mean Different Things

Alcohol use disorder, often shortened to AUD, is a diagnosis. Terms such as heavy drinking, binge drinking, and intoxication describe alcohol exposure or a pattern at a particular time. Those patterns can cause serious harm without meeting the criteria for AUD, although repeated alcohol misuse increases the risk of developing the disorder.^[5]

Binge Drinking

The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern that raises blood alcohol concentration (the amount of alcohol in the blood) to 0.08%, or 0.08 grams of alcohol per deciliter, or higher.^[5] For a typical adult, this corresponds to about five or more drinks for a male or four or more for a female within approximately two hours.^[5]

A U.S. standard drink contains 0.6 fluid ounces, or 14 grams, of pure alcohol. Different beverages can contain the same amount of alcohol even when their serving sizes differ.^[5]

The Substance Abuse and Mental Health Services Administration uses a survey definition: five or more drinks for males or four or more for females on the same occasion on at least one day during the past month. Because the definitions and timeframes differ, estimates based on them should not be treated as interchangeable.^[5]

Heavy Drinking

The National Institute on Alcohol Abuse and Alcoholism defines heavy drinking for men as five or more drinks on any day or 15 or more per week. For women, it defines heavy drinking as four or more on any day or eight or more per week.^[5]

The Substance Abuse and Mental Health Services Administration instead defines heavy alcohol use for its surveys as binge drinking on five or more days during the past month. A person can meet a heavy-drinking definition without having AUD, and someone with AUD may not report that pattern during every measured period.^[5]

What Happens During Alcohol Withdrawal?

Withdrawal can occur when a person whose body has adapted to prolonged heavy alcohol exposure suddenly stops or substantially reduces drinking. It can be painful and, in some cases, life-threatening.^[2][7]

Early symptoms may include anxiety, disturbed sleep, poor appetite, vivid dreams, headache, nausea, sweating, a fast heart rate, elevated blood pressure, increased reflexes, and fever. Symptoms often begin 6 to 24 hours after alcohol is stopped or reduced.^[6]

Seizures can begin as early as eight hours after reduction or cessation and may occur for up to 48 hours, with peak activity around 24 hours. Hallucinations may develop within 12 to 24 hours. Withdrawal delirium, a dangerous state of severe confusion and nervous-system overactivity, may begin 72 to 96 hours after the last drink.^[6]

Timelines are estimates, not guarantees. Because severe complications can develop after earlier symptoms, the time since alcohol was reduced or stopped is part of withdrawal-risk assessment.^[6]

When Alcohol Withdrawal Needs Emergency Care

Call 911 for a possible alcohol overdose, especially if someone cannot wake up, has slow or irregular breathing, or has a seizure. Do not assume an unconscious person can safely sleep it off.^[8]

During possible withdrawal, a seizure, severe confusion, hallucinations, fever, or an irregular heartbeat warrants emergency care. MedlinePlus advises going to an emergency department or calling 911 for these symptoms.^[3]

For suicidal crisis, emotional distress, or substance-use concerns in the United States, call or text 988 for support. Use emergency services when danger is immediate.^[9][8]

If fear of withdrawal has kept you drinking, that fear belongs in the conversation about care. Early identification and medication management can reduce the risk of severe or complicated withdrawal. A clinician can assess the risk and arrange treatment before you try to stop on your own.^[2][6]

Alcohol detox is not the same as long-term AUD treatment. Guidance recommends beginning or connecting the person with ongoing AUD care during withdrawal management when their condition permits.^[6]

Treatment Options for Alcohol Use Disorder

Effective treatment is individualized. It may combine behavioral healthcare, medication, mutual support, management of physical or mental health conditions, and help with practical barriers.^[1]

Care is available in more places than residential rehabilitation programs. Outpatient care involves scheduled appointments without an overnight stay; telehealth delivers appointments remotely. Intensive outpatient treatment and partial hospitalization provide more coordinated outpatient care for complex needs. Residential programs provide a 24-hour treatment setting; inpatient services provide medically directed 24-hour care.^[2]

These settings differ in purpose and intensity. Assessment should guide the choice, including whether withdrawal management or other medical monitoring is needed.^[6][4]

