Alcohol Abuse and Alcoholism: Symptoms, Withdrawal, Treatment and Recovery

About one in ten people will develop an alcohol problem during their life. If you have a problem, you don’t have to suffer in silence. There is help. Many people have overcome their alcohol problem and are living happier lives.

Table of Contents

Do You Have an Alcohol Problem?
Alcohol Withdrawal and Detox
Alcoholism and Alcohol Abuse Treatment
How to Help Someone with Alcoholism

Alcohol Abuse, Alcoholism and Alcohol Dependence?

These terms are now considered part of a spectrum called Alcohol Misuse Disorders. The terms alcohol abuse, alcoholism, and alcohol dependence have fallen out of favor, in an effort to avoid negative associations. But they all mean the same thing. These are the two defining characteristics of an Alcohol Misuse Disorder:

  1. You have difficulty controlling how much alcohol you drink. For example, once you start to drink, one drink leads to more drinks, and the next day you realize you drank more than you would have liked.
  2. You continue to drink even though it has negative consequences to your life. For example, drinking has hurt your relationships, but you continue to drink.

Do You Have a Drinking Problem?

The CAGE test for alcohol abuse and alcohol addiction is a simple and accurate self-test to help you decide if you have a problem. Answer yes or no to each question.[1]

  1. Have you ever thought you should Cut down on your drinking?
  2. Have you ever felt Annoyed when people have commented on your drinking?
  3. Have you ever felt Guilty or badly about your drinking?
  4. Have you ever had an Eye opener drink when you wake up to steady your nerves or to get rid of a hangover?

Your Score:

The CAGE test for alcohol abuse and alcoholism was given to over 500 randomly selected people, and these are the results.[2]
To get your score, give one point for each yes answer.

If you scored 1, there is a 75% chance you are dependent on alcohol.
If you scored 2, there is an 85% chance you are dependent on alcohol.
If you scored 3, there is a 95% chance you are dependent on alcohol.
If you scored 4, there is a 99% chance you are dependent on alcohol.

An even more detailed test for alcohol abuse and alcoholism - the AUDIT test developed by the World Health Organization.

Definition and Diagnosis of an Alcohol Use Disorder (F10.20)

Alcohol use disorder diagnostic criteria based on the DSM-5.[3]
You have experienced at least two of the following negative consequences:

  1. Do you sometimes have difficulty controlling how much alcohol you drink or how long you drink?
  2. Have you made unsuccessful attempts to cut down on your drinking?
  3. Do you sometimes spend a significant amount of time drinking or recovering from drinking?
  4. Have there been negative consequences to your home life, school, or work? (Have you ever lost time off work because of your alcohol use?)
  5. Have there been negative consequences to your relationships, personal life, or social life? (Has anyone ever commented on your alcohol use? Do you sometimes conceal how much alcohol you use?)
  6. Have you put off things or neglected to do things because of your alcohol use? (Have you ever disappointed your family or friends? Have you ever missed a family event?)
  7. Have you continued to use despite these negative consequences?
  8. Do you occasionally have strong cravings for alcohol?
  9. Has your tolerance for alcohol increased? Are you able to drink more than you did before?
  10. Have you experienced withdrawal symptoms the next day after drinking? (Have you ever been shaky or sweaty that evening or the next day?)
  11. Has your alcohol use led to dangerous situations? (Have you ever been charged with impaired driving?)

If you have experienced 2-3 of these symptoms, you meet the criteria for Mild Alcohol Misuse.(F10.120)
If you have experienced 4-5 of these symptoms, you meet the criteria for Moderate Alcohol Misuse.(F10.20)
If you have experienced at least 6 of these symptoms, you meet the criteria for Severe Alcohol Misuse.(F10.20)

How Much Drinking is Too Much?

The maximum limit for alcohol use has been set by the National Institute of Alcohol Abuse and Alcoholism.[4]

  • For men, more than 4 drinks in a day, or more than 14 drinks per week
  • For women, more than 3 drinks in a day, or more than 7 drinks per week
  • A standard drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of spirits

A study of over 26,000 people showed that individuals who drink more than the maximum limit have a high risk of becoming alcoholics. [5]

What is Moderate Alcohol Use or Social Drinking?

