Alcohol Abuse and Dependence
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This topic is about alcohol abuse and dependence in adults. For information about alcohol problems in teens or children, see the topic Teen Alcohol and Drug Abuse.
What are alcohol abuse and alcohol dependence?
Alcohol abuse means having unhealthy or dangerous drinking habits, such as drinking every day or drinking too much at a time. Alcohol abuse can harm your relationships, cause you to miss work, and lead to legal problems such as driving while drunk (intoxicated). When you abuse alcohol, you continue to drink even though you know your drinking is causing problems.
If you continue to abuse alcohol, it can lead to alcohol dependence. Alcohol dependence is also called alcoholism. You are physically or mentally addicted to alcohol. You have a strong need, or craving, to drink. You feel like you must drink just to get by.
You might be dependent on alcohol if you have three or more of the following problems in a year:
Alcoholism is a long-term (chronic) disease. It's not a weakness or a lack of willpower. Like many other diseases, it has a course that can be predicted, has known symptoms, and is influenced by your genes and your life situation.
How much drinking is too much?
Alcohol is part of many people's lives and may have a place in cultural and family traditions. It can sometimes be hard to know when you begin to drink too much.
You are at risk of drinking too much and should talk to your doctor if you are: 1
What are some signs of alcohol abuse or dependence?
Certain behaviors may mean that you're having trouble with alcohol. These include:
How are alcohol problems diagnosed?
Alcohol problems may be diagnosed at a routine doctor visit or when you see your doctor for another problem. If a partner or friend thinks you have an alcohol problem, he or she may urge you to see your doctor.
Your doctor will ask questions about your symptoms and past health, and he or she will do a physical exam and sometimes a mental health assessment. The mental health assessment checks to see whether you may have a mental health problem, such as depression.
Your doctor also may ask questions or do tests to look for health problems linked to alcohol, such as cirrhosis .
How are they treated?
Treatment depends on how bad your alcohol problem is. Some people are able to cut back to a moderate level of drinking with help from a counselor. People who are addicted to alcohol may need medical treatment and may need to stay in a hospital or treatment center.
Your doctor may decide you need detoxification , or detox, before you start treatment. You need detox when you are physically addicted to alcohol. When you go through detox, you may need medicine to help with withdrawal symptoms.
After detox, you focus on staying alcohol-free, or sober. Most people receive some type of therapy, such as group counseling. You also may need medicine to help you stay sober.
When you are 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 deal with work and family. This makes it easier to stay sober.
You will likely need support to stay sober and in recovery. This can include counseling and support groups like Alcoholics Anonymous. Recovery is a long-term process, not something you can achieve in a few weeks.
Treatment doesn't focus on alcohol use alone. It addresses other parts of your life, like your relationships, work, medical problems, and living situation. Treatment and recovery support you in making positive changes so you can live without alcohol.
What can you do if you or another person has a problem with alcohol?
If you feel you have an alcohol problem, get help. Even if you are successful in other areas of your life, visit a doctor or go to a self-help group. The earlier you get help, the easier it will be to cut back or quit.
Helping someone with an alcohol problem is hard. If you're covering for the person, you need to stop. For example, don't make excuses for the person when he or she misses work.
You may be able to help by talking to the person about what his or her drinking does to you and others. Talk to the person in private, when the person is not using drugs or alcohol and when you are both calm. If the person agrees to get help, call for an appointment right away. Don't wait.
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Frequently Asked Questions
It's not clear why some people abuse alcohol or become addicted to it and others do not. Alcoholism often runs in families (genetic), but your drinking habits also are influenced by your environment and life situations, such as friends or stress levels.
Signs of alcohol abuse
Signs of alcohol dependence or addiction
Other signs include:
Signs of alcohol problems in children and teens can be different from the ones for adults. For more information, see the topic Teen Alcohol and Drug Abuse.
Do you have a drinking problem?
You might not realize that you have a drinking 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, it's still possible to be abusing alcohol and to be at risk for becoming addicted to it.
Alcohol abuse or dependence 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 begin 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 problems quit for days, weeks, or even months before they start drinking again. But unless you can consistently keep your drinking under control and not fall back into unhealthy patterns, you need help.
Problems from drinking
Long-term heavy drinking harms your liver, nervous system, heart, and brain. It can cause health problems or make them worse. These problems include:
Alcohol abuse also can contribute to stomach problems, interactions between medicines and alcohol, and sexual problems. It can lead to violence, accidents, social isolation, and problems at work, school, or home. You also may have legal problems, such as traffic tickets or accidents, as a result of drinking.
