What is alcohol use disorder (AUD)? 

For most adults, moderate alcohol use is probably not harmful. However, about 18 million adult Americans have an alcohol use disorder (AUD). This means that their drinking causes distress and harm.  

AUD can range from mild to severe, depending on the symptoms. Severe AUD is sometimes called alcoholism or alcohol dependence. 

AUD is a disease that causes: 

• Craving – a strong need to drink 
• Loss of control – not being able to stop drinking once you’ve started 
• Negative emotional state – feeling anxious and irritable when you are not drinking 

What is binge drinking? 

Binge drinking is drinking so much at once that your blood alcohol concentration (BAC) level is 0.08% or more. For a man, this usually happens after having 5 or more drinks within a few hours. For a woman, it is after about 4 or more drinks within a few hours.  

Not everyone who binge drinks has an AUD, but they are at higher risk for getting one. 

What are the dangers of too much alcohol? 

Too much alcohol is dangerous. Heavy drinking can increase the risk of certain cancers. It may lead to liver diseases, such as fatty liver disease and cirrhosis. It can also cause damage to the brain and other organs. Drinking during pregnancy can harm your baby. Alcohol also increases the risk of death from car crashes, injuries, homicide, and suicide. 

How do I know if I have an alcohol use disorder (AUD)? 

You may have an AUD if you can answer yes to two or more of these questions: 

In the past year, have you 

• Ended up drinking more or for a longer time than you had planned to? 
• Wanted to cut down or stop drinking, or tried to, but couldn’t?
• Spent a lot of your time drinking or recovering from drinking? 
• Felt a strong need to drink? 
• Found that drinking – or being sick from drinking – often interfered with your family life, job, or school? 
• Kept drinking even though it was causing trouble with your family or friends? 
• Given up or cut back on activities that you enjoyed just so you could drink? 
• Gotten into dangerous situations while drinking or after drinking? Some examples are driving drunk and having unsafe sex. 
• Kept drinking even though it was making you feel depressed or anxious? Or when it was adding to another health problem? 
• Had to drink more and more to feel the effects of the alcohol? 
• Had withdrawal symptoms when the alcohol was wearing off? They include trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, and sweating. In severe cases, you could have a fever, seizures, or hallucinations. 

If you have any of these symptoms, your drinking may already be a cause for concern. The more symptoms you have, the more serious the problem is. 

What should I do if I think that I might have an alcohol use disorder (AUD)? 

If you think you might have an AUD, see your health care provider for an evaluation. Your provider can help make a treatment plan, prescribe medicines, and if needed, give you treatment referrals. 

A good place to start is the NIAAA Alcohol Treatment Navigator. 

What are the treatments for alcohol use disorder? 

Most people with an alcohol use disorder can benefit from some form of treatment. Medical treatments include medicines and behavioral therapies. For many people, using both types give them the best results.  

People who are getting treatment for AUD may also find it helpful to go to a support group such as Alcoholics Anonymous (AA). If you have an AUD and a mental illness, it is important to get treatment for both. 

Some people may need intensive treatment for AUD. They may go to a residential treatment center for rehabilitation (rehab). Treatment there is highly structured. It usually includes several different kinds of behavioral therapies. It may also include medicines for detox (medical treatment for alcohol withdrawal) and/or for treating the AUD. 

Which medicines can treat alcohol use disorder? 

Three medicines are approved to treat AUD: 

• Disulfiram causes unpleasant symptoms such as nausea and skin flushing whenever you drink alcohol. Knowing that drinking will cause these unpleasant effects may help you stay away from alcohol. 
• Naltrexone blocks the receptors in your brain that make you feel good when you drink alcohol. It can also reduce your craving for alcohol. This can help you cut back on your drinking. 
• Acamprosate helps you avoid alcohol after you have quit drinking. It works on multiple brain systems to reduce your cravings, especially just after you have quit drinking. 

Your health care provider can help you figure out if one of these medicines is right for you. They are not addictive, so you don’t have to worry about trading one addiction for another.  

They are not a cure, but they can help you manage AUD. This is just like taking medicines to manage a chronic disease such as asthma or diabetes. 

Which behavioral therapies can treat alcohol use disorder? 

Another name for behavioral therapies for AUD is alcohol counseling. It involves working with a health care professional to identify and help change the behaviors that lead to your heavy drinking. 

• Cognitive-behavioral therapy (CBT) helps you identify the feelings and situations that can lead to heavy drinking. It teaches you coping skills, including how to manage stress and how to change the thoughts that cause you to want to drink. You may get CBT one-on-one with a therapist or in small groups. 
• Motivational enhancement therapy helps you build and strengthen the motivation to change your drinking behavior. It includes about four sessions over a short period of time. The therapy starts with identifying the pros and cons of seeking treatment. Then you and your therapist work on forming a plan for making changes in your drinking. The next sessions focus on building up your confidence and developing the skills you need to be able to stick to the plan. 
• Marital and family counseling includes spouses and other family members. It can help to repair and improve your family relationships. Studies show that strong family support through family therapy may help you to stay away from drinking. 
• Brief interventions are short, one-on-one, or small-group counseling sessions. It includes one to four sessions. The counselor gives you information about your drinking pattern and potential risks. The counselor works with you to set goals and provide ideas that may help you make a change. 

Is treatment for alcohol use disorder effective? 

For most people, treatment for an AUD is helpful. But overcoming an alcohol use disorder is an ongoing process, and you may relapse (start drinking again). You should look at relapse as a temporary setback and keep trying.  

Many people repeatedly try to cut back or quit drinking, have a setback, then try to quit again. Having a relapse does not mean that you cannot recover. If you do relapse, it is important to return to treatment right away, so you can learn more about your relapse triggers and improve your coping skills. This may help you be more successful the next time. 

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Source: MedlinePlus, National Library of Medicine