Condition Basics

What is alcohol use disorder?

Alcohol use disorder means that a person drinks alcohol even though it causes harm to themselves or others. Harm can range from mild (a hangover) to severe (being the cause of or a victim of violence, needing hospital care, or even death). Alcohol use disorder affects the brain and can be treated. People with this disorder find it hard to control their alcohol use. They need to use more alcohol to get the same effects (tolerance). Over time, drinking too much alcohol may cause health problems, like liver and heart problems. It can also increase your risk of getting cancer.

What causes it?

It's not clear why some people develop alcohol use disorder and others don't. It seems to run in families (genetic). Drinking habits are affected by your family situation, friends, and where you live. Some peoples’ lives are stressful, and they may use alcohol to cope with health or relationship problems. Drinking alcohol changes the way the brain works. It makes it harder to control urges and manage stress.

What are the symptoms?

Your drinking may be a problem if:

• You can't cut down or control how much or how often you drink alcohol, even when you want to.
• You spend a lot of time drinking or recovering from alcohol.
• You can't do your main tasks at school, work, or home.
• You keep drinking, even though it's hurting your relationships.
• You have uncomfortable symptoms when you drink less.
• You have had others tell you they think you have a problem with your drinking.

How is it diagnosed?

Alcohol use disorder may be diagnosed at a routine doctor visit or when you see your doctor for another problem. Your doctor will ask questions about how drinking is affecting your life and about your past health situation and will do a physical exam. Your doctor may do tests to look for health problems linked to alcohol, like cirrhosis.

How is alcohol use disorder treated?

When some people realize their drinking is a problem, they decide to quit and can do so on their own or with support from family or friends. Others can stop or cut back on drinking with help from a counsellor or mutual support groups like Alcoholics Anonymous or SMART Recovery (Self-Management and Recovery Training).

What Increases Your Risk

Certain things make alcohol use disorder more likely. These are called risk factors.

Risk factors that make you more likely to drink harmful amounts of alcohol include:

• Genes. There is often a family history of alcohol use disorder.
• Early use. The younger you were when you first started drinking alcohol, the higher your risk for alcohol use disorder later as an adult.
• Having a mental health condition or conditions. This could include depression, post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenia, and anxiety disorders.
• Use of other substances. This could include the use of tobacco or drugs. Your risk is also higher when you use prescription medicines in ways they are not intended to be used.
• Environment. You may live in an area where alcohol is easy to get, people drink a lot, or heavy drinking is accepted as part of life.
• 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 heavily 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 too much.

Just because you have risk factors doesn't mean you'll develop alcohol use disorder. A person who has many risk factors won't always develop alcohol use disorder. And a person who has no risk factors can have alcohol use disorder.

Symptoms

Maybe you've wondered about your alcohol habits or how to tell if your drinking is becoming a problem.

Here are some of the symptoms of alcohol use disorder. Talk to your doctor or an addiction counselor if you notice two or more symptoms. They can help you make a plan about how to recover.

• You drink larger amounts of alcohol than you ever meant to. Or you've been drinking heavily for a longer time than you thought you would.
• You can't cut down or control your use. Or you think about how you wish you could cut down.
• You spend a lot of time getting or drinking alcohol or recovering from its effects.
• You have strong cravings for alcohol.
• You can no longer do your main jobs at work, at school, or at home.
• You keep drinking alcohol, even though your use hurts your relationships.
• You have stopped doing activities you used to enjoy because you drink instead.
• You drink alcohol in situations where doing so is dangerous.
• You keep drinking alcohol even though you know it's causing health problems.
• You need more and more alcohol to get the same effects, or you get less effect from the same amount over time. This is called tolerance.
• You have uncomfortable symptoms when you stop drinking alcohol or use less. This is called withdrawal.

Alcohol use disorder can range from mild to severe. The more symptoms you have, the more severe the disorder may be. It also means you may experience more symptoms of withdrawal.

You might not realize that your drinking is a problem. You might not drink large amounts at a time. Or you might go for days or weeks between the times you drink. When you drink a lot after not drinking for a while, this is called binge drinking. This kind of drinking causes harm and puts you at risk too.

Physical signs of alcohol use disorder

The physical signs of alcohol use disorder can be vague in the early stages of the disease. Some early symptoms include:

• Blackouts, which cause you to not remember what happened when you were drinking. Blackouts aren't the same as passing out. Passing out means that you lose consciousness. You don't pass out when you have an alcohol blackout. But you do lose your memories of the event.
• Injuries and illnesses you can't explain. You might have new physical problems, such as stomach cramps. Or another health problem may get worse.

As alcohol use disorder continues or gets worse, physical symptoms of long-term heavy drinking can develop. You may:

• Not feel hungry, not eat well, and lose weight.
• Notice tiny blood vessels on your skin that look like spider webs (spider angiomas).
• See swelling or redness of the palms of your hands.
• Have redness on your face, especially your nose and cheeks.
• Keep getting infections and skin sores (abscesses).
• Have less interest in sex. You might also notice shrinkage of the testicles and impotence.
• Have a sore or upset stomach (gastritis).
• Feel numbness and tingling in your feet or hands.
• Be unsteady when on your feet.
• Have liver problems, such as cirrhosis.

