Alcohol Misuse and Dependence

Topic Overview

Is this topic for you?

This topic is about alcohol misuse and dependence in adults. For information about alcohol problems in teens or children, see the topic Teen Alcohol and Drug Use.

What are alcohol misuse and alcohol dependence?

Alcohol misuse means having unhealthy or dangerous drinking habits, such as drinking every day or drinking too much at a time. Alcohol misuse can harm your relationships, cause you to miss work, and lead to legal problems such as driving while drunk (intoxicated). When you misuse alcohol, you continue to drink even though you know your drinking is causing problems.

If you continue to misuse 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:

• You cannot quit drinking or control how much you drink.
• You need to drink more to get the same effect.
• You have withdrawal symptoms when you stop drinking. These include feeling sick to your stomach, sweating, shakiness, and anxiety.
• You spend a lot of time drinking and recovering from drinking, or you have given up other activities so you can drink.
• You have tried to quit drinking or to cut back the amount you drink but haven't been able to.
• You continue to drink even though it harms your relationships and causes physical problems.

Alcohol dependence 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:^{footnote 1}

• A woman who has more than 3 drinks at one time or more than 7 drinks a week. A standard drink is 1 can of beer, 1 glass of wine, or 1 mixed drink.
• A man who has more than 4 drinks at one time or more than 14 drinks a week.

Interactive Tool: Do You Have a Drinking Problem?

What are some signs of alcohol misuse or dependence?

Certain behaviors may mean that you're having trouble with alcohol. These include:

• Drinking in the morning, often being drunk for long periods of time, or drinking alone.
• Changing what you drink, such as switching from beer to wine because you think it will help you drink less or keep you from getting drunk.
• Feeling guilty after drinking.
• Making excuses for your drinking or doing things to hide your drinking, such as buying alcohol at different stores.
• Not remembering what you did while you were drinking (blackouts).
• Worrying that you won't get enough alcohol for an evening or weekend.

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 dependent on 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 dependent on 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.

Frequently Asked Questions

Cause

It's not clear why some people misuse alcohol or become dependent on it and others do not. Alcohol use problems often run in families (genetic), but your drinking habits also are influenced by your environment and life situations, such as friends or stress levels.

Symptoms

Signs of alcohol misuse

• You have problems at work or school because of your drinking, such as being late or not going at all.
• You drink in risky situations, such as before or while driving a car.
• After drinking, you can't remember what happened while you were drinking (blackouts).
• You have legal problems because of your drinking, such as being arrested for harming someone or driving while drunk (intoxicated).
• You get hurt or you hurt someone else when you are drinking.
• You keep drinking even though you have health problems that are caused or made worse by alcohol use, such as liver disease (cirrhosis).
• Your friends or family members are worried about your drinking.

Signs of alcohol dependence

• You cannot quit drinking or control how much you drink.
• You need to drink more to get the same effect.
• You have withdrawal symptoms when you stop drinking. These include feeling sick to your stomach, sweating, shakiness, and anxiety.
• You spend a lot of time drinking and recovering.
• You have given up other activities so you can drink.
• You keep drinking even though it harms your relationships and causes health problems.

Other signs include:

• You drink in the morning, are often drunk for long periods of time, or drink alone.
• You change what you drink, such as switching from beer to wine because you think that doing this will help you drink less or keep you from getting drunk.
• You feel guilty after drinking.
• You make excuses for your drinking or do things to hide your drinking, such as buying alcohol at different stores.
• You worry that you won't get enough alcohol for an evening or weekend.
• You have physical signs of alcohol dependence, such as weight loss, a sore or upset stomach (gastritis), or redness of the nose and cheeks.

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 Use.

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 misusing alcohol and to be at risk for becoming dependent on it.

Interactive Tool: Do You Have a Drinking Problem?

What Happens

Alcohol misuse 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:

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

Alcohol use 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 misuse 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:^{footnote 2}

• Genes. People with alcohol problems often have a family history of alcohol misuse and dependence.
• Being male. A man is 3 times more likely to develop problems with alcohol than a woman is.
• Early use. The younger you were when you first started drinking alcohol, the higher your risk for alcohol problems later as an adult.
• Mental health. If you have mental health problems, such as depression, post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenia, or anxiety disorders, you are more likely to use alcohol.
• Use of other substances. You are more likely to misuse alcohol if you misuse other things, such as tobacco, illegal drugs, or prescription medicines.
• Environment. If you live in an area where alcohol is easy to get, people drink a lot, or heavy drinking is accepted as part of life, you are more likely to drink.
• 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 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.

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 become dependent on alcohol. And a person who has no risk factors can become dependent on alcohol.

When to Call a Doctor

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

• Has the symptoms of alcohol poisoning. These can include vomiting, coughing up blood, gasping for breath, passing out, and seizures.
• Has a history of heavy drinking and is having severe withdrawal symptoms but is not willing to get treatment.
• Has delirium tremens (DTs), which can lead to death. Symptoms can include seizure, shaking, a fast heartbeat, and seeing or hearing things that aren't there (hallucinations).
• Is thinking or talking about suicide or harming others. For more information, see the warning signs of suicide.

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. You need to call right away, because people who agree to get help often don't follow through with making the appointment.
• Has stopped drinking but starts drinking again (has a relapse).
• Has severe stomach pain.

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

Watchful waiting is a wait-and-see approach. Watchful waiting is not a good choice for alcohol misuse 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:

• Family medicine doctors.
• General practitioners.
• Nurse practitioners.
• Physician assistants.
• Internists.
• Psychiatrists.
• Psychologists.

