What Is Alcohol Use Disorder?
Alcohol Use Disorder (AUD) is a chronic, treatable illness, characterized by uncontrolled drinking and negative consequences from alcohol. It includes what is traditionally called alcoholism.
Definition of Alcohol Use Disorder
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines AUD as:1
“… a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.”
This ranges from what some people call “problem drinking,” to what is commonly known as alcohol dependence, or alcoholism.
Is AUD the Same Thing as Alcohol Addiction?
A person who is addicted to alcohol certainly qualifies as having alcohol use disorder. However, the term AUD is a bit more flexible, and describes a wide range of problems.
According to the American Society of Addiction Medicine (ASAM), the definition of addiction is:2
“… a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”
This describes many people with AUD, but may not cover every type of problem drinking.
How Is Alcohol Use Disorder Diagnosed?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnoses AUD based on a list of 11 symptoms.3 Experiencing two or three of these issues in one 12-month period is enough for a diagnosis of mild alcohol use disorder. Four to five symptoms means moderate AUD, and having six or more qualifies as severe alcohol use disorder.
These 11 qualifications include:
- Alcohol getting in the way of important responsibilities
- Getting into dangerous situations because of alcohol use
- Increased tolerance (feeling the need to drink more to experience the same effects)
- Having withdrawal symptoms and cravings
AUD looks different from individual to individual. For one person, AUD might mean binge drinking too often and getting into dangerous situations. For another, alcohol use disorder might mean drinking heavily all day and having issues with their family and job. This is why different people will need different types of treatment to overcome AUD.
How AUD Happens
There’s no single cause or trigger for AUD that holds true for all people. But there are several risk factors, such as:
- Frequent heavy alcohol use or binge drinking, especially at a younger age
- Genetics and family history of alcoholism
- Social influences, including peer pressure or social norms around drinking
- Mental health conditions like depression, PTSD, and ADHD
Some people develop problems with alcohol due to self-medication—attempting to manage chronic pain, stress, childhood trauma, or difficult emotions via substance use. Others can develop AUD as their body chemistry adjusts to frequent social drinking (including binge drinking), developing alcohol cravings or mental health symptoms after the fact. In many cases, it is some combination of these factors.
Whatever the root cause of a person’s drinking, alcohol misuse causes lasting changes to the brain. These changes lead to more severe AUD and make it harder to avoid alcohol long-term.
Why Is Alcohol So Hard to Quit?
Quitting alcohol can be incredibly difficult, and much more complicated than “just stop drinking.” One reason is the changes to brain chemistry caused by long-term heavy alcohol use.
Alcohol:
- Activates the brain’s “reward circuit,” compelling you to drink again and to drink more over time
- Makes the brain’s “stress circuit” more sensitive, so people experience unpleasant feelings when they try to stop
- Impairs impulse control, decision-making, and critical thinking skills, so it’s harder to choose not to drink.
When people try to stop drinking without addressing these brain changes, cravings can get even worse over time.
There are also reasons why it can be hard for people to seek support to quit drinking. Some are in denial, while some fear society’s stigma around addiction. Others worry about the cost of treatment, or the need to take time away from work or family to attend traditional rehab.