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What Happens

Alcohol use disorder 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 start 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 use disorder quit for days, weeks, or even months before they start to drink again. But unless you can consistently keep your drinking under control and not fall back into unhealthy patterns, you need help to learn to cope in a healthy way.

Problems from alcohol use disorder

Drinking too much alcohol causes health problems or makes the ones you have worse. These problems include:

• Changes to the way your brain works. This can be changes to your moods and how you act. It can make it hard to think clearly. Or it can make you clumsy.
• Cirrhosis or pancreatitis.
• High blood pressure.
• Osteoporosis.
• Cancer of the breast, tongue, esophagus, throat, voice box, liver, colon, or rectum.
• Stroke and heart attacks.
• A brain disorder called Wernicke-Korsakoff syndrome.

Heavy alcohol use also can cause stomach problems, interactions between medicines and alcohol, and sexual problems. It can lead to violence, injuries, social isolation, and problems at work, school, or home. You also may have legal problems, such as traffic tickets or car crashes, as a result of drinking.

Drinking alcohol causes unique problems for older adults. They can be more sensitive to the effects of alcohol, meaning it has bigger effects. Alcohol can make problems with thinking clearly worse. The way alcohol is digested changes as people get older. This causes them to have a higher level of alcohol in their blood.

Drinking also makes symptoms of mental health conditions worse. When your drinking is a problem and you have a mental health condition, it is called a concurrent disorder. Seeing your doctor or another healthcare provider can help you cope better with mental health conditions, like depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, and schizophrenia. You may drink less when mental health symptoms are managed better.

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When to Call a Doctor

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

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away.

• Call or text Canada's suicide and crisis hotline at 988.
• Kids or teens can call Kids Help Phone: 1-800-668-6868 or text CONNECT to 686868.
• Go to the Talk Suicide Canada website at https://talksuicide.ca or the Kids Help Phone website at https://kidshelpphone.ca for more information.

Consider saving these numbers in your phone.

Call a doctor or 811 right away if you or someone you care about:

• Has withdrawal symptoms, such as confusion and trembling.
• Agrees to consider participating in treatment and wants more information.
• Has stopped drinking but starts drinking again (has a return to use).
• Has severe stomach pain.

Watchful waiting

Watchful waiting is a wait-and-see approach. Watchful waiting is not a helpful choice when you or someone you care about has symptoms of alcohol use disorder. If you have concerns about your drinking or the drinking of someone you care about, talk to your doctor or an addiction counsellor about ways to start to make changes towards your recovery.

Mutual support groups can also help you and your family:

• Alcoholics Anonymous (AA), SMART Recovery, LifeRing, or other support groups help people who are concerned about their drinking.
• Al-Anon and Alateen (for teenagers) are for family members, friends, and others who are affected by someone's drinking.

Exams and Tests

Alcohol use disorder may be diagnosed at a routine doctor visit or when you see your doctor for another problem.

Your doctor will ask questions about your symptoms and past health and will do a physical exam. There will be tests to look for health problems linked to alcohol, such as cirrhosis, how your body uses vitamins, or troubles you may have with memory.

People who drink too much also may have mental health conditions. These may include depression, anxiety disorders, schizophrenia, bipolar disorder, or post-traumatic stress disorder (PTSD). When you have alcohol use disorder and a mental health condition at the same time, it is called a concurrent disorder.

If your doctor thinks this applies to you, they will do a mental health assessment or refer you to another healthcare provider like a psychologist, clinical social worker, psychiatrist, or mental health therapist. Your doctor or psychiatrist may prescribe medicines. Other healthcare providers may help you by doing talk therapy.

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Treatment Overview

Asking for help is up to you. When you ask, people with experience can give you help to make changes. You don't have to do it alone. There are many types of treatments you can try.

• Group therapy, one or more types of counselling, and alcohol education.
• Medicines that help to:
  • Reduce withdrawal symptoms or help you safely stop drinking.
  • Reduce cravings for alcohol.
• Mutual support groups like Alcoholics Anonymous (AA) or SMART Recovery.

Some people are able to stop or cut back on drinking with help from family members and friends. Others get help from a counsellor or doctor. When people with moderate to severe alcohol use disorder try to stop drinking, they may need medicines and care from a doctor to help them withdraw safely. When withdrawing at home is not safe, they may need to stay in a hospital or treatment centre.

Detox

Recovery

When you stop using alcohol, you have taken an important step in your recovery journey. One of the next steps is to figure out ways to deal with problems and stresses without drinking. Make a plan to stay focused on your recovery, such as learning to manage work, relationships, and any medical problems you may have.

