Alcohol Addiction

Alcohol addiction is one of the leading causes of preventable death in the United States. Most people with an alcohol use disorder improve with treatment, but less than 10 percent of people with the disease receive treatment. Unfortunately, social stigma and misunderstanding of the disease prevent many people from getting assistance that can help them lead happier, healthier lives.

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The prevalence of alcohol consumption and its acceptance by society creates the misconception that the beverage is safe. But many people who drink alcohol, even those who attempt to consume it responsibly, develop a chronic disease called alcoholism.

Alcoholism, also referred to as alcohol addiction or an alcohol use disorder, is a disease that changes the way the brain works. Like other mental health issues, alcoholism causes negative emotions and changes in impulse control. And like other chronic conditions, such as diabetes, alcoholism causes cravings.

But alcohol addiction has been stigmatized as a moral failing for centuries. This misconception has prevented millions of people from getting treatment for the health condition. More than 15 million Americans aged 12 and older had an alcohol use disorder in 2015, according to the National Survey on Drug Use and Health.

An estimated 88,000 Americans die from excessive alcohol use each year.

Despite the risks, adults aged 21 and up can legally consume alcohol in the United States. But most Americans try their first alcoholic beverages during adolescence. Studies show that people who try alcohol at young ages are more likely to develop an addiction to alcohol because the brain is more vulnerable while it’s developing.

The 2016 Monitoring the Future survey revealed that more than 60 percent of high schoolers had tried alcohol by 12th grade, and a third of 12th-grade participants drank alcohol at least once in the 30 days before the survey.

Grade in Which Alcohol Was First Consumed

graph of when students first consumed alcohol Source: 2016 Monitoring the Future Survey

Alcohol recovery is complicated by the presence of the substance in everyday life. People in recovery frequently face pressures to drink. They’re surrounded by alcohol triggers in social media, advertisements and restaurants. No other substance of abuse is consumed as publicly or commonly as alcohol.

Fortunately, alcoholism is the most widely studied substance use disorder. Groups such as Alcoholics Anonymous have provided people with free support for decades. Scientists have developed medications that can ease withdrawal symptoms, reduce cravings and prevent future drinking. Therapists and counselors practice techniques that allow people to find happiness without drinking.

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Defining Alcoholism & Alcoholic

The terms alcoholism, alcohol addiction and alcohol use disorder are often used interchangeably. Alcohol use disorder is the official term for recurring alcohol consumption that causes clinically significant impairment and an inability to meet responsibilities, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

The term alcoholic is often used loosely and indiscriminately. An alcoholic may be someone who is addicted or physically dependent on alcohol. It’s also used to describe drinkers who are not addicted or dependent but tend to experience problems involving alcohol.

Many alcoholics have a drink of choice. They may believe they have a liquor addiction, beer addiction or wine addiction because they associate a specific drink with a specific experience. Those associations can cause them to develop cravings for specific beverages. The term alcoholism encompasses addictions to each type of alcohol.

The APA classifies alcohol use disorders as mild, moderate or severe depending on how many diagnostic criteria a person meets. Someone with a mild disorder meets two to three criteria. Someone who meets four to five criteria has a moderate disorder, and anyone who meets six or more criteria has a severe disorder.

The criteria for alcoholism have nothing to do with how much someone drinks, how long they have been drinking or the type of alcohol they drink. People are addicted to alcohol when they lose the ability to control their drinking. They feel an uncontrollable urge to drink, and they have incredible difficulty stopping themselves from drinking.

Stages of Alcoholism

The stages of alcoholism aren’t scientifically defined like the severities of alcohol use disorders, but they provide an easy-to-understand view of how someone becomes addicted to alcohol. As a person progresses through the stages, he or she becomes more severely addicted.

Some people remain in the early stage their entire life, and others rapidly progress to end-stage alcoholism. The way alcohol affects each person is determined by a combination of genetic, environmental and social factors.

Early-Stage Alcoholism

The first stage of alcoholism is characterized by drinking more than usual, finding reasons to drink and drinking to reduce unhappy feelings or stress. People may consciously use alcohol to feel happier or may not realize they’re drinking more often.

During the early stage, a person’s tolerance to alcohol increases. Alcoholics have to drink progressively higher amounts to feel the same positive effects they’re used to, and they do not exhibit signs of intoxication after drinking low levels of alcohol. Early-stage alcoholics often think alcohol makes them function more normally because they begin to feel negative side effects when they stop drinking.

Middle-Stage Alcoholism

As people progress to the middle stage, they begin to become dependent on alcohol. They suffer withdrawal symptoms when they quit drinking. They drink to avoid withdrawal rather than drinking to achieve happiness.