Drinking alcohol can cause unique problems for older adults, pregnant women, and people who have other health conditions. If you are pregnant, you should not drink any alcohol, because it may harm your baby.
Drinking also makes symptoms of mental health problems worse. When you have a drinking problem and a mental health problem, it's called a dual diagnosis. It's very important to treat all mental health problems, such as depression. You may drink less when mental health problems are treated.
What Increases Your Risk
Many people drink alcohol throughout their lives without any problems. Other people who drink alcohol have problems with it. Why do some people abuse alcohol and become dependent on it, while others don't?
Certain things make an alcohol problem more likely. These are called risk factors.
Risk factors include: 2
Just because you have risk factors for alcohol problems doesn't mean you'll have a drinking problem. A person who has many risk factors won't always develop alcoholism. And a person with no risk factors can become dependent on alcohol.
When to Call a Doctor
Call 911 or other emergency services if you or someone else:
Call a doctor right away if you or someone you care about:
Call a doctor if you're concerned that you or someone you care about may have an alcohol problem. To learn what to look for, see Symptoms.
Watchful waiting is a wait-and-see approach. Watchful waiting is not a good choice for alcohol abuse and dependence. 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.
Who to see
Health professionals who diagnose and treat alcohol problems include:
Other health professionals who can help with recovery include:
Find a health professional who has chemical dependency certification (CDC) or is a certified alcoholism counselor (CAC).
Support groups can also help you and your family:
Exams and Tests
Alcohol use problems may be diagnosed during a routine doctor visit or when you see your doctor for another problem. Many people don't go to a doctor for alcohol problems but for problems that are caused by long-term alcohol use.
To learn which type of questions your doctor may ask, use this short quiz:
People who drink also may have mental health problems. These may include depression, anxiety disorders, or post-traumatic stress disorder (PTSD). If you have a drinking problem and a mental health problem, it's called a dual diagnosis. A dual diagnosis can make treatment for an alcohol problem harder.
If your doctor thinks you have a mental health problem, he or she may do a mental health assessment.
Treatment for alcohol abuse and dependence usually includes group therapy, one or more types of counseling, and alcohol education. You also may need medicine. A 12-step program often is part of treatment and continues after treatment ends.
Treatment doesn't just deal with alcohol. It will help you manage problems in your daily life so you don't have to depend on alcohol. You'll learn good reasons to quit drinking.
Treatment helps you overcome dependence, but it doesn't happen all at once. Recovery from alcohol abuse or dependence—staying sober—is a lifelong process that takes commitment and effort.
Can you quit on your own?
If you are abusing alcohol and are not dependent on it, you may be able to cut back or quit on your own. But most people need help when they quit drinking.
If you want to quit, talk to your doctor. When you get a doctor's help, treatment for alcohol abuse or dependence is safer, less painful, and quicker. If you can't stop drinking alcohol with just your doctor's help, a treatment program can help you get through the first cravings for alcohol and learn how to stay sober.
How does treatment start?
You might start treatment with your family doctor, or your doctor may recommend that you enter a treatment facility. A friend may bring you to a self-help group, such as Alcoholics Anonymous, or you might go to a clinic that deals with alcohol abuse. You may just decide that you drink too much and want to cut back or quit on your own.
You may have a treatment team to help you. This team may include a psychologist or psychiatrist, counselors, doctors, social workers, nurses, and a case manager. A case manager helps plan and manage your treatment.
When you first seek treatment, you may be asked questions about your drinking, health problems, work, and living situation. Be open and honest to get the best treatment possible. Your treatment team may write a treatment plan, which includes your treatment goals and ways to reach those goals. This helps you stay on track.
Do you need detox?
Your doctor may decide you need detoxification , or detox, before you start treatment. You need detox when you are physically addicted to alcohol. This means that when you stop drinking, you have physical withdrawal symptoms, such as feeling sick to your stomach or intense anxiety.
Detox helps get you ready for treatment. It doesn't help you with the mental, social, and behavior changes you have to make to get and stay sober.
Whether you need detox and whether you can go through it at home or need to go to a clinic or other facility depends on how severe your withdrawal symptoms are. Most people don't need to stay at a clinic but do need to check in with a doctor or other health professional. Whether you need to spend time in a clinic (called inpatient care) also depends on other problems you may have, such as a mental health problem.
Your doctor may give you medicines to help reduce withdrawal symptoms.
What's the best treatment program for you?
Your doctor can help you decide which type of program is best for you.
If you are thinking about going into a treatment program, here are some questions to ask.
What does a treatment program include?