Cognitive Behavioral Therapy for Alcohol Use Disorder

Cognitive behavioral therapy, or CBT, is a time-limited, multisession treatment that examines thoughts, emotions, and environmental situations connected with drinking. It teaches coping skills to support abstinence or reduced harm and often includes planning for high-risk situations and a return to drinking.^[10]

What Research Shows About CBT

A meta-analysis, which combines results from multiple studies, included 30 randomized trials across alcohol and other drug use disorders. Compared with minimal treatment, cognitive behavioral therapy produced a moderate improvement in substance-use frequency or quantity. Benefits were maintained at follow-up periods of 1 to 6 months and 8 months or later.^[10]

CBT’s advantage was more modest when compared with other therapies or supports that could themselves be beneficial. The studies also varied in therapist training, supervision, how closely therapists followed the treatment method, substances involved, and settings. These findings support CBT as an effective option, not as demonstrably superior to every other evidence-based treatment.^[10]

Motivational Interviewing for Changing Alcohol Use

Motivational interviewing is a collaborative, nonconfrontational approach that helps a person explore mixed feelings about change and strengthen their own reasons and commitment. Motivational enhancement therapy uses a structured approach to help people build motivation, a plan, and confidence for changing their drinking.^[11][12]

What Research Shows About Motivational Interviewing

A review of 93 randomized studies involving 22,776 participants with alcohol or other substance use found that motivational interviewing may reduce substance use compared with no intervention, particularly soon after treatment. Compared with treatment as usual or another active treatment, however, it generally showed little or no demonstrated advantage.^[12]

Confidence in many findings was low because studies differed substantially and often had methodological limitations. Motivational interviewing can be a useful way to engage someone without demanding immediate certainty, but it should not be presented as uniquely effective.^[12]

Medications for Alcohol Use Disorder

AUD medications can help people stop or reduce drinking and avoid a return to drinking. Naltrexone can reduce the urge to drink; acamprosate can make abstinence easier to maintain.^[2]

Three nonaddictive medications are approved in the United States for AUD: naltrexone, acamprosate, and disulfiram. Their suitability and benefits vary. A healthcare professional can help match the choice to your health, other medicines, and goals.^[2][11]

Medication can be used alone or with counseling. Taking an approved AUD medication is not “trading one addiction for another,” but benefits and side effects vary.^[2]

Medications used to manage acute withdrawal serve a different purpose from continuing AUD medications. Withdrawal treatment requires medical assessment, particularly after prolonged heavy drinking.^[2]

Mutual-Support Options for Alcohol Recovery

Alcoholics Anonymous and other 12-step programs offer peer support. Secular alternatives are also available. Mutual-support groups may be used on their own or as an additional layer alongside professional treatment.^[2][1]

Alcoholics Anonymous provides local and online meeting information through its service network and meeting resources.^[13]

A group’s philosophy, spiritual content, meeting format, and expectations may or may not fit a particular person. Trying a different meeting or a secular option is reasonable if the first group does not feel useful.

Alcohol Treatment Goals and Recovery

Treatment can help people stop drinking, drink less, avoid heavy drinking, reduce alcohol-related harm, improve functioning, or work toward a combination of these outcomes. The most appropriate goal depends on AUD severity, health, safety, and personal circumstances.^[2]

Abstinence means not drinking alcohol. Reduced drinking means consuming less or drinking less often, but the practical importance depends on whether heavy drinking and alcohol-related consequences also decrease.

In NIAAA’s recovery definition, remission means AUD symptoms other than craving are no longer present. Recovery is broader. The National Institute on Alcohol Abuse and Alcoholism defines it as pursuing remission from AUD and cessation of heavy drinking, often accompanied by improvements in health, relationships, and well-being.^[1]

For some people, abstinence may be the only sustainable option because of AUD severity, inability to control drinking, pregnancy, medication interactions, or medical conditions. Reduced drinking can nevertheless be a meaningful treatment target or step for others.^[2][5]

Managing Alcohol Cravings

A practical approach is to recognize triggers, avoid those that can reasonably be avoided, and prepare coping responses for the rest. Cravings are often predictable and temporary, even when they feel powerful.^[14]