The middle stage of alcoholism is characterized by drinking in secret, increases in unpredictable behavior and problems with relationships, work or school. Alcoholics in this stage begin to recognize that they have lost their ability to control how much they drink, but they’re often afraid to admit they have a drinking addiction.

Late-Stage Alcoholism

Late-stage alcoholism is characterized by dramatic physical and mental health problems. People are often malnourished, and their organs become stressed. They often have liver, respiratory or heart problems. They tend to suffer from severe depression or anxiety when they go too long without alcohol.

People in the final stage of alcoholism are usually on the verge of losing their jobs, being kicked out of school or ruining relationships with family and friends. They may or may not realize they have a drinking addiction, but they are so obsessed with drinking that it is the most important thing in their lives.

Outstretched hands of a man talking
    at an alcoholics support group meeting

Dr. Kevin Wandler of Advanced Recovery Systems describes the signs and symptoms of alcohol addiction. He discusses the roles that tolerance and withdrawal play in alcohol addiction.

What Causes Alcohol Addiction?

Most addictive substances, including alcohol, affect the pleasure and reward center in the brain. This part of the organ motivates us to partake in activities that benefit survival, such as eating, having sex and socializing.

The reward system in the brain makes us feel happy by releasing a neurotransmitter called dopamine during those experiences. Dopamine causes happiness. The brain remembers which experiences caused happiness and programs itself to desire those experiences.

Alcohol is physically and psychologically addictive because it manipulates the reward system in the brain. It helps us relax and let loose during social situations, making it psychologically addictive. It also causes the brain to release endorphins, another neurotransmitter that causes pleasure.

When alcohol affects the balance of chemicals in the brain, we lose coordination, get excited or feel sleepy. The brain adapts to these changes so it can function normally in the presence of alcohol. This compensation is called tolerance.

Each type of alcohol is equally addictive, but the way someone consumes alcohol can affect their likelihood of becoming addicted. Taking a shot of liquor or chugging a beer is more likely to cause a dopamine rush than slowly sipping a glass of wine. Drinking three glasses of wine with dinner each night is more likely to cause alcohol dependence than having one or two beers at happy hour once a week.

Alcohol Dependence vs. Alcohol Addiction

Regular alcohol consumption can make a person dependent on alcohol. Dependence is different from addiction. When people regularly consume alcohol, their brains continuously adapt to its presence. The brain eventually reprograms itself to rely on alcohol to function. When that happens, a person becomes dependent on alcohol to feel normal.

When alcohol isn’t present, the brain reacts violently, causing alcohol withdrawal symptoms. The more dependent a person is on alcohol, the more severe the withdrawal symptoms will be.

Alcohol Withdrawal Symptoms

Minor symptoms of alcohol withdrawal include:

  • Fatigue
  • Clammy skin
  • Sweating
  • Restlessness

Severe symptoms of alcohol withdrawal include:

  • Tremors
  • Anxiety
  • Nausea
  • Insomnia

Delirium tremens, or DTs, is the most intense symptom of withdrawal and can cause hallucination, confusion, agitation and seizure. In some cases it can be life-threatening.

These symptoms, which are byproducts of dependence, usually occur within 48 to 96 hours after the last drink. Dependence often leads to addiction and makes recovering from addiction difficult. Addiction is a disease associated with repeated destructive behaviors despite negative consequences. People addicted to alcohol take risks to consume alcohol or continue to drink even though it causes problems.

Risk Factors for Alcohol Addiction

Most risk factors for alcohol use disorders fall under two categories: genetic and environmental. Some people are naturally more susceptible to addiction because of genetic traits or characteristics. They may feel more pleasure from alcohol than other people, or they may be more prone to compulsive decision-making.

They may have a pre-existing mental health condition, such as depression, anxiety, bipolar disorder or post-traumatic stress disorder. Numerous studies show people with mental health disorders are more likely to develop alcohol use disorders, and people who are addicted to alcohol are more likely to develop mental health disorders. The two diseases occur simultaneously, and they amplify one another’s symptoms.

Other risk factors for alcohol addiction include:

  • Family history of alcoholism
  • Having parents or siblings who drink regularly
  • Lack of parental support or communication
  • Having friends who drink
  • Easy availability of alcohol
  • Exposure to trauma or abuse
  • Exposure to advertisements for alcohol
  • Poor school performance
  • Alienation or isolation
  • Conduct issues

Exposure to one risk factor doesn’t mean someone will develop an alcohol use disorder, but a combination of risk factors increases the risk. Learning about the effects of alcohol, how to drink responsibly and how to recognize the warning signs for alcoholism can help individuals take steps to reduce their risk.

group of supportive
    friends walking

What Are Heavy Drinking and Binge Drinking?

