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Signs & Symptoms of Alcoholism

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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. 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.

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6 Warning Signs of Alcoholism: How to Recognize It

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

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

The brain eventually stops releasing the hormone with normal stimuli such as food. 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 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. Some internal triggers are mental disorders such as depression, trauma, and bipolar disorder. External triggers include places that remind you of alcohol. 

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 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. It's a highly unpleasant reaction 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 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 the alcohol addiction.

Common symptoms of alcohol withdrawal include:

  • Shakiness
  • Headaches
  • Trouble sleeping
  • Irritability
  • Mood swings,
  • Gastrointestinal upset
  • Anxiety
  • Depression
  • Hallucinations
  • 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 hippocampal tissue loss causes memory decline, impaired reasoning, and reduced cognitive function.6, 7

Alcohol consumption also increases a person’s risk for impulsive behavior.8 This impulsivity, in combination 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: Alcoholics can’t choose when they can and can’t drink. This inability to control one’s drinking is a symptom of exposure to unhealthy drinking patterns. 

How to recognize it: Drinking more alcohol or drinking for longer periods than intended indicates 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, desensitizing 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 alcohol elimination. 

People with functional alcoholism don’t have the classic signs of alcoholism. 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. They will drink increasing amounts of alcohol over time to achieve their desired effects.

6. Spending time drinking despite the consequences

Why it happens: Alcoholism is a medical condition that affects your behavior and cognitive abilities. Alcohol cravings, impulsive 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. Despite worsening consequences, they will continue to drink.

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

  • Appetite and weight changes
  • 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
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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
  • 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.

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When is Addiction Treatment Necessary?

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

  • Drinking more alcohol or drinking for longer periods
  • Difficulty reducing alcohol consumption or stopping 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 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 or someone you know starts showing these signs, you should get immediate help. 

Don’t wait until a person has more than six symptoms before seeking treatment. By then, 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 or hostile. Confrontations facilitated by a medical professional and family members who genuinely care about them are helpful.15
  • Encourage your loved one to seek alcohol treatment: Help them explore treatment options.
  • Be there for them when they’re struggling: Mental health professionals can help patients with dual diagnosis. However, you can also provide the support they need during difficult times. Your presence can prevent them from relapsing.
  • Maintain strong boundaries: Don’t 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 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, remember that there is no single treatment for alcoholism. More often than not, a multidisciplinary approach is needed. What matters is that you can sustain long-term recovery by preventing relapse.

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Updated on October 7, 2022
15 sources cited
  1. Substance Abuse and Mental Health Services Administration. “The National Survey on Drug Use and Health: 2019.” 2020.
  2. American Academy of Family Physicians. “Problem Drinking and Alcoholism: Diagnosis and Treatment.” 2002.
  3. Centers for Disease Control and Prevention. “Alcohol and Substance Misuse.” 
  4. Di Chiara G. "Alcohol and dopamine." Alcohol Health Res World, 1997.
  5. Simioni, N., Cottencin, O., Guardia, D., & Rolland, B. "Early relapse in alcohol dependence may result from late withdrawal symptoms." Medical hypotheses, 2012. 
  6. Harvard Health Publishing. “This is your brain on alcohol.” 2017.
  7. Science Daily “Heavy, Chronic Drinking Can Cause Significant Hippocampal Tissue Loss.” 2006.
  8. Dick DM, Smith G, Olausson P, et al. "Understanding the construct of impulsivity and its relationship to alcohol use disorders." Addict Biol, 2010.
  9. National Institute on Alcohol Abuse and Alcoholism. “Alcohol Alert.”
  10. National Institute on Alcohol Abuse and Alcoholism. “Drinking Levels Defined.”
  11. Edenberg HJ, Foroud T. "Genetics and alcoholism." Nat Rev Gastroenterol Hepatol, 2013.
  12. Strandheim, A., Holmen, T.L., Coombes, L., et al. "Alcohol intoxication and mental health among adolescents." Child Adolesc Psychiatry Ment Health, 2009. 
  13. The American Journal of Psychiatry. “Age at First Alcohol Use: A Risk Factor for the Development of Alcohol Disorders.”
  14. Institute of Medicine (US) Committee on Community-Based Drug Treatment. "Bridging the Gap between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment." National Academies Press, 1998.
  15. Polcin DL, Mulia N, Jones L. "Substance users' perspectives on helpful and unhelpful confrontation: implications for recovery." J Psychoactive Drugs, 2012.

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