Triggers can be external, such as a place or time of day associated with drinking, or internal, such as tension, frustration, or a passing thought. Recognizing which kind you are facing can help you choose a response.^[14]

Helpful strategies include:

• Keeping a brief record of when cravings occur
• Identifying the person, place, emotion, thought, or sensation involved
• Reviewing personal reasons for changing
• Contacting someone trustworthy
• Leaving a tempting situation
• Choosing an absorbing alternative activity
• Challenging the thought that one drink cannot cause harm
• Allowing the urge to rise and pass without acting on it

Avoidance does not have to mean isolation. A person can suggest activities that do not involve alcohol or temporarily leave high-risk settings while developing stronger coping skills.^[14]

If cravings remain difficult to manage or self-directed strategies are not helping after a few weeks, professional counseling or medication support may be appropriate.^[14]

Why Alcohol Use Becomes Hard to Control

AUD does not have one determining cause. Genetic and environmental factors interact to shape vulnerability, and each person’s combination of influences can differ. No single risk factor establishes that someone will develop the disorder.^[1][15]

Reward, Relief, and Learned Habits

Alcohol can reinforce drinking by producing rewarding effects or temporary relief from uncomfortable physical or emotional states. With repeated drinking, the brain can learn to connect alcohol’s effects with people, places, feelings, and other cues. Those cues may become stronger prompts to drink, strengthen habitual drinking, and help lay the groundwork for compulsive use.^[15][1]

Stress, Emotions, and Pain

Stress can contribute to vulnerability and to a return to drinking during recovery. Trauma, accumulated life stressors, genetic makeup, and drinking history can interact in shaping a person’s stress response. Once moderate to severe AUD is established, stress-system activity during early or prolonged withdrawal can fuel negative emotional states that help maintain the cycle.^[1]

Alcohol and chronic pain can also interact in both directions. Heavy drinking to relieve pain can contribute to AUD, while AUD-related changes in pain processing may contribute to chronic pain. Addressing drinking goals and pain together may be more useful than leaving either problem untreated.^[16]

Brain Changes Associated With Alcohol Use Disorder

Chronic heavy drinking can affect brain systems involved in motivation, memory, decision-making, impulse control, attention, and sleep. As AUD becomes more severe, alcohol-related changes can make stopping more difficult. They do not make recovery impossible: with months of abstinence, at least some changes in brain function, thinking, feeling, and behavior may improve.^[15][1]

Alcohol Risk Factors Do Not Determine Your Future

Genetic differences contribute to vulnerability alongside environmental factors, but risk is not destiny. A family history or another risk factor does not by itself determine whether AUD will develop, and people with similar risks can have different outcomes.^[1][15]

What Harms Can Alcohol Cause?

Alcohol-related harm and AUD overlap, but they are not identical. Alcohol can cause an injury, medication interaction, pregnancy-related harm, or health complication in a person who does not have AUD. AUD refers to the impaired-control pattern and associated distress or impairment, not simply to the presence of alcohol-related disease.^[5]

Immediate Harms From Alcohol Use

A single binge-drinking episode can increase the likelihood of motor vehicle crashes, atrial fibrillation (an irregular heart rhythm), drowning, hypothermia (dangerously low body temperature), trauma, falls, burns, unsafe sexual behavior, infection exposure, suicide, and overdose. Alcohol can also intensify the sedating effects of other drugs.^[16][17][8]

An alcohol-related blackout is a gap in memory for events while drinking. A person can remain awake during a blackout while the brain fails to form new memories; this differs from passing out.^[18]

Continued drinking after an alcohol-related memory blackout is one possible AUD symptom, but a blackout by itself does not establish the diagnosis. AUD depends on the overall pattern and number of symptoms during the same 12-month period.^[2][1]

Long-Term Physical Health Harms From Alcohol Use

Alcohol’s harmful effects across organs and body systems contribute to more than 200 health conditions. Risks generally rise as alcohol exposure increases, although some harms begin at relatively low levels of consumption.^[16]

Long-term heavy drinking can contribute to liver disease, pancreatitis (inflammation of the pancreas), bleeding in the digestive tract, heart rhythm problems, high blood pressure, immune dysfunction, respiratory complications, and painful conditions.^[16][19]