When struggling with the question of whether you have an alcohol problem or not, it helps to know what is a social drinker. [6]

  • For men, no more than 2 drinks per day
  • For women, no more than 1 drink per day
  • Some guidelines suggest at least 2 non-drinking days per week.

It is important to note that even low-risk drinking is not no-risk drinking. A review of over 200 medical studies showed that even moderate alcohol use increases the risk of some cancers, especially cancers of the mouth, larynx, and esophagus. [7]

Standard Alcohol Drink Size:

Alcohol Use Statistics: Drinking Percentiles

A study of over 44,000 college students in 1997 found the following pattern of alcohol use:[8]

  • 37% of students drank less than 1 drink per week.
  • 50% of students drank no more than 1 drink per week.
  • 70% of students drank no more than 4 drinks per week.
  • The top 20% of students drank at least 8 drinks per week.
  • The top 10% of students drank at least 13 drinks per week.
  • The top 5% of students drank at least 20 drinks per week.

These are useful statistics to know when dealing with adolescents who say “everybody drinks to get drunk in college.”

Stages of Alcoholism: The Functioning Alcoholic

  • Early stage: You regularly drink too much, but you haven’t suffered many consequences. This is when it’s easiest to make a change. But it is also when denial is highest.
  • Middle stage: This is the classic functioning alcoholic. You still have a job, but your relationships are beginning to suffer.
  • Late stage: Drinking is affecting your job. You have had legal problems, financial problems, or medical problems due to your drinking. This is what people think alcoholism is like, but this is the end of the line.

Alcoholism is progressive. The consequences get worse over time. It's never easy to quit. But if you have already suffered some consequences, there's never a better time to quit than now.

Alcohol Withdrawal and Detox

Six Alcohol Withdrawal Symptoms

  • Anxiety: Anxiety, restlessness, irritability, insomnia
  • Head: Headaches, dizziness
  • Chest: Chest tightness, difficulty breathing, palpitations
  • GI: Nausea, vomiting, diarrhea, stomach aches
  • Muscles: Muscle tension, tremors, shakes
  • Skin: Sweating, tingling

Alcohol withdrawal occurs because your brain works much like a spring. Alcohol is a brain depressant that pushes down on the spring. When you suddenly stop drinking it is like taking the weight off the spring. The spring rebounds, your brain produces excess adrenaline that causes withdrawal symptoms.

Five Serious Alcohol Withdrawal Symptoms

  • Grand mal seizures
  • Heart attacks
  • Strokes
  • Hallucinations
  • Delirium tremens (DTs)

If you suddenly stop drinking frequent or large amounts of alcohol, you may be at risk of a seizure, stroke, or heart attack. A medically supervised detox can minimize your withdrawal symptoms and reduce the risk of dangerous complications.

Alcohol Detox (Detoxification) to Prevent Withdrawal

Most severe alcohol withdrawal symptoms occur in the first three to four days after stopping drinking. Detoxification involves taking a short course of medication to help reduce or prevent withdrawal symptoms. Medications such as Valium (diazepam), Librium (chlordiazepoxide), or Ativan (lorazepam), members of the benzodiazepine family, are usually used for detox.

Detox can be done as either an inpatient or outpatient depending on the person’s health, their volume of drinking, and their past history of withdrawal.

The Neuroscience Behind Alcohol Withdrawal

What happens in the brain during alcohol withdrawal? GABA (gamma-aminobutyric acid) is the main calming neurotransmitter of the brain. GABA and adrenaline are supposed to be in balance during normal brain functioning. Frequent drinking causes the brain to produce less GABA, because the brain begins to rely on alcohol for part of its calming. So, frequent drinking causes your brain chemistry to be out of balance with an excess of adrenaline. When you suddenly stop drinking, your brain doesn’t have enough GABA neurotransmitter to balance the excess of adrenaline, which causes withdrawal symptoms.

