Alcohol Addiction

Are you struggling with problems related to alcohol use? Do you suspect you might have an alcohol addiction? Maybe you’ve tried quitting on your own, but it hasn’t worked. You are able to go a few days or weeks without drinking, but then an unexpected setback causes you to return to your old drinking habits.

Or maybe it’s a loved one you’re worried about. You fear their alcohol use is negatively affecting your family. Yet, they insist they don’t have a drinking problem and make excuses for their behavior. But you can see how it is slowly destroying their life.

Alcohol is a powerful, addictive substance. But unlike illegal drugs, it is readily available in every grocery, convenience, and corner store. This can make something as simple as driving down the street a trigger for drinking alcohol.

What Is Alcohol?

Alcohol (ethyl alcohol or ethanol) is an intoxicating substance that is legally available and widely consumed in various forms like beer, wine, and hard liquor. It is produced by using yeast to ferment sugars and starches in different foods, for example, the sugar in grapes to make wine. The fermented product can also be distilled to make various spirits like rum, brandy, gin, tequila, vodka, and whiskey.

The history of alcohol use by humans dates back thousands of years, and interest in alcohol has only increased in modern times. Drinking alcohol is considered an inherent part of socializing and celebrations in many cultures around the world.

Alcohol is technically classified as a depressant ^[1] because it depresses or slows down the central nervous system, including brain functioning and neural activity. While the initial effects of drinking alcohol can be stimulating (e.g., “loosening up”, having reduced social inhibitions), the later effects, especially after a heavy drinking session, are sedating (e.g., slowed thinking and reaction times, drowsiness, sedation, and even unconsciousness, coma, and death in severe cases).

Drinking alcoholic beverages occasionally and in limited quantities is largely considered safe. But the fact that alcohol is a socially acceptable intoxicant makes it particularly dangerous. Many people start drinking socially with controlled consumption of alcohol, but progress over time to problematic drinking patterns or addiction, which experts refer to as an “alcohol use disorder”. In fact, alcohol is often called the “gateway drug” for youth as it is believed to precede the use of other illegal drugs.

What Is Alcohol Use Disorder?

Alcohol use disorder is a chronic mental health disorder that can affect people of all ages, genders, and ethnicities, from all walks of life. The most severe form of alcohol use disorder is called alcohol “addiction” and involves a physical and psychological dependence on alcohol. A person is said to have an alcohol use disorder if they have problems controlling their drinking, they continue using alcohol even when it is causing problems, and they develop withdrawal symptoms if they try to stop drinking.

It is important to know that alcoholism is a complex, chronic condition that affects the individual drinker as well as their loved ones. Even small amounts of alcohol can cause physical and psychological harm. People battling alcohol abuse are not morally corrupt and do not lack willpower.

Alcohol use disorder can lead to a variety of health problems. Drinking also affects important brain functions like decision-making and impulse control. In addition, people struggling with alcohol addiction are often unable to function normally without alcohol. Drinking can impact their personal life, relationships, school or work performance, and finances. Some people with an alcohol use disorder get involved in illegal activities under the influence of alcohol and find themselves in trouble with the law.

What Makes Alcohol Addictive?

Alcohol makes people feel good. It produces a “high” by increasing the production of endorphins, which are the brain’s natural pleasure and reward chemicals. Continued excessive alcohol use can lead to changes in brain chemistry such that the person is unable to control their drinking. Heavy drinkers frequently develop a physical dependence on alcohol, leading to intense cravings and withdrawal symptoms when alcohol consumption is substantially reduced or stopped. ^[2]

Warning Signs and Symptoms of an Alcohol Use Disorder

People who are addicted to alcohol are often in denial and are unable or unwilling to accept that they have a drinking problem. It therefore falls on family members and friends to spot the warning signs of problematic alcohol use and get help. Listed below are the symptoms of alcohol use disorder. ^[3]

• The person is drinking more or for longer than intended.
• They are unable to stop drinking despite a desire to quit.
• The person is spending a lot of time either drinking or recovering from the effects of alcohol.
• They want alcohol so badly that it’s all they can think about (cravings, urges to drink). 
• Drinking is interfering with their responsibilities at work, school, or in the home.
• The person continues to use alcohol despite having persistent or recurrent impacts on interpersonal relationships caused or worsened by the effects of alcohol.
• They have given up or reduced important social, occupational, or recreational activities because of their drinking behavior.
• The person uses alcohol in situations where it is hazardous (e.g., driving under the influence, unsafe sex).
• They continue to drink despite negative consequences on their physical or mental health.
• The person has developed a tolerance, which can show up as either:
  • Needing to drink much more than before to achieve intoxication or the desired effects.
  • Finding that the same number of drinks has much less effect than they once did.
• The person experiences withdrawal, which can show up as either:
  • Symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, seizures, or hallucinations when the effects of alcohol are wearing off.
  • Using alcohol (or a closely related substance, such as a benzodiazepine) in order to relieve or avoid withdrawal symptoms.

