Alcohol use disorder is drinking alcohol in a way that is harmful. It covers a range: hazardous drinking raises the risk of future harm, harmful drinking is already damaging physical or mental health, and alcohol dependence means the body has adapted to alcohol so that stopping brings on withdrawal symptoms.
Key points
- Alcohol use disorder is a range, not one condition: hazardous drinking, harmful drinking and alcohol dependence.
- A person need not be at the severe end to benefit from help. Brief advice in primary care works before dependence develops.
- Anyone physically dependent on alcohol should not stop suddenly on their own. Severe withdrawal can involve seizures, confusion and hallucinations, and can be fatal.
- Depression and anxiety run both ways with heavy drinking, and often settle within weeks of stopping.
- NICE guideline CG115 covers assisted withdrawal, psychological therapies and relapse prevention medication.
Symptoms
- Regularly drinking more than intended, difficulty cutting down despite wanting to; cravings, such as needing a drink on waking.
- Needing more alcohol for the same effect (tolerance); guilt or remorse after drinking, or others raising concerns about it.
- Withdrawal on stopping or cutting down: anxiety, poor sleep, nausea, a racing heartbeat, sweating and shaking, in severe cases seizures.
Causes and risk factors
- Regularly drinking above the UK low-risk guideline of 14 units a week; existing depression or anxiety; other substance use.
- A social network where heavy drinking is usual; difficulty cutting down despite wanting to is a defining sign, not weak willpower.
Treatment
- Hazardous and harmful drinking: brief intervention from a non-specialist is effective and good value at this stage.
- Assisted, medically supervised withdrawal for moderate to severe dependence; never stop suddenly if physically dependent.
- Relapse prevention medication (acamprosate, naltrexone, disulfiram) alongside psychological support; mutual aid groups such as Alcoholics Anonymous and SMART Recovery.
When to speak to a professional
- You regularly drink more than you meant to, or find it hard to cut down; you need a drink in the morning.
- Get medical help before you try to stop if you get withdrawal symptoms when you cut down.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.