Signs & Symptoms of Alcoholism

What is Alcoholism (Alcohol Use Disorder)?

Alcoholism, alcohol abuse, and alcohol addiction are common terms for alcohol use disorder (AUD).

The three main signs of alcoholism are:

• A fixation with alcohol
• The inability to control drinking
• Drinking alcohol despite negative consequences

Alcoholism or alcohol use disorder (AUD) is a chronic disease that arises from alcohol misuse. This can include any excessive drinking habit. Long-term alcohol use leaves lasting effects on a person’s health. It may also cause social and legal problems.

Unless treated, alcohol use disorder will worsen with time. In some cases, it can even be fatal. Knowing the signs and symptoms of alcoholism can help you get early treatment and prevent complications.

How Common is Alcohol Use Disorder?

Alcohol use is the second most common substance use disorder in the United States. The 2019 National Survey on Drug Use and Health (NSDUH) shows the prevalence of alcohol use disorder in the United States.¹ Based on their findings:

• 73.1% of the surveyed population struggled with alcohol use, compared to just 38.5% who used illicit drugs.
• Eleven million older adults aged 26 and above had an alcohol use disorder.
• 3.1 million young adults aged 18 to 25 reported having AUD.
• AUD increased among teenagers (aged 12 to 17) from an estimated 401,000 in 2018 to 414,000 in 2019.

Studies also show that alcoholism often goes undiagnosed.² This means there could be more Americans struggling with alcohol use disorder who have not sought help from a medical professional.

Alcohol Misuse vs. Addiction

Alcohol misuse or alcohol abuse is a mild form of alcohol use disorder. It can refer to the unhealthy habit of excessive drinking, which increases a person’s risk for negative consequences.

On average, women who consume more than one drink per day and men who consume more than two drinks per day suffer from alcohol misuse.³ Heavy drinking and binge drinking are also considered symptoms of alcohol use.

Alcohol use that isn’t managed in time will often lead to addiction. Alcohol addiction is a severe form of alcohol use disorder that requires medical intervention. Although chronic, it’s also preventable if you know which signs to look out for.

Signs Alcohol Misuse is Turning into Alcoholism

A person with worsening alcohol misuse will start spending more time drinking. They will also begin to lose track of their lives as they become increasingly preoccupied with alcohol. This includes:

• Inability to keep up with responsibilities. They might neglect family, fail to pay bills on time, skip classes, or show up late for work more frequently.
• Social isolation. A person addicted to alcohol might not see friends or family members as often.
• Loss of interest in activities. They will spend less time on hobbies and personal interests.

Unfortunately, most people ignore these early signs of alcohol addiction. What this does is create a missed opportunity for early recovery.

6 Warning Signs of Alcoholism: How to Recognize It

Once alcoholism sets in, it’s usually hard to ignore. You may have mild, moderate, or severe alcohol use disorder, depending on the signs and symptoms. 

Below are the six definitive signs of alcohol use disorder:

1. Intense cravings for alcoholic drinks

Why it happens: The brain releases dopamine whenever you engage in certain activities, like eating food. The “feel-good” hormone induces pleasure and encourages you to repeat these behaviors. However, research shows that alcohol affects the brain differently.⁴

With normal stimuli such as food, the brain eventually stops releasing the hormone. As a result, you will no longer feel the same level of satisfaction. On the other hand, alcohol continues to trigger its release despite repeated consumption. The brain then gets used to the presence of dopamine and seeks it out, hence the cravings.

How to recognize it: Alcohol cravings can occur randomly or when triggered by external or internal factors. Mental disorders such as depression, trauma, and bipolar disorder are some internal triggers. Places that remind you of alcohol are other examples of external triggers.

2. Experiencing withdrawal symptoms after you stop drinking

Why it happens: People who drink heavily for too long become physically dependent on alcohol. Alcohol dependence is a symptom of alcohol addiction. Like drug dependence, alcohol causes physiological changes in the brain. However, these changes only become apparent when you experience withdrawal symptoms.

Unlike alcohol cravings, which occur as a behavioral response, withdrawal is a physical reaction to reduced blood alcohol levels. This reaction can be highly unpleasant. It's also associated with a higher risk for relapse in the first month of quitting.⁵

How to recognize it: Alcohol withdrawal encompasses a range of physical and behavioral signs that appear within the first 6 to 12 hours after the last drink. Withdrawal symptoms can last for 3 to 5 days, depending on the severity of alcohol addiction.

