What Is Alcohol Use Disorder?

Alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol use despite negative consequences. It exists on a spectrum from mild to severe and is diagnosed based on specific criteria. AUD is treatable with medications and behavioral approaches.

What You'll Discover:

• The medical definition of alcohol use disorder.

• Signs and symptoms that indicate AUD.

• How AUD differs from heavy drinking or alcoholism.

• The spectrum of severity from mild to severe.

• Risk factors that contribute to developing AUD.

• Treatment options for alcohol use disorder.

Many people wonder if their drinking has crossed a line. The term "alcohol use disorder" provides a clinical framework for understanding when drinking becomes a medical condition rather than just a habit.

Understanding what AUD actually means helps you assess your own relationship with alcohol and understand your options if you're concerned.

The Medical Definition

Alcohol use disorder is a medical diagnosis defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard reference used by healthcare providers to diagnose mental health conditions.

The DSM-5 defines alcohol use disorder as "a problematic pattern of alcohol use leading to clinically significant impairment or distress."

This means AUD isn't simply about how much you drink. It's about whether drinking is causing problems in your life and whether you find it difficult to control.

The diagnosis requires meeting at least two of eleven specific criteria within a 12-month period. More criteria met means more severe AUD.

AUD is recognized as a chronic relapsing brain disorder by major medical organizations including the National Institute on Alcohol Abuse and Alcoholism.

The Eleven Diagnostic Criteria

The DSM-5 specifies eleven criteria used to diagnose alcohol use disorder. Meeting two or three indicates mild AUD. Four or five indicates moderate AUD. Six or more indicates severe AUD.

1. Drinking more than intended - You often drink more alcohol or for longer periods than you planned. You might tell yourself you'll have two drinks and end up having six.

2. Unsuccessful attempts to cut down - You've tried to reduce your drinking or stop altogether but haven't been able to succeed. Despite wanting to drink less, you keep drinking at the same level or more.

3. Significant time spent on alcohol - You spend a lot of time obtaining alcohol, drinking, or recovering from drinking. This might mean hangovers regularly affecting your mornings or planning activities around drinking.

4. Cravings - You experience strong urges or desires to drink. These cravings can feel compelling and difficult to ignore.

5. Failure to fulfill obligations - Drinking causes you to fail at major responsibilities at work, school, or home. This might include missing deadlines, poor performance, or neglecting family duties.

6. Continued use despite social problems - You keep drinking even though it's causing or worsening problems in relationships. Arguments about drinking, damaged friendships, or family conflict haven't led you to stop.

7. Giving up activities - You've reduced or stopped participating in activities you used to enjoy because of drinking. Hobbies, social activities, or interests have fallen away as drinking takes priority.

8. Hazardous use - You drink in situations where it's physically dangerous, such as before driving, operating machinery, or swimming.

9. Continued use despite physical or psychological problems - You keep drinking even though you know it's causing or worsening a physical or mental health problem. This could include continuing to drink despite liver problems, depression, or anxiety.

10. Tolerance - You need to drink more than you used to in order to feel the same effects, or the same amount of alcohol has less effect than it once did.

11. Withdrawal - You experience withdrawal symptoms when you stop drinking or drink less. These can include sweating, trembling, nausea, anxiety, or insomnia. Or you drink specifically to avoid these symptoms.

Understanding the Spectrum

Alcohol use disorder isn't an all-or-nothing diagnosis. It exists on a spectrum of severity.

Mild AUD (2-3 criteria) - You meet two or three of the diagnostic criteria. Drinking is causing some problems, but they may be relatively contained. You might not think of yourself as having an alcohol problem, but the clinical threshold has been crossed.

Moderate AUD (4-5 criteria) - You meet four or five criteria. Drinking is causing more significant problems across multiple areas of life. The pattern is more established and concerning.

Severe AUD (6+ criteria) - You meet six or more criteria. This corresponds to what people traditionally called "alcoholism." Drinking is causing serious problems and may involve physical dependence.

