Alcohol Use Disorder

Condition Basics

What is alcohol use disorder?

Alcohol use disorder means that a person drinks alcohol even though it causes harm to themselves or others. It can range from mild to severe. People with this disorder may find it hard to control their alcohol use. Over time, drinking too much alcohol may cause health problems, like liver or blood pressure problems.

What causes it?

It's not clear why some people develop alcohol use disorder and others don't. It often runs in families (genetic). But drinking habits also are influenced by your environment and life situations, such as friends or stress levels.

What are the symptoms?

Your drinking may be a problem if:

• You can't cut down or control your use.
• You spend a lot of time drinking or recovering from alcohol.
• You can't do your main tasks at work or home.
• You keep drinking, even though it's hurting your relationships.
• You have uncomfortable symptoms when you drink less.

How is it diagnosed?

Alcohol use disorder may be diagnosed at a routine doctor visit or when you see your doctor for another problem. Your doctor will ask questions about your symptoms and past health and will do a physical exam. Your doctor may do tests to look for health problems linked to alcohol, like cirrhosis.

How is alcohol use disorder treated?

Some people are able to stop or cut back on drinking with help from a counsellor or support group. People with moderate to severe alcohol use disorder may need medical treatment. They may need to stay in a hospital or treatment centre. Medicines that help reduce withdrawal symptoms and cravings may be used.

What Increases Your Risk

Certain things make alcohol use disorder more likely. These are called risk factors.

Risk factors that make you more likely to drink harmful amounts of alcohol include:

• Genes. There is often a family history of alcohol use disorder.
• Early use. The younger you were when you first started drinking alcohol, the higher your risk for alcohol use disorder later as an adult.
• Having a mental health condition or conditions. This could include depression, post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenia, and anxiety disorders.
• Use of other substances. This could include the use of tobacco or drugs or the misuse of prescription medicines.
• Environment. You may live in an area where alcohol is easy to get, people drink a lot, or heavy drinking is accepted as part of life.
• Friends. Your friends may influence you to drink by directly urging you to or by drinking when you're around them.
• Problems with others. You may be more likely to drink heavily when you are having problems in your family or with friends.
• Not having purpose or satisfaction in your life. If you have no activities that give you a sense of purpose, you may be more likely to drink too much.

Just because you have risk factors doesn't mean you'll develop alcohol use disorder. A person who has many risk factors won't always develop alcohol use disorder. And a person who has no risk factors can have alcohol use disorder.

Symptoms

Maybe you've wondered about your alcohol habits or how to tell if your drinking is becoming a problem.

Here are some of the symptoms of alcohol use disorder. You may have it if you have two or more of the following symptoms:

• You drink larger amounts of alcohol than you ever meant to. Or you've been drinking for a longer time than you ever meant to.
• You can't cut down or control your use. Or you constantly wish you could cut down.
• You spend a lot of time getting or drinking alcohol or recovering from its effects.
• You have strong cravings for alcohol.
• You can no longer do your main jobs at work, at school, or at home.
• You keep drinking alcohol, even though your use hurts your relationships.
• You have stopped doing important activities because of your alcohol use.
• You drink alcohol in situations where doing so is dangerous.
• You keep drinking alcohol even though you know it's causing health problems.
• You need more and more alcohol to get the same effect, or you get less effect from the same amount over time. This is called tolerance.
• You have uncomfortable symptoms when you stop drinking alcohol or use less. This is called withdrawal.

Alcohol use disorder can range from mild to severe. The more symptoms you have, the more severe the disorder may be.

You might not realize that your drinking is a problem. You might not drink large amounts when you drink. Or you might go for days or weeks between drinking episodes. But even if you don't drink very often, your drinking could still be harmful and put you at risk.

Physical signs of alcohol use disorder

The physical signs of alcohol use disorder can be vague in the early stages of the disease. Some early symptoms include:

• Blackouts, which cause you to not remember what happened when you were drinking. Blackouts aren't the same as passing out. Passing out means that you lose consciousness. You don't pass out when you have an alcohol blackout. But you do lose your memories of the event.
• Injuries and illnesses you can't explain. You might have new physical problems, such as stomach cramps. Or another health problem may get worse.

As alcohol use disorder gets worse, physical symptoms of long-term heavy drinking can develop. You may:

• Not feel hungry, not eat well, and lose weight.
• Notice tiny blood vessels on your skin that look like spider webs (spider angiomas).
• See swelling or redness of the palms of your hands.
• Have redness on your face, especially your nose and cheeks.
• Keep getting infections and skin sores (abscesses).
• Have less interest in sex. You might also notice shrinkage of the testicles and impotence.
• Have a sore or upset stomach (gastritis).
• Feel numbness and tingling in your feet or hands.
• Be unsteady when on your feet.
• Have liver problems, such as cirrhosis.

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What Happens

Alcohol use disorder can develop very quickly or happen gradually over years.

