Medical disclaimer: This article is for education only and isn’t a substitute for personal medical care. If someone has slow or irregular breathing, blue/gray skin, can’t be woken, has seizures, or seems very cold, call 911 (U.S./Canada)—these are signs of alcohol overdose.
What is Alcohol Use Disorder?
Alcohol Use Disorder (AUD) is a medical condition in which alcohol use leads to significant distress or problems at home, work, school, or health.
Clinicians use DSM-5-TR criteria — 11 possible symptoms over 12 months — and rate AUD as mild (2–3), moderate (4–5), or severe (6+) based on how many are present.
Symptoms include loss of control, cravings, risky use, role failures, and tolerance/withdrawal.
AUD is treatable. Many people improve with a mix of counseling, medication, and practical supports.
How alcohol affects the brain and body
Alcohol acts on reward, stress, and self-control circuits in the brain. Over time, repeated heavy use changes these circuits, making cutting down or stopping difficult without help. These changes also explain tolerance (needing more to get the same effect) and withdrawal (shaking, anxiety, insomnia, nausea when levels drop).
What counts as “a drink”?
- U.S. standard drink: 14 g of pure alcohol = 12 oz beer (5%), 5 oz wine (12%), or 1.5 oz spirits (40%).
- Canada standard drink: 13.45 g of pure alcohol = 341 mL beer (5%), 142 mL wine (12%), 43 mL spirits (40%).
Risk guidance (Canada, 2023):
- 0–2 drinks/week: likely to avoid alcohol-related consequences
- 3–6/week: cancer risk rises
- 7+/week: heart/stroke risk rises; each drink adds risk further
Plan with your clinician using this as a starting point.
Red flags: how to recognize a problem
Behavior and life impact
- Drinking more or longer than intended; repeated failed cut-down attempts
- Cravings; spending lots of time obtaining/using/recovering
- Problems at home/school/work; conflicts or isolation
- Drinking in risky situations (e.g., driving); continuing despite harm
- Tolerance and/or withdrawal symptoms (see next section)
These reflect the DSM-5-TR symptom set used to diagnose AUD.
Physical signs
- Hangovers, morning “eye-openers,” tremor, sweating, poor sleep, palpitations
- Stomach/liver issues; numbness/tingling; changes in memory/concentration
- During intoxication: slurred speech, unsteady gait, blackouts
Overdose (alcohol poisoning): call 911
- Confusion, inability to wake up, vomiting
- Slow breathing (<8/min) or gaps >10 seconds, seizures, very low body temperature, pale/blue skin.
Withdrawal: why abruptly stopping can be dangerous
After heavy, prolonged use, stopping suddenly can trigger withdrawal within hours: anxiety, shakiness, sweating, nausea, insomnia, and in some people seizures or delirium tremens (DTs)—a medical emergency that needs supervised care.
People with past severe withdrawal, seizures/DTs, major medical illness, or daily heavy use should seek medical guidance before stopping.
Alcohol + other drugs or medicines
Avoid alcohol with opioids (e.g., oxycodone, fentanyl) or benzodiazepines (e.g., alprazolam, clonazepam). Even hours apart, these combinations can slow or stop breathing. Many prescriptions and OTC meds also interact with alcohol (e.g., bleeding, liver damage, sedation). Ask your clinician or pharmacist.
Screening and self-checks (not a diagnosis)
- AUDIT / AUDIT-C are brief, validated tools used in primary care to flag risky drinking and possible AUD. Positive screens should be followed by a clinical assessment.
- USPSTF endorses short screens (e.g., AUDIT-C, single-question screen) for adults.
- Self-check website: NIAAA Rethinking Drinking offers quizzes and change-planning tools.
Treatment that works
Bottom line: Choose from a menu of evidence-based options—many people improve when medications and counseling are combined.
Evidence-based therapies
- Motivational Interviewing (MI) and Cognitive-Behavioral Therapy (CBT) help set goals, build coping skills, and prevent relapse. Contingency management (structured rewards for meeting goals) can augment care in some settings.
