Alcohol misuse

Signs of alcohol misuse and alcohol-use disorder

Alcohol-use disorder can be mild, moderate or severe, and it often builds up gradually rather than appearing overnight. You might be misusing alcohol, or developing alcohol-use disorder, if you recognise several of the following in yourself over the past year:

• drinking more, or for longer, than you meant to
• wanting to cut down or stop, and finding you can't
• spending a lot of time drinking or recovering from it
• craving a drink so strongly you can't think of much else
• letting drinking get in the way of work, family or college
• continuing to drink even though it's harming your relationships, mood or health
• needing more alcohol than you used to, to feel the same effect
• getting withdrawal symptoms, such as shaking, sweating or anxiety, when you cut down.

The more of these apply to you, the more urgent it is to make a change. If you're a heavy, regular drinker and you stop or cut down suddenly, you may develop withdrawal symptoms such as anxiety, difficulty sleeping, sweating, a racing heartbeat or, in severe cases, seeing or hearing things that aren't there, confusion or seizures.

These symptoms usually begin 6–12 hours after your last drink and last 3–7 days, though some can linger for months. Get medical support rather than stopping suddenly if you think you're dependent on alcohol, as withdrawal can be dangerous without help.

Causes and risk factors

Your risk of developing alcohol-use disorder depends partly on how much, how often and how quickly you drink. Regular heavy drinking changes the way your brain works over time, which is part of why alcohol-use disorder is considered a brain disorder rather than simply a matter of willpower, and why it can make you vulnerable to relapse even after you've stopped. Risk factors include:

• starting to drink at an early age, particularly before age 15
• a family history of alcohol problems; genetics accounts for around 60% of your risk
• mental health conditions such as depression, anxiety or PTSD, or a history of childhood trauma
• drinking regularly above low-risk guidelines, currently no more than 14 units a week for men and women in the UK.

Persistent alcohol misuse can also cause serious health problems in its own right, including liver disease, heart disease, stroke, pancreatitis, and several types of cancer including mouth, breast and bowel cancer. It can also lead to wider problems such as job loss, relationship breakdown, domestic abuse and homelessness.

If you're pregnant or trying to conceive, the safest approach is to avoid alcohol completely, since drinking in pregnancy raises the risk of miscarriage, stillbirth, premature birth and long-term harm to your baby. Drinking heavily can also reduce a man's sperm quality.

How alcohol-use disorder is classified

Doctors describe alcohol-use disorder as mild, moderate or severe, based on how many recognised symptoms apply to you: two or three is considered mild, four or five moderate, and six or more severe. This range is sometimes called a spectrum, running from alcohol misuse at the milder end through to severe dependence, which some people call alcoholism.

Diagnosing alcohol misuse

If you see a GP or an alcohol support service about your drinking, they'll ask about how much and how often you drink and how it's affecting your life. You may be asked to fill in a short questionnaire, such as the Alcohol Use Disorders Identification Test (AUDIT), to help work out whether your drinking has reached a harmful level.

You may also be offered blood tests to check whether your drinking has affected your health, for example your liver.

Treatment for alcohol misuse

How alcohol-use disorder is treated depends on how much you're drinking and how dependent you are. Treatment might aim to help you stop drinking completely, particularly if you're dependent, or to support you to cut down to a safer level if you're not ready to stop.

Talking therapies, such as cognitive behavioural therapy (CBT), help you understand and change your relationship with drinking, and are often combined with mutual-support groups such as Alcoholics Anonymous or SMART Recovery, which offer peer support at low or no cost.

If you're dependent on alcohol, you may need medical support to stop safely. Detoxification involves a nurse or doctor helping you cut down gradually, or prescribing medicines, often chlordiazepoxide, over a short period to control withdrawal symptoms safely, since stopping suddenly can be dangerous.

Once you've stopped drinking, you might also be offered medicine to help you stay sober. Acamprosate and naltrexone both help reduce cravings, while disulfiram causes unpleasant effects, such as feeling sick or a headache, if you drink alcohol while taking it. These medicines are usually taken for 6–12 months and are not addictive themselves.

You may have treatment while living at home, or, if you need more intensive support such as detox, as a hospital inpatient. You'll usually be given a keyworker to support you throughout, and your treatment plan will be tailored to your circumstances.

When to see a doctor

See a GP or an alcohol support service if you're worried about your drinking, if you want help to cut down or stop, or if you're worried about someone else's drinking. It's also worth asking for help if you've tried to stop before and found it difficult, since setbacks are common and getting support early can make a real difference.

Get medical help before you try to stop or cut down if you think you might be dependent on alcohol, since withdrawal can be dangerous without support.

Call 999 or go to A&E if you or someone else has severe withdrawal symptoms after stopping drinking, such as visible shaking, severe confusion, hallucinations or a seizure. Do not drive yourself; ask someone else to drive you, or call for an ambulance.