In the beginning, your drinking might not seem to be any different from the way other people drink. You may drink only with friends or at parties. It may stay like this, or you may start to drink more. Your drinking might become a way for you to feel normal or to cope with life's problems.

You might think that you can quit drinking at any time. Many people who have alcohol use disorder quit for days, weeks, or even months before they start to drink again. But unless you can consistently keep your drinking under control and not fall back into unhealthy patterns, you need help.

Problems from alcohol use disorder

Drinking too much alcohol on a regular basis harms your liver, nervous system, heart, and brain. It can cause health problems or make them worse. These problems include:

• Cirrhosis or pancreatitis.
• High blood pressure.
• Osteoporosis.
• Certain types of cancer, including breast cancer.
• Stroke.
• A brain disorder called Wernicke-Korsakoff syndrome.

Heavy alcohol use also can cause stomach problems, interactions between medicines and alcohol, and sexual problems. It can lead to violence, injuries, social isolation, and problems at work, school, or home. You also may have legal problems, such as traffic tickets or car crashes, as a result of drinking.

Drinking alcohol can cause unique problems for older adults and people who are pregnant or who have other health conditions. If you are pregnant, you should not drink any alcohol because it can harm your baby.

Drinking also makes symptoms of mental health conditions worse. When you have a drinking problem and a mental health condition, it's called a dual diagnosis. It's very important to treat all mental health conditions, such as depression. You may drink less when mental health conditions are treated.

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When to Call a Doctor

Call 911 or other emergency services if you or someone else:

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away.

• Call or text Canada's suicide and crisis hotline at 988.
• Call Talk Suicide Canada: 1-833-456-4566 or text 45645 (4 p.m. to midnight ET).
• Kids or teens can call Kids Help Phone: 1-800-668-6868 or text CONNECT to 686868.
• Go to the Talk Suicide Canada website at https://talksuicide.ca or the Kids Help Phone website at https://kidshelpphone.ca for more information.

Consider saving these numbers in your phone.

Call a doctor right away if you or someone you care about:

• Has withdrawal symptoms, such as confusion and trembling.
• Agrees to be seen for possible treatment.
• Has stopped drinking but starts drinking again (has a relapse).
• Has severe stomach pain.

Watchful waiting

Watchful waiting is a wait-and-see approach. Watchful waiting is not a good choice for alcohol use disorder. If you have concerns about your drinking or the drinking of someone you care about, talk to your doctor. Early treatment makes recovery more likely.

Support groups can also help you and your family:

• Alcoholics Anonymous (AA), LifeRing, or similar support groups are for people with alcohol use disorder.
• Al-Anon and Alateen (for teenagers) are for families and friends affected by someone's drinking.

Exams and Tests

Alcohol use disorder may be diagnosed at a routine doctor visit or when you see your doctor for another problem.

Your doctor will ask questions about your symptoms and past health and will do a physical exam. Your doctor also may ask questions or do tests to look for health problems linked to alcohol, such as cirrhosis.

People who drink too much also may have mental health conditions. These may include depression, anxiety disorders, or post-traumatic stress disorder (PTSD). If you have alcohol use disorder and a mental health condition, it's called a dual diagnosis. A dual diagnosis can make treatment for alcohol use disorder harder.

If your doctor thinks you have a mental health condition, your doctor may do a mental health assessment.

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Treatment Overview

Getting help is up to you. But you don't have to do it alone. There are many types of treatments that can help. They include:

• Group therapy, one or more types of counselling, and alcohol education.
• Medicines that help to:
  • Reduce withdrawal symptoms and help you safely stop drinking.
  • Reduce cravings for alcohol.
• Support groups.

Some people are able to stop or cut back on drinking with help from a counsellor. People who have moderate to severe alcohol use disorder may need medical treatment. They may need to stay in a hospital or treatment centre.

Detox

Your doctor may decide that you need detoxification, or detox, before you start treatment. You need detox when you are physically dependent on alcohol. When you go through detox, you may need medicine to help with withdrawal symptoms. These symptoms can be severe and sometimes fatal. Detox helps get you ready for treatment. It doesn't help you with the mental, social, and behaviour changes you have to make to get and stay sober.

You may need to stay at a clinic or other facility. Or you may be able to detox at home if your doctor says it's okay.

After detox, you focus on staying alcohol-free, or sober. Most people get some type of therapy, such as group counselling. You also may need medicine to help you stay sober. You may take medicine that can help reduce your craving for alcohol or that makes you sick to your stomach when you drink.

Recovery

When you're 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 manage work, relationships, and any medical problems you may have. This makes it easier to stay sober.

Alcohol use disorder changes certain chemicals in areas of the brain that control pleasure, reward, and memory. This makes it hard to stay sober even after treatment. So you will likely need support to stay sober and in recovery. This can include counselling and support groups like Alcoholics Anonymous and SMART Recovery (Self-Management and Recovery Training). Your family or friends might also want to attend a support group such as Al-Anon or Alateen. A 12-step program often is part of treatment and continues after treatment ends. Recovery is a long-term process. It's not something you can achieve in a few weeks.

