Alcohol use disorder

Alcohol is part of many family meals, holidays and friendships. For most adults who drink, it never becomes a problem. For some, drinking slowly takes over. They want to stop or cut back and find they cannot. That is called alcohol use disorder, or AUD. It is a health condition, not a weakness of character.¹

AUD is common. In 2024, about 27 million U.S. adults, roughly 1 in 10, had it in the past year.² It can be mild, moderate or severe, and help works at every level. This page covers what counts as a drink, how alcohol affects the body, why stopping suddenly can be dangerous, and how to change your drinking safely. It is part of our substance use section.

What is alcohol use disorder?

AUD means a person has trouble stopping or controlling alcohol use even though it is causing harm to health, work, money or relationships.¹ You may hear older words like alcoholism, alcohol abuse or alcohol dependence. AUD is the current medical term for all of them.¹

Doctors count how many of 11 signs a person has had in the past year. Having 2 or 3 signs is mild AUD, 4 or 5 is moderate, and 6 or more is severe.¹ The signs include:¹

• Drinking more, or for longer, than you planned.
• Trying to cut down and not being able to.
• Spending a lot of time drinking or recovering from it.
• Strong cravings, or a pull toward alcohol.
• Missing home, work or school duties, or drinking even though it hurts relationships.
• Giving up activities you enjoyed, or drinking in risky situations such as before driving.
• Drinking even though it is hurting your health or mood.
• Tolerance, which means needing more to feel the same effect.
• Withdrawal, which means feeling sick or shaky when alcohol wears off.

If some of these sound familiar, you are not alone, and it is worth talking with someone. Our page on signs of a substance use problem has short screening questions. Being able to "hold your liquor" is not a protection. It is a reason for more caution.⁷

Risk comes from several places. About 60 percent of the risk is inherited. Starting to drink at a young age, depression, PTSD, ADHD and childhood trauma all raise the chance of AUD.¹

What counts as a drink, and how much is too much?

A U.S. standard drink holds about 0.6 ounces (14 grams) of pure alcohol. These all count as one drink:³

A large wine pour or a strong craft beer can hold two drinks or more. A 750 ml bottle of wine holds about 5 drinks. Measure 5 ounces of wine at home once to see how a glass really looks.^4,7

What do the experts say about limits? There is no amount of alcohol that is guaranteed safe, and less is better.⁴ The U.S. Dietary Guidelines for 2025 to 2030 say to "consume less alcohol for better overall health." They no longer give a daily number. They also say some people should not drink at all, including people recovering from AUD, people who cannot control how much they drink, and people who take medicines or have health conditions that interact with alcohol.⁶

For comparison, the CDC describes moderate drinking as no more than 1 drink a day for women and 2 for men.⁵ These are not targets. They are the point where risk starts to climb.

• Binge drinking is 4 or more drinks for a woman, or 5 or more for a man, within about 2 hours.⁴
• Heavy drinking is 8 or more drinks a week for a woman, or 15 or more for a man, or 4 or 5 or more on any day.⁴

How does alcohol affect health?

Over time, heavy drinking can harm nearly every part of the body. Here is what researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) report:⁸

• Liver. Fatty liver is very common in heavy drinkers and can fully heal if a person stops. Continued drinking can lead to inflammation, scarring (cirrhosis) and liver cancer.
• Heart. Alcohol raises blood pressure, can cause irregular heartbeat (including atrial fibrillation), and can weaken the heart muscle. Reducing intake can improve heart function.
• Cancer. Alcohol is linked to cancers of the mouth, throat, voice box, esophagus, colon, rectum, liver and breast. About 1 drink a day is linked to a 5 to 15 percent higher breast cancer risk.
• Pancreas. Alcohol is a leading cause of long-lasting pancreas inflammation, which can cause pain and trouble digesting food.
• Brain and nerves. Heavy use can damage the brain, cause memory and thinking problems, and add to the risk of dementia. Some of this may partly improve after a person stops. Low vitamin B1 (thiamine) can cause a brain emergency called Wernicke's encephalopathy, and later a lasting memory loss called Korsakoff syndrome.
• Bones, stomach and infection. Alcohol raises the risk of fractures, stomach bleeding and pneumonia.

Drinking is also tied to injuries, car crashes, falls, burns and violence.⁵ It is also linked to depression and anxiety, even though some people drink to cope with them.⁵ It can disturb sleep too.