Alcohol-related liver injury can include fat accumulation, inflammation, scarring (including fibrosis and cirrhosis) and liver cancer. These terms describe different forms or stages of injury, not a guaranteed sequence for every person.^[16]

Fatty liver can improve if alcohol use stops, but continued heavy drinking may allow inflammation and more advanced injury to develop. Liver stages do not necessarily progress in a simple order, and more than one stage can be present in the same person.^[16]

Alcohol can also interact dangerously with opioid painkillers by increasing respiratory depression (the slowing or stopping of breathing that can lead to overdose) and can increase overdose risk with other sedating drugs.^[16]

Alcohol Use and Mental Health

AUD can occur alongside depressive disorders, anxiety disorders, trauma- and stress-related disorders, sleep disorders, and other substance use disorders. A healthcare professional can consider these co-occurring conditions when assessing symptoms and discussing treatment options.^[2]

Relationships and Daily Responsibilities

AUD symptoms can affect caregiving, household responsibilities, school, employment, recreation, and close relationships. Repeated conflict, giving up valued activities, and failing to meet major responsibilities are diagnostic symptoms when they are part of the problematic alcohol-use pattern.^[2]

Consequences vary. A person does not need to lose a job, experience homelessness, or develop liver disease before AUD deserves attention.

Alcohol Care That Fits Your Circumstances

Assessment should consider more than the amount a person drinks. Guidance for withdrawal care examines physical health, emotional and cognitive conditions, readiness to change, the potential for continued problems, and the recovery or living environment, as well as intoxication and withdrawal risk.^[6]

Your other health conditions, medicines, and living situation can change the support you need during withdrawal. These belong in the assessment even when the amount you drink seems similar to someone else’s.^[6]

For a teenager, look for care that specifically treats adolescents. NIAAA’s Alcohol Treatment Navigator serves adults and directs families seeking teen care to adolescent-specific resources; its adult provider search should not be treated as a youth-care recommendation.^[4]

Alcohol Use During Pregnancy

Alcohol use during pregnancy increases the risk of fetal alcohol spectrum disorders, a group of lifelong physical, behavioral, and cognitive effects associated with prenatal alcohol exposure. National guidance identifies pregnancy or possible pregnancy as a situation in which alcohol should be avoided.^[5]

Anyone who has been drinking heavily for a prolonged period should seek medical help before suddenly stopping because withdrawal can be painful and potentially life-threatening. That safety guidance also applies during pregnancy.^[2]

Considering Other Substance Use Alongside Alcohol

Alcohol combined with opioid painkillers can slow or stop breathing and increase overdose risk. Combining alcohol with other sedating drugs can also raise overdose risk.^[16]

Recent use of alcohol and other substances can also affect the interpretation of withdrawal symptoms. Some other withdrawal syndromes can resemble alcohol withdrawal, so clinicians assess possible alternative explanations.^[6]

Housing and Social Circumstances in Alcohol Care

A person’s recovery or living environment is one of the areas considered when determining treatment needs and level of care. This matters because one setting may not fit every person’s risks, strengths, and circumstances.^[6]

Research on Treatment During Homelessness

A randomized trial, which assigned participants to groups by chance, involved 308 adults ages 21 to 65 in Seattle who had experienced homelessness in the past year and met older diagnostic criteria for AUD. It tested a harm-reduction approach that did not require abstinence. During the 12-week treatment period, active-treatment groups showed some improvements in alcohol use, alcohol-related harm, or physical quality of life compared with usual services.^[20]

This Seattle trial illustrates why formulation-specific evidence matters. The study did not demonstrate that extended-release naltrexone produced the combined intervention’s results. No statistically clear difference was detected in the main outcomes between the naltrexone and placebo injection groups. A placebo injection contains no active study medication; both groups also received the same behavioral program.^[20]

This result does not establish that the treatments were equivalent. Some improvements were not maintained after treatment ended, supporting further study of ongoing care.^[20]

Because this trial tested a specific program in a particular population and city, it does not establish one treatment plan for everyone. It does show why treatment effects should be interpreted in light of the population, intervention components, comparison group, and follow-up period.