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Counselling

Treatment for alcohol use disorder usually involves one or more types of counselling. These include:

• Individual and group therapy. This is where you talk about your recovery with a counsellor or with other people who are trying to quit. You can get support from others who have struggled with alcohol.
• Cognitive behavioural therapy (CBT). You learn to change thoughts and actions that make you more likely to use alcohol. A counsellor teaches you ways to deal with cravings and avoid going back to alcohol.
• Motivational interviewing (MI). You resolve mixed feelings about quitting and getting treatment. A counsellor helps you find personal motivation to change.
• Motivational enhancement therapy (MET). It uses motivational interviewing to help you find motivation to quit. It usually lasts for 2 to 4 sessions.
• Brief intervention therapy. This provides feedback, advice, and goal-setting in very short counselling sessions.
• Couples and family therapy. It can help you become and stay sober and keep good relationships within your family.

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Medicines

Medicines can help treat alcohol use disorder.

Some medicines reduce withdrawal symptoms during detoxification. These include:

• Anti-anxiety medicines (benzodiazepines such as diazepam). They treat withdrawal symptoms such as delirium tremens (DTs).
• Seizure medicines. They reduce or stop severe withdrawal symptoms.

Other medicines help you stay sober during recovery. These include:

• Naltrexone. It interferes with the pleasure you get from drinking.
• Acamprosate. It may reduce your craving for alcohol.
• Disulfiram. It makes you sick to your stomach when you drink.
• Topiramate. It may help treat alcohol use disorder.

Along with medicine, you might need vitamins and supplements. Alcohol use can cause your body to become low in certain vitamins and minerals, especially thiamine (vitamin B1). You might need to take thiamine supplements to improve your nutrition during recovery. Thiamine helps prevent Wernicke-Korsakoff syndrome, which causes brain damage. You also might need supplements to help replace fluids and electrolytes.

Staying Sober After Treatment

Recovery from alcohol use disorder means finding a way to stay sober. Here are some things that can help.

• Have a plan for a lapse or relapse.

  Talk to people involved in your recovery. Decide who you can call, where you can go, and what to do if you have a lapse or relapse.

  People you can turn to include your support group sponsor, your doctor, your counsellor, family, friends, or a crisis hotline.

• Avoid triggers.

  It may be helpful to write down your triggers and plan ahead for how to deal with them. You might need to avoid certain situations or people or stay away from a favourite place or activity. If you know you can't avoid a trigger, bring a friend with you for support.

• Find support.

  An important part of recovery is being sure you have support. You can:

  • Use social support and support groups. Support comes in many forms. You can find it in seminars and groups led by professionals, 12-step groups with people who also have alcohol use disorder, and your relationships with family and friends.
  • Connect with others you trust. They can help you stop drinking and stay sober by encouraging positive steps.
  • Take part in recovery group activities. You may have used alcohol to make friends or be with a social group. Your counsellor or doctor can help you learn skills to make friends without drinking.
  • Find a sponsor, and work with them. A sponsor is someone who has been in recovery for a long time and helps you stay sober.
• Manage stress.

  Some people find that relieving stress helps them during recovery.

  You can find ways to manage stress, such as sharing your feelings with others or writing to express your journey through recovery. Do something you enjoy, like a hobby or volunteer work. Learn how to relax your mind and body with breathing exercises or meditation.

• Have a healthy lifestyle.

  When you have alcohol use disorder, you often get away from some of the basics of good health. Part of recovery is finding your way back to a healthy lifestyle.

  • Be active.
  • Get enough sleep.
  • Eat healthy foods. These foods include vegetables and fruits, whole grain foods, and protein foods like nuts, beans, lean meat, and fish.
• Talk to others about your drinking.

  If you can, talk with your family or friends about your drinking and recovery. Your family and friends need to know that they didn't cause your alcohol use disorder but that they can help you during recovery.

  • Try to be open and honest with loved ones about your drinking. This will help them understand what you're going through and how they can help. Many treatment programs offer counselling to help you solve problems with people who care about you.
  • Talk about what may cause a relapse, and discuss your relapse plan.

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Giving Support

When someone you care about has decided to get treatment for alcohol use disorder, you can play an important part in helping them stay sober. Here are some things you can do.

• Decide whether to keep alcohol in the house, if you drink.

  Having alcohol in your home might make it harder for your loved one to stay sober.

• Be involved and patient.

  Attend recovery meetings with your loved one, and be supportive.

  Know that it may take a long time for you to trust and forgive the person and for the person to forgive themself.

• Be open to changes in your loved one.

  Your loved one may seem like a different person after they are sober. You may need to rebuild your relationship.

• Ask how recovery is going.

  But ask about it in a respectful way.

• Help your loved one plan for a relapse.

  Relapse is common after treatment. This doesn't mean that the treatment failed. Try to help your loved one see relapse as a chance to keep working on skills to avoid drinking.

• Focus on the positive progress being made.

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