12 Warning Signs of Alcohol Use Disorder

Alcohol Use Disorder (AUD) is often misunderstood and affects millions of individuals worldwide. Characterized by an inability to manage alcohol consumption despite negative consequences, AUD can significantly impact one’s health, relationships, and overall quality of life. Recognizing the warning signs of AUD is crucial for early intervention and effective treatment. These signs range from increased tolerance and withdrawal symptoms to neglecting responsibilities and continuing to drink despite clear harm. 

According to data from the 2022 National Survey on Drug Use and Health (NSDUH), 29.5 million people aged 12 and older were diagnosed with AUD. This translates to approximately 10.5% of the population in this age group, showcasing a significant public health concern.

What are the 12 Warning Signs of Alcohol Use Disorder?

Alcohol Use Disorder (AUD) is characterized by various criteria, including drinking more or longer than intended, unsuccessful attempts to cut down, spending excessive time drinking or recovering, experiencing cravings, and interference with responsibilities and social life. Here is a list of the 12 Warning signs to look for when determining whether someone has Alcohol Use Disorder.

1. Drinking More or Longer than Intended

This warning sign indicates regularly consuming more alcohol or spending more time drinking than initially planned. According to data from the Centers for Disease Control and Prevention (CDC), in the United States, approximately 17% of adults aged 18-24 and 15% of adults aged 25-34 reported binge drinking (defined as consuming five or more drinks on a single occasion for men, or four or more drinks for women) in the past month, based on a survey conducted in 2020. This behavior not only increases the risk of accidents, injuries, and violence but is also associated with a range of health problems such as liver disease, cardiovascular issues, and mental health disorders.

2. Unsuccessful Attempts to Cut Down

Unsuccessful attempts to cut down on alcohol consumption is a common warning sign of Alcohol Use Disorder (AUD), reflecting the challenges individuals face in controlling their drinking behavior. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) published an article called “Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5” in 2021 stating that approximately 15 million adults in the United States struggle with AUD. Among individuals who try to reduce or control their alcohol intake, many experience repeated setbacks and are unable to achieve sustained moderation.

3. Spending a Lot of Time Drinking or Recovering From Drinking

Spending a substantial amount of time drinking or recovering from drinking is another warning sign of Alcohol Use Disorder (AUD), indicating a deep involvement with alcohol-related activities that interfere with daily life. This behavior encompasses not only the time spent consuming alcohol but also the time required to recuperate from its effects, such as dealing with hangovers or recovering from alcohol-induced impairment.

Experiencing hangovers, characterized by symptoms such as headache, dehydration, fatigue, and nausea, following episodes of heavy alcohol consumption, indicates excessive drinking habits or alcohol misuse.

4. Cravings

One of the key warning signs of Alcohol Use Disorder (AUD) is experiencing strong urges or cravings to drink alcohol. Cravings are intense, often irresistible desires to consume alcohol and occur at any time, often triggered by environmental cues or emotional states that have been associated with past drinking.

Understanding Alcohol Cravings:

• Persistent and Intrusive: Cravings for alcohol can be persistent and intrusive, making it difficult for individuals to focus on tasks or engage in daily activities without thoughts of drinking.
• Triggered by Cues: Specific cues such as the sight of a bar, the smell of alcohol, or even stress and emotional states can trigger cravings, reflecting a conditioned response.
• Neurobiological Basis: Cravings are linked to changes in brain pathways that involve reward, motivation, and memory. Alcohol alters the brain’s neurotransmitters like dopamine, which reinforces the behavior of drinking and strengthens the cravings.
• Impact on Recovery: Cravings are a significant challenge in the recovery process and can lead to relapse if not effectively managed.

Management of cravings is necessary for the treatment of AUD, involving strategies like cognitive-behavioral therapy, medication such as naltrexone which reduces the urge to drink, and support groups that offer coping techniques and community support.

