Signs of Alcohol Use Disorder Aren't Always Loud - Here's What to Know

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This informational guide, part of PS's Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

Alcohol use disorder (AUD) is a diagnosis that encompasses many different alcohol-related issues: alcohol abuse, alcohol dependence, alcohol addiction, and alcoholism. People with AUD typically have trouble controlling their alcohol consumption; are preoccupied with thoughts of when they'll have their next drink; or have had adverse social, professional, or health-related problems as a result of drinking.

AUD has the perception of being more of a problem among men, and while they do consume more alcohol than women, that gap is closing. A 2017 study sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that between 2002 and 2013, the number of women who had four or more drinks a day on a weekly basis (considered high-risk drinking) increased by 58 percent and the number of women with AUD increased by 84 percent.

The stigma that still surrounds alcohol issues can make it difficult for people to admit they have a problem. Plus, it's not always easy to spot the signs.But recovery is possible, even for people with more severe disorders.

Experts Featured in This Article:

Sharon Wilsnack, PhD, is an alcohol researcher at the University of North Dakota School of Medicine and Health Sciences.

What Is Alcohol Use Disorder?

"Alcohol use disorder is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol or continuing to use alcohol even when it causes problems," according to the Mayo Clinic. AUD can range from mild to severe, and while there's a perception that people with alcohol issues tend to be older and have spent decades drinking, there's no time requirement — it's possible to develop a disorder very soon after starting to drink.

What Are Signs of AUD?

Common signs of alcohol use disorder aren't always easy to spot, says Sharon Wilsnack, PhD, an alcohol researcher at the University of North Dakota School of Medicine & Health Sciences. Here are signs to look out for, per Dr. Wilsnack and the Mayo Clinic:

Increased tolerance: This may look like needing four drinks to get the same buzz you used to get from two and suffering withdrawal symptoms when you try to cut back or stop.
Blackouts: "If friends mention something you said or did while under the influence but you don't remember the incident, it's time to be concerned," Dr. Wilsnack.
Binge drinking: This is defined as having at least four to five drinks within two hours. Reminder: one drink is just five ounces of wine, 12 ounces of beer, or 1.5 ounces of distilled spirits.
Putting yourself in unsafe situations after consuming alcohol, like drinking and driving.
Continuing to drink even when it's causing physical, social, work, or relationship problems.
Spending a significant amount of time drinking, recovering from drinking, or thinking about drinking.

Another warning sign: "If you have the urge to drink when something stressful happens or you try to set limits on your consumption and have a hard time sticking with those limits, those are signs as well," Dr. Wilsnack says.

The health consequences of consuming too much alcohol range from liver disease and digestive problems to high blood pressure, bone damage, and neurological issues, such as numbness in your hands and feet. Drinking while pregnant can also result in birth defects. "Research shows that women develop alcohol-related health problems more quickly and with lower levels of consumption than men," Dr. Wilsnack notes. "That's probably because women's bodies have less water, so they have a higher blood-alcohol concentration when they consume the same amount as men."

Causes of AUD

There isn't one single cause of AUD. Experts believe several factors can play a role in developing AUD:

Genetics are thought to be responsible for about half the risk of developing AUD, according to the NIAAA. But environment matters, too. If one or both of your parents drank heavily when you were a child, that early role modeling increases your risk independent of any genetic factors.
A history of trauma elevates the risk of developing AUD in adulthood. So does having a mental health disorder, including depression, anxiety, or bipolar disorder, reports the Mayo Clinic, but drinking alcohol excessively can also worsen or even cause symptoms of mood disorders.
Drinking in adolescence — especially binge drinking — is problematic, too. A recent national survey found that among people ages 26 and older, those who began drinking before age 15 were more than five times more likely to report having AUD in the past year, compared to those who waited until they were at least 21 to begin drinking. Worth noting: the risk of early drinking was higher for women than men.

How Is AUD Diagnosed?

If you think you're experiencing symptoms of AUD, talk to your primary health care provider. They will assess your drinking habits via a 1:1 conversation, but may also perform a physical and/or psychological exam and run certain lab tests to determine your diagnosis and recommend the best course of action.

Treatments For AUD

Treatment typically includes psychological counseling to help people with AUD understand the factors that contribute to their drinking, including any other mental health issues that may be playing a role, and to give them the tools they need to change their behavior. That may include prescription medication meant to help you moderate or stop drinking, such as disulfiram, an oral medication that causes nausea and headaches when combined with alcohol; naltrexone, a drug that blocks the feel-good sensations alcohol triggers; or acamprosate, which can help curb alcohol cravings.

Many AUD experts and people who are in recovery emphasize that receiving ongoing emotional support through group therapy or a local 12-step program — which have the added benefits of being widely available, accessible to all, and completely free — is crucial. "Recovery can be a lifelong process, but having support is an important factor that can keep you on the right track," Dr. Wilsnack says.

If you or someone you know is struggling with an alcohol use disorder, the Substance Abuse and Mental Health Services (SAMHSA) has resources available including a national 24/7 helpline at 1-800-662-HELP (4357). You can also send your zip code via text to 435748 (HELP4U) for treatment referral and information services.

Ginny Graves is an award-winning writer in the San Francisco Bay Area whose work focuses on science, psychology, health, nature, and the human-animal bond.

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