Alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It’s a common condition, and contrary to common misconceptions, effective treatments are available. Recognizing the symptoms and understanding the diagnosis criteria are the first steps towards seeking help and recovery.
Alcohol Use Disorder is a prevalent issue, yet often overlooked and untreated.
Effective treatments exist and can significantly improve outcomes.
Seeking help is a sign of strength, and recovery is possible at any stage.
It’s important to remember that seeking treatment and making positive changes is possible at any point, whether you’re looking to reduce your alcohol consumption or achieve complete abstinence. You don’t need to wait for alcohol to take over your life to seek support.
Prevalence of Alcohol Use Disorder
- Alcohol consumption is widespread, with 84% of adults aged 18 and older in the U.S. reporting having consumed alcohol at some point in their lives.1
- Approximately 11% of adults aged 18 and over experienced AUD in the past year.1
- Among young adults aged 18-25, the prevalence is higher, with about 15% having AUD in the past year, including 14% of full-time college students.2
- An estimated 3% of adolescents aged 12 to 17 also struggled with AUD in the past year.1
- It’s concerning that one in ten children live in households with a parent who has AUD.3
- Genetics play a role, as the rate of AUD is three to four times higher among close relatives of individuals with AUD.
- While many people experience being “drunk” occasionally, only a minority, less than 20%, develop a persistent alcohol use disorder.
Identifying Alcohol Use Disorder: Symptoms and Diagnosis Criteria
Alcohol use disorder is diagnosed based on specific criteria that indicate a problematic pattern of alcohol use leading to clinically significant impairment or distress. The diagnosis isn’t solely based on how much alcohol a person drinks or how often they drink, but rather on the impact alcohol has on their life and well-being. According to the diagnostic criteria, individuals experiencing two or more of the following symptoms within a 12-month period may be diagnosed with AUD:
- Drinking more or for longer than intended: This involves repeatedly exceeding your self-imposed limits on alcohol consumption, both in terms of quantity and duration.
- Persistent desire or unsuccessful efforts to cut down or control alcohol use: This refers to making repeated attempts to reduce or stop drinking but being unable to do so, despite a genuine desire to change.
- Craving: Experiencing an intense desire, urge, or need to drink alcohol, often making it difficult to focus on other things. This craving can be so strong that it dominates thoughts and behaviors.
- Alcohol use interfering with major obligations: Alcohol consumption negatively impacts responsibilities at home, work, or school. This can manifest as poor performance, absenteeism, neglect of duties, or conflicts arising from drinking.
- Continued alcohol use despite interpersonal problems: Persisting in alcohol use even when it causes or exacerbates relationship problems with family or friends. This indicates a lack of control over drinking despite its negative social consequences.
- Giving up important activities due to alcohol use: Sacrificing or reducing participation in social, occupational, or recreational activities because of alcohol. This shows alcohol becoming a central priority over previously valued aspects of life.
- Recurrent alcohol use in physically hazardous situations: Repeatedly using alcohol in situations where it is physically dangerous, such as driving under the influence, operating machinery, or mixing alcohol with certain medications.
- Tolerance: Developing a need for markedly increased amounts of alcohol to achieve intoxication or the desired effect, or experiencing a diminished effect with continued use of the same amount. This indicates the body adapting to chronic alcohol exposure.
- Withdrawal symptoms: Experiencing unpleasant physical or psychological symptoms when alcohol use is reduced or stopped. These symptoms can include shakiness, anxiety, restlessness, nausea, sweating, or, in severe cases, seizures. Using alcohol (or a similar substance) to relieve or avoid withdrawal symptoms is also a diagnostic criterion.
It’s crucial to understand that experiencing just one or even occasional intoxication does not automatically equate to an alcohol use disorder. The diagnosis requires a pattern of problematic alcohol use that causes significant distress or impairment. If you recognize two or more of these symptoms in yourself or someone you know, it may be a sign of AUD, and seeking professional evaluation is recommended.
Health Impacts and Consequences of Alcohol Use
- AUD is a significant public health concern, being the 4th leading preventable cause of death in the United States.4
- Chronic heavy alcohol consumption can have detrimental effects on nearly every organ system in the body, particularly the digestive, cardiovascular, and nervous systems.