If a person has 2–3 of the above symptoms within the past 12 months, their alcohol use disorder is considered “mild”; 4–5 symptoms is “moderate”; and 6 or more symptoms is considered a “severe” alcohol use disorder.

Drinking Levels: How Much Alcohol Is Safe to Drink?

It’s a common misconception that drinking alcohol within limits is relatively safe. But the truth is that alcohol consumption can quickly escalate to dangerous levels of alcohol use or addiction. To drink responsibly, it’s important to be aware of what constitutes a standard drink, how much alcohol is in your drinks, and how many drinks are too many.

The amount of liquid in your glass, can, or bottle does not tell you the amount of alcohol you’re consuming. Different alcoholic beverages have variable alcohol contents, which is roughly as follows:^[4]

• Light beers: 4.2% alcohol
• Regular beers: 5% alcohol
• Malt liquors: 7% alcohol
• Wine: 12% alcohol
• Distilled spirits: 40% alcohol

In the United States, one standard alcoholic drink is roughly 14 grams of pure alcohol. In other words, if you drink a 1.5 fl. oz shot of whiskey, a 5 fl. oz glass of wine, or a 12 fl. oz bottle of regular beer, it counts as one drink. On the other hand, a 12 oz craft beer with a higher level of alcohol (e.g., 9%) may be equal to two standard drinks. Similarly, drinks like martinis or margaritas often have more than just one “shot” of liquor, and therefore count as more than one standard drink.

How many standard drinks can you safely consume on a daily or weekly basis without developing alcohol addiction?

The U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention say up to 2 drinks a day for men and 1 drink a day for women is considered moderate drinking.

According to the National Institute on Alcohol Abuse and Alcoholism and the Substance Abuse and Mental Health Services Administration, 5 or more drinks for men and 4 or more drinks for women on any given day is considered heavy alcohol consumption.

Heavy episodic drinking, commonly called “binge drinking,” is drinking a large amount of alcohol in a short period of time. It is defined as drinking such that your blood alcohol concentration (BAC) reaches a level of 0.08 g/dL. This usually happens after men consume 5 drinks and women consume 4 drinks over about 2 hours. Binge drinking on more than 4 days per month qualifies as heavy alcohol use. ^[5] Heavy alcohol use and binge drinking are major risk factors for developing an alcohol use disorder.

Alcohol Use Disorders in the United States

Alcohol use is a public health crisis in the United States and has been a problem for a long time. Alcoholism affects people without regard to age, gender, race, and socioeconomic status. The stereotypical picture of an alcoholic as a derelict homeless person who drinks to escape reality is not entirely true. A college student, a high-functioning business executive, and a young mother of two children who drink to cope with stress are just as likely to have an alcohol use disorder.

The estimated cost of excessive alcohol use in the United States is nearly $249 billion per year, including healthcare ($28 billion), lost productivity at work ($179 billion), motor vehicle collisions ($13 billion), and criminal justice and law enforcement ($25 billion). ^[6] 

In addition to the economic burden of alcohol use in the US, the health impact is profound as well as the social impact on both individuals and communities. 

Statistics on Alcohol Use and Addiction

Alcohol consumption levels and patterns in the United States offer a deep insight into the problem of alcohol addiction. Here are some interesting statistics on alcohol use and its consequences in the U.S.^[7]

• Nearly 8 out of 10 Americans ages 12 and older have drunk alcohol at some point in their lifetime.
• Roughly 1 in 4 people (21.7%) in the U.S. reports binge drinking within the past month.
• There is an emerging trend of high intensity drinking, consisting of consuming alcohol at levels that are two more times higher than the gender-specific thresholds for binge drinking.
• More than 29 million people (age 12+) in the United States have an alcohol use disorder, including over 750,000 adolescents (ages 12–17).
• Among those with an alcohol use disorder, only 7.6% received treatment within the past year.
• Approximately 7.5 million children in the US who are below the age of 17 (10.5% of children in this age group) live with a parent who has alcohol problems.
• According to the World Health Organization, alcohol is a causal factor for more than 200 diseases and health conditions.
• Alcohol is one of the leading causes of preventable deaths in the US. An estimated 140,000 Americans die due to excessive alcohol use each year.