How Common Is Alcohol Use Disorder?

The 2024 National Survey on Drug Use and Health estimated past-year AUD in these U.S.

age groups:

• Ages 12 or older: 27.9 million people, or 9.7% of this age group, had AUD in 2024.^[21]
• Ages 12 to 17: 775,000 adolescents, or 3.0% of this age group, had AUD in 2024.^[21]
• Ages 18 or older: 27.1 million adults, or 10.3% of this age group, had AUD in 2024.^[21]

These estimates apply to the U.S. civilian, noninstitutionalized population, excluding people in institutions such as prisons and people on active military duty. Each percentage uses its own age group as the denominator, so the overall percentage should not be treated as the rate for adolescents or adults individually.^[22][21]

Prevalence depends on the year, population, timeframe, and diagnostic method. These are past-year estimates, not counts of everyone who has ever experienced AUD. Many 2024 estimates are comparable with updated estimates from 2021 through 2023, but not with estimates from 2020 or earlier because survey methods changed.^[21]

Finding and Comparing Alcohol Treatment

You can ask for an assessment without knowing which kind of care you need or assuming residential treatment is necessary. Primary care, a mental health professional, an addiction specialist, or a qualified treatment program may be able to assess AUD and discuss appropriate options.^[1]

The National Institute on Alcohol Abuse and Alcoholism’s Alcohol Treatment Navigator is a noncommercial U.S. resource designed to help adults find evidence-based care. It recommends searching trusted sources, asking providers focused questions, and comparing the quality and fit of available options.^[4]

Cost and Access to Alcohol Treatment

When planning how to pay for treatment, ask for the full expected cost before enrolling. If insured, ask both the provider and insurer about network status, deductibles, copayments, prior authorization, medication coverage, and limits on visits.

If cost, transportation, work, caregiving, disability, language, or privacy is a barrier, ask whether the provider offers telehealth, outpatient care, scheduling flexibility, payment arrangements, or coordination with lower-cost services. Telehealth and online support can help some people maintain routines and privacy.^[4][1]

Not everyone has access to every level of care. If some options are inaccessible, focus on care you can realistically attend and continue, including appropriate outpatient, telehealth, or online options when available.^[4][1]

Supporting Someone With Alcohol Use Disorder

A healthcare professional can review the number, pattern, and severity of symptoms to assess whether AUD may be present and discuss an appropriate course of action. You can offer practical support with finding or contacting a provider if the person wants it.^[2]

The National Institute on Alcohol Abuse and Alcoholism notes that someone seeking treatment may wish to ask a trusted person for help with the process and support along the way. Keep any offer manageable and specific rather than assuming responsibility for another person’s recovery.^[4]

Do not encourage someone who has been drinking heavily for a prolonged period to stop suddenly without medical guidance. Withdrawal can be potentially life-threatening, and seizures or severe confusion require urgent medical help.^[2][6]

Take the Next Step Toward Alcohol Recovery

Choose a next step that fits what is happening now:

• If you are wondering about your drinking, review the 11 AUD symptoms and note which, if any, have occurred during the past 12 months. A healthcare professional can examine their number, pattern, and severity rather than relying on a label or drinking frequency alone.^[2]

• If alcohol is causing problems, ask a healthcare provider for an assessment and guidance. A positive heavy-drinking screen can be followed by an AUD symptom checklist to determine whether the disorder is present and how severe it may be.^[1]

• If you want treatment, compare behavioral care, approved medications, mutual support, telehealth, and available treatment settings. You do not need to choose a lifetime plan before making a first appointment.^[2][4]

• If cost or logistics are barriers, ask providers and insurers about total costs, coverage, and remote options. The National Institute on Alcohol Abuse and Alcoholism’s noncommercial Navigator can help U.S. adults compare evidence-based care, and a trusted person can help with the search if wanted.^[4]

• If you have been drinking heavily for a prolonged period, seek medical help before suddenly stopping because withdrawal can be painful and potentially life-threatening.^[2]

For a possible overdose or severe withdrawal symptoms, use emergency care. In the United States, call 911 for an emergency or call or text 988 for crisis support.^[8][3][9]