Alcohol use disorder: Info and an action plan

Alcohol use disorder (AUD) is the current diagnosis for what may also be called chronic alcoholism, alcohol addiction, alcohol abuse, dipsomania, and alcohol dependence. We can define unhealthy drinking behaviors in a variety of ways, but problems are the common denominator. That is, our friend/enemy/frenemy alcohol (technically ethanol) is a psychoactive drug that can cause serious problems in our lives. But how do you know when your drinking habits are harmful? And is it possible to predict who can drink recreationally without becoming addicted? And if you do find yourself thinking about alcohol all the time, what are you supposed to do about it?

This comprehensive look at alcohol use disorder will seek to answer these questions, and many more. The subject of alcohol tends to elicit strong reactions. Most of us have deliberated about how much to drink, and what, and when, and why. We have turned down glasses of wine and we have stared into empty bottles. We might associate alcohol with friends and fun times, or with guilt, loss, and shame. Often, our feelings are mixed.

Bearing this in mind, we will try to give you the facts without embellishing or editorializing. Everyone’s relationship with alcohol is deeply personal, which is why successful AUD treatment can run the gamut. In this article, we aim to offer a compassionate, clinical framework in which to think about drinking and its effects on our well-being.

What Is Alcohol Use Disorder?

Alcohol use disorder (AUD) is the term that the American Psychiatric Association (APA) uses to describe a harmful drinking pattern, as defined in the Diagnostic and Statistical Manual of Disorders, Fifth Edition (DSM-5). (In the United States, the DSM-5 is considered the bible of mental health issues.) An earlier version of that manual, the DSM-IV, distinguished between alcohol abuse and alcohol dependence. Those disorders have now merged into AUD. So that’s the background, but what’s the big picture?

Is alcohol use disorder a mental illness? AUD is both a medical condition and a mental health condition. The DSM-5 categorizes AUD as a substance use disorder. People use and misuse substances like drugs and alcohol all the time, but when they begin to suffer significant problems as a result, and continue to use those substances despite the significant problems, their behavior pattern becomes a disorder. 

The word “addiction” has fallen out of favor in mental health circles, but substance use disorders often (but not always) include an element of physical dependency. So a person with alcohol use disorder might experience unpleasant withdrawal symptoms when they’re not drinking. Their brain circuitry might come to rely on alcohol, which intensifies cravings and makes relapse more likely. What are the DSM-5 criteria for an alcohol use disorder? Let’s take a deeper look.

Alcohol Use Disorder DSM-5 Criteria

There are 2,048 potential ways to have the symptoms of alcohol use disorder. This is because a DSM-5 diagnosis of AUD requires at least two symptoms out of 11, which can be combined in various ways over the course of a year. And the exact combination of symptoms is significant. For example, if someone exhibits only number 10 (tolerance) and number 11 (withdrawal), but not symptoms 1-9, then their AUD interventions will probably look different from those of the drinker who frequently misses work due to hangovers and has multiple DUIs on their record. 

You can think of the DSM-5 symptoms of AUD as stand-alone, or categorize them in groups. To be diagnosed with the disorder, an individual demonstrates at least two of the following over a 12-month period:

[Criteria grouping A: Impaired control over substance use]

  1. Consumes more alcohol or spends more time drinking than intended.
  2. Wants to limit or halt alcohol use, but hasn’t succeeded.
  3. Spends a significant amount of time obtaining alcohol, drinking alcohol, and recovering from alcohol consumption.
  4. Craves alcohol.

[Criteria grouping B: Social impairment]

  1. Has suffered consequences at home, school, or work due to recurring alcohol use.
  2. Has suffered relationship problems due to recurring alcohol use.
  3. Has given up or cut back on enjoyable activities due to recurring alcohol use.

[Criteria grouping C: Risky use]

  1. Continues to use alcohol in situations when it’s physically dangerous (e.g., drives drunk, has unprotected sex).
  2. Continues to use alcohol despite knowing it’s causing them physical or psychological harm. 

[Criteria grouping D: Pharmacological

  1. Has become increasingly tolerant of alcohol, meaning they are less sensitive to the effects of drinking and need to drink more to become intoxicated. 
  2. Suffers withdrawal symptoms within a few hours or days after they stop drinking.