Alcohol Abuse and Alcoholism Treatment

If you have decided you have an alcohol problem, there is help and hope. Self-help groups, online groups, your physician, counsellor, alcohol rehab, and websites like this are all potential supports.

Using supports helps you feel like you’re not alone. They give you confidence that you can change. They show you techniques that have worked for others. Asking for help and using supports dramatically increases your chances of success.

Learn more about treatment recovery skills and relapse prevention through these links. You can change your life. Below are the various kinds of alcohol addiction supports that exist.

Self-Help Groups

Addiction self-help groups are an important resource of recovery for two reasons. First, they're effective. Millions of people have recovered through them. Second, they're free and universally available.

You feel like you’re not alone. You meet people who are going through the same thing. Addiction is an isolating disease. Self-help groups give you the chance to reach out and receive help.

You believe that recovery is possible. You see that other people have recovered from addiction, and you develop confidence that you can also change your life.

You won't be judged. It’s probably difficult for you to talk about your drinking, because you're afraid nobody will understand you and they'll criticize you. So you bottle everything up inside, which makes you feel more guilt and shame, and makes you want to drink even more. The people at a self-help group won't judge you because they've heard it all before. They've done it all before. They know you're not crazy. You're addicted.

For more information, here is a list of recommended links to addiction self-help groups.

Alcohol Counseling

The first step in recovery is deciding if you have a problem. This can be difficult, because your addicted-self will try hard to convince you that you don't have a problem. This is where a trained professional can gently help. They can keep you from tricking yourself and prevent you from slipping back into denial. They are trained to look for signs of trouble.

Counselors and health professionals can also help maintain your motivation for change, which is so important in the journey of recovery. They can act like your personal trainer. Counselors and health professionals can help you develop healthy coping skills so that you won’t be tempted to turn to drugs or alcohol to self-medicate.

For more information, here is a list of addiction counselors, therapists, psychologists, psychiatrists, and addiction physicians, listed by country. Each website has a directory or health professional register for finding help in your area.

Alcohol Rehab (Rehabilitation)

There is a wide range of alcohol rehab programs, including inpatient, outpatient, day-patient, and evening programs. Inpatient rehab facilities are the most structured. Generally, these programs run for 30, 60, or 90 days. There is a benefit to stepping out of your environment so that you can completely focus on recovery without any distractions, as in an inpatient program. However, that is not an option for many people.

How Can Rehab Help?

Overcoming substance abuse requires learning new knowledge and skills. These are some of the skills you can learn in a rehab program:

  • How to handle cravings
  • Relaxation and stress management
  • How to change your negative inner dialog with cognitive therapy
  • Identifying your high-risk situations
  • Relapse prevention techniques

Most addiction rehab programs have at least a one-year aftercare component that provides support as you practice applying your new skills in your everyday life.

Alcoholism Treatment with Medication

There are three medications that can help you overcome alcoholism:

  • Antabuse (disulfiram)
  • Campral (acamprosate).
  • ReVia (naltrexone)

Antabuse is the most studied of these three. Clinical trials have shown that Antabuse, and to a lesser extent acamprosate and naltrexone can help:

  • Reduce craving for alcohol [9]
  • Reduce the risk of relapse.[10, 11]

How to Help Someone with an Alcohol Problem

What You Can Do: Advice for Family and Friends

If someone you love has a drinking problem, you may be struggling with how to help them and how to avoid being overwhelmed. You are probably feeling a combination of anger, fear, shame, and sometimes even guilt. At times, it may seem easier to ignore the problem. But denying it will only cause more damage to you, your family, and the person drinking. I hope some of these suggestions will help.