5. Interference with Responsibilities

Recurrent alcohol use can have a severe impact on an individual’s ability to meet their responsibilities across various aspects of life, including work, school, and home. When drinking takes precedence over fulfilling obligations, it’s a clear indicator of Alcohol Use Disorder (AUD). According to an article published by the U.S. Office of Personnel Management (opm.gov), absenteeism is estimated to be 4 to 8 times greater among alcoholics and alcohol abusers. Other family members of alcoholics also have greater rates of absenteeism. Accidents and on-the-job injuries are far more prevalent among alcoholics and alcohol abusers.

• Workplace Impact: Alcohol compromises professional performance by reducing an individual’s ability to concentrate, meet deadlines, and maintain productivity. It may lead to increased absenteeism and even job loss.
• Academic Consequences: In students, excessive drinking leads to poor academic performance due to missed classes, decreased ability to study, and impaired cognitive functions.
• Home and Family Life: At home, alcohol misuse disrupts family dynamics, lead to neglect of children or household duties, and strain relationships.

6. Continued Use Despite Social Problems

Continuing to drink alcohol despite causing or worsening social or interpersonal problems is a hallmark of Alcohol Use Disorder (AUD). This behavior shows how deeply alcohol can affect one’s social interactions and relationships. Individuals with AUD persist in their drinking even though it leads to recurrent arguments, disrupts their social life, and causes estrangement within personal relationships. These consequences reflect the compulsion of AUD, where the urge to drink overrides the natural inclination to maintain healthy and supportive relationships.

Research indicates that this pattern of behavior is not only disruptive but also indicative of the deeper neurological and psychological impacts of alcohol dependence. A study that was updated in 2023 by The National Institute on Alcohol Abuse and Alcoholism (NIAAA) notes that continued alcohol use in the face of mounting social problems is a critical sign of AUD. This behavior often isolates individuals from their social support, which is essential for recovery and maintaining sobriety.

7. Giving Up Activities

One of the significant warning signs of Alcohol Use Disorder (AUD) is the abandonment or reduction of important social, occupational, or recreational activities due to alcohol use. This symptom reflects the profound impact that alcohol can have on an individual’s daily life and priorities. When individuals begin sacrificing activities they previously found important or enjoyable in favor of drinking, it’s a strong indicator of the severity of their alcohol-related issues.

This change often marks a shift where alcohol consumption becomes a central focus, overshadowing other aspects of life, including hobbies, career commitments, and social engagements. The reduction in engagement with these activities not only diminishes quality of life but also isolates individuals from support networks and healthy routines that could help mitigate their dependence on alcohol.

8. Dangerous Situations

Using alcohol in situations where it poses a physical hazard, such as driving or operating machinery, is a significant warning sign of Alcohol Use Disorder (AUD). This behavior increases the risk of accidents and injuries, not only to the individual but also to others.

According to the National Highway Traffic Safety Administration (NHTSA) in 2022, approximately 32% of all traffic crash fatalities in the United States involved drivers with blood alcohol concentrations (BACs) of 0.08 grams per deciliter (g/dL) or higher, leading to over 13,000 deaths. This demonstrates the severe risk posed by driving under the influence of alcohol, which is one of the most common examples of using alcohol in hazardous situations​.

Using alcohol in situations where it is physically hazardous extends beyond driving; it includes a variety of scenarios where judgment, coordination, and physical control are critical. Here are a few more examples:

1. Operating Heavy Machinery: This can include working with construction equipment or machinery in factories. Alcohol impairs the operator’s ability to react quickly and make sound decisions, significantly increasing the risk of accidents and injuries.
2. Swimming or Water Activities: Alcohol consumption before or during activities like swimming, boating, or surfing can severely affect balance, coordination, and judgment. This increases the risk of drowning or other water-related accidents.
3. Handling Firearms: Alcohol use can impair judgment and slow reaction times, which are critical when handling firearms or engaging in hunting and other shooting sports.
4. Cooking: Using alcohol while cooking, especially when using a gas stove or an open flame, can be risky. Impaired individuals are more prone to accidents, such as burns or fires.
5. Caring for Children: While not physically hazardous to the individual, drinking alcohol while responsible for the care of children can lead to poor judgment and delayed reactions in emergency situations, posing a risk to the child’s safety.
6. Climbing or Hiking: Engaging in climbing, hiking, or other similar activities while under the influence can lead to missteps and poor decision-making, increasing the likelihood of falls or other serious injuries.