The DSM-5 also breaks down AUD by severity: 

  • Mild AUD: has 2-3 symptoms
  • Moderate AUD: has 4-5 symptoms
  • Severe AUD: has 6+ symptoms

And finally, DSM-5 criteria can specify whether someone is:

  • In early remission: It’s been 3-12 months since the person has met AUD criteria. During this time they haven’t experienced any symptoms, though there’s an exception for craving (#4). 
  • In partial remission: It’s been over 12 months since the person has met AUD criteria. During this time they haven’t experienced any symptoms, though there’s an exception for craving (#4).
  • In a controlled environment: The person doesn’t have access to alcohol (e.g., they’re incarcerated or in a rehab facility).

Alcohol Use Disorder ICD 11 

Though clinicians in the United States primarily use the DSM-5 for diagnosing mental health conditions, clinicians across the world tend to favor the International Classification of Diseases (ICD), which is in its 11th edition. The ICD-11, published by the World Health Organization (WHO), does not use the term “alcohol use disorder.” Instead, this global health manual distinguishes between three kinds of alcohol problems:

  • Episode of harmful use of alcohol: Someone has hurt themselves or someone else due to a single episode of alcohol consumption.
  • Harmful pattern of use of alcohol: Someone has hurt themselves or someone else due to their alcohol habits. This has happened over the course of at least 12 months if alcohol use is sporadic, or at least one month if alcohol use is continuous. 
  • Alcohol dependence: Someone feels driven to consume alcohol despite its interference in their life. They often show physical signs of dependence like tolerance and withdrawal symptoms. Dependence is evident over the course of at least 12 months or at least three months if alcohol use is continuous. 

What Does Alcohol Use Disorder Look Like?

Clinical criteria can help make a formal diagnosis, but what does alcohol use disorder look like in daily life? Does it mean that you often drink alone? Does it mean that you routinely have whiskey for breakfast? Does it mean that you own t-shirts that say “Wine O’Clock,” or that you hit rock bottom and lose everything? 

It all depends on the severity and symptomatology of the disorder. The following real-world signs may indicate that you’re struggling with alcohol use. 

Warning Signs of Alcohol Use Disorder

  • You decline to attend events or do activities where alcohol isn’t served
  • You feel anxious or agitated in the hours or days after you stop drinking
  • You hide the amount you drink from friends, family, and/or your doctor
  • You experience memory loss or blackouts when drinking
  • You spend a great deal of time thinking about alcohol when you’re sober
  • You have numerous, sometimes contradictory excuses for drinking (e.g., “I needed to celebrate a good day at work,” or “I needed to drown out a bad day at work”)
  • You drink to overcome the discomfort of a hangover or withdrawal symptoms
  • You know that drinking is making you more depressed and/or anxious, but you do it anyway
  • You’ve promised yourself that you wouldn’t drink, or you’d only have X amount of drinks, but then you somehow changed your mind
  • All your strategies for relaxing include alcohol
  • You make frequent jokes about being an alcoholic
  • You get angry or defensive if someone confronts you about your drinking
  • You neglect your responsibilities
  • You get into legal trouble
  • Your personality changes when you drink
  • You lie about how much you drink
  • You lose interest in food 
  • You lose interest in your personal hygiene or appearance

AUD Symptom Glossary

Alcohol abuse: According to Elizabeth Fiser, Psychiatric Mental Health Nurse Practitioner (PMHNP) at Thriveworks, alcohol abuse and alcohol misuse can be interchangeable with alcohol use. She defines alcohol abuse as “a deleterious situation for the one using and for those who love and care for them. It is a mosaic of drinking frequently. It impedes a person’s day-to-day quality of life.”

Binge drinking: Both the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) define binge drinking as consuming 5+ alcoholic drinks for men, or 4+ alcoholic drinks for women, within a few hours. This brings someone’s blood alcohol concentration (BAC) to 0.08 percent or higher. 

Drinking in moderation: For men, drinking in moderation is defined by consuming two drinks or fewer per day, and for women, one drink or less per day. This can also be called controlled drinking or nonproblematic drinking.