Alcohol use disorder changes parts of the brain that control pleasure, reward, and memory. It will take time to change them back. Having support can help you to stay focused on recovery. Think about what worked best for you in the past when you tried to change. This can include counselling and mutual support groups like Alcoholics Anonymous and SMART Recovery (Self-Management and Recovery Training).

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Counselling

Treatment for alcohol use disorder usually involves one or more types of counselling. These include:

• Individual and group therapy. This is where you talk about your recovery with a counsellor or with other people who are trying to change. Your counsellor may use different kinds of therapies to help you.
• Cognitive behavioural therapy (CBT). You learn to change thoughts and actions that make you more likely to use alcohol. A counsellor teaches you ways to deal with cravings and cope with your thoughts or feelings in a healthier way.
• Motivational interviewing (MI). You resolve mixed feelings about quitting and getting treatment. A counsellor helps you find personal motivation to change.
• Motivational enhancement therapy (MET). It uses motivational interviewing to help you find motivation to quit. It usually lasts for 2 to 4 sessions.
• Brief intervention therapy. This provides feedback, advice, and goal-setting in very short counselling sessions.
• Couples and family therapy. Your counsellor works with you and people who are important to you. They help you work on problems your drinking caused. A goal may be to help you and your family think of ways to talk with each other in healthier ways.

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Medicines

Medicines can help treat alcohol use disorder.

Some medicines reduce withdrawal symptoms during detoxification. These include:

• Anti-anxiety medicines, which may help with delirium tremens (DTs).
• Stomach medicines, which may help with throwing up or diarrhea.
• Seizure medicines, which may reduce or stop severe withdrawal symptoms.

Other medicines help you stay in recovery. These include:

• Naltrexone. It interferes with the pleasure you get from drinking.
• Acamprosate. It may reduce your craving for alcohol.
• Disulfiram. It makes you sick to your stomach when you drink.
• Topiramate. It may help to reduce your cravings for alcohol.

Along with medicine, you might need vitamins and supplements. Heavy drinking causes your body to become low in certain vitamins and minerals. Your doctor may suggest taking thiamine (vitamin B1) supplements while you recover. Thiamine helps prevent Wernicke-Korsakoff syndrome, which causes brain damage. You also might need supplements to help replace fluids and electrolytes.

Staying Sober After Treatment

Recovery from alcohol use disorder means finding new habits to replace alcohol use. Here are some things that can help.

• Have a plan for how to get back into recovery after a return to use.

  Choose people to help you in recovery. They can help you through the rough patches. Decide who you can call, where you can go, and what to do if you return to use.

  People you can turn to include your support group sponsor, your doctor, your counsellor, family, friends, or a crisis hotline.

• Avoid triggers.

  It may be helpful to write down your triggers and plan ahead for how to deal with them. You might need to avoid certain situations or people or stay away from a favourite place or activity. If you know you can't avoid a trigger, bring a friend with you for support.

• Find support.

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

  • 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 alcohol use disorder, and your relationships with family and friends.
  • Connect with others you trust. They might encourage positive changes in how you think and act, help you figure out what to do about a problem, find new things to do with your free time, or teach you skills you need to be in recovery.
  • Take part in group activities where alcohol is not used. Your counsellor or sponsor can help you learn skills to make friends without drinking. At first it will feel odd not to drink. Practice will help you get used to being with people without using alcohol.
  • Find a sponsor, and work with them. A sponsor is someone who has experience in recovery and helps you cope with things that might trigger you to drink again.
• Manage stress.

  Some people find that relieving stress helps them during recovery.

  You can find ways to manage 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.

• Have a healthy lifestyle.

  When you have alcohol use disorder, you often get away from some of the basics of good health. Part of recovery is finding your way back to a healthy lifestyle.

  • Be active.
  • Get enough sleep.
  • Eat healthy foods. These foods include vegetables and fruits, whole grain foods, and protein foods like nuts, beans, lean meat, and fish.
• Talk to others about your drinking.

  Talk with your family or friends you trust about your drinking and recovery and goals you have. Your family and friends need to know that they didn't cause your alcohol use disorder but that they can help you during recovery.

  • Talks like this help them understand what you're going through and how they can help. Share what may cause a return to use and tell them about the plan you have to return to recovery.
  • Many treatment programs offer counselling to help you and people you care about solve problems in your relationships.

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Giving Support

When someone you care about has decided to get treatment for alcohol use disorder, you can play an important role. Here are some things you can do.

• Decide whether to keep alcohol in the house, if you drink.

  Having alcohol in your home might make it harder when your loved one comes to visit.

• 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 others and yourself for things that happened while your loved one was drinking.

• Be open to changes in your loved one.

  Making many changes to the way they live will make your loved one seem like a different person. It will take time for you to get to know them as a person in recovery.

• Ask how recovery is going.

  But ask about it in a respectful way.

• Help your loved one make a plan for a possible return to use.

  A return to use is a common part of recovery. It provides an opportunity to learn about what does not work. Encourage your loved one to see a return to use as a chance to keep working on skills for recovery.

• Focus on the positive progress being made.

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