9. Increased Tolerance

Developing a tolerance, where more alcohol is required to achieve the same effect, is a key symptom of AUD, as noted in an article called “Alcohol Use Disorder” published in 2023 by the American Psychiatric Association reviewed by Smita Das, M.D. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that tolerance is characterized by either a need for markedly increased amounts of alcohol to achieve intoxication or the desired effect, or a markedly diminished effect with continued use of the same amount of alcohol​​.

These changes occur as the body’s enzymes become more efficient at metabolizing alcohol and the brain’s neurotransmitter systems adapt to its presence, particularly affecting systems that control sedation and inhibition. Tolerance increases the risk of escalating alcohol intake, which leads to AUD.

10. Withdrawal Symptoms

Alcohol withdrawal is a significant symptom and warning sign of Alcohol Use Disorder (AUD), signaling physical dependence on alcohol. Withdrawal occurs when a person who has been drinking heavily reduces or stops alcohol consumption. The symptoms manifest because the body has adapted to the presence of alcohol and reacts when its levels suddenly decrease.

What is Alcohol Withdrawal?

Alcohol withdrawal involves a range of symptoms that can vary from mild to severe, depending on the duration and quantity of alcohol use. Common symptoms include:

• Anxiety: A feeling of nervousness or panic.
• Tremors: Shaking, especially noticeable in the hands.
• Sweating: Increased perspiration, often accompanied by a clammy feeling.
• Increased Heart Rate: The heart may beat rapidly and irregularly.
• Insomnia: Difficulty falling asleep or staying asleep.
• Nausea and Vomiting: Stomach discomfort and vomiting.
• Hallucinations: Seeing, hearing, or feeling things that are not there.
• Seizures: In severe cases, withdrawal can cause seizures.

Severe forms of withdrawal can lead to delirium tremens (DTs), which include confusion, rapid heartbeat, and fever. This condition can be life-threatening and requires immediate medical attention.

According to “Alcohol Use Disorder” published by the National Institute on Alcohol Abuse and Alcoholism and reviewed by George F. Koob, PhD:

• Up to half of people with AUD experience withdrawal symptoms when they stop drinking.
• Approximately 3-5% of individuals undergoing alcohol withdrawal will experience delirium tremens.
• Alcohol withdrawal is responsible for about 260,000 emergency department visits annually​​.

11. Lying and Deception

Lying and deception about alcohol consumption are significant behavioral signs of Alcohol Use Disorder (AUD). These behaviors often manifest as attempts to minimize or hide drinking habits from others, reflecting the psychological and social aspects of the disorder.

• Stashing Alcohol: Individuals will hide alcohol in unusual places to consume it secretly or ensure constant availability.
• Underreporting Consumption: Frequently, individuals lie about the quantity of alcohol they consume, often downplaying it to avoid judgment or concern.
• Drinking Alone: Consuming alcohol in solitude is an attempt to hide the extent of one’s drinking from family and friends.
• Hiding Alcohol Use: This includes drinking before social events to mask the amount consumed in public or waiting to drink until others are not present.

These behaviors are driven by a need to maintain alcohol use despite negative consequences, such as deteriorating relationships and social isolation. The secrecy surrounding alcohol consumption is often a red flag for AUD because it indicates that the individual is aware of the potential disapproval of their drinking patterns and the problems associated with their alcohol use.

Engaging in deceptive practices about alcohol use often correlates with feelings of guilt or shame associated with drinking. The cycle of hiding alcohol use, experiencing guilt about deceit, and then drinking to alleviate these negative feelings perpetuates the severity of AUD.