Hangover: A hangover is an unpleasant bouquet of symptoms that emerge in the immediate wake of alcohol consumption. Hangovers vary from person to person, but they may include headaches, stomach upsets, irritability, anxiety, and fatigue. 

Heavy alcohol use: For men, healthy alcohol use means consuming 14+ drinks per week, and for women, consuming 7+ drinks per week. Heavy alcohol use can also be defined as binge drinking for more than five days in the past month.

Sobriety: Sobriety is a human’s natural state of being, when someone doesn’t have any measurable psychoactive substances in their body.  

Withdrawal: When someone suffers specific physical and mental symptoms when they discontinue a substance, the phenomenon is called withdrawal. Alcohol withdrawal is a DSM-5 diagnosis.

Are There Different Types of AUD?

Alcohol use disorder can be mild, moderate, or severe according to DSM-5 criteria. But some clinicians have attempted to categorize people with AUD or alcohol dependence according to subtype. For example, a survey from the NIAAA determined that there were five types of people with alcohol dependence:

  • Young adult subtype
  • Young antisocial subtype
  • Functional subtype
  • Intermediate familial subtype
  • Chronic severe subtype

The NIAAA called its typology the “five-cluster solution.” But this is certainly not the only way of classifying problem drinkers. There are also the four subtypes of alcoholism defined by Robert Zucker in 1987: 

  • Negative-affect alcoholism
  • Antisocial alcoholism
  • Developmentally cumulative alcoholism
  • Developmentally limited alcoholism

And the two subtypes proposed by Thomas Babor in 1992:

  • Type A alcoholic, characterized by later onset, fewer problems, and less severe dependence
  • Type B alcoholic, characterized by childhood risk factors, more problems, and a more severe course of disease

Informally, there are countless names for different types of drinkers. For example, a dry drunk is what the founder of Alcoholics Anonymous (AA) christened someone who was technically sober, but hadn’t addressed any of the underlying issues that motivated them to drink. Because there’s been no real change, the dry drunk is vulnerable to relapse.

Are There Stages of Alcoholism?

Alcohol use disorder can have a variable course. For some people, AUD might begin in the teen years and worsen at a steady pace. Other people may quit drinking, then relapse multiple times. And others may go into remission forever. So there’s no one way an individual can develop AUD. 

Some researchers have attempted to outline progressive phases of alcoholism, however. For example, E. Morton Jellinek posited five phases that form what’s known as the Jellinek curve:

  • Pre-alcoholism 
  • Prodromal (early alcoholism)
  • Crucial (middle alcoholism)
  • Chronic (late alcoholism)
  • Recovery or rehabilitation

The 2016 “Surgeon General’s Report on Alcohol, Drugs, and Health” specifies three stages in the addiction cycle:

  1. Binge/intoxication, where you enjoy the rewards and effects of a substance. This stage is associated with the basal ganglia region of the brain. 
  2. Withdrawal/negative affect, where you experience negative emotions when you’re not taking the substance. This stage is associated with the extended amygdala region of the brain. 
  3. Preoccupation/anticipation, where you crave and seek substances after being abstinent. This stage is associated with the prefrontal cortex region of the brain.

AUD relapse and recovery can also have stages. For example, one medical doctor who specializes in addiction refers to the emotional, mental, and physical stages of relapse. Recognizing these stages and intervening early can be crucial in maintaining recovery. The same doctor also describes the stages of recovery: abstinence, repair, and growth.

What Causes Alcohol Use Disorder?

There are many ways to think about how and why someone develops alcohol use disorder. One camp believes that anyone who drinks alcohol will eventually become addicted because that’s the nature of the drug. So it’s not a matter of if, but when. Other camps believe that only certain factors encourage AUD, and without this alchemy, some moderate drinkers can basically remain immune. 

But the bottom line is that alcohol use disorder is a heterogeneous disease, meaning it’s pretty different for everyone. There’s no single origin story for the affliction. So experts think in terms of risk factors. Research has shown that the following elements can contribute to the development of AUD.