Common symptoms of alcohol withdrawal include shakiness, headaches, trouble sleeping, irritability, mood swings, and gastrointestinal upset. Some people may also experience anxiety, feelings of depression, hallucinations, and seizures.

3. Impaired decision making

Why it happens: Problem drinking causes the hippocampus to shrink. The more a person drinks, the greater the shrinkage.⁶ Research suggests that the loss of hippocampal tissue causes memory decline, impaired reasoning, and reduced cognitive function.^{6, 7}

Alcohol consumption also increases a person’s risk for impulsive behavior such as unsafe sex.⁸ This impulsivity, along with reduced cognition, can lead to poor life choices.

How to recognize it: People addicted to alcohol often engage in risky behaviors (e.g., unprotected sex, drunk driving, and/or getting involved in legal problems) and usually have impaired judgment from alcohol use.

4. Unable to control drinking

Why it happens: The inability to control one's drinking isn't something an alcoholic actively chooses. Instead, it is a symptom of the collective physiological and behavioral changes the brain undergoes after being exposed to unhealthy drinking patterns.

How to recognize it: Drinking more alcohol, or drinking for longer periods than intended, are indicators that a person is struggling to control their drinking habits. Some chronic alcohol users will openly express previous failed attempts at quitting alcohol.

5. Increased tolerance to alcohol

Why it happens: Alcohol tolerance can happen for different reasons. The most common cause is the repeated consumption of large amounts of alcohol, which desensitizes the brain to its intoxicating effects. 

Tolerance can also develop if you drink in the same environment, or as a metabolic response that speeds up the elimination of alcohol. People with functional alcoholism don’t have the classic signs of an alcoholic. They develop tolerance by learning to function while intoxicated.^[9]

How to recognize it: A person with alcohol tolerance doesn’t show signs of intoxication after heavy drinking. It usually takes more for them to get drunk. Some of them even complain about it. To achieve their desired effects, they will drink increasing amounts of alcohol over time.

6. Spending time drinking despite consequences

Why it happens: Alcoholism is a medical condition that affects your behavior and cognitive abilities. The combination of alcohol cravings, difficulty controlling drinking habits, impaired decision making, and withdrawal symptoms are enough to keep someone hooked to the substance.

How to recognize it: A person with AUD will spend most of their time drinking. They will also prioritize drinking above anything else. They might give up activities, interests, and responsibilities to maintain their habit. In spite of worsening consequences, they will continue to drink.

What are the Physical Signs of Alcoholism?

Alcohol use disorder causes a range of physical symptoms. These can appear shortly after drinking alcohol or as a result of prolonged alcohol use and alcohol addiction.

Short-Term Physical Signs of Alcohol Use Disorder

• Aggressive behavior
• Emotional outbursts
• Poor muscle control
• Lack of coordination
• Slurred speech
• Confusion
• Slow reaction time
• Vomiting
• Blackouts

Long-Term Physical Signs of Alcohol Addiction

• Changes in appetite and weight
• Memory problems
• Mental health issues
• Redness of the face, resulting in tiny web-like blood vessels on the skin (spider angioma)
• Repetitive infections
• Low sex drive

Who is at Risk of Developing Alcohol Use Disorder?

Some people are more at risk of developing alcohol use disorder than others. For example:

1. People who engage in binge drinking or heavy drinking

Binge drinking is the consumption of large amounts of alcohol on a single occasion. This means five or more drinks for men and more than four drinks for women within two hours. The Substance Abuse and Mental Health Services Administration (SAMHSA) further defines it as excessive drinking for five or more days in a month.

Heavy drinking is the regular consumption of excessive amounts of alcohol. This means having more than four drinks per day or 14 drinks per week in men; and more than three drinks per day or seven drinks per week in women.

2. A family history of alcohol use disorders

Scientists identified genetic factors that increase a person’s ability to metabolize alcohol and make them susceptible to its sedative effects.¹¹ Consequently, having these genes increases your risk for alcohol problems. It also helps explain why alcohol use disorder tends to run in the family.