12. Continuing to Drink Despite Health Problems

Continuing to drink alcohol despite clear health problems is a critical sign of Alcohol Use Disorder (AUD). This behavior is particularly concerning as alcohol consumption is linked to a wide array of serious health issues. According to the Centers for Disease Control and Prevention, excessive alcohol use leads to chronic diseases like heart disease, liver disease, and cancers of the breast, mouth, and liver. It also weakens the immune system, making the body more susceptible to infections like pneumonia and tuberculosis​. This continuation of drinking despite knowing the risks reflects the complex interplay between addiction, mental health, and cognitive dissonance. Here is a list of why a person with AUD would continue to drink despite knowing the consequences:

1. Denial and Minimization: Many individuals with AUD do not fully acknowledge the severity of their health issues or the role alcohol plays in exacerbating these conditions. Denial serves as a psychological defense mechanism that protects them from the distress associated with acknowledging the harmful consequences of their drinking.
2. Dependence and Craving: Physiological dependence on alcohol leads to strong cravings, making it extremely difficult for individuals to abstain, even when they are aware of the negative health impacts. The body’s physical dependence on alcohol will override cognitive assessments of health risks.
3. Coping Mechanism: For some, alcohol serves as a way to cope with stress, anxiety, or underlying mental health issues. This creates a cycle where the individual continues to drink to alleviate distress, despite knowing the adverse effects on their health.
4. Altered Brain Chemistry: Chronic alcohol use will alter the brain’s chemistry and functioning, affecting decision-making and impulse control. This impairs a person’s ability to make healthy choices and recognize the long-term consequences of their drinking behavior.

What are the Physical Symptoms of Alcoholism?

Physical symptoms of alcoholism include but are not limited to noticeable weight loss or gain due to changes in eating habits, a persistent smell of alcohol on the breath, skin changes such as jaundice or a flushed appearance, and a general deterioration in personal grooming and physical appearance. Other physical signs include coordination problems and visible tremors, especially in the hands. Chronic alcohol use also leads to redness in the nose and cheeks, and the development of spider angiomas – small, spider-like blood vessels visible under the skin.

The long-term health effects of alcoholism are extensive and affect nearly every organ in the body. Liver damage is one of the most significant consequences, including conditions such as fatty liver, alcoholic hepatitis, fibrosis, and cirrhosis. Chronic alcohol abuse will also lead to cardiovascular problems, including hypertension, heart disease, and stroke. The risk of developing certain types of cancer, including liver, breast, esophagus, and throat cancer, increases significantly. Gastrointestinal issues, such as pancreatitis and gastritis, are also common. Alcoholism has profound effects on the brain, resulting in cognitive impairments, memory problems, and an increased risk of dementia.

What are the Behavioral Changes of an Alcoholic?

Alcoholics will show sudden mood swings, increased secrecy around drinking, and lose interest in activities they once enjoyed. They often become irritable or defensive when discussing alcohol. Alcoholism also strains professional and personal relationships, leading to missed work, financial strain, and conflicts with loved ones. It can result in isolation as the individual prioritizes alcohol over commitments. 

A study by the National Institute of Health found that chronic alcohol exposure leads to brain adaptations, shifting behavior control from areas involved in decision-making to those associated with habit formation. This research shows that alcohol use can lead to alcohol dependence.

What is the Spectrum of Alcohol Use Disorder?

Alcohol Use Disorder (AUD) encompasses a spectrum of behaviors and symptoms related to alcohol consumption. It’s diagnosed based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a manual used by mental health professionals for diagnosis. The spectrum of AUD ranges from mild to severe, with each level reflecting different degrees of dysfunction and impairment due to alcohol use. Here’s a breakdown of the spectrum and how these levels are determined:

1. Mild AUD: Individuals with mild AUD may exhibit two to three symptoms from the DSM-5 criteria. These symptoms include drinking more than intended, unsuccessful attempts to cut down, spending excessive time on drinking-related activities, cravings, and continued alcohol use despite social or interpersonal problems.
2. Moderate AUD: Moderate AUD is characterized by the presence of four to five symptoms from the DSM-5 criteria. In addition to the symptoms mentioned for mild AUD, individuals with moderate AUD would experience interference with responsibilities such as work, school, or home life, giving up important activities due to alcohol use, engaging in risky situations while drinking, and developing increased tolerance to alcohol.
3. Severe AUD: Severe AUD involves six or more symptoms from the DSM-5 criteria. These individuals typically exhibit all the symptoms mentioned earlier, including withdrawal symptoms when alcohol use is reduced or stopped. They also would engage in deceptive behaviors to hide their drinking, experience health problems directly related to alcohol use, and continue drinking despite awareness of the negative consequences.