Risk Factors for Alcoholism

  • Genetics. According to the DSM-5, genes are responsible for approximately 40-60% of alcohol use disorder. Can you predict who will get AUD based on family history? If someone has a close relative with AUD, they’re far more likely to develop the condition. Small genetic variations can also help determine how a person metabolizes alcohol, and how sensitive they are to the drug. For example, when some people of Asian descent drink, they can experience negative physical reactions like the alcohol flush reaction, where their faces become red or blotchy and their heart rate accelerates. This discomfort makes it less likely that they’ll become heavy drinkers. 
  • Environment. Someone’s immediate surroundings can influence their alcohol intake. On a cultural level, alcohol needs to be available and acceptable. On a social level, peers can influence drinking, while a lack of peer and family support can increase someone’s AUD risk. And on an emotional level, the presence of stress can cause someone to drink, for alcohol may reduce anxiety in the short term. Socioeconomic status has also been linked to AUD outcomes. 
  • Childhood and early life experiences. As with many mental health disorders, early childhood trauma, abuse, or neglect can set up the brain for problems down the road. AUD is also associated with conduct disorder and repeated antisocial behavior in children. And the younger someone begins drinking, the higher their risk of developing alcohol dependence, possibly due to alcohol’s influence on gene expression.
  • Gender. Though men still tend to suffer from AUD in greater numbers than women, women are catching up at an alarming rate. Women’s alcohol abuse tends to progress faster than men’s, which is called telescoping. Girls and women also suffer higher rates of sexual abuse and victimization, and may begin heavy drinking as a way of coping with negative affect and stress.
  • Personality. Though there is no such thing as an “addictive personality,” high impulsivity has been linked to an earlier onset of AUD and a more severe course of illness. 
  • Age. If someone starts drinking in adolescence when their brain is more sensitive to the toxicity of alcohol, they may become more impulsive, and hence more susceptible to severe AUD.

Alcohol Use Disorder and Other Mental Health Conditions

Harmful drinking patterns are associated with a large number of other mental health conditions, especially depressive disorders and anxiety disorders. Alcohol can also directly trigger certain psychiatric disorders. These are called alcohol-induced disorders and they typically resolve when the individual stops drinking.  

Alcohol-induced Disorders

  • Alcohol-induced psychotic disorder 
  • Alcohol-induced bipolar disorder 
  • Alcohol-induced depressive disorder 
  • Alcohol-induced anxiety disorder 
  • Alcohol-induced sleep disorder 
  • Alcohol-induced sexual dysfunction 
  • Alcohol-induced major or mild neurocognitive disorder (such as Wernicke-Korsakoff syndrome)

Most Common AUD Comorbidities

Alcohol use disorder can be present at the same time as other psychiatric disorders. When this happens, we call them comorbid disorders. More common AUD comorbidities include the following:

Alcohol As Coping Mechanism

Picture a young woman with social anxiety. When she pours herself a glass of wine or a shot of liquor before going out with friends or on a date, she feels more at ease. This is because alcohol can act as an anxiolytic agent, meaning it can temporarily reduce anxiety. The young woman had been experiencing some nervousness, some dysphoria, and wine seemed to alleviate those negative feelings. Now that she feels slightly sedated and happy, she’s more easy-going and sociable. Where’s the harm? 

The harm comes if the young woman develops a pattern of turning to alcohol every time she feels anxious. Not only can this prevent her from finding the internal resources to cope with her emotions, but over time alcohol acts on the brain as a stressor. The young woman thought that she was relieving stress, but in reality, her wine consumption is causing a stress response. The longer she drinks, the more her brain’s reward system and stress system become dysregulated, and it becomes harder and harder for her to maintain control over alcohol – and her own well-being. 

As in the above example, alcohol is frequently used as a maladaptive coping mechanism. Feeling depressed? You drink. Feeling stressed? You drink. Worried about your marriage? You drink. Instead of dealing with these negative feelings head-on, someone with alcohol use disorder might feel motivated to pick up a bottle. And eventually, all those bottles can disrupt the brain’s ability to generate happiness on its own. 

Alcohol in Society

Alcohol has been part of human society for a long time – almost 10,000 years. Historically, various temperance movements and teetotalers (never-drinkers) have tried to make people abstain from alcohol altogether, but they’ve hardly achieved global success. Beer only trails water and tea as the most popular beverage in the world! In the United States, we tend to accept alcohol consumption as a part of life. But there are still safeguards in place meant to protect people from harm. For example, the minimum drinking age is 21. And it’s illegal to drive a car while intoxicated. 

