Drinking alcohol too much or too often, or being unable to control alcohol consumption, can be a sign of alcohol misuse, and in some cases alcohol use disorder (AUD).

AUD previously went by other names such as “alcohol abuse,” “alcohol dependence,” and “alcoholism.” To differentiate AUD from alcohol misuse and to reduce stigma around the condition, in 2013 the DSM–5 integrated these terms into a single, diagnosable disorder called alcohol use disorder (AUD).

Alcohol misuse refers to single episodes during which you might drink excessively. When this occurs repeatedly over time and when it begins to impact your health and your life, alcohol misuse can become AUD. The disorder can also be broken down further into mild, moderate, and severe subtypes.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) says that about 14 million adults in the United States struggle with AUD. These disorders can be disruptive and life threatening.

However, since alcohol affects people in different ways, recognizing AUD in yourself or in others can be subjective and challenging. Read on to learn more about the symptoms, risk factors, treatments, diagnosis, and where to get support.

Alcohol affects different people in different ways. Generally, however, the difference between alcohol misuse and AUD lies in looking at how a person drinks in the short term, as opposed to over a prolonged period of time.

In addition, AUD is an addiction disorder, which means you may have a difficult time stopping alcohol consumption, even when you want to. The definition of AUD also includes the impact that such drinking has on your health and life.

Alcohol misuse

According to the Centers for Disease Control and Prevention (CDC), moderate drinking is typically defined as two drinks or fewer for men per day, or one drink or less for women.

If you are drinking more than that at any one time, you may be misusing alcohol. Excessive drinking is defined as 15 drinks or more a week for men and eight drinks or more a week for women.

But alcohol misuse can also be about how or when you drink. For example, any alcohol consumption by a pregnant person can be considered alcohol misuse, as well as drinking under the legal age of 21.

Alcohol use disorder

AUD refers to what is colloquially known as alcoholism, which is a term that the DSM-5 no longer uses.

According to the DSM-5, you may have at least mild AUD if you’ve experienced at least two of the following in the last year:

  • had times when you ended up drinking more, or longer, than you intended
  • wanted to cut down or stop drinking, or tried to, but couldn’t
  • spent a lot of time drinking, being sick, or getting over other after effects
  • wanted a drink so badly you couldn’t think of anything else
  • found that drinking — or being sick from drinking — often interfered with taking care of your home or family, or caused job or school problems
  • continued to drink even though it was causing trouble with your family or friends
  • given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink
  • gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)
  • continued to drink even though it was making you feel depressed or anxious, or adding to another health problem, or after having had a memory blackout
  • had to drink much more than you once did to get the effect you want, or found that your usual number of drinks had much less effect than before.
  • found that when the effects of alcohol were wearing off, you had withdrawal symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure, or you sensed things that were not there

The symptoms of alcohol misuse and AUD can overlap. But alcohol misuse, also known as excessive drinking, has a more immediate impact, whereas the symptoms of AUD will be more prolonged.

Physical symptoms of alcohol misuse

A high concentration of alcohol in the blood causes physical symptoms, such as:

  • slurred speech
  • slowing of reflexes
  • a decreased ability to control bodily movements
  • difficulty concentrating
  • gaps in memory, or brownouts
  • poor decision-making abilities
  • staying conscious but not having memory of your actions, which is called a blackout
  • hangovers

Very high concentrations of alcohol in the blood can cause breathing problems, coma, or death. It can also lead to alcohol poisoning.

Behavioral symptoms of excessive drinking

Becoming cognitively impaired from excessive drinking of alcohol can lead to risky behaviors that can result in injury or death of an affected person or of others.

Research shows a high correlation between alcohol misuse and high-risk sexual behavior, violence, crime, self-injury, and fatal injury from things like motor vehicle accidents. People with AUD represent about 20–35 percent of completed suicides.