This spectrum approach recognizes that alcohol problems vary in intensity. Someone with mild AUD is different from someone with severe AUD, and treatment approaches can be tailored accordingly.

How Common Is AUD?

Alcohol use disorder affects millions of people.

According to the National Institute on Alcohol Abuse and Alcoholism, approximately 29.5 million Americans aged 12 and older had AUD in a recent survey year. This represents about 10.5% of the population in that age group.

The condition affects people across all demographics, income levels, education levels, and professions. AUD doesn't discriminate based on social status or success.

Despite its prevalence, less than 10% of people with AUD receive any treatment. This treatment gap represents a significant public health problem.

Many people with AUD never seek help due to stigma, lack of awareness about treatment options, or not recognizing that their drinking has become problematic.

AUD vs. Heavy Drinking

Not everyone who drinks heavily meets criteria for alcohol use disorder, and not everyone with AUD drinks extremely heavily.

Heavy drinking is defined by quantity: more than 14 drinks per week for men or 7 for women, or more than 4 drinks per occasion for men or 3 for women.

Alcohol use disorder is defined by problems and loss of control, not just quantity. Someone could drink heavily but experience no significant problems and maintain full control over their drinking. They would not meet criteria for AUD.

Conversely, someone might not drink in extremely high quantities but still meet AUD criteria because they can't control their drinking, experience cravings, or continue despite consequences.

The distinction matters because treatment isn't just about reducing amount. It's about addressing the problematic patterns that define the disorder.

AUD vs. Alcoholism

The term "alcoholism" was used for decades but isn't a clinical diagnosis. It carries connotations of severe dependence and often implies moral failing.

Alcohol use disorder replaced "alcohol abuse" and "alcohol dependence" as diagnostic terms when the DSM-5 was published in 2013. The change reflects a more nuanced, medical understanding of alcohol problems.

Key differences:

Alcoholism suggests a fixed identity ("I am an alcoholic"). AUD describes a condition you have that can be treated.

Alcoholism often implies severe problems. AUD captures the full spectrum from mild to severe.

Alcoholism has moral undertones. AUD frames the condition as a medical issue like diabetes or hypertension.

Both terms describe real problems with alcohol. The clinical terminology of AUD is more precise and less stigmatizing.

Risk Factors for Developing AUD

Multiple factors influence whether someone develops alcohol use disorder.

Genetics - Family history of alcohol problems increases risk. Research suggests genetics account for about 50% of the risk for AUD. If close relatives have had alcohol problems, you're more likely to develop them.

Age of first drink - Starting to drink at a younger age increases risk of developing AUD later in life. The brain is still developing through early adulthood, making it more vulnerable to alcohol's effects.

Mental health conditions - Depression, anxiety, trauma, and other mental health issues increase AUD risk. Many people drink to manage symptoms of other conditions.

Social environment - Peer drinking patterns, cultural attitudes toward alcohol, and availability all influence drinking behavior and AUD risk.

Stress and trauma - High stress and traumatic experiences increase vulnerability to AUD. Alcohol may be used as a coping mechanism.

Drinking patterns - Regular heavy drinking, binge drinking, and early tolerance development all increase risk for developing AUD.

Having risk factors doesn't mean you'll develop AUD, but awareness helps you monitor your relationship with alcohol.

Signs You May Have AUD

Several warning signs suggest alcohol use may have become problematic.

You think about drinking frequently - Alcohol occupies significant mental space. You look forward to drinking, plan around it, or feel preoccupied with when you'll drink next.

You drink more than you intend - Despite telling yourself you'll limit consumption, you regularly exceed what you planned.

You've tried unsuccessfully to cut back - Attempts to reduce drinking haven't worked, or reduction didn't last.

Others have expressed concern - Friends, family, or partners have mentioned worry about your drinking.

Drinking affects your life - Work performance, relationships, health, or other areas are suffering due to alcohol.

You've experienced consequences - DUI, health problems, lost relationships, or other concrete negative outcomes have resulted from drinking.

