What Is Alcohol Use Disorder?

You’ve done it again. A late-night, binge-drinking bender with your buddies and a massive hangover to greet you the next day. “Do I have a problem?” you may be wondering. “This happens every weekend at least.”

You may not have anything to worry about. The occasional night out doesn’t inherently mean you have an alcohol abuse disorder, but there comes a point when it does. Keep reading to find out whether your habits are turning into alcohol use disorder.

Defining AUD

We may have heard the terms “alcoholism” or “alcohol dependence,” but they are officially known by the preferred term “alcohol use disorder” (AUD). AUD is more than just regular or heavy drinking. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) classifies it as a disease or medical condition. But what is alcoholism?

Alcoholism, or AUD, means we have a hard time stopping or controlling alcohol use despite negative consequences on our health or social and professional life, as well as physical withdrawal symptoms when we stop drinking. It means that excessive drinking is getting in the way of our daily life, more than just a bender on the weekends. Sometimes we may have a mild case of AUD but not know it, as there are different severities of AUD and different criteria we need for each level of severity.

AUD is very common. According to the NIAAA, 28.8 million adults in the U.S. had AUD in 2021. That’s 11.2% of adults in the U.S.

So does that mean that 28.8 million people are suffering from severe alcoholism every day? Not exactly. AUD ranges from mild to moderate to severe, depending on how many alcohol use disorder symptoms or “criteria” we have. The criteria are basically a list of questions we ask ourselves — or a health professional asks us — to evaluate our drinking habits. Let’s take a look at them.

Criteria for AUD

We talked about criteria for determining if we have AUD, so now let’s go through what these criteria are. Here are the questions to ask yourself:

• Do you often end up drinking more than you planned or spending more time drinking than you planned?
• Have you thought about or tried quitting or cutting back on alcohol but always ended up going back to it?
• Have you often found yourself spending copious amounts of time on alcohol, whether it’s from physically drinking it or time spent recovering the morning after?
• Have you ever found yourself thinking about a drink so much that you couldn’t concentrate on anything else? 
• Have you had to change your plans because of drinking? 
• Have you continued to drink even though you knew it was affecting your job or home life? 
• Have you taken time away from activities you enjoy in order to spend time drinking or recovering from drinking? 
• Have you often found yourself in dangerous situations during or after drinking, such as swimming, driving, walking in a sketchy part of town, or exposed to unsafe sexual behavior?
• Have you kept drinking even though it was affecting your mental health and memory or causing other health problems?
• Do you find that you need more alcohol to get the same buzz that you used to get with just one drink?
• Have you had withdrawal symptoms after drinking, such as lack of sleep, tremors or seizures, anxiety, sweating, nausea, racing heart, general feelings of discomfort, or even odd sensations that weren’t there before?

If you answered “yes” to any one of these questions, don’t freak out just yet! Answering “yes” to 2-3 of these questions indicates mild AUD. Answering “yes” to 4-5 indicates moderate AUD, and answering “yes” to 6 or more indicates severe AUD.

But how do we end up here? What has to happen from when we’re born to when we realize we have AUD? It turns out, there are many factors that put us at risk, and most of them are preventable and treatable.

Risk Factors for AUD

We can be at risk for AUD both by being prone to it and by developing it. Let’s take a closer look at the risk factors.

• Genetics. If we have family members with AUD, we’re more likely to develop it ourselves. In fact, 60% of AUD cases can be attributed to genes.
• Family history and environment. This is different from genetics but still related. If we have family members with AUD or live in an environment where alcohol is abused, we’re likely to develop it. This can be a vicious cycle — our family members may have AUD from genetic reasons, and, as a result, they abuse alcohol in front of us, making us more prone than we were already since we share their genes. The same is true if we have close friends or a partner who drinks regularly or heavily.
• Starting early. You know all those wild high school parties in just about every ‘80s movie, where kids are drinking copious amounts of alcohol and have to clean the house five minutes before the parents get home? Well, this very thing can lead to AUD. Starting drinking at an early age like high school or college, especially before our brain has had time to fully develop, greatly increases our risk. In fact, those who start drinking before age 15 are three times more likely to develop AUD than those who wait until they’re 21 or older, and the risk is even greater for women. This still applies to those of us under 21 though, which is one reason why the “college drinking culture” is more dangerous than we think, particularly for underage freshmen or sophomores. 
• Mental health conditions. Those of us who have conditions such as chronic depression, schizophrenia, or anxiety are at risk for AUD, as alcohol is often used as a way to cope with difficult emotions.
• History of trauma. Similar to the mental health conditions idea, people often use alcohol to cope with emotions after a traumatic experience (from childhood or adulthood), which can lead to AUD if we don’t control it.
• Bariatric surgery. Several studies have found that those who undergo bariatric surgery — such as gastric bypass or other extreme weight-loss surgeries — are linked to an increased risk of AUD after surgery, typically years after the surgery. There are various explanations for why this happens, such as changes in alcohol sensitivity post surgery, hormonal and metabolic changes, and changes in gut bacteria associated with alcohol intake.
• Media representation. Remember that high school party from every ‘80s movie we talked about earlier? Portrayals of alcohol being a fun and glamorous activity, especially for underage young people, is problematic because it sends the message that it’s okay to start drinking in high school if all your friends are doing it, or all the popular kids are doing it. Being exposed to media like this makes us more likely to not think twice about having a drink before our body is developed enough to handle it.

