The Major Symptoms of Alcohol Use Disorder — and the 3-Step Treatment Process

You may have heard the terms "alcohol dependence" and "alcohol abuse." Alcohol use disorder (AUD) is a single medical diagnosis that encompasses these formerly separate disorders.

Around 15 million people in the United States have AUD, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Here's what you need to know about alcohol use disorder, including symptoms, treatment options and what to do if you suspect that you or a loved one may have AUD.

Alcohol dependence was previously identified as at least three of the following behaviors occurring in a 12-month period, per the American Psychiatric Association (APA) :

• Need for increasing amounts of alcohol to reach intoxication or increased "tolerance"
• Withdrawal symptoms
• Drinking in larger or longer amounts
• Trying to decrease drinking, but being unable to
• Giving up social, occupational, or recreational activities because of drinking
• Greater time being spent drinking, recovering from drinking, or trying to give up from drinking
• Continuing drinking despite being aware of recurrent physical or psychological problems caused by drinking

Alcohol abuse, on the other hand, was formerly defined by the APA as only one of the following behaviors over the course of 12 months:

• Recurrent use of alcohol resulting in a failure to fulfill major role obligations
• Recurrent alcohol use in situations where it could cause physical harm
• Recurrent legal problems related to one's alcohol use
• Continued alcohol use despite social or interpersonal problems linked to drinking

Beginning in May 2013 however, both alcohol dependence and alcohol abuse were reclassified under the diagnosis of AUD, per the NIAAA. Put simply, AUD is a medical condition characterized by a compulsive loss of control over alcohol use, leading to life problems and functional decline, says Patrick Fehling, MD, a psychiatrist at UCHealth Center for Dependency, Addiction and Rehabilitation (CeDAR).

People with AUD often recognize the negative effects of drinking, but are still unable to stop.

AUD is the medical diagnosis for what most people call alcoholism, says Keith Heinzerling, MD, an internist and addiction medicine specialist at Providence Saint John's Health Center in Santa Monica. However, many people with AUD do not fit the stereotypical picture of alcoholism, either because they are less severely affected, or because they may be able to function despite their alcohol problems, he says.

One of the defining characteristics of AUD is that the disorder will lead to increasing negative consequences of alcohol use, while the person continues to drink, despite being aware of those consequences. This "is due to multiple factors, including psychology and the person's environment," Dr. Heinzerling says.

Alcohol use disorder has a prevalence of around 6 percent in the general population, according to the NIAAA. Risk factors include a family history of addiction, other prior addictions and a life history of physical or emotional trauma, according to Dr. Fehling.

The condition can range from mild to moderate to severe, per the Mayo Clinic — more symptoms indicate a heightened severity. Symptoms, per the Mayo Clinic, include:

• Tolerance to alcohol
• Experiencing withdrawal symptoms
• Cravings to drink
• Drinking alcohol in unsafe scenarios
• An inability to keep up with work, social and family obligations
• Repeated unsuccessful efforts to quit or control the alcohol intake

Here are some of the common negative outcomes that result from AUD, per the NIAAA:

• Psychosocial problems or conflicts, such as performing poorly at work or school
• An inability to maintain responsibilities
• Arguments with family/friends
• Concern from family or friends about their drinking, along with increasing conflict about their drinking
• Psychological symptoms, like increasing anxiety, depression and insomnia — which the person often tries to manage with even more alcohol
• Physical symptoms, including liver damage or changes in the red blood cell count (these can be identified through blood work or a physical exam with a doctor)
• Increased risk of breast, liver, colorectal, esophageal, and head and neck cancers
• Decreased immune system function (even a single bout of drinking heavily can reduce your immune system function for a full 24 hours)

AUD is diagnosed by an interview and examination by a physician or therapist to determine if the patient meets the most recent criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), Dr. Heinzerling says.

In some cases, if the individual gives consent, the clinician may also ask their family or friends the diagnostic questions to screen for AUD. A person must meet two of the 11 criteria to receive a diagnosis of AUD — the more criteria that are met, the more severe the AUD.

In some situations, AUD can be tricky to identify, explains Sanam Hafeez, PsyD, a New York City neuropsychologist and faculty member of Columbia University, because some people who have it will be mask their symptoms well. "The fact is, there are many people who are able to stay 'high functioning' with AUD, so much so that the people closest to them can be fooled," she says.

Alcohol use disorder is treated through a combination of therapy approaches, peer support and medication-assisted treatment to prevent relapses, Dr. Fehling says. The most important thing to understand about treating AUD is that it is a disease — and as such, it needs to be treated as any other type of chronic disease that will require ongoing treatment, monitoring and disease management.

"People often forget that it's a disease process, creating blame and stigma for individuals who continue to relapse and struggle with sobriety," Dr. Fehling explains.

Treatment for AUD generally follows three main steps:

The first step for treating AUD is for the doctor and the individual seeking treatment to agree on a goal together, Dr. Heinzerling says. In most cases of AUD, the treatment goal is total abstinence from alcohol, he says.

However, some patients with less severe AUD are able to go back to some alcohol use. "Predicting who will be successful is hard and even in these cases, I would recommend at least a temporary period of abstinence before deciding whether a cautious trial of drinking in moderation would be appropriate," Dr. Heinzerling adds.

Once the goal of either short- or long-term alcohol abstinence has been established, the next goal is to safely stop the alcohol use.

Potential withdrawal symptoms include tremors, hallucinations and seizures, per Harvard Health Publishing. Medications are sometimes used to prevent these symptoms, according to the Mayo Clinic. Withdrawal often occur at a hospital or inpatient clinic, per the Mayo Clinic. Consult with your doctor to determine which course of action is best for you.

After the "detox" period is over, it's critical for treatment to continue to prevent a relapse, says Dr. Heinzerling. Physically withdrawing from alcohol does not address the underlying issues that lead the person to develop AUD, he adds.

The following tools are used in treating AUD on an ongoing basis, according to Dr. Heinzerling:

‌Medications:‌ Several medications are available to treat AUD, but none are a cure, per the Substance Abuse and Mental Health Services Administration (SAMHA). The medications have a mild to moderate effect, Dr. Heinzerling says. "Current medications won't make a person who doesn't want to change instantly change."

‌Counseling:‌ Through counseling, individuals with AUD learn strategies to help stop drinking or manage triggers, per the NIAAA. "If there are serious psychological issues with the AUD, then counseling to address these is critically important along with the counseling to change the drinking behaviors," Dr. Heinzerling says.

‌Support:‌ "Support is the most important," Dr. Heinzerling says. He defines support as everything from cultivating a supportive environment through things like avoiding bars and people who trigger your drinking, to social support, such as joining a self-help group like Alcoholics Anonymous (AA). There are many types of 12-step programs that can be helpful, including SMART Recovery, LifeRing or Women for Sobriety (WFS), per a February 2017 study in the Journal of Substance Abuse Treatment .

If you suspect that you have AUD, learn about available treatment plans so you can take charge of your own health care, Dr. Fehling recommends.

Many people mistakenly think that the only treatment options available for AUD are in-patient rehab or AA, when in reality, most people receive and do well with outpatient treatment, which includes doctor and therapist visits, and self-help group attendance, like AA, Dr. Heinzerling says.

In-patient treatment, says Dr. Heinzerling, is reserved for patients without a safe place to live, with serious medical or psychological issues that require close monitoring or for people who have failed outpatient treatment multiple times.

Call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357) if you need to talk to someone about your drinking habits.