- Gastrointestinal issues are common, ranging from acid reflux and gastritis to more severe conditions like stomach ulcers, liver cirrhosis, and pancreatitis, which can occur in approximately 15% of heavy drinkers.
- AUD significantly increases the risk of accidents, injuries, and violence.5
- Alcohol misuse is a major contributing factor to suicide risk.
- Heavy drinking can also negatively impact mental health, often worsening symptoms of depression and making treatment more challenging.
It’s estimated that a staggering 40% of individuals in the U.S. will experience an alcohol-related adverse event at some point in their lives. Alcohol is implicated in up to 55% of fatal car accidents.6
Binge drinking, defined as consuming four or more drinks for women and five or more drinks for men within about two hours, is also a serious concern. Binge drinking is most prevalent among young adults, with approximately 29% of individuals aged 18 to 25 reporting binge drinking in the past month.2 (For a more detailed definition, refer to the NIAAA Glossary).
Treatment and Recovery from Alcohol Use Disorder
Alarmingly, less than 5% of individuals in the U.S. diagnosed with alcohol use disorder receive any form of treatment.1 This highlights a significant gap between the prevalence of AUD and access to care.
Fortunately, evidence-based treatments, including behavioral therapies (counseling), medications, and mutual support programs, are highly effective in treating AUD and supporting recovery.
Consulting with a primary care physician or another healthcare professional is a crucial first step in seeking help.
- Recovery is a personal journey, and there’s no one-size-fits-all approach. Some individuals may aim for complete abstinence, while others may focus on reducing their drinking to safer levels and managing it in specific situations.
- Recovery is often a process with periods of improvement and potential relapse. Relapse is a common part of the recovery journey and doesn’t signify failure.
- Support from family and friends is invaluable for individuals embarking on recovery.
- Developing a personalized treatment plan with a doctor and consistently tracking progress significantly increases the likelihood of successful recovery.
Medications for AUD Treatment
Medications are a valuable tool in AUD treatment, and there are three FDA-approved medications specifically for this purpose:
- Naltrexone: This medication helps reduce heavy drinking episodes.
Understanding Naltrexone
Naltrexone is an FDA-approved medication that aids in the treatment of alcohol use disorder by reducing alcohol cravings and supporting recovery. Here's an overview of its mechanism, suitability, and considerations:
**What is naltrexone and how is it administered?** Naltrexone is one of the three FDA-approved medications for treating AUD in adults (not approved for children). It's available as a daily oral pill (50mg, brand name ReVia) and as an extended-release intramuscular injection (380mg, brand name Vivitrol) lasting 28 days. The injectable form is also approved for opioid use disorder. Injections are administered monthly, eliminating the need for daily pills.
**What are the uses of naltrexone?** Naltrexone is effective in reducing heavy drinking days and promoting recovery. It can support abstinence goals by diminishing alcohol cravings and intrusive thoughts about alcohol.
**Important information to share with your healthcare provider:** Before starting naltrexone, disclose all current medications. Avoid opioid pain medications while taking naltrexone and in the week prior. Naltrexone is not recommended during pregnancy. Inform your provider about pregnancy, breastfeeding, or plans to become pregnant to discuss risks and benefits. Liver function tests may be conducted before starting naltrexone to ensure liver health.
**Potential side effects of naltrexone:** Side effects are generally mild or absent. Minor side effects may include stomach upset, nausea, vomiting, diarrhea, constipation, fatigue, muscle aches, and headache. Injectable naltrexone may cause injection site redness and tenderness. These usually resolve within a few days. Persistent side effects should be reported to your doctor. Liver problems are a potential serious side effect, indicated by jaundice, dark urine, stomach upset, pale stools, or loss of appetite. Seek immediate medical attention if these occur.
**Duration of naltrexone treatment:** Treatment duration varies. Some may take it for less than a year, others for longer. Consult your healthcare provider to determine the appropriate duration based on your health history and treatment progress.- Acamprosate: This medication assists in maintaining abstinence by reducing cravings and urges to drink.
Understanding Acamprosate
Acamprosate is another FDA-approved medication for AUD, typically taken as two 333 mg tablets (666 mg total) three times daily. It works in the brain to reduce alcohol cravings and urges.- Disulfiram: This medication discourages drinking by causing unpleasant physical reactions if alcohol is consumed.