You feel defensive about drinking - When the topic comes up, you feel the need to minimize, hide, or justify your consumption.

If several of these apply, assessment for AUD may be worthwhile.

The Neuroscience of AUD

Alcohol use disorder involves real changes in brain structure and function.

Research from the NIH shows that repeated alcohol exposure changes the brain's reward, stress, and decision-making systems.

Reward system changes - Alcohol activates the brain's reward circuitry, releasing dopamine. Over time, the brain adapts, requiring more alcohol to achieve the same effect and reducing pleasure from other activities.

Stress system changes - Chronic alcohol use increases stress hormone levels when not drinking, creating discomfort that drinking temporarily relieves. This contributes to continued drinking.

Prefrontal cortex changes - The brain region responsible for judgment, impulse control, and decision-making is impaired by chronic alcohol use. This makes it harder to control drinking even when wanting to stop.

These brain changes help explain why willpower alone often isn't enough to overcome AUD. The condition involves neurological alterations that medication can help address.

Treatment for Alcohol Use Disorder

AUD is a treatable medical condition. Several evidence-based approaches exist.

Medication-assisted treatment - FDA-approved medications like naltrexone can reduce cravings and drinking. Naltrexone works by blocking the brain's reward response to alcohol, making drinking less pleasurable and weakening the drive to drink over time.

Behavioral therapies - Cognitive behavioral therapy, motivational interviewing, and other therapeutic approaches help change thinking and behavior patterns around drinking.

Support groups - Peer support through groups like AA or SMART Recovery provides community and accountability.

Combination approaches - Many people benefit from combining medication with therapy or support groups.

The best treatment approach depends on individual circumstances, severity, and preferences. Treatment doesn't require hitting "rock bottom." Early intervention for mild or moderate AUD can prevent progression.

Learn how naltrexone works for reducing alcohol consumption as part of medication-assisted treatment.

Common Questions About AUD

Can you have AUD and not drink every day?

Yes. AUD is about problematic patterns, not daily drinking. Someone who binge drinks only on weekends but meets other criteria can have AUD. The key factors are loss of control and negative consequences, not frequency.

Is AUD the same as being an alcoholic?

The conditions describe similar problems. AUD is the current medical terminology that captures a spectrum of severity. "Alcoholic" is an older term often associated with severe dependence. AUD is more precise and less stigmatizing.

Can mild AUD get worse?

Yes. Without intervention, mild AUD can progress to moderate or severe over time. Early treatment can prevent progression. This is one reason why addressing even mild AUD is worthwhile.

Do I need to quit completely if I have AUD?

Not necessarily. Treatment goals can include moderation for some people, especially with mild AUD. However, for severe AUD or people who've tried moderation unsuccessfully, abstinence may be recommended. Treatment can be tailored to your situation.

Is AUD genetic?

Genetics play a significant role, accounting for roughly 50% of risk. However, having genetic predisposition doesn't mean you'll develop AUD, and not having family history doesn't make you immune. Environment and choices also matter.

Recovery Is Possible

With appropriate treatment, many people with AUD achieve significant improvement or full recovery.

Recovery doesn't always mean lifelong abstinence. For some people, especially those with mild AUD, moderation becomes possible with treatment. For others, abstinence is the safest path.

The key is recognizing that AUD is a medical condition, not a character flaw. Seeking help is a sign of strength, not weakness.

Treatment works. Medications are effective. Recovery is achievable.

Conclusion

Alcohol use disorder is a medical condition defined by problematic drinking patterns that cause distress or impairment. It exists on a spectrum from mild to severe and is diagnosed based on specific criteria related to control, consequences, and physical dependence.

Understanding AUD as a medical condition rather than a moral failing opens the door to effective treatment. Medications, therapy, and support can help people reduce or stop drinking.

If you're questioning whether your drinking qualifies as AUD, that question itself may be worth exploring.

Take the online Alcohol Use Assessment to evaluate your drinking patterns and see if medication-assisted treatment could help.