What are the Different Types of Alcoholics?

There are 5 different subtypes of alcoholics, each with unique characteristics and behaviors. These include:

• Young Adult Subtype: Typically young adults who drink less frequently but tend to binge when they do.
• Young Antisocial Subtype: Young individuals, often with antisocial personality traits, who start drinking early and heavily.
• Functional Subtype: Middle-aged, well-educated individuals with stable jobs and families who drink heavily without apparent issues.
• Intermediate Familial Subtype: Middle-aged individuals with a family history of alcoholism, exhibiting moderate to high alcohol dependence.
• Chronic Severe Subtype: Individuals with a long history of alcohol problems, high rates of psychiatric disorders, and substance abuse.

What is High Functioning vs. Functional Alcoholism?

The terms “high-functioning” and “functional” alcoholism are often used interchangeably to describe individuals who continue to perform well in their professional and personal lives despite their alcohol dependency. However, when comparing the two, the focus is primarily on the level of functionality and the perception of their condition. 

High-functioning alcoholics may not only maintain but excel in their roles, with their success often masking their addiction. On the other hand, functional alcoholics, exhibiting signs such as managing basic responsibilities without significant external achievements, may not demonstrate the same level of outward success or proficiency. Identifying functional alcoholic signs is critical, as both types can lead to a delay in recognizing the need for help because their competence can disguise the severity of their condition. 

What is Binge Drinking vs AUD?

Binge drinking and Alcohol Use Disorder (AUD) are related yet distinct concepts. Binge drinking is the consumption of an excessive amount of alcohol in a short period, typically defined as five or more drinks for men and four or more for women within about two hours. It’s a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. While binge drinking can lead to immediate harm and may increase the risk of developing AUD, it is not, in itself, indicative of an alcohol use disorder.

Alcohol Use Disorder (AUD), on the other hand, is a medical condition diagnosed when an individual’s drinking causes distress or harm. It’s characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. AUD ranges from mild to severe, based on the number of criteria met, such as a strong craving for alcohol, inability to limit drinking, and withdrawal symptoms when not drinking.

Signs Specific to Binge Drinking

Signs of binge drinking are often related to the acute effects of alcohol consumption. These include:

• Experiencing blackouts or memory lapses.
• Engaging in risky behaviors, such as driving under the influence or unprotected sex.
• Physical signs of intoxication, like slurred speech, impaired coordination, and vomiting.
• Legal or social problems arising from a binge drinking episode, such as arrests for DUI or public disturbances.

Binge drinking can be occasional and does not necessarily lead to physical dependence on alcohol, unlike AUD, which involves a chronic pattern with physical and psychological dependence. Understanding the distinction between binge drinking and AUD is important for recognizing when casual drinking has turned into a more serious issue requiring professional help.

What is the Role of Family and Friends of Alcoholics?

Family and friends are integral in the journey of someone dealing with Alcohol Use Disorder (AUD). They often stand at the forefront, being the first to notice the shifts in behavior, mood swings, or alterations in daily routines that might hint at the underlying issue of alcohol dependency. Their close relationship and day-to-day interactions position them uniquely to observe these changes, which might not be as evident to the outer world. 

By providing a supportive environment, family and friends can gently encourage the acknowledgment of the issue and the pursuit of professional help. This includes being there through the ups and downs, helping navigate the challenges of sobriety, and celebrating the victories, no matter how small. Their involvement not only helps in the practical aspects of recovery but also emotionally fortifies the individual, reminding them that they are not alone in their journey towards healing.

What are Warning Signs of College Alcohol Use Disorder?