But alcohol still exacts a heavy cost on society in terms of public health and the economy. In the US alone, excessive alcohol use is responsible for $249 billion in losses every year, and is a leading risk factor for death and disability. The World Health Organization (WHO) has made several recommendations to limit this harm:

  • Raise taxes on alcohol
  • Ban or restrict alcohol advertising
  • Reduce alcohol availability 

Interestingly, research has found that social, cultural, and personal expectations can play a significant role in how people feel and behave when they drink. For example, someone who expects to feel positive when they drink is more likely to feel positive when they drink. And someone who expects to feel socially outgoing when they drink might become more extroverted when intoxicated. So alcohol expectations can be a self-fulfilling prophecy, and understanding someone’s beliefs about alcohol can be an important step in changing drinking behaviors. 

Women and Alcohol

Some interesting research points to sex and gender differences in drinking patterns and alcohol use disorder. Not only are women’s bodies more vulnerable to the negative health consequences of alcohol, but women are also more likely to hide their drinking problems because they fear being judged. This can prevent them from seeking the psychosocial support they need to recover from AUD.

Teens and Alcohol

Studies show that the earlier someone is initiated into drinking behaviors, the more likely they are to develop alcohol use disorder in young adulthood. Heavy drinking in adolescence can also disrupt normal brain development, both accelerating a reduction in gray matter and slowing the growth of white matter. Weakened executive functions can lead to more impulsivity and more drinking, which can lead to weaker executive functions, and so on in a vicious cycle.   

Finally, underage drinking is a common contributing factor in car crashes, accidents, overdoses, and suicide.

How Does Alcohol Affect the Body?

Alcohol can affect the body both directly, on a cellular level; and indirectly, in terms of leading to accidents, violence, injuries, and risky behaviors. All in all, alcohol use disorder can reduce someone’s lifespan by 10 years. The “Surgeon General’s Report on Alcohol, Drugs, and Health” cites 88,000 deaths in the US every year due to alcohol misuse. This section will look at the short- and long-term effects of alcohol use on human health. 

What Are the Short-term Effects of Alcohol Use?

The short-term effects of alcohol depend on how much a person drinks, what their tolerance is, what their expectations are (related to the placebo effect), and other complex variables. In small amounts, alcohol can cause someone to feel mildly euphoric, talkative, relaxed, or uninhibited. In greater amounts, alcohol can lead to anger, mood swings, sleep deprivation, slurred speech, unconsciousness, and even death. The DSM-5 distinguishes between alcohol use disorder and alcohol intoxication. 

What Are the Long-term Effects of Alcohol Use?

Alcohol is associated with hundreds of long-term health problems, including the following:

  • Cardiovascular diseases and complications
  • Low-grade hypertension
  • Mental and behavioral disorders
  • Liver cirrhosis and liver disease
  • Pancreatitis
  • Impaired immune response
  • Sexual dysfunction
  • Fertility issues
  • Gastritis
  • Stomach or duodenal ulcers
  • Some cancers (e.g., esophagus, stomach, and breast)*
  • Peripheral neuropathy
  • Cognitive impairment and dementia
  • Neuroadaptive changes 

Alcohol use in pregnant women can also lead to fetal alcohol syndrome (FAS) and various pre-term birth complications.

*The Environmental Protection Agency (EPA) classifies acetaldehyde, the chief metabolite of ethanol, as a probable human carcinogen.

Neurobiology of Alcohol

Alcohol primarily works on the brain by impeding the activity of the central nervous system. What’s the mechanism for this? Alcohol boosts the effects of gamma-aminobutyric acid, or GABA, an inhibitory neurotransmitter. Alcohol also affects other neurotransmitters like serotonin, endocannabinoids, opioid peptides, and dopamine, which are all part of the brain’s reward pathways. So people keep drinking because of this positive reinforcement, but also because not drinking can cause them to feel bad (negative reinforcement) due to hyperactivity and dysfunction in the nervous system. This is what’s known as the addiction cycle. 

