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What is Alcohol Use Disorder (AUD)?

Alcohol use disorder (AUD), also known as alcoholism or alcohol addiction, is a chronic relapsing brain disease. It affects your physical and mental health and changes the way your brain works.

Someone with an AUD also experiences physical alcohol dependence. Severe withdrawal symptoms will develop if they suddenly stop drinking. Headaches, anxiety, mild tremors, and insomnia are common symptoms.

In severe cases, delirium tremens (DTs) occur. This happens because the brain is unable to rebalance, causing confusion in the brain that can result in normal body function regulation.

This can also affect your heart rate and blood pressure, which increases your risk of a heart attack or stroke.

You have a higher risk of developing alcoholism if you:

  • Have a family history of alcohol use disorder (AUD)
  • Started drinking before the age of 15 
  • Have a mental health disorder, such as generalized anxiety disorder (GAD), attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), or depression 
  • Have a history of trauma, especially childhood trauma

Symptoms of Alcohol Use Disorder (AUD)

The symptoms of alcoholism, or alcohol use disorder (AUD), vary widely. There are physical symptoms and psychological symptoms.

An important part of recovery is understanding the different signs and symptoms of alcohol addiction.

Not all symptoms of alcohol addiction are physical, and many alcoholics become good at hiding alcoholism-related symptoms.

The DSM-5 (the diagnostic and statistical manual of mental disorders—the gold standard for mental health disorders in the United States) defines AUDs as substance use disorders where an individual displays two of the following 11 symptoms in a year:

  1. Drinking more or for longer than was intended
  2. Unsuccessful attempts to cut down or stop alcohol use
  3. Spending a lot of time obtaining, using, or recovering from alcohol consumption
  4. Cravings for alcohol
  5. Failure to fulfill responsibilities at work, school, or home due to drinking alcohol
  6. Continuing to drink despite having social problems caused by the effects of alcohol
  7. Important social, work, or recreational activities are stopped or reduced because of alcohol use
  8. Drinking in physically dangerous situations
  9. Continuing to drink even though it is known to have negative effects on your health.
  10. Developing a tolerance
  11. Having withdrawal symptoms

Physical Symptoms of Alcoholism

Physical symptoms associated with AUD occur due to the effects of alcohol on the body and brain.

When you drink, you may experience slower reaction times, blackouts, a lack of coordination, impaired judgment, memory loss, and slurred speech. This can impair daily activities, such as working or driving.

Heavy drinking can wreak havoc on the body, resulting in a wide array of physical symptoms. These can include:

  • Headaches
  • Nausea and vomiting
  • Fatigue
  • Profuse sweating
  • Rapid heartbeat
  • Vomiting
  • Nausea
  • Loss of appetite and weight loss
  • Tremors and body shakes
  • Fever
  • Seizures

In cases where someone consumes an excessive amount of alcohol at one time, a loss of consciousness, coma, and even death is possible.

Alcoholics may experience intense cravings for alcohol, as well as a strong compulsion to continually drink. As the body develops a tolerance for alcohol, more alcohol is necessary to achieve the desired levels of intoxication and its perceived benefits.

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Mental & Behavioral Symptoms of Alcoholism

Behavioral symptoms are often what cause people to recognize that their friend or family member has an AUD. These include, but are not limited to:

  • Binge drinking
  • Replacing normal activities with drinking
  • Inability to stop drinking or reduce drinking
  • Loss of interest in previous hobbies or activities
  • Increased absences from work/school
  • Unexplained changes in mood
  • Problems sleeping (insomnia)
  • Mental health disorders (depression, anxiety, aggression/irritability, paranoia, etc.)
  • Money problems 
  • Legal problems

What are Alcohol Withdrawal Symptoms?

When alcohol is not available, alcoholics may experience withdrawal symptoms.

With regular, excessive drinking, the brain adjusts its chemistry to try and balance out the depressant effects of alcohol by increasing the production of stimulating chemicals.

When alcohol is not available, these increased chemical levels essentially overstimulate the brain, resulting in withdrawal symptoms such as tremors, insomnia, and anxiety. 

Alcohol withdrawal symptoms can range from mild to severe, depending on the level of addiction.

Mild withdrawal symptoms include:

  • Anxiety
  • Depression
  • Mood swings
  • Headaches
  • Abdominal cramping
  • Insomnia
  • Mild tremors
  • Loss of appetite
  • Problems thinking
  • Fatigue
  • Heart palpitations

More severe withdrawal symptoms include:

  • High blood pressure
  • Rapid breathing
  • Irregular heartbeat
  • Difficulty breathing
  • Fever
  • Agitation
  • Hallucinations
  • Confusion
  • Severe sweating
  • Seizures
  • Delirium tremens (DTs)

Withdrawal occurs during detox, which is the first step of virtually all alcohol treatment programs.

The 4 Stages of Alcoholism (Symptoms to Look For)

If you suspect someone you know has an alcohol problem, there are four stages of alcoholism to be aware of. Each stage has its own set of symptoms:

1. Pre-Alcoholics

During the pre-alcoholic stage, a person will begin drinking in social settings. As they continue to drink, they may also start using alcohol for stress relief.

2. Early Stage Alcoholics

During the early stage of alcoholism, the person is becoming more clearly dependent on alcohol. They tend to think a lot about drinking and often bring up alcohol during conversations.

Rather than just drinking in social settings, these people may drink alone or have trouble deciding not to drink.