10 Things You Can Do to Help Someone with Alcoholism

  • Educate yourself on addiction and recovery.
  • Tell the person that it is hard for you to raise the topic of their drinking, but you are concerned. You care about them. Let them know what their drinking is also doing to your family.
  • Try not to accuse or judge. Avoid name calling. This is a difficult time for both of you.
  • Provide a sober environment that reduces the triggers for using.
  • Provide enough time for recovery activities. Don’t expect them to stay sober without outside help. Meetings, counselling, rehab, aftercare all take time. Recovery is the foundation on which they will build their life. All other activates are secondary.
  • Understand that your lives will change. Do not wish for your old life back. You both need to create a new life where it is easier to not use alcohol and drugs.
  • Make sure that you both have fun. People use alcohol to escape, relax, and reward themselves. The alcoholic needs to find alternative ways to escape, relax, and reward themselves, otherwise they will turn back to their addiction.
  • Set boundaries that you all agree on. The goal of boundaries is to improve the health of the whole family. Do not use boundaries to punish or shame.
  • If you want to provide financial support, buy the goods and services the person needs instead of giving them money that they might use to buy alcohol.
  • Recognize and acknowledge the potential the person has within them.

8 Things Not To Do

  • Don’t be surprised if the person is defensive.
  • If possible, try not to be negative when dealing with them. That will only increase their feelings of guilt and shame, and may push them further into drinking.
  • Try not to punish, threaten, bribe, or preach. That may make them more defensive.
  • Do not enable. Do not provide excuses or cover up for them.
  • Do not shield them from the consequences of their drinking. People are more likely to change if they have suffered enough negative consequences.
  • Do not argue or try to discuss things with the person when they are under the influence. It won’t get you anywhere.
  • Don't try to drink along with them.
  • Don’t blame yourself. Remember the “three C’s” of dealing with an addict: You didn't Cause the addiction, You can't Control the addiction, You can't Quit drinking for them.

Things You Can Do For Yourself

  • Practice loving detachment. Discover how you can do that without feeling guilty and without being punitive?
  • Living with an alcoholic is exhausting. You also need time to recover.
  • Practice self-care. Discover what your needs are beyond the needs of the alcoholic. Discover how to take care of yourself even when the other person does not take care of themselves.
  • Avoid self-blame. You can’t control another person’s decisions, and you cannot force them to change.
  • Do not work harder than the person you’re trying to help. The best approach is to not do things for the alcoholic, but instead to be an example of balance and self-care.
  • Being a caretaker is not good for you or for them. Understand that there is only so much you can do.
  • Ask for help. Talk to a professional. Go to a support group. (Some support groups are listed below.)

More Mental Health Information …

The book “I Want to Change My Life.” contains more information on how to overcome anxiety, depression, and addiction.


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  2. Bush, B., Shaw, S., Cleary, P., Delbanco, T. L., et al., Screening for alcohol abuse using the CAGE questionnaire. Am J Med, 1987. 82(2): p. 231-5.
  3. American Psychiatric Association, DSM-5 The Diagnostic and Statistical Manual of Mental Disorders. 5 ed, ed. D. Kupfer: American Psychiatric Association.
  4. National Institute of Alcohol Abuse and Alcoholism, Helping Patients Who Drink Too Much: A Clinicians Guide, 2005.
  5. Dawson, D. A., Grant, B. F., & Li, T. K., Quantifying the risks associated with exceeding recommended drinking limits. Alcohol Clin Exp Res, 2005. 29(5): p. 902-8.
  6. US Health and Human Services, Dietary Guidelines for Americans 2015-2020, 2015.
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  8. Meilman, P. W., Presley, C. A., & Cashin, J. R., Average weekly alcohol consumption: drinking percentiles for American college students. J Am Coll Health, 1997. 45(5): p. 201-4.
  9. Petrakis, I., Ralevski, E., Nich, C., Levinson, C., et al., Naltrexone and disulfiram in patients with alcohol dependence and current depression. J Clin Psychopharmacol, 2007. 27(2): p. 160-5.
  10. Krampe, H., Stawicki, S., Wagner, T., Bartels, C., et al., Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome. Alcohol Clin Exp Res, 2006. 30(1): p. 86-95.
  11. De Sousa, A., & De Sousa, A., A one-year pragmatic trial of naltrexone vs disulfiram in the treatment of alcohol dependence. Alcohol Alcohol, 2004. 39(6): p. 528-31.
Last Modified:July 12, 2021