Why Do People Drink?

The grim statistics in the previous section are proof that heavy alcohol use, binge drinking, and alcohol addiction can have dangerous, even fatal consequences. But despite the dangers of alcohol, people continue to drink. It is often a combination of psychological and social factors that leads to the transition from occasional social alcohol consumption to problematic alcohol use and addiction. The motivation to consume alcohol can come from various sources, a few of which are listed below.

• Past experiences: A person’s prior experience with alcohol shapes their current expectations about alcohol and the value they place on drinking. For example, memories of a fun time with friends that involved alcohol use can lead to the belief that drinking equals a good time, which can serve as a motivation to drink.
• Personality factors: Certain personality charac­teristics, such as sensation-seeking, risk-taking, and impulsivity have been linked to heavier drinking patterns.
• Life circumstances: Some people drink alcohol as an escape from difficult life circumstances or to cope with stress or unpleasant emotions. This can be triggered by life events such as a divorce or the death of a loved one, childhood trauma, or loneliness.
• Social norms: Commonly acceptable social behaviors and peer pressure affect a person’s drinking habits. For instance, college students tend to drink more on campuses that have a strong drinking culture.
• Environmental factors: A variety of external factors influence a person’s motivation to drink. For example, heavy taxation on alcoholic beverages can make it less attractive for a person to purchase and consume alcohol. Evidence has shown that a 10% increase in taxes can lead to a 7% reduction in alcohol consumption.

How Long Does It Take to Develop an Alcohol Use Disorder?

Social drinking is largely considered harmless. Most people believe that as long as they drink occasionally and responsibly, alcohol can’t do any harm. But what many people don’t realize is that an alcohol use disorder can develop relatively quickly, even in social drinkers. What starts as occasional social alcohol consumption can rapidly transition into problematic alcohol use and addiction.

There is no specific timeline of how long it takes a person to develop an alcohol use disorder. There are too many variables to make an accurate prediction. It’s like asking how long it will take to drive from LA to San Francisco. It would depend on traffic, how fast the person drives, and how many times they stop along the way.

Similarly, the time it takes to develop an alcohol use disorder can vary greatly from person to person. The only way to reduce your risk of becoming addicted to alcohol is to avoid binge drinking and heavy alcohol use. These drinking patterns are associated with a higher risk of developing an alcohol addiction. Also, certain people are inherently at an increased risk of developing alcoholism and should be careful about using even small amounts of alcohol. This includes people with a history of emotional trauma, those with mental health conditions, and a family history of alcoholism (children of alcoholics are up to four times more likely to develop alcohol problems compared to the general population).

Causes and Risk Factors for Alcoholism

You may have wondered why some people never have any problems with alcohol while others spend years battling alcohol use disorders. This is because different people have different reactions to alcohol, depending on age, gender, race, body weight, and several other factors. Here are some of the risk factors that can increase a person’s chances of developing an addiction to alcohol:

• Alcohol use disorders run in families. People with family members who have struggled with alcohol use disorder are more likely to have similar problems. ^[8]
• Starting drinking at a young age predisposes a person to develop alcohol use disorders later in life.
• Men are more likely than women to develop alcohol use disorders, but women are more likely to suffer alcohol-related health complications. ^[9]

Deaths from Alcohol

Every year, around 140,000 deaths in the United States are caused by excessive alcohol use, with men accounting for nearly 70% of these deaths. ^[10]

Top causes of alcohol-associated deaths include:

• Alcoholic liver disease

• Cardiovascular disease

• Cancers

• Alcohol use disorder

• Alcohol-impaired driving fatalities

• Deaths by suicide

Health Effects of Alcohol

Alcohol has a negative effect on health, both in the short and long term. In the short term, alcohol impairs decision-making ability and reaction times, putting a person at risk of motor vehicle accidents, falls, drowning, violence, and sexual assault. In the long term, alcohol is a known causal factor in more than 200 health conditions, including liver disease, heart disease, and cancer.

Short-term health effects of alcohol

• Risky behaviors due to lowered inhibitions, for example, unsafe sex with an increased risk of unplanned pregnancy and sexually transmitted infections (STIs).
• Injuries and fatalities from falls, motor vehicle collisions, and other accidents.
• Increased risk of violence, including homicide and sexual assaults.
• Alcohol poisoning deaths from dangerously high blood-alcohol levels.
• Drowsiness, dizziness, slurred speech, blurred vision, nausea, vomiting. 