3. Middle Stage Alcoholics

The physical symptoms of alcoholism develop during this stage. They are typically obvious to others around them. The signs include:

  • Weight gain or weight loss
  • Stomach bloating
  • Sluggishness
  • Shaking
  • Sweating
  • Skin changes
  • Facial redness/puffiness 

4. End-Stage Alcoholics 

End-stage alcoholics have been drinking heavily for many years and typically experience serious health problems. Drunk driving, memory loss, and frequent trips to the hospital often occur during end-stage alcoholism. 

Severe Alcohol Abuse & Health Problems

Many people with alcohol problems, especially functional alcoholics, do not notice symptoms of alcohol use disorder (AUD) until it is too late. Often, medical complications from alcohol are the first signs that something is wrong.

Excessive alcohol use comes with many risk factors such as the liver, heart, and digestive system. When alcohol damages these organs, a variety of different medical conditions and symptoms can occur, including:

Liver Disease

Excessive drinking on a regular basis can lead to a variety of different medical conditions involving the liver.

Fatty liver disease, or hepatic steatosis, occurs when alcohol damages the cells within the liver, resulting in a buildup of fat in the liver.

This is often the earliest stage of alcohol-related liver disease and can progress to alcoholic hepatitis and cirrhosis of the liver.

Cirrhosis is the late stage of liver disease where the liver becomes scarred, impairing liver function. Symptoms of alcohol-related liver disease include:

  • Loss of appetite and weight loss
  • Swelling in the legs and abdomen
  • A yellowish tone to the skin and eyes (jaundice)
  • Redness on the palms of the hands
  • Easy bruising and abnormal bleeding
  • Confusion and problems with thinking and memory
  • Changes in stool color (pale or light color)

Digestive Issues

Alcohol is very caustic to the stomach and digestive system.

In other words, excessive drinking can lead to a variety of digestive issues. This includes gastritis (inflammation of the stomach lining), stomach and esophageal ulcers, and pancreatitis (inflammation of the pancreas).

In addition, regular alcohol use can affect the absorption of vitamins and nutrients necessary for normal body function. Symptoms of digestive issues can include:

  • Abdominal pain
  • Nausea and vomiting
  • Regurgitation of food
  • Acid reflux and heartburn

Cancer

Alcohol is a human carcinogen and is linked to certain cancers, including:

  • Head and neck cancer
  • Esophageal squamous cell carcinoma
  • Liver cancer
  • Breast cancer (in women)
  • Colorectal cancer

Heart Problems

Alcohol negatively affects your heart rate and blood pressure, increasing your risk of heart attack, heart failure, and stroke. Alcohol addiction also leads to a condition known as alcoholic cardiomyopathy.

This condition occurs when long-term alcohol abuse weakens and thins the heart muscle and affects its ability to pump blood.

Untreated, this can lead to congestive heart failure. Symptoms of alcoholic-related heart complications include:

  • Rapid and irregular pulse
  • Shortness of breath
  • Fatigue and weakness
  • Dizziness or fainting
  • Swelling in the legs, feet, and ankles
  • A cough that produces a frothy, pink mucus

Other Health Problems

Excessive, long-term alcohol use can also lead to the following health problems:

  • Anemia
  • Nerve damage
  • Dementia
  • Seizures
  • Depression
  • Infectious diseases
  • High blood pressure
  • Pancreatitis
  • Gout
  • Brain damage
  • Weakened immune system

Treatment Options & Support Groups for Alcoholism

There are many treatment options available for alcoholism, including:

  • Inpatient programsinpatient treatment takes place at a licensed residential treatment center. These programs provide 24/7 comprehensive, structured care. You'll live in safe, substance-free housing and have access to medical monitoring.
  • Partial hospitalization programs (PHP) partial hospitalization programs (PHP) are sometimes referred to as intensive outpatient programs (IOP).
  • Outpatient programs outpatient treatment is less intensive than inpatient and partial hospitalization programs. These programs organize your treatment session based on your schedule. The goal of outpatient treatment is to provide therapy, education, and support in a flexible environment.
  • Medication-assisted treatment (MAT) medications may be used in alcohol addiction treatment. Some medicines can help reduce the negative side effects of detoxification and withdrawal.
  • Support groups Support groups such as Alcoholics Anonymous (AA) and SMART Recovery are open to anyone with a substance abuse problem. They are peer-led organizations dedicated to helping each other remain sober. They can also be the first step towards recovery or part of a long-term aftercare plan.

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Resources

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“ALCOHOL'S DAMAGING EFFECTS ON THE BRAIN.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, pubs.niaaa.nih.gov/publications/aa63/aa63.htm.

“Alcohol Use Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 11 July 2018, https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243.

“Alcohol Use Disorder.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, 4 June 2020, www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders.

“Alcohol-Induced Pancreatitis Symptoms and Signs.” Alcohol.org, https://www.alcohol.org/comorbid/pancreatitis/.

 “Alcoholic Gastritis: Stomach Pain, Bloating, Regurgitation, Vomiting.” Alcohol.org, https://www.alcohol.org/comorbid/gastritis/.

“Alcoholic Liver Disease: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, https://medlineplus.gov/ency/article/000281.htm.

“Drinking Levels Defined.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking.

“Fatty Liver Disease.” MedlinePlus, U.S. National Library of Medicine, 19 Nov. 2019, https://medlineplus.gov/fattyliverdisease.html.

Harvard Health Publishing. “Alcohol Withdrawal.” Harvard Health, https://www.health.harvard.edu/a_to_z/alcohol-withdrawal-a-to-z.

Solan, Janet Barwell and Matthew. “Alcoholic Cardiomyopathy: Causes, Symptoms, and Diagnosis.” Healthline, Healthline Media, 8 Feb. 2018, https://www.healthline.com/health/alcoholism/cardiomyopathy#symptoms.

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