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Alcohol use disorder: signs, causes and treatment
How to tell when drinking has become alcohol use disorder, why it happens, and the treatments that work, from therapy to medication.
Earl Johns, MSN, PMHNP-BC
Board-certified psychiatric nurse practitioner and founder of Wellthy Psychiatry & Wellness
✓ Medically reviewed by Earl Johns, MSN, PMHNP-BC
Photos are illustrative and don’t show actual patients.
Alcohol use disorder, often called alcoholism, is a medical condition, not a character flaw. It ranges from mild to severe, and it’s very treatable.
What counts as alcohol use disorder
Clinicians look for 11 signs over the past year. Two or three signs is mild, four or five is moderate, and six or more is severe.
Common signs include drinking more or longer than you meant to, trying to cut back without success, and spending a lot of time drinking or recovering. Others are cravings, falling behind at work or home, and giving up activities you used to enjoy.
Needing more alcohol to feel the same effect, and having withdrawal symptoms like shakiness, sweating, anxiety or poor sleep as it wears off, are also signs.
What raises the risk
Family history, starting young, trauma, ongoing stress, and conditions like depression, anxiety and ADHD all raise the risk. For LGBTQ+ people, minority stress and social lives built around bars can add to it.
How much is heavy drinking?
In the US, a standard drink is 12 ounces of beer, 5 ounces of wine or 1.5 ounces of spirits. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy drinking as more than 4 drinks on any day or 14 a week for men, and more than 3 on any day or 7 a week for women.
Treatment works
Effective options include therapy such as CBT and motivational interviewing, peer support like SMART Recovery or AA, and medications such as naltrexone or acamprosate. Treating depression, anxiety or ADHD at the same time often makes recovery easier.
Don’t stop suddenly after heavy daily drinking
If you drink heavily every day, stopping abruptly can cause dangerous withdrawal, including seizures. Talk with a clinician first so you can taper or detox safely.
Free, confidential help is available 24/7 from SAMHSA’s National Helpline at 1-800-662-4357.
A gentle next step
Wellthy Psychiatry offers judgment-free, LGBTQ+ affirming care by telehealth across California. A free 15-minute phone consult is an easy way to see if we’re a good fit.
This article is for general education and isn’t medical advice. If you’re in crisis, call or text 988, the Suicide & Crisis Lifeline, or call 911.
About the author
Earl Johns, MSN, PMHNP-BC
Board-certified psychiatric nurse practitioner · UCSF-trained · Founder of Wellthy Psychiatry & Wellness
Earl provides LGBTQ+ and neurodivergent-affirming psychiatric care, blending medication management, therapy and whole-person approaches. His background includes inpatient psychiatry and community mental health at Glenn County Behavioral Health and Equity Health, a federally qualified health center. He sees clients in San Francisco and by telehealth across California.
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