Health effects of binge drinking

• Increased risk of unintended pregnancy. ^[11]
• Increased likelihood of engaging in unplanned sex with an increased risk of contracting HIV and other sexually transmitted diseases. ^[12] 
• Increased risk of assault, violence, physical injuries, and fatal non-traffic accidents such as homicides, suicides, and accidental injuries. ^[13]
• Increased risk of stillbirths and miscarriages in pregnant women and fetal alcohol spectrum disorders (FASDs) in children exposed to alcohol in utero due to maternal alcohol use during pregnancy. These is no specific medical test available for diagnosing FASDs, and so doctors look for a combination of distinctive facial features, below-average height or weight, and central nervous system issues to assess whether it may be present. Physical and mental issues for the child can vary in severity and could include coordination issues, learning difficulties, attention difficulties, speech and language problems, vision and hearing impairment, poor sleeping as a child, and issues with the heart, bones, and kidneys. ^[14]
• Alcohol is also a contributing factor to road accidents. Legislators around the world have introduced some form of restriction on driving while under the influence. One study in New Zealand found that young people who drink and drive have a 2.6 times higher rate of traffic accidents than those who did not. ^[15]
• Binge drinking is a risk factor for alcohol poisoning, which is a major cause of death in the United States. There are 2,200 alcohol poisoning deaths in the United States each year. 3 out of 4 deaths due to alcohol poisoning are in men between the ages of 35 and 64 years of age. Approximately 30% of people who die from alcohol poisoning have alcohol dependence (alcoholism or alcohol use disorder). ^[16] There is wide difference in alcohol poisoning deaths among different states. Alaska reports the highest number of alcohol poisoning deaths per million while Alabama reports the lowest.

Long-term health effects of alcohol use

• Alcoholic liver disease is a common complication in heavy, long-term drinkers. The liver metabolizes alcohol (ethanol), and therefore it is no surprise that it suffers to the highest levels of tissue damage in people with alcohol use disorders. Excessive drinking causes lesions on the liver, including inflammation, fat accumulation, scar tissue development, and tissue remodeling. Other than quitting drinking and liver transplants, there are few options available for treating the condition. ^[17]
• Alcohol use is one of the most common causes of acute and chronic pancreatitis. Pancreatitis occurs when the pancreas becomes inflamed. This organ plays an important role in the metabolism of alcohol, and as a result, it frequently experiences complications in people with alcohol issues. Alcoholic pancreatitis develops to a greater extent in heavier drinkers, but some heavy drinkers don’t have early identifiable symptoms of the condition. ^{[18] [19]}
• Drinking alcohol can cause damage to the blood vessels and make them narrower, leading to hypertension (high blood pressure). Researchers have also proposed additional methods by which this could happen, including imbalances caused by alcohol in the central nervous system. Increased blood pressure is itself associated with a wide range of health conditions. It has been established that alcohol has a larger effect on systolic blood pressure versus diastolic blood pressure. ^[20]
• People who abuse alcohol have a 10 times higher risk of acquiring pneumococcal pneumonia and a 4 times higher risk of dying from pneumonia. ^[21]
• The role of alcohol in the development of sepsis is not fully understood, but we do know that alcohol consumption can cause inflammatory dysfunction and cause oxidative stress.
• Heavy drinking increases the risk of stroke. One meta-analysis found that those who consume more than 60 g of alcohol per day (heavy drinkers) are more likely to experience a stroke while those with more moderate drinking patterns may have a reduced risk of both hemorrhagic and ischemic stroke. However, some studies have found that moderate drinking is associated with an increased risk of stroke compared to no drinking. ^{[22] [23]}
• Heavy drinking is linked to a number of poor cardiovascular health outcomes, including high blood pressure, heart disease, heart failure, and stroke. People with alcohol use disorders are at risk of developing asymptomatic alcoholic cardiomyopathy (ACM). This can lead to the emergence of signs and symptoms of heart failure. Unless alcohol consumption is completely eliminated, the mortality rate can be as high as 50% within four years. ^[24] Chronic alcohol consumption is also linked to heart rhythm problems (heart arrhythmias), including the heart beating too fast, too slow, or irregularly. Studies in particular point towards tachycardias (resting heart rate greater than 100 beats per minute) being a concern in heavy drinkers. There is also some evidence that heavy drinking increases the risk of sudden death by fatal arrhythmia. ^[25]
• Alcohol is associated with fertility problems in both males and females. Men may experience worsening semen quality with increasing alcohol consumption. In one study which examined 100 males with alcohol use disorders, only 12% presented with normal semen parameters. Among the heavier drinkers in the group (those consuming 80 g per day), none had normal semen parameters, which suggests a dose–response relationship. Women who have more than two drinks per day experience higher risk of infertility issues. This effect is even more pronounced in older women. ^[26]
• Alcohol is associated with an increased risk for many types of cancers, including breast, liver, esophageal, pancreatic, and colorectal cancer, among others. In the case of breast cancer, for example, more than 100 studies have demonstrated a link between alcohol consumption and the disease. While we know alcohol plays a multifactorial role in cancer development, the precise mechanisms are not yet fully understood. ^[27]
• Alcohol use disorders and mental health conditions such as anxiety and depression are commonly present together. We don’t yet fully understand how these conditions are linked, but a number of pathways have been proposed. Alcohol consumption may cause anxiety, people with anxiety may be drawn to alcohol for self-medication, or other unknown factors may lead to both anxiety and alcohol use. ^[28] One specific anxiety disorder that has been linked to alcohol use disorders is post-traumatic stress disorder (PTSD). ^[29]
• Alcohol consumption is associated with brain damage. Studies have shown that people with alcohol use disorders have a smaller brain volume compared to those who don’t have alcohol use disorders. This difference is most severe in the frontal cortex. There is also evidence to suggest that the neurodegeneration caused by excessive alcohol consumption can make people more impulsive and less able to resist the temptations presented by addiction. ^[30]
• Heavy drinking weakens the immune system. ^[31] It leads to an increased likelihood of pneumonia, sepsis, and other immune-related issues. It also slows down tissue repair and makes you more likely to experience complications from surgery.
• There is an association between alcohol and chronic inflammation. ^[32]