How Does Alcohol Use Disorder Affect Relationships?

Frequently, alcohol problems don’t just affect the drinker, but everyone close to them: kids, friends, family members, coworkers, etc. Alcohol abuse can lead to dysfunction within a couple or a family, but relationship dysfunction can also increase someone’s alcohol use. The reciprocal nature of these issues is why people in recovery from AUD often benefit from family therapy and/or marriage counseling

Parental alcoholism can also have a damaging effect on children’s mental health, leading to low self-esteem, externalizing disorders, and/or trust issues. There’s even a 12-step support group for children who have grown up with alcoholic parents: Adult Children of Alcoholics (ACA) & Dysfunctional Families World Support Organization.

What Happens When You Quit Alcohol?

If your body is dependent on alcohol and you stop drinking, you will likely experience short-term physical and mental discomfort due to withdrawal. These symptoms usually fade or at least become more manageable after 72 hours. This process is often called an alcohol detox, and for severe drinkers, it can be dangerous. 

Within weeks, months, and years of not drinking, your body and mind will slowly recover from the drug. You’ll feel healthier and more energized after you get over these hurdles. But physical detox is only the first step in overcoming AUD. You also have to figure out the emotional side of the equation as well. With the right tools, it’s very possible to undo alcohol’s damage to your nervous system – and to your life.  

Alcohol Withdrawal

Alcohol withdrawal can include a number of extremely unpleasant symptoms like depression, anxiety, sweating, tremors, insomnia, nausea, gastrointestinal (GI) issues, and cravings. Because none of this feels good, and the only cures are time (several hours to a few days), medication, or more alcohol, many people choose to resume drinking. And to make matters worse, the more times you withdraw from alcohol and then relapse, the worse your withdrawal symptoms can be. This is due to the kindling effect

There are two specific subtypes of alcohol withdrawal worth mentioning here:

  • Alcohol withdrawal delirium. Also known as delirium tremens (DT) and acute withdrawal, this is a medical condition that can cause severe symptoms like seizures or hallucinations when a heavy drinker quits drinking. It’s treated with benzodiazepines (e.g., diazepam, chlordiazepoxide, lorazepam, oxazepam, and midazolam) and it sometimes requires hospitalization.
  • Post-acute withdrawal syndrome (PAWS). This is a collection of psychological and emotional symptoms that can lead to relapse. PAWS symptoms include irritability, anxiety, and concentration problems, and they can last months.

Alcohol Use Disorder Screening and Diagnosis

Most people diagnose themselves with AUD. Research indicates that only 1 in 6 American adults are asked about their drinking behaviors in health care settings. The CAGE questionnaire is a popular screening for AUD. It asks people the following:

  1. Have you ever felt you should Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt bad or Guilty about your drinking?
  4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?

Other assessments include the Alcohol Use Disorders Identification Test (AUDIT), the Alcohol Dependence Data Questionnaire, the Michigan Alcoholism Screening Test (MAST), or one of the MAST derivatives. Lab tests and imaging are not required for an AUD diagnosis. 

If you receive the diagnosis in a clinical setting, your provider may provide brief counseling and prescribe a medication like naltrexone, then recommend therapy, harm reduction approaches, or a mutual support group. 

Alcohol Use Disorder Treatment

As we’ve emphasized throughout this article, alcohol use disorder is different for everyone. This means that interventions should be customized for each drinker. But – and this is crucial – every drinker should have hope that they can find a path to recovery. Though AUD is a chronic health condition that can last for years or a lifetime, the majority of people with AUD recover over time, whether on their own, with medication, or with plenty of psychosocial support. Success rates are high, and there are countless options for effective interventions. 

You may choose complete abstinence (zero tolerance) or take a harm reduction approach. Well-being can look different to different people. But you have to be ready to change. And because alcohol has hijacked your brain’s reward systems for so long, you’ll need to learn how to be happy without alcohol. Sometimes this can mean learning to be comfortable with being uncomfortable. You may have to “redefine fun.” This period of personal growth can be something to look forward to, rather than dread. After all, we tend to overestimate the pleasures of drinking, and underestimate its penalties. 