Heavy drinking and binge drinking are warning signs for alcoholism, but a person can binge drink or drink heavily and not have an alcohol use disorder. Heavy drinking is defined as having five or more drinks on one occasion five times in 30 days. Binge drinking can be defined as having five or more drinks on the same occasion once in the past 30 days, or drinking until the blood alcohol content level reaches 0.08 grams per deciliter.

In 2015, 25 percent of Americans aged 12 and older said they engaged in binge drinking in the past month.

A 2015 study published in the American Journal of Public Health found binge drinking and heavy drinking were more common in northern states in the West and Midwest, states along the Pacific, and in New England states. The lowest rates of binge and heavy drinking were found in the South and Utah.

Alcohol facts about heavy drinking often involve research on young people. Research compiled by the National Institute on Alcohol Abuse and Alcoholism consistently indicates that people drink the heaviest in their late teens and early twenties. Young adults are also the most likely to binge drink. However, studies also indicate that young adults tend to binge drink and drink heavily regardless of college enrollment status.

Marital status tends to affect drinking behavior among young men and women. After getting married, young men and women drink less than at any other time in their lives.

Risks of Binge Drinking and Heavy Drinking

Binge Drinking

The immediate and most visible risks of binge drinking include a high propensity to engage in reckless behavior such as drunk driving, jumping off of buildings, fighting or having unsafe sex. Binge drinking increases a person’s chance of blacking out and suffering alcohol poisoning.

Heavy Drinking

Heavy drinking causes side effects similar to alcoholism, such as increased risk of cancer, organ damage and mental health problems. Heavy drinking also increases a person’s chance of becoming dependent on and addicted to alcohol.

Blurry view of a crowded city street

Side Effects of Alcohol Addiction & Heavy Drinking

Most people consume alcohol because it changes the way they think or act. It makes most people relax and gain confidence, but it also diminishes coordination and judgement. The more people drink and the more quickly they drink, the more likely they are to experience other short-term side effects of alcohol.

Immediate side effects of alcohol include:

  • Slurred speech
  • Glassy eyes
  • Flushed skin
  • Trouble seeing
  • Nausea
  • Vomiting
  • Diarrhea
  • Memory loss
  • Unconsciousness
  • Shallow breathing

If a person consumes too much alcohol, he or she can develop alcohol poisoning, which can lead to choking on vomit, severe dehydration, hypothermia, irregular heartbeat, seizures, brain damage and death. Binge drinking is the most common cause of alcohol poisoning.

In 2015, 6.5 percent of adults aged 12 and older said they engaged in heavy drinking in the past month.

Some people with alcoholism combine alcohol with other substances. But the risks of mixing alcohol with certain medications include health problems such as fainting, loss of coordination, internal bleeding, breathing difficulties and heart problems.

The body can recover from alcohol’s most noticeable effects in a matter of hours. After a good night’s sleep, someone can recover from a night of drinking with a headache that will be gone in less than a day. However, the long-term effects of binge drinking every weekend, drinking heavily or consuming numerous drinks daily takes a heavy toll on the body.

The body’s organs slowly deteriorate and struggle to function when people drink heavily. The main organs damaged by heavy alcohol abuse include the brain, liver, heart and pancreas. Alcohol can also damage the central nervous system and weaken the immune system. The damage to the body leads to a variety of health problems.

The side effects and risks of long-term alcohol abuse include:

  • Depression
  • Anxiety
  • Dementia
  • Stroke
  • Suicidal thoughts
  • Increased risk of cancer
  • Inflamed stomach lining (gastritis)
  • Pain in the hands and feet (neuropathy)
  • Heart attack (myocardial infarction)
  • Irregular heartbeat (atrial fibrillation)
  • High blood pressure (hypertension)
  • Heart muscle disease (cardiomyopathy)
  • Chronic liver damage ( liver cirrhosis)
  • Inflamed liver (alcoholic hepatitis)
  • Inflamed pancreas (pancreatitis)

Long-term alcohol abuse also increases a person’s risk of social problems such as unemployment, relationship problems and exposure to violence. It increases a person’s risk of traffic accidents, falls and firearm injuries.

Alcohol can also harm a fetus at any stage of pregnancy, and there is no known safe limit to the amount of alcohol a pregnant woman can consume. Fetal alcohol spectrum disorders are a group of alcohol-related conditions that can occur during an infant’s development. Some symptoms of fetal alcohol spectrum disorders can be eased, but there is no way to reverse the damage.

How Kelly Found Sobriety

Alcohol made Kelly feel relaxed and funny. It also made her lose her job and friendships. Read about Kelly’s recovery journey and how sobriety helped her find happiness.

Recognizing and Treating Alcohol Addiction

Alcohol-related health problems, withdrawal symptoms and cravings are strong indicators that someone has an alcohol use disorder. Other indicators include blacking out regularly, getting in trouble after drinking, an inability to stop drinking, and behaving compulsively to find alcohol.