Treatment programs usually include counseling, such as:
A treatment program may include medicines that can help keep you sober during recovery. You may take medicine that can help reduce your craving for alcohol or that makes you sick to your stomach when you drink.
Most programs provide education about alcohol abuse and dependence. Understanding alcohol problems can help you and your family know how to overcome them. Some programs also offer job or career training.
What else should you think about?
Medicines can be used to help treat alcohol abuse and dependence. Some medicines reduce withdrawal symptoms during detoxification. Other medicines help you stay sober during the long process of recovery.
Medicines for withdrawal
Medicines most often used to treat withdrawal symptoms during detoxification include:
Medicines for recovery
Medicines used to help you stay sober during recovery include:
Vitamins and supplements
Alcohol abuse 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 .
Recovery from alcohol abuse or dependence means finding a way to stay sober while changing your attitudes and behaviors. You will work to restore relationships with your family and friends and people at your job or school. You will need to find meaning and happiness in a healthy lifestyle that doesn't include alcohol.
Recovery is not a cure. It is a lifelong process. It begins in treatment, but it doesn't end when your treatment ends. There are 10 principles of recovery (What is a PDF document?) that can help you reach your goals and learn new things to help yourself. They help you gain self-confidence and respect for yourself. They make clear that you're in charge of your recovery. How far you go is up to you.
An important part of recovery is being sure you have support. You can:
Plan for lapse and relapse
Stopping alcohol use is very hard. It's not unusual to have setbacks, even years later. Very few people succeed the first time they try. Many people who are trying to recover from alcohol addiction will have lapses or relapses along the way.
It's smart to plan for a lapse or relapse before it happens. Your doctor, family, and friends can help you do this.
Deal with stress
Some people find that relieving stress helps them during recovery. Although there is little research to show that managing stress helps you stay sober, you may find that it helps you feel better overall.
You can find ways to deal with 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.
You can do many things to reduce stress. To learn more, see the topic Stress Management.
Have a healthy lifestyle
When you abuse or are dependent on alcohol, you often get away from some of the basics of good health. Part of recovery is finding your way back to a healthy lifestyle.
Talk to your family about your drinking
Alcohol abuse or dependence can harm your relationships with family and friends. You and your family may feel you have turned against each other. You may be angry at your family and friends, and they may be angry at you.
If you can, talk with your family and friends about your drinking problem and recovery . Your family and friends need to know that they did not cause your alcohol problem but that they can help you during recovery.
For Family and Friends
If someone close to you has had a drinking problem, you know how hard it can be. You know how living or dealing with someone who abuses or is dependent on alcohol can change and even destroy your life. You're an important part of your loved one's treatment and recovery. Your emotions and life may change too, and taking care of yourself is also important.
It can be very hard to live with a family member who has a drinking problem. It's best not to try to control, excuse, or cover up the person's drinking. Instead, encourage your family member to seek treatment. Find a good time to talk to the person.
Help with treatment and recovery
When the choice for treatment has been made, you play an important part. You can help your loved one stop drinking and help repair the damage done to your family or relationship. Here are some things you can do:
Take care of yourself
Taking care of yourself while you help your loved one is important. You probably will feel relief and happiness when the person decides to get help. But treatment and recovery mean changes in your life too. Your emotions may become more complicated. You may:
These feelings are normal. You've been through a bad period of your life, and what happened is not easy to forget. Nor is it easy to forgive your loved one. Keep in mind that recovery is the road to a better life and that you can help your loved one get there.
Find your own support
You may find that talking to people who also have loved ones with alcohol problems helps your own recovery. Al-Anon and similar programs are for people with family members or friends with alcohol problems. Other support groups are specially designed for certain age groups, such as Alateen for teens and Alatot for younger children.
These programs help you recover from the effects of being around someone who abused or was dependent on alcohol. You also may try family therapy .
Other Places To Get Help
Last Revised: January 18, 2012
National Institute on Alcohol Abuse and Alcoholism (2005). Helping Patients Who Drink Too Much: A Clinician's Guide (NIH Publication No. 07-3769). Washington, DC: National Institutes of Health. Also available online: http://pubs.niaaa.nih.gov/publications/Practitioner/cliniciansGuide2005/clinicians_guide.htm.
Schuckit MA (2009). Alcohol-related disorders section of Substance-related disorders. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 10th ed., vol. 1, pp. 1268–1288. Philadelphia: Lippincott Williams and Wilkins.
Buchner DM (2012). Physical activity. In L Goldman, A Shafer, eds., Cecil Medicine, 24th ed., pp. 56–58. Philadelphia: Saunders.
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