Alcoholism: signs, causes, and treatments

If you’ve ever found yourself questioning the amount of alcohol you drink or wondering if it might be causing you harm, you aren’t alone. Alcoholism is a significant problem in the United States.

Excessive alcohol use directly contributes to more than 85,000 deaths per year in the U.S., making it the third leading preventable cause of death. It also contributes to numerous physical and mental health issues (Alozai, 2020).

Recovery from alcohol addiction is a long journey, but it is possible with medical and social support. 

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Historically, someone was said to abuse alcohol when they drank too much alcohol occasionally or had drinking habits that led to impaired health, ability to work, or judgment. It used to be thought that alcohol abusers were generally not physically dependent on alcohol (Alozai, 2020).

The term “alcohol dependence” was once reserved for people who were physically dependent on alcohol and were unable to make it through the day without it (Alozai, 2020).

Today, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) does not differentiate these two disorders. Instead, a unified diagnosis of “alcohol use disorder” (AUD) was created (Alozai, 2020).

The rate of problematic alcohol use is relatively high in the United States. Health professionals at the Centers for Disease Control and Prevention (CDC) estimate that approximately 25.1% of adults aged 18 and over had at least one heavy drinking day in the past year. The following are considered the criteria for binge drinking: five or more drinks for men and four or more drinks for women (CDC, 2021).

To diagnose alcoholism, your healthcare provider will ask you for a detailed history of your alcohol use, including the frequency and amounts of alcohol you consume. They will also ask you about your history of alcohol use, any prior treatment, and if any of your family members struggle with addiction (Alozai, 2020).

A standard screening tool for alcohol use disorders is the CAGE questionnaire. A score of two or greater indicates the person likely experiences problem drinking behaviors (Nehring, 2020). 

1. Have you ever felt you should Cut down on your drinking?

2. Have you ever been Annoyed by people criticizing your drinking? 

3. Have you ever felt Guilty about your alcohol use?

4. Have you ever needed an eye-opener (a drink early in the morning) to steady your nerves or get rid of a hangover?

Your healthcare provider may also conduct a physical exam. This exam will include looking for signs of alcohol withdrawal (elevated heart rate and blood pressure, shaking, confusion) and lab tests to look for damage to the liver (Alozai, 2020).

Contact a medical or behavioral healthcare provider if you think you may have a problem with drinking. Your healthcare provider can provide you with referrals for inpatient or outpatient alcohol treatment, help you obtain medications that can ease detox symptoms, and provide you with resources for support groups.

The exact causes of alcohol addiction are not known. Several risk factors are thought to contribute to its development. These include (Nehring, 2020):

• Home and environmental influences

• Peer interactions

• Genetic factors such as family history

• Level of functioning

• Other mental health disorders 

Alcohol addiction carries many medical and social risks. The longer and more severe the alcohol abuse, the more likely it is for a person to experience negative consequences.

Social risks

The social consequences of alcoholism can include (Nehring, 2020):

• Losing a job

• Separation/divorce

• Loss of relationships with friends and family

• Loss of a home

• Legal issues such as driving under the influence charges

Physical risks

Alcohol addiction can also cause severe physical consequences, including (Nehring, 2020):

• Frequent falls

• Blackouts or memory loss

• High blood pressure

• Sleep disturbances

• Pancreatitis

• Emotional disturbances

• Liver disease such as cirrhosis

• Nutritional deficiencies

• Heart disease

Believe it or not, one of the most dangerous medical risks of alcoholism happens when heavy or long-time users attempt to stop drinking abruptly. Suddenly stopping the use of alcohol can cause withdrawal. This can range from mild symptoms to a severe form of withdrawal known as delirium tremens, which can be fatal. Alcohol withdrawal needs to be managed by a medical provider (Newman, 2020).

The symptoms of alcohol withdrawal can start within six hours after your last drink but can take as long as 24–28 hours to begin (Newman, 2020). 

Mild symptoms of alcohol withdrawal can include (Newman, 2020):

• Trouble sleeping

• Feeling shaky

• Overactive reflexes

• Anxiety

• Stomach upset

• Headache

• Palpitations

Moderate symptoms include withdrawal seizures. Oral medications can treat mild and moderate symptoms of withdrawal with oral medications. Short-term tapering doses of long-acting benzodiazepines, such as Librium or Valium, are the most commonly used. About 50% of people who experience withdrawal seizures are at increased risk of severe alcohol withdrawal (Newman, 2020).

In the most severe form of withdrawal, delirium tremens, a person may experience visual hallucinations, elevated heart rate, elevated blood pressure, elevated body temperature, sweating, and agitation. These symptoms will require treatment in a hospital setting. Someone with severe symptoms will likely need intravenous (IV) medications, IV fluids, and close monitoring (Newman, 2020).

Alcohol addiction treatment options generally involve a combination of medications, individual therapy, and peer support groups. None of these options is considered more effective than another, so treatment is usually customized to individual needs (Leggio, 2017).

Individual therapy

Two commonly used types of individual therapy include cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET). CBT focuses on identifying thoughts and feelings that trigger unhelpful behaviors and could lead to relapse. MET helps the person frame the decision to change their drinking behaviors regarding a dilemma, working through feelings of resistance to change (Leggio, 2017).

Medications

Several prescription medications have been used to help people maintain sobriety after their initial detoxification (Guenzel, 2020). 

Disulfiram (Antabuse) is a medication that causes a person to experience uncomfortable physical symptoms if they consume alcohol. This acts as a deterrent to relapse, as the person may think twice about drinking if they know they will become ill if they do so. Challenges with disulfiram include non-adherence (meaning that a person may not take it if they know they might feel sick because of it) and accidental alcohol exposures (Guenzel, 2020).

Naltrexone is a medication used to reduce cravings which decreases the risk of relapse. It is available both as an oral tablet taken daily and as a monthly injection (Guenzel, 2020).

Acamprosate (Campral) is another medication used to prevent relapse by reducing cravings for alcohol (Guenzel, 2020).

Peer support groups

A variety of peer support groups have been established to allow individuals dealing with addictions to receive support and assist others. The most well-known of these are Alcoholics Anonymous (AA) and Self-Management and Recovery Training (SMART). Both emphasize the need for frequent meetings, working through a specified program (steps), and guidance from a mentor or sponsor (Guenzel, 2020). 

There’s limited scientific support for the efficacy of peer support groups, but researchers recognize that well-designed studies are difficult since you can’t randomly allocate the motivation to participate in the programs. One small study found that AA participants did show increased treatment acceptance rates and retention in the recovery program (Guenzel, 2020).

If you or a loved one are struggling with alcohol use or mental health issues, consider calling the Substance Abuse and Mental Health Services Administration (SAMHSA) national helpline. 

SAMHSA’s helpline is free and confidential. It’s staffed 24/7, 365-days-a-year to provide treatment referrals and information for anyone facing mental health or substance use concerns. Services are available in both English and Spanish.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Editorial Guidelines | Medical Review Process

Current version

May 27, 2021

Written by

Ellyn Vohnoutka, BSN, RN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.