Medications for AUD (talk with a clinician)
- First-line: Naltrexone (daily pill or monthly injection) and Acamprosate help reduce heavy drinking and support abstinence. Disulfiram can be considered when supervised and abstinence is the goal. Authoritative guideline: APA Pharmacotherapy Guideline (2018); newer systematic reviews support efficacy, including extended-release naltrexone.
- Evidence snapshots:
- Acamprosate increases continuous abstinence vs. placebo in meta-analyses (Cochrane).
- Extended-release naltrexone reduces overall and heavy drinking days vs. placebo.
Medication choice depends on goals (cut down vs. abstain), medical history, other meds, and side-effect profiles. Your clinician can help tailor a plan. PubMed
Peer and family support
- Alcoholics Anonymous (A.A.) and other 12-step groups are widely available; SMART Recovery offers skills-based, secular groups; Moderation Management supports cut-down goals for some. Use these alongside professional care.
Harm-reduction: if you’re not ready to quit
- Set limits before you start; schedule alcohol-free days
- Pace & space: sip slowly, alternate with non-alcoholic drinks
- Eat before/during; avoid drinking when sleep-deprived or depressed
- Never drive after drinking; avoid mixing with sedatives/opioids
- Use standard drinks to track intake; check out the Rethinking Drinking change-plan and tips.
Special situations
- Pregnancy & trying to conceive: There’s no known safe amount of alcohol in pregnancy. Alcohol exposure can cause Fetal Alcohol Spectrum Disorders (FASDs). If stopping is hard, talk to a clinician—safe help is available.
- Teens/young adults, older adults, chronic pain, or co-occurring conditions (depression, anxiety, PTSD): integrated care improves outcomes. Ask providers about programs that can manage both substance use and mental health together.
How clinicians diagnose and plan care
Clinicians review DSM-5-TR symptoms, medical/psychiatric history, and goals. They may order labs when indicated, assess withdrawal risk, and recommend the level of care (e.g., outpatient vs. medically supervised withdrawal) and supports (therapy, medication, peer groups, recovery coaching). Expect shared decision-making—your goals matter.
Practical resources (U.S. and Canada)
United States
- 988 Suicide and Crisis Lifeline: Call/text 988 (24/7) for mental health or substance-use crises. (Note: the specialized “Press 3” LGBTQ+ youth option ended July 17, 2025; general 988 services continue.)
- FindTreatment.gov: A national locator for addiction/mental-health services.
- NIAAA Alcohol Treatment Navigator: A step-by-step guide to finding quality alcohol care.
- SAMHSA National Helpline: 1-800-662-HELP (4357) (24/7). SAMHSA
Canada
- 9-8-8 Suicide Crisis Helpline — call/text 988 (24/7, English/French). Canada.ca
- Government of Canada — Get help with substance use (links to provincial/territorial services). Canada.ca
- Provincial examples: CAMH (Ontario) programs & Access CAMH; ConnexOntario (1-866-531-2600) for 24/7 navigation to addiction/mental-health services. Canada.ca
References
- NIAAA Core Resource: AUD from risk to diagnosis to recovery; screening methods; alcohol–medication interactions; overdose. niaaa.nih.gov+3niaaa.nih.gov+3niaaa.nih.gov+3
- Standard drinks: NIAAA (U.S.); Health Canada/CCSA (Canada). niaaa.nih.gov+1
- Canada’s Guidance on Alcohol and Health (2023): risk by weekly drinks. CCSA
- Withdrawal emergencies: MedlinePlus (alcohol withdrawal; delirium tremens). MedlinePlus+1
- Medications for AUD: APA Pharmacotherapy Guideline (2018); systematic reviews for acamprosate and extended-release naltrexone. PubMed+2Cochrane+2
- Crisis/treatment navigation: 988 Lifeline (U.S.); FindTreatment.gov; Government of Canada mental-health/substance-use help. 988 Lifeline+2FindTreatment.gov+2