Alcohol Use Disorder Therapy

Many mental health professionals are specially trained to help people with alcohol use disorder. They might be certified addiction counselors (CACs), licensed clinical social workers (LCSWs), psychologists, licensed professional counselors (LPCs), psychiatrists, or another kind of experienced therapist. Here are some of the most effective psychosocial interventions for alcohol use disorder:

  • Brief interventions, especially ones that include motivational interviewing, such as motivational enhancement therapy (MET)
  • Operant conditioning approaches (e.g., contingency management and the community reinforcement approach)
  • Cognitive behavioral therapy (CBT) and cognitive therapy to address negative thinking patterns and beliefs about drinking
  • Acceptance- and mindfulness-based approaches
  • 12-step facilitation (e.g., Alcoholics Anonymous)
  • Other mutual support groups and self-help groups like SMART (Self-Management and Recovery Training)
  • Coping skills and life skills training
  • Lifestyle changes that incorporate self-care and mind-body relaxation
  • Marriage counseling and/or family therapy

Alcohol Use Disorder Medications

The Food and Drug Administration (FDA) has approved three drugs for the treatment of alcohol use disorder. These medications are underutilized in the AUD population, only being prescribed to about 10% of people who seek help. 

  • naltrexone (Vivitrol, Revia), which can be taken orally or as a long-acting injectable. It prevents someone from feeling pleasure when they drink.
  • acamprosate, which can help alleviate withdrawal symptoms.
  • disulfiram (Antabuse), which causes someone to feel sick if they drink. 

Off-label medications that might hold promise for the treatment of AUD include topiramate, ondansetron, gabapentin, and varenicline. 

Future Treatment Directions

Evidence-based alcohol use disorder treatment options are expanding as researchers learn more about the condition. But we’ve already come a long way. In the late 19th century, Sigmund Freud treated alcohol addiction with cocaine! Today’s novel treatments are more likely to involve smart watches and electrodes than asylums and controlled substances. For example, evidence-based AUD interventions of tomorrow may include the following:

An AUD Action Plan

How do you go from a self-diagnosis of alcohol use disorder to a full recovery? Start by feeling some compassion for yourself. This means accepting, without judgment, that you have struggled to master a potent drug. Self-compassion is the direct opposite of shame and depression, both of which tend to be part and parcel of alcohol abuse. So the first step is often to be kinder to yourself and more mindful of your hardships and your common humanity. Therapy can frequently help with this process. 

At the same time, you explore what protects you from drinking. What are your positive motivators? Alcohol use disorder tends to make people seek “highly salient alcohol rewards” over more meaningful things like strong relationships and long-term health. So recovery should include not just an absence of alcohol, but the presence of deeper, more abstract rewards. Think of recovery as a restoration of what makes you feel happy and whole. It may take some time to find yourself again, but this courageous adventure can begin with sobriety. 

Table of contents

What Is Alcohol Use Disorder?

What Does Alcohol Use Disorder Look Like?

Are There Different Types of AUD?

Are There Stages of Alcoholism?

What Causes Alcohol Use Disorder?

Alcohol Use Disorder and Other Mental Health Conditions

Alcohol As Coping Mechanism

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Elizabeth Fiser, PMHNP

Elizabeth Fiser is a Psychiatric Mental Health Nurse Practitioner (PMHNP) who specializes in a range of areas including alcohol use, addiction, anxiety, depression, trauma and PTSD, women’s issues, and more.

Wistar Murray

Wistar Murray

Wistar Murray writes about mental health at Thriveworks. She completed her BA at the College of William & Mary and her MFA at Columbia University.

We only use authoritative, trusted, and current sources in our articles. Read our editorial policy to learn more about our efforts to deliver factual, trustworthy information.

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We update our content on a regular basis to ensure it reflects the most up-to-date, relevant, and valuable information. When we make a significant change, we summarize the updates and list the date on which they occurred. Read our editorial policy to learn more.

  • Originally published on June 16, 2017

    Author: Lenora KM

  • Updated on September 1, 2022

    Author: Wistar Murray

    Reviewer: Elizabeth Fiser, PMHNP

    Changes: Rewrote article to offer additional insights into AUD. Clinically reviewed to confirm the accuracy and enhance value.

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