Alcohol Abuse and Dependence

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This topic is about alcohol abuse and dependence in adults. For information about alcohol problems in teens or children, see the topic Teen Alcohol and Drug Abuse. For information about drug abuse in adults, see the topic Drug Abuse and Dependence.

What are alcohol abuse and alcohol dependence?

Alcohol abuse means having unhealthy or dangerous drinking habits, such as drinking every day or drinking too much at a time. Alcohol abuse can harm your relationships, cause you to miss work, and lead to legal problems such as driving while drunk (intoxicated). When you abuse alcohol, you continue to drink even though you know your drinking is causing problems.

If you continue to abuse alcohol, it can lead to alcohol dependence. Alcohol dependence is also called alcoholism. You are physically or mentally addicted to alcohol. You have a strong need, or craving, to drink. You feel like you must drink just to get by.

You might be dependent on alcohol if you have three or more of the following problems in a year:

• You cannot quit drinking or control how much you drink.
• You need to drink more to get the same effect.
• You have withdrawal symptoms when you stop drinking. These include feeling sick to your stomach, sweating, shakiness, and anxiety.
• You spend a lot of time drinking and recovering from drinking, or you have given up other activities so you can drink.
• You have tried to quit drinking or to cut back the amount you drink but haven't been able to.
• You continue to drink even though it harms your relationships and causes you to develop physical problems.

Alcoholism is a long-term (chronic) disease. It's not a weakness or a lack of willpower. Like many other diseases, it has a course that can be predicted, has known symptoms, and is influenced by your genes and your life situation.

How much drinking is too much?

Alcohol is part of many people’s lives and may have a place in cultural and family traditions. It can sometimes be hard to know when you begin to drink too much.

You are at risk of drinking too much and should talk to your doctor if you are:¹

• A woman who has more than 3 drinks at one time or more than 7 drinks a week. A standard drink is 1 can of beer, 1 glass of wine, or 1 mixed drink.
• A man who has more than 4 drinks at one time or more than 14 drinks a week.

If you think you might have a drinking problem, take a short quiz to check your symptoms:

Interactive Tool: Do You Have a Drinking Problem?

What are some signs of alcohol abuse or dependence?

Certain behaviors may mean that you're having trouble with alcohol. These include:

• Drinking in the morning, being drunk often for long periods of time, or drinking alone.
• Changing what you drink, such as switching from beer to wine because you think it will help you drink less or keep you from getting drunk.
• Feeling guilty after drinking.
• Making excuses for your drinking or doing things to hide your drinking, such as buying alcohol at different stores.
• Not remembering what you did while you were drinking (blackouts).
• Worrying that you won't get enough alcohol for an evening or weekend.

How are alcohol problems diagnosed?

Alcohol problems may be diagnosed at a routine doctor visit or when you see your doctor for another problem. If a partner or friend thinks you have an alcohol problem, he or she may urge you to see your doctor.

Your doctor will ask questions about your symptoms and past health, and he or she will do a physical exam and sometimes a mental health assessment. The mental health assessment checks to see whether you may have a mental health problem, such as depression.

Your doctor also may ask questions or do tests to look for health problems linked to alcohol, such as cirrhosis.

How are they treated?

Treatment depends on how bad your alcohol problem is. Some people are able to cut back to a moderate level of drinking with help from a counselor. People who are addicted to alcohol may need medical treatment and may need to stay in a hospital or treatment center.

Your doctor may decide you need detoxification, or detox, before you start treatment. Detox flushes out the alcohol in your body. You need detox when you are physically addicted to alcohol. When you go through detox, you may need medicine to help with withdrawal symptoms.

After detox, you focus on staying alcohol-free, or sober. Most people receive some type of therapy, such as group counseling. You also may need medicine to help you stay sober.

When you are sober, you've taken the first step toward recovery. To gain full recovery, you need to take steps to improve other areas of your life, such as learning to deal with work and family. This makes it easier to stay sober.

You will likely need support to stay sober and in recovery. This can include counseling and support groups like Alcoholics Anonymous. Recovery is a long-term process, not something you can achieve in a few weeks.

Treatment doesn't focus on alcohol use alone. It addresses other parts of your life, like your relationships, work, medical problems, and living situation. Treatment and recovery support you in making positive changes so you can live without alcohol.

What can you do if you or another person has a problem with alcohol?

If you feel you have an alcohol problem, get help. Even if you are successful in other areas of your life, visit a doctor or go to a self-help group. The earlier you get help, the easier it will be to cut back or quit.

Helping someone with an alcohol problem is hard. If you're covering for the person, you need to stop. For example, don't make excuses for the person when he or she misses work.

You may be able to help by talking to the person about what his or her drinking does to you and others. Talk to the person in private, when the person is not using drugs or alcohol and when you are both calm. If the person agrees to get help, call for an appointment right away.