Other health professionals who can help with recovery include:

• Addiction psychiatrists, or other doctors who specialize in addiction medicine.
• Licensed mental health counselors.
• Social workers.

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:

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

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.

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

To learn which type of questions your doctor may ask, use this short quiz:

Interactive Tool: Do You Have a Drinking Problem?

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 Overview

Treatment for alcohol misuse 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 misuse or dependence-staying sober-is a lifelong process that takes commitment and effort.

Can you quit on your own?

If you are misusing 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.

Alcohol Problems: How to Stop Drinking

If you want to quit, talk to your doctor. When you get a doctor's help, treatment for alcohol misuse 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 misuse. 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 dependent on 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.

• In outpatient treatment, you regularly go to a mental health clinic, counselor's office, hospital clinic, or local health department for treatment.
• In inpatient treatment, you stay at a facility and have treatment during the day or evening. This usually lasts 1 to 6 weeks. You most likely will then go to outpatient treatment.
• In residential treatment, you live at the facility while you recover. These programs may last for months. This may be a good option if you have a long history of alcohol or drug use, have a bad home situation, or don't have social support.

If you are thinking about going into a treatment program, here are some questions to ask.

What does a treatment program include?

Counseling

Treatment programs usually include counseling, such as:

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

Medicine

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.

Education

Most programs provide education about alcohol misuse and dependence. Understanding alcohol problems can help you and your family know how to overcome them. Some programs also offer job or career training.

Support groups

Treatment programs often include going to a support group, such as Alcoholics Anonymous (AA). Your family members also might want to attend a support group such as Al-Anon or Alateen.

What else should you think about?

• If you have an alcohol problem and a mental health problem, such as depression, you will need treatment for both problems. Doctors call this a dual diagnosis.
• Alcohol typically affects older adults more strongly than younger adults.
• Alcohol use in the military can interfere with military readiness.
• Some people are sent to alcohol treatment because of a court decision. This may happen if you have an alcohol problem and you commit a crime. A court may require treatment and keep track of your progress. Treatment often is available in prison.

Medications

Medicines can be used to help treat alcohol misuse 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:

• Antianxiety medicines (benzodiazepines such as diazepam), which treat withdrawal symptoms such as delirium tremens (DTs).
• Seizure medicines to reduce or stop severe withdrawal symptoms during detoxification.

Medicines for recovery

Medicines used to help you stay sober during recovery include:

• Disulfiram (Antabuse), which makes you sick to your stomach when you drink.
• Naltrexone (ReVia, Vivitrol), which interferes with the pleasure you get from drinking.
• Acamprosate (Campral), which may reduce your craving for alcohol.
• Topiramate (Topamax), which may help treat alcohol problems.

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.

Recovery

Recovery from alcohol misuse 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.

To stay sober after treatment, focus on your goals. Find things to do, such as sports or volunteer work. Learn how to say no to alcohol and drugs.

Find support

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

• Develop and 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 drinking problems, and your relationships with family and friends. You can make support groups more helpful by being an active member.
• Connect with family and friends. They can help you stop drinking and stay sober by encouraging positive steps. For them to do this, you have to be honest with them about your problems and help them by trying.
• Take part in recovery group activities. You may have used alcohol to make friends or be with a social group. Your counselor or doctor can help you learn skills to make friends without drinking. For example, your counselor may help you find a social skills training class.
• Find a sponsor, and work with this person. A sponsor is someone who has been in recovery for a long time and helps you stay alcohol-free.

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 dependence will have lapses or relapses along the way.

• A lapse is the first time you use alcohol again after you have quit or brief episodes of alcohol use at later points.
• A relapse is not being able to stay sober over time.

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 misuse 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.

• Exercise and be active. This may give you something to do instead of thinking about alcohol, and it also can help reduce stress. People who are fit usually have less anxiety, depression, and stress than people who aren't active.
• Get enough sleep.
• Eat a balanced diet. This helps your body deal with tension and stress. Whole grains, dairy products, fruits, vegetables, and protein are part of a balanced diet.

Talk to your family about your drinking

Alcohol misuse 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.

• 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 counseling for families to help you solve problems at home.
• Talk about what may cause a relapse and discuss your relapse plan.

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 misuses 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.

Encourage treatment

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.

Alcohol Problems: Helping Someone Get Treatment

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:

• If you drink, decide whether you want to keep alcohol in the house. 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 himself or herself.
• Be aware that your loved one may seem like a different person after he or she is sober. You may find it hard to get used to this person. You may need to rebuild your relationship.
• Understand that you have the right to know how recovery is going, but ask about it in a respectful way.
• Help your loved one plan for a relapse. Most people relapse after treatment. This doesn't mean the treatment failed. Try to help your loved one see relapse as a chance to do better and to keep working on skills to avoid drinking.
• Focus on the positive actions your loved one is making.

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:

• Resent what the person did to you in the past.
• Not trust the person. You may not want to give the person the house key, the car key, or money. You also may feel guilty about not trusting the person.
• Find it hard to give up or share your family role. For example, if you took over child-rearing when your partner was drinking, you may resent his or her becoming involved again. If you managed money, you may resent having to make shared decisions on how to spend money.
• Resent that the person is spending more time at meetings or with others in recovery than with you.
• Worry so much about relapse that you avoid anything that you think may upset the person. You also may resent this feeling.

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 misused or was dependent on alcohol. You also may try family therapy.