You shouldn’t attempt to drive or operate heavy machinery while under the effects of alcohol. In the United States, the legal limit for driving under the influence of alcohol is 0.08 percent, except in the state of Utah, where it’s 0.05 percent.

Physical complications of alcohol use disorder

Many people with AUD continue to drink even as they develop health problems related to drinking. Over the long term, AUD may lead to serious health conditions, while worsening others.

These can include:

Additionally, research shows that prolonged consumption of alcohol may be associated with a rise in high blood pressure and can increase the risk of cardiovascular problems over time.

It may also lead to the development of different types of cancer. This is because when you drink, your body breaks down alcohol into acetaldehyde. This is a chemical that can damage your DNA and lead to cells growing out of control.

Another complication is alcohol withdrawal syndrome, which may occur after you stop drinking and can cause symptoms such as nausea, shaking, and sweating. It can also lead to serious symptoms like seizures, fever, or hallucinations, and can be a medical emergency.

If you have a history of withdrawal symptoms, see a health professional before quitting. You should also see a professional before quitting alcohol if you have other health conditions.

Treatment of AUD focuses on relieving symptoms of alcohol withdrawal in the short term and then suppressing alcohol cravings in the long term.

But everyone’s recovery from AUD is different. Some require medications lifelong while others do not, and some drink in moderation during their recovery while others abstain.

Treatment also often involves detoxification followed by medication and therapy, but everyone’s treatment plan is different where some do not require detoxification, for example, or some may opt-out of therapy.

While medication is recommended for anyone with moderate to severe alcohol use disorder, those with mild AUD may consider therapy without medications

Medications

Health professionals sometimes prescribe medications to reduce the symptoms of withdrawal. Other medications can help you quit drinking by suppressing alcohol cravings or making you feel sick when alcohol enters your body.

Medication can also help reduce cravings.

Some of the medications for AUD include:

  • naltrexone (Revia, Vivitrol)
  • acamprostate (Campral)
  • disulfiram (Antabuse)

Behavioral treatments

As you recover from AUD, you may find it helpful to see a psychotherapist who uses cognitive behavioral therapy (CBT) techniques. CBT helps you modify your thoughts and actions, while also learning alternative coping mechanisms.

For some people, alcohol misuse results from psychological or social factors. They may drink to calm down or loosen up in social settings. Others use alcohol to cope with psychological issues or stress in their daily lives.

AUD may also run in families. However, genetics doesn’t guarantee a problem with alcohol. The exact mechanism that causes people to misuse alcohol is unclear.

Alcohol misuse is more common at certain points in life. Males, college students, and people going through serious life events or trauma are more likely to experience AUD.

Other risk factors include:

If you have a concern that you have AUD, you can see a health professional for consultation. They may ask you about your drinking habits and health history.

They may also use blood tests to assess your overall health, paying special attention to areas of the body most impacted by alcohol, including the brain and other parts of the nervous system, as well as the heart and liver.

How do you know if you have AUD?

It can be hard to see there is a problem even if the drinking is negatively impacting your health and your life.

There is screening that may help you recognize AUD in yourself or others. According to the NIAAA, AUD may be classified based on the following:

  • Mild: experiencing two or three symptoms
  • Moderate: experiencing four to five symptoms
  • Severe: experiencing six or more of the above symptoms

Having support and seeking professional treatment increases the chances for recovery from AUD. Groups such as Alcoholics Anonymous (AA) provide support for people who are recovering.

Other support options include:

The Substance Abuse and Mental Health Services Administration (SAMSA) also offers a free national hotline for people struggling with different types of substance use disorders at 800-662-HELP (4357).

Recognizing the early signs and risk factors for AUD can help you seek early treatment and intervention to break alcohol misuse patterns. This may require a lifelong effort.

If AUD is not treated, it can increase your risk for serious health problems. After completing treatment for AUD, it’s possible to have a risk of relapse. It’s important to recognize warning signs and seek help if you’re concerned about having a relapse. Continued therapy and support help minimize this risk.