That may seem like a long list, and it is! The truth is, in today’s society there are so many things that put us at risk for AUD and we need to be vigilant about our alcohol intake and make sure we prioritize our health. If we don’t, we’re in for a slew of nasty health problems, both short and long-term. Let’s take a look at what happens if we let AUD get out of control.

Effects of AUD

AUD affects our health and our daily lives in both the short and long term.

Short-Term Effects

Some short-term effects of AUD include the following:

• Effects on memory. Alcohol affects our brain and memory, and if we abuse alcohol, we may find ourselves blacking out.
• Motor vehicle accidents. According to the U.S. Department of Transportation, 37 people die in drunk driving accidents each day. Those with AUD are more likely to drive drunk, or get in a car with someone else who is drunk, than those who don’t have it.
• Problems with employment or finances. Drinking costs money, and missing work to nurse your hangover doesn’t create the best impression. Chronic alcohol abuse not only puts us at risk for employment troubles but also puts a dent in our wallet.
• Risky behavior. When we’re intoxicated, our inhibitions are lowered, and we’re more likely to engage in risky behaviors such as engaging in unprotected sex, getting into a car with a stranger, or starting a fight.
• Interactions with medications. Alcohol has countless interactions with medications, and if we abuse alcohol every day, we increase this risk as we’re likely to be on some medication at some point.

And this is just the beginning: AUD left untreated can set us up for a whole world of additional problems.

Long-Term Effects

If we don’t get help for AUD, we may find ourselves dealing with more long-term consequences.

• Liver disease. Hepatic steatosis — or fatty liver — occurs in 90-95% of people with heavy alcohol use over a long period of time. When this progresses, it can lead to other more severe liver diseases such as cirrhosis.
• Digestive problems. Alcohol abuse can also cause gastritis (inflammation of the stomach lining) and even contribute to stomach and esophageal ulcers. All these problems on top of the alcohol can affect our body’s vitamin and nutrient absorption and lead to malnutrition over time.
• Weakened immune system. Since our body sees alcohol as a poison, its priority is to eliminate it, and other functions get put on hold, including the immune system. This can increase our risk of getting sick or increase our recovery time if we do get sick.
• Social impact. Remember the drunk driving we mentioned earlier? Well, that can do more harm than just physical injury. Getting busted for a DUI can cost thousands of dollars and require years of classes and breathalyzer check-ins. Not to mention, it stays on your driving record for years and can impact future employment or travel opportunities (for example, you cannot enter Canada from the U.S. if you’ve had a DUI in the past five years). Not to mention, getting into dangerous situations because of booze may result in a crime or criminal record, both of which can affect the rest of our lives, as well as have other consequences for our social life.
• Problems with relationships. Excessive drinking can affect relationships with loved ones, especially if we continually choose alcohol over them.

Now, hopefully, you’re not panicking as you read this because there is no need to! The good news is, there is plenty you can do to prevent AUD before it gets to this point — and it’s never too late to treat it.  Let’s take a closer look.

Prevention and Treatment of AUD

For those of us worried about having AUD or developing it, here are some things we can do to keep ourselves safe:

• Stop it in its tracks. Knowing the signs of AUD early on will help us recognize unhealthy behavior before it gets out of control. If we find ourselves hungover multiple days a week, we can track our intake and see how much alcohol we’re really consuming. This is especially helpful for mild AUD cases to keep it from progressing.
• Find support. Support from others who have recovered from AUD can inspire us to do so as well, and it can encourage us to not let it get out of hand.
• Stay away from friends who drink heavily. If we have loved ones who are becoming a bad influence on us, it may be time to change up our friends group. Remember, our health is the most important thing, and if someone doesn’t support us in that, it may be time to reconsider the relationship.
• Get an alcohol screening. Did you know there is such a thing as an “alcohol screening”, similar to a screening for any other type of disease? More information can be found on this CDC website.
• Detox and therapy. Detox helps us get rid of our physical dependency on alcohol, and therapy can help us address the emotions behind it. For more information about detox and other treatments for AUD, check out Reframe’s blog “Understanding the Stages of Alcohol Use Disorder: Causes and Treatment.”

There are plenty of resources out there for those of us who have AUD and are looking for guidance. The NIAAA website has a ton of information about AUD, current research, and other things we can do to help ourselves. Also, don’t forget that the Reframe app is here to help address AUD, whether that means quitting or cutting back!

As always, if you do find we have severe AUD, don’t forget to consult with a doctor or health professional so they can help you find what will work best for you. Sometimes you can’t do it alone and may need medical intervention, especially in severe cases of AUD. Whatever method you find, we’re here to support you!

Key Takeaways

Some of us may be embarrassed to admit that we said yes to a bunch of those AUD criteria, but we shouldn’t be! Understanding our habits is the first step to keeping us healthy, and there is no shame in asking for help! AUD is easily preventable as long we learn how to drink mindfully and responsibly. And if we’re extremely prone to AUD and have a history of alcoholism, it may be best to avoid alcohol for good. There is a whole, healthy, booze-free world out there waiting for us!