3. People who are exposed to environmental factors

Certain places put you at risk of alcohol use disorder. Some of them include:

• Living near stores that sell alcoholic drinks
• Being around people with drinking problems
• Living in a place that traumatized you

4. People with poor mental health

People with mental health problems such as depression and anxiety are also at risk of developing alcohol use disorder.¹² A person with AUD who also shows signs of mental disorders has a dual diagnosis.

5. Underage alcohol drinkers

Children who started drinking between 11 and 14 have a higher risk for alcohol-related problems in older age. Ten years after their first survey, researchers confirmed that 13.5% of participants already suffered from alcohol misuse, and 15.9% had alcohol dependence.¹³

What are the Dangers & Consequences of Alcoholism?

Long-term alcohol use has wide-ranging adverse effects on a person's health and mental wellness. These include:

• Increased risk for injury and accidents
• Involvement in violence and legal issues
• Alcohol poisoning
• Miscarriage
• Fetal alcohol syndrome
• High risk for unplanned pregnancy
• Sexually transmitted disease due to unprotected sex
• Chronic health problems (e.g., diabetes and cardiovascular disease)
• Liver and pancreatic diseases
• Risk for certain cancers (e.g., head, neck, breast, and liver cancer)
• Mental health disorders (e.g., depression, anxiety, and bipolar disorder)
• Severe withdrawal (e.g., life-threatening delirium tremens)

The consequences of alcohol addiction are irreversible, with some leading to death. They leave lasting effects and add to the financial and social burdens of alcoholism.

When is Addiction Treatment Necessary?

Alcoholism can be mild, moderate, or severe. Symptoms include:

• Drinking more alcohol or drinking for longer periods than intended
• Difficulty reducing alcohol consumption or stoping drinking altogether
• Spending a lot of time drinking or being sick from its after-effects
• Having intense cravings for alcohol
• Experiencing problems at home, school, or work as a result of drinking
• Drinking even though it causes problems with friends or family
• Drinking even when you decided you would not drink on a specific occasion
• Giving up important activities or interests to drink
• Engaging in risky behavior after drinking
• Continuing to drink even though it causes feelings of depression, anxiety, and other health issues
• Consuming more alcohol to get the same effects you previously experienced with less alcohol
• Experiencing withdrawal symptoms when the alcohol wears off

People with 2 to 3 symptoms suffer from mild alcoholism. If you start showing these signs or know someone who does, you should get immediate help. Try not to wait until a person has more than six symptoms before seeking treatment. By that time, they already have severe alcoholism, which can be more difficult to treat.

Tips for Helping a Loved One with Addiction Treatment

• Early intervention is the key to more successful alcohol treatment. Patients with low alcohol dependence and fewer symptoms during admission have better outcomes.¹⁴
• Avoid negative exchanges. Alcoholics perceive confrontations as unhelpful to their recovery if they are overly critical, hostile, or involve people they don't have a good relationship with. Confrontations facilitated by a medical professional and family members who genuinely care about them are seen as helpful.¹⁵
• Encourage your loved one to seek alcohol treatment. Help them explore treatment options.
• Be there for them when they’re struggling. While a mental health professional can help patients struggling with dual diagnosis, you can also provide the support they need during difficult times. If they’re in recovery or in the process of quitting alcohol, your presence can prevent them from relapsing.
• Maintain strong boundaries. Do not protect them from the legal, occupational, or social consequences of drinking. Don't make excuses for why they broke the law or missed work or school. Allow them to deal honestly with the problems caused by their drinking.
• Get help from an alcohol treatment facility. They can provide medical advice and create a treatment plan that is suited to the patient’s needs.
• Be patient and realistic. Recognize that the only person who can help the alcoholic get sober is themselves. Until someone decides they want to get sober and quit drinking, they will never do so.

Treatment Options for Alcohol Use Disorder (AUD)

Patients can access a variety of treatments for alcoholism. The three basic types of alcohol treatment are:

• Behavioral treatments provide counseling to help change your negative drinking behaviors.
• Medications are used to help you overcome withdrawal symptoms.
• Support groups include 12-step programs like Alcoholics Anonymous. They provide support through peers who are also struggling with alcohol use problems.

When exploring these options, keep in mind that there is no single treatment for alcoholism. More often than not, a multidisciplinary approach is needed. What matters is that you are able to sustain long-term recovery through the prevention of relapse.