Understanding Disulfiram
Disulfiram is an FDA-approved medication that discourages alcohol consumption by blocking alcohol breakdown, leading to a buildup of toxic byproducts. Consuming alcohol while taking disulfiram results in severe discomfort, including headache, nausea, vomiting, confusion, sweating, rapid heartbeat, and chest pain. It's crucial to avoid all alcohol sources, not just beverages. Dosage ranges from 250-500 mg oral tablets daily.These medications are non-addictive and can be used alone or in combination with behavioral therapies.
Behavioral Treatments for Alcohol Use Disorder
Behavioral treatments, also known as therapy or counseling, play a vital role in helping individuals understand and modify behaviors contributing to heavy drinking. Counseling approaches may include:
- Developing coping skills to reduce or stop drinking.
- Building a strong social support network.
- Setting realistic and achievable recovery goals.
- Learning strategies to manage or avoid triggers that can lead to relapse.
Various behavioral therapies are effective, such as cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), marital and family counseling, and brief interventions. (More information on psychotherapy.)
Mutual Support Groups for Recovery
Community-based peer support groups, like Alcoholics Anonymous and other 12-step programs, provide valuable support for many individuals in recovery. However, they are not a substitute for professional medical treatment, medication, or therapy.
NAMI (National Alliance on Mental Illness) offers numerous resources, support helplines, support groups, and other forms of assistance for individuals with mental health conditions and their families.
SMART Recovery (Self-Management and Recovery Training) empowers individuals with the skills needed to overcome addictions and make positive life changes. They offer online and in-person mutual support meetings, including specialized meetings for families, veterans, and other communities.
Moderation Management™ provides a non-judgmental and compassionate peer-support community for individuals concerned about their drinking and seeking positive lifestyle changes, including moderation strategies.
Finding Professional Treatment for Alcohol Use Disorder
The NIAAA Alcohol Treatment Navigator® is a valuable online resource to help adults find alcohol treatment for themselves or loved ones. The Navigator assists in locating programs, therapists, and doctors, and provides guidance on questions to ask and how to choose quality care.
For adolescent treatment, NIAAA recommends resources from the Partnership for Drug-Free Kids.
Important Note: Abruptly stopping alcohol after heavy, prolonged drinking can lead to alcohol withdrawal, a potentially dangerous and even life-threatening condition. Medical supervision and medications can safely manage withdrawal symptoms. (NIAAA)
Support for Family and Friends of Individuals with AUD
Individuals struggling with AUD may not always recognize they have a problem or be aware of available and effective treatments. If you are concerned about someone’s drinking, seeking advice from a primary care physician or a professional specializing in alcohol treatment can provide guidance on how to approach the person and offer support.
Physician Review
Smita Das, M.D. Chair, APA Council on Addiction Psychiatry
Jeremy Kidd, M.D. Member, APA Council on Addiction Psychiatry
November 2023
Physician Review – naltrexone update
Alëna Balasanova, M.D., FAPA
September 2024
References
1. National Institute on Alcohol Abuse and Alcoholism (NIAAA). (n.d.). Alcohol Use in the United States. Retrieved from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
2. Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). National Survey on Drug Use and Health (NSDUH). Table 2.23B—Binge Alcohol Use in Past Month: Among People Aged 18 to 25, by Detailed Race/Ethnicity: Percentages, 2022 and 2023. https://www.samhsa.gov/data/sites/default/files/reports/rpt43482/NSDUHtablesII-2023/NSDUHtablesII-2023/NSDUHtab2pt23B.htm
3. National Institute on Alcohol Abuse and Alcoholism (NIAAA). (n.d.). Children of Alcoholics. Retrieved from https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/children-of-alcoholics
4. Centers for Disease Control and Prevention (CDC). (2023). Alcohol-Related Disease Impact (ARDI). Retrieved from https://www.cdc.gov/alcohol/ardi/index.htm
5. World Health Organization (WHO). (2018). Global status report on alcohol and health 2018. Luxembourg: Publications Office of the European Union.
6. National Highway Traffic Safety Administration (NHTSA). (2020). Traffic Safety Facts 2019 Data: Alcohol-Impaired Driving. Washington, DC: U.S. Department of Transportation.