Alcohol and Pregnancy

Women of childbearing age should refrain from behaviors such as binge drinking, because it puts them at risk of unintended pregnancy due to risky sexual behaviors under the influence of alcohol.

Pregnant women or women who are planning a pregnancy soon should avoid drinking alcohol. There is no safe drinking limit during pregnancy. Several medical conditions, such as fetal alcohol syndrome (FAS), have been directly linked to alcohol use during pregnancy. FAS is a condition in which babies exposed to alcohol during pregnancy develop growth problems and irreversible brain damage.

Moderate alcohol consumption (1 drink per day) is not known to be harmful while breastfeeding (especially if waiting 2 hours after drinking), but avoiding alcohol is the safest option for new mothers.

Alcohol Poisoning or Overdose

Alcohol poisoning is a serious, sometimes fatal, consequence of heavy drinking. When someone consumes a large amount of alcohol quickly, alcohol and its metabolites (breakdown products) accumulate in the blood faster than the liver can get rid of them. ^[33] This leads to major adverse effects, including effects on vital functions such as heart rate, breathing, body temperature, and the gag reflex. Alcohol poisoning is a medical emergency and can cause coma and even death. Symptoms of alcohol poisoning include:

• Confusion
• Seizures
• Slow breathing
• Vomiting
• Bluish tinge to the skin
• Reduced body temperature
• Unconsciousness

If you suspect someone has suffered alcohol poisoning, call 911. Don’t leave the person unattended until help arrives. Try to keep the person sitting up and awake to reduce the risk of choking on vomit.

Alcohol Withdrawal Syndrome

When a heavy drinker abruptly stops drinking, either intentionally in an attempt to quit drinking or unintentionally because of lack of access to alcohol, they can suffer several unpleasant and potentially dangerous symptoms which are collectively called alcohol withdrawal syndrome. Severe alcohol withdrawal syndrome frequently requires medical care in the hospital, including intensive care to manage medical complications like seizures. The symptoms of alcohol withdrawal can start 1–3 days after the last drink and may include: ^[34]

• Fast breathing and fast heart rate
• High blood pressure
• Dilated pupils
• Elevated body temperature
• Sweating
• Nausea, vomiting, diarrhea
• Tremors (shaking hands)
• Seizures
• Agitation, irritability, disorientation
• Anxiety
• Insomnia
• Delusions, hallucinations, paranoia
• Combativeness

The most severe form of alcohol withdrawal is called delirium tremens (DTs). Symptoms of DTs may include confusion, agitation, disorientation, hallucinations, sweating, fever, high blood pressure, and fast heart rate.

Because of the risk of severe alcohol withdrawal and delirium tremens, people who have a long history of heavy alcohol use and alcohol addiction should not attempt to quit cold turkey at home. Treatment at an alcohol rehab center and medically supervised withdrawal are necessary to help alcoholics safely stop drinking.

Last updated: February 28, 2024