What Is an Alcoholic? Understanding the Definition and Signs of Alcohol Use Disorder

The term "alcoholic" gets used casually, but the medical definition of alcohol use disorder applies to more people than you might expect.

What You'll Learn:

• The medical definition of alcohol use disorder.

• The 11 signs used to diagnose alcohol problems.

• How doctors determine mild, moderate, and severe AUD.

• Statistics on how many Americans are affected.

• Risk factors that make some people more vulnerable.

• When to seek help and what treatment options exist.

The word "alcoholic" brings to mind a specific image for most people, but the medical definition of alcohol use disorder is quite different. According to the National Institute on Alcohol Abuse and Alcoholism, nearly 28 million Americans meet the criteria for alcohol use disorder. Many of them would never use the word alcoholic to describe themselves.

Understanding the actual definition can help you figure out where you stand and whether it makes sense to do something about your drinking.

What Is an Alcoholic? The Medical Definition

The term "alcoholic" was first used in 1852, but doctors and researchers have moved away from it. The preferred clinical term is now alcohol use disorder, or AUD. This shift matters because words like "alcoholic" can carry stigma that keeps people from getting help.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines alcohol use disorder as "a problematic pattern of alcohol use leading to clinically significant impairment or distress." In practical terms, it means your drinking is causing problems, whether that involves your health, your relationships, your work, or your ability to function the way you want to.

One important point is that AUD exists on a spectrum from mild to severe. It's not a binary condition where you either are or aren't an alcoholic. This means someone can have a real issue with alcohol even if they're still holding down a job and maintaining relationships. For more on this distinction, see our guide to understanding alcohol use disorder.

The 11 Signs of Alcohol Use Disorder

Doctors use 11 specific criteria to assess whether someone has alcohol use disorder. Meeting just two of these within a 12-month period qualifies for a diagnosis.

1. Drinking more or longer than intended - You plan to have two drinks but consistently end up having five or six.

2. Unsuccessful attempts to cut down - You've tried to reduce your drinking or quit entirely, but it hasn't stuck.

3. Spending a lot of time drinking or recovering - A significant portion of your week revolves around alcohol or dealing with hangovers.

4. Craving alcohol - You experience a strong urge to drink at certain times of day or in specific situations.

5. Failing to fulfill responsibilities - Drinking has interfered with your obligations at work, school, or home.

6. Continuing despite relationship problems - Alcohol has caused tension with people you care about, but you continue drinking anyway.

7. Giving up important activities - You've stopped participating in hobbies or social events because of drinking.

8. Drinking in risky situations - You've used alcohol in situations where it could be physically dangerous.

9. Continuing despite health problems - You know alcohol is affecting your health, but you drink anyway.

10. Needing more to get the same effect - You've developed tolerance and need to drink more than you used to.

11. Experiencing withdrawal symptoms - When you stop drinking, you experience shakiness, sweating, nausea, or anxiety.

The American Psychiatric Association uses these criteria to determine whether someone's drinking has crossed from social use into a medical condition.

How Severity Is Determined

Not everyone with alcohol use disorder has the same level of impairment. The DSM-5 classifies severity based on how many criteria someone meets:

Mild AUD - Meeting 2-3 criteria. Many people at this level are still functioning well in most areas of life.

Moderate AUD - Meeting 4-5 criteria. The impacts are more noticeable and drinking likely affects multiple areas of life.

Severe AUD - Meeting 6 or more criteria. Alcohol has a significant grip on daily life.

The key takeaway is that you don't need to meet all 11 criteria for your drinking to be worth addressing. Even mild AUD can progress over time if left alone. For more on recognizing when drinking has become problematic, see our article on symptoms of alcohol addiction.

Statistics on Alcohol Use Disorder in America

The numbers provide helpful context for understanding how common this condition actually is.

According to 2024 data from the National Institute on Alcohol Abuse and Alcoholism, 27.9 million Americans ages 12 and older had alcohol use disorder in the past year. That works out to 9.7% of the population in that age group.

Among young adults ages 18 to 25, the prevalence is even higher at 15.1%. This age group has one of the highest rates in the country. On the other end of the spectrum, 2.9 million adults ages 65 and older meet the criteria for AUD.

Something to consider is that the rate of alcohol-related deaths in the United States more than doubled between 1999 and 2021. Each year, approximately 5 million emergency department visits are alcohol-related.

Risk Factors That Increase the Likelihood of AUD

Some people are more vulnerable to developing alcohol use disorder than others. Understanding these risk factors can help you assess your own situation.

Genetics - Research suggests that approximately 60% of the risk for developing AUD is genetic. If you have a family history of alcohol problems, your baseline risk is higher. This doesn't mean you're destined to develop AUD, but it does mean you may want to be more cautious. Our article on alcohol addiction and genetics covers this topic in detail.

Starting young - People who begin drinking before age 15 are significantly more likely to develop alcohol use disorder later in life.

Mental health conditions - Depression, anxiety, PTSD, and ADHD all increase the risk of developing AUD. Many people use alcohol as a way to cope with symptoms of these conditions.

History of trauma - Childhood trauma and other adverse life experiences are associated with higher rates of alcohol use disorder in adulthood.

When to Seek Help

One persistent myth about alcohol problems is that you need to hit rock bottom before seeking help. This isn't true. Waiting until things get really bad only makes recovery harder.

If you meet even two of the diagnostic criteria, it's reasonable to talk to a healthcare provider about your drinking. Here are some practical signs that it might be time:

• Your tolerance has increased noticeably over the past year.

• You've experienced withdrawal symptoms when you stop drinking.

• People in your life have expressed concern.

• You've broken promises to yourself about cutting back.

• Drinking has started affecting your work, relationships, or health.

Getting help doesn't necessarily mean going to rehab or joining a 12-step program. There are multiple approaches to treating AUD, and many can be done discreetly from home.

Take the online Alcohol Use Assessment to see if medication-assisted treatment could be a good fit.

Treatment Options That Work

Research shows that most people who get treatment are able to reduce or eliminate their drinking.

Medication - The FDA has approved naltrexone as a treatment for AUD. Naltrexone works by blocking opioid receptors in the brain that are responsible for the pleasurable feelings associated with alcohol. When you drink with naltrexone in your system, you don't get the same rewarding sensation. This reduces cravings over time. The typical dose is 50mg daily, and it can be taken whether you're aiming for complete abstinence or simply want to drink less.

Behavioral therapy - Working with a counselor can help you identify triggers, develop coping strategies, and address underlying issues that contribute to drinking.

Support groups - Peer support provides accountability and connection with others who understand what you're going through.

Combination approaches - Research suggests that medication combined with therapy or coaching produces better outcomes than either approach alone.

Many people with AUD get effective treatment through telehealth services without needing to attend in-person appointments.

Getting Started

The definition of alcoholic has evolved significantly over the years. What used to be seen as a character flaw is now understood as a medical condition with clear diagnostic criteria and effective treatments.

You don't need to fit a specific stereotype to have alcohol use disorder. Meeting just two of the 11 criteria is enough for a diagnosis. The sooner you address the issue, the easier it typically is to make progress.

Take the Alcohol Use Assessment to see if naltrexone-assisted treatment could help you reduce your drinking or quit altogether.