More than 15 million American adults had an alcohol use disorder in 2015.

Source: National Survey on Drug Use and Health

Alcoholism is a self-diagnosable condition, but many people struggle to recognize the symptoms. Some people believe they can function while drinking heavily, but they don’t recognize the long-term health problems that are associated with heavy drinking.

Health providers diagnose alcohol use disorders by asking several questions about a person’s lifestyle and consumption of alcohol. The answers to the questions indicate how many symptoms the person has. Depending on the number of symptoms, a person is diagnosed with a mild, moderate or severe alcohol use disorder.

One major reason people don’t seek rehab is a phenomenon called personal exceptionalism. Personal exceptionalism refers to an individual’s belief that he or she is unique. Some people think they’re not like everyone else and that an alcohol-related illness won’t affect them. In short, they’re in denial. Personal exceptionalism allows people to justify immoral actions or behaviors that they would otherwise condemn. Many other people tend to lie about their addiction to alcohol and think that someone else is to blame.

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It can be difficult to convince loved ones that they need treatment for problem drinking. If you’ve tried to talk to friends or family members about their drinking habits and they’ve been resistant, consider contacting an interventionist. Interventionists teach friends and families effective ways to communicate with loved ones suffering from alcoholism and other forms of addiction.

“It’s pretty clear when someone’s life becomes unmanageable or when there are consequences that are occurring from use.”

Interventionist Karen Rainer, Circle of Care Consultants

Individuals who have mild alcohol use disorders or who have been drinking for a short period of time may be able to recover on their own or with the help of friends, family members or support groups, such as Alcoholics Anonymous. Quitting without treatment is risky, though, because some alcohol withdrawal symptoms can be life-threatening.

Alcohol rehab helps people overcome alcohol withdrawal in a safe setting. Health professionals ease the experience with around-the-clock care and monitoring. Rehab facilities can offer medications that help people abstain from drinking.

The U.S. Food and Drug Administration has approved three medications for assisting treatment for alcohol use disorders:

Campral (acamprosate calcium) Delayed-Release Tablets package label


Acamprosate can relieve withdrawal symptoms such as insomnia, anxiety and depression.

Disulfiram Tablets, USP 250 mg package label


Disulfiram discourages drinking by causing sweating, flushing and nausea when a patient drinks alcohol.

Vivitrol (naltrexone for extended-release injectable suspension) package label


Naltrexone blocks cravings and mental side effects caused by alcohol such as euphoria or intoxication.

Physicians and addiction specialists can also prescribe a variety of medications, such as anticonvulsants and anti-nausea drugs, to treat symptoms of withdrawal.

Once people detox from alcohol, counseling and therapy are vital for preventing alcohol relapse. They have to learn to live without alcohol.

  • Cognitive behavioral therapy
  • Dialectical behavioral therapy
  • Multidimensional family therapy
  • Motivational interviewing
  • Motivational incentives

These therapies help people find motivation for entering rehab, garner positive reinforcement and learn to identify and overcome underlying causes of alcoholism. After rehab, individuals should continue to access the support groups and resources available for alcoholics. The resources increase a person’s ability to maintain sobriety.

Quiz: Am I an Alcoholic?

Determine if you are an alcoholic or how much alcohol is affecting your life by taking the 11-question quiz.

Stories of Recovery from Alcohol Addiction

Read real stories of real people who have overcome the disease of alcoholism.

Tash Moore, a recovered alcoholic and social media management professional

Tash Moore

A group of friends got Tash to try her first drink, but depression and insecurities fueled her addiction to alcohol. She tried quitting cold turkey, but withdrawals sent her to the hospital. Learn how therapy helped her finally enter sobriety.

Dan Renaud, a recovered addict and program director of River Oak Center

Dan Renaud

At age 21, Dan had been drinking for more than six years. He turned to the only resource that was available in the 1980s: Alcoholics Anonymous. See how Dan is helping teens avoid the mistakes he made growing up.

Susan Broderick, a recovered alcoholic and head of research at Georgetown University's National Juvenile Justive Prosecution Center

Susan Broderick

Susan Broderick came from a family of alcoholics. Despite her animosity toward her parents’ drinking habits, Susan followed in their footsteps. Learn how Susan has maintained recovery from alcoholism despite numerous obstacles.

Alcoholism is one of the most common chronic diseases in the United States. Nearly every person knows someone affected by alcoholism, and its prevalence can distort its seriousness. Alcoholics can take several paths to recovery. Treatment, support, faith and persistence can help any person live in sobriety.

Kim Borwick, M.A.
Kim Borwick, M.A., Editor,
Medical Reviewer
Ashraf Ali
Psychiatrist, Los Angeles County Department of Mental Health

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