Alcohol use disorder (alcoholism)

Alcohol use disorder is the clinical term health professionals use for problematic drinking. Many people still use the word alcoholism or alcohol addiction. AUD is not a moral failing or a lack of willpower; it involves changes in the brain's reward, stress and self-control systems that make drinking harder to manage.

AUD exists on a spectrum. Mild AUD may involve drinking more than intended or using alcohol to cope with stress. Severe AUD may involve strong cravings, physical dependence and withdrawal symptoms when not drinking.

Some people describe themselves as a functioning alcoholic: they keep up with work and family life while drinking heavily. Functioning on the outside does not mean alcohol isn't causing harm, and the risks to physical and mental health still apply. Only a doctor or qualified professional can assess whether drinking meets the criteria for AUD.

Many people ask, "Am I an alcoholic?" Rather than focusing on labels, it helps to look at patterns. Common signs of alcoholism or AUD include:

• Drinking more, or for longer, than you meant to.
• Wanting to cut down but finding it hard.
• Spending a lot of time drinking or recovering from it.
• Strong cravings or urges to drink.
• Drinking affecting work, school or family responsibilities.
• Continuing despite arguments, health problems or worsening mood.
• Giving up activities you used to enjoy.
• Needing more alcohol to feel the same effect.
• Withdrawal symptoms such as shaking, sweating, nausea, anxiety or insomnia when you stop.

If you recognize several of these signs, consider speaking to a doctor or mental health professional. Being honest about your drinking helps them help you.

AUD develops from a combination of factors:

• Genetics and family history.
• Starting to drink at a young age.
• Mental health conditions such as anxiety, depression, trauma or ADHD, where alcohol may be used to cope.
• Ongoing stress, loneliness or major life changes.
• Social and cultural environments where heavy drinking is normal.
• Easy access to alcohol.

Alcohol can seem to relieve anxiety or low mood in the short term, but over time it tends to make both worse and disrupts sleep. This can create a cycle in which a person drinks to feel better, feels worse the next day and drinks again.

The sober curious movement reflects a growing number of people who choose to question their relationship with alcohol, even without a diagnosis. Reflecting on why and how you drink is a healthy step for anyone.

Treatment for AUD is effective and can be adapted to your goals, whether that is cutting down or stopping completely.

Options include:

• Medical assessment: a doctor can check your physical health and advise on safe ways to reduce or stop.
• Medically supervised withdrawal (detox) for people with physical dependence.
• Psychological therapies, such as cognitive behavioral therapy, motivational interviewing and contingency management, which help you understand triggers, build coping skills and strengthen motivation.
• Medications prescribed by a psychiatrist or doctor that can reduce cravings or support abstinence.
• Treatment of co-occurring conditions such as anxiety, depression or trauma.
• Mutual support groups and family involvement.

A psychiatrist, psychologist or clinical psychologist can help create a plan. In the first visit, expect questions about how much and how often you drink, your health, mood and what you want to change.

If you drink heavily every day, stopping suddenly can be dangerous. Alcohol withdrawal can cause severe symptoms, including seizures and confusion. Talk to a doctor before stopping so they can advise on a safe plan.

Practical steps that help many people:

• Set a clear goal: reduce, take a break or stop.
• Track how much you drink to understand patterns.
• Remove alcohol from home and plan alcohol-free activities.
• Identify triggers, such as stress or certain social settings, and plan alternatives.
• Tell someone you trust about your goal.
• Look after sleep, food and exercise.

Seek emergency care (call 911 in the US or your local emergency number) for severe withdrawal symptoms like seizures, hallucinations or confusion. If you have thoughts of suicide, call or text 988 in the US, or Samaritans on 116 123 in the UK and Ireland.