For college students, warning signs of AUD might include skipping classes, a drop in grades, frequent parties or social events centered around heavy drinking, and references to binge drinking or blackouts. According to the 2022 National Survey on Drug Use and Health, approximately 49.0% of full-time college students ages 18 to 22 reported drinking alcohol. Among these students, about 28.9% engaged in binge drinking during the same timeframe. College life often comes with newfound freedom and social pressures that exacerbate or conceal alcohol misuse, making it essential for family and friends to stay engaged and observant.

What are Warning Signs of Teenage Alcohol Use Disorder?

Teenagers exhibit warning signs like changes in their friend group, secretive behavior, a lack of interest in previously enjoyed activities, or physical signs such as smelling of alcohol. According to the 2022 National Survey on Drug Use and Health, about 11.5% of adolescents aged 12 to 17 reported drinking alcohol. Adolescence is a time of significant change and vulnerability, and teenage drinking is often mistaken for “normal” exploratory behavior, making open communication and awareness of the signs of AUD imperative.

When Should I Seek Help and Treatment?

It’s time to seek help and treatment for Alcohol Use Disorder (AUD) when alcohol consumption negatively impacts health, personal relationships, or responsibilities. Immediate action is beneficial, starting with a discussion with a healthcare professional who can offer advice and direct you to addiction experts.

The approach chosen for treatment depends on factors like the severity of AUD, personal health history, and the presence of co-occurring mental health conditions, all of which are determined through a detailed assessment by a qualified professional. Engaging in treatment, supported by professionals and loved ones, is a significant step towards recovery. Here are the different types of treatment for AUD:

• Medical Detox: This involves supervised withdrawal from alcohol to manage potentially severe withdrawal symptoms safely. Medical professionals monitor vital signs, administer medications if necessary, and provide support during this process.
• Therapy Sessions: Cognitive Behavioral Therapy (CBT) is a common approach used to address the underlying thoughts, beliefs, and behaviors contributing to alcohol use. Other therapeutic modalities like motivational interviewing, family therapy, and group therapy may also be beneficial.
• Support Groups: Participation in support groups like Alcoholics Anonymous (AA) provides a supportive environment where individuals can share experiences, receive encouragement, and learn coping strategies from others in similar situations.
• Medications: Certain medications can be prescribed to help manage cravings and reduce the desire to drink. Examples include naltrexone, acamprosate, and disulfiram. These medications are often used in conjunction with therapy for comprehensive treatment.

What are the 4 types of wives of alcoholics?

The four types of wives of alcoholics are: the martyr, the controller, the blamer, and the avoided.    

What are the 5 types of alcoholics?

The five types of alcoholics are: young adult, young antisocial, functional, chronic and intermediate familial.

What are the 5 most common causes of alcoholism?

The five most common causes of alcoholism are genetic predisposition, social environment, psychological factors, early exposure to alcohol, and stress.

What are the 5 A’s of alcoholism?

The five A’s of alcoholism are: acceptance, awareness, alternatives, actions, and abstaining.

Who are most likely to be alcoholics?

Those most likely to be alcoholics include individuals with a family history of alcoholism, people suffering from mental health disorders, individuals experiencing high levels of stress, and those with a history of trauma.

What age group has the most alcoholics?

The age group most associated with high rates of alcohol consumption and potentially problematic drinking behaviors varies by region and demographic factors. However, globally, young adults (specifically those in their late teens to late 20s) and middle-aged adults (those in their 30s and 40s) are often identified as groups with significant levels of alcohol consumption.

What is the impact of AUD on mental health?

Alcohol Use Disorder (AUD) has a profound impact on mental health, contributing to and exacerbating existing mental health conditions. According to WHO, alcohol consumption can lead to a range of mental health issues, including depression, anxiety, and psychotic disorders. The relationship between AUD and mental health is bidirectional, with mental health disorders also increasing the risk of developing AUD.

Understanding the link between childhood trauma and AUD is crucial for addressing the mental health aspects of alcohol dependence. Addressing these underlying issues is a vital part of the recovery process. Engaging in drug & alcohol seminars can provide valuable insights into managing mental health in the context of AUD recovery. According to WHO, integrating mental health treatment with AUD treatment is essential for effective recovery, highlighting the need for comprehensive care approaches.