Here is the hopeful part. Many of these harms ease when a person drinks less or stops. Drinking less lowers risk.⁵

Why withdrawal can be dangerous

When a body gets used to alcohol, it works harder to stay alert. If the alcohol suddenly stops, the body stays "revved up." That is withdrawal. More than half of people with AUD have some withdrawal symptoms when they stop or cut back.⁹ A smaller group, about 3 to 5 percent, have the most severe form.⁹

How it can unfold. Timing varies from person to person.^9,10

• Mild symptoms can begin as early as 6 hours after the last drink: shaky hands, anxiety, trouble sleeping, sweating, headache, upset stomach and a racing heart.
• Seizures are most likely in the first 12 to 48 hours. A seizure can happen even without other severe signs.
• Seeing or hearing things that are not there can start within about a day and often passes in a day or two.
• Delirium tremens (DTs) usually start about 2 to 4 days after the last drink, though they can start later. They bring sudden severe confusion, hallucinations, fever, heavy sweating and a fast heartbeat. DTs are a medical emergency and need a hospital stay.

Doctors can treat withdrawal with medicines and close monitoring, and treatment lowers the danger a great deal.^9,10 Never try to treat withdrawal at home with leftover sedatives or by drinking "just a little" to ease it. If you are in the hospital for another reason, tell the team how much you have been drinking so they can watch for withdrawal.¹⁰

Stopping sleeping pills or anti-anxiety pills suddenly can be dangerous too. Read more on cannabis, sedatives and stimulants.

Alcohol and your medicines

Alcohol can change how medicines work, or add to their effects. This matters more as we age, because older adults often take several medicines and the body responds to alcohol and drugs differently.¹¹ Examples from NIAAA:¹¹

• Sleeping pills and anti-anxiety medicines (such as alprazolam, lorazepam, diazepam or zolpidem). Together with alcohol they add up to deep sedation, slowed breathing, falls and memory blackouts.
• Opioid pain medicines. Both slow breathing, and the combination can be deadly even at low amounts. Alcohol is involved in about 15 to 20 percent of opioid-related deaths. See opioids and overdose.
• Acetaminophen (Tylenol). Alcohol raises the risk of liver damage. The FDA advises avoiding alcohol while taking it.
• Ibuprofen, naproxen and aspirin. Alcohol adds to the risk of stomach bleeding.
• Warfarin and other blood thinners. Alcohol raises the risk of serious bleeding.
• Antidepressants. Alcohol can add to drowsiness and dizziness and may make the medicine work less well.

Always ask your doctor or pharmacist whether your medicines are safe with alcohol. Do not start, stop or change a medicine on your own. Our pages on alcohol, medicines and older adults and sleep medicines go deeper.

How can I cut down or stop safely?

The best first step is to talk with a doctor, nurse or pharmacist. You do not need to be sure you have a problem. Doctors talk about drinking all the time.

If you drink heavily or daily, or you have had withdrawal symptoms before, ask a doctor before you cut back, so any withdrawal can be managed safely.^1,9 Medical help is not a sign of failure. It is the safest way to begin.

If your drinking is lighter, these steps may help:

1. Write down why. Health, a family event, better sleep, more energy, saving money. Keep your reasons where you will see them.
2. Track your drinks for a week. Count real standard drinks. The numbers often surprise people.
3. Set a limit or a quit date, and tell someone you trust.
4. Change what is around you. Keep less alcohol at home. Plan other things to do at the times you usually drink.
5. Slow down. Sip water or a non-alcoholic drink between drinks, and eat first.
6. Plan for tough moments. Cravings usually fade if you wait. A walk, a call or a breathing exercise can help.

NIAAA offers free worksheets and a booklet called Rethinking Drinking, in English and Spanish, that walk through these steps.⁷ If cutting down does not work after a fair try, you may need more support. That is common.

If you slip, you have not failed. Most people need more than one try.

What treatment helps?

Treatment works, and the main kinds can be combined. Most care happens in outpatient settings, which means you live at home and go to appointments.^1,12

Our treatment and recovery page explains the levels of care and what to expect, including relapse as part of recovery. Many people recover, though setbacks are common.¹

If you are worried about someone else

You cannot force a person to change, but your support matters. Read helping a family member for approaches that work better than arguments. Take care of yourself too. Our care circle tool can help you share the load.

When to get help

• Call 911 for seizures, severe confusion, hallucinations, chest pain, trouble breathing, vomiting that will not stop after heavy drinking, or a person who is passed out and cannot be woken. Alcohol poisoning can slow breathing and the heartbeat.⁵
• Call or text 988 any time you or someone you love is thinking about suicide. It is free and open 24 hours a day. Drinking is linked to a higher risk of suicide.⁵ You can also make a safety plan.
• Call the SAMHSA National Helpline at 1-800-662-4357 for free, private help finding treatment. It is open 24 hours a day, every day, in English and Spanish.¹³
• See a doctor soon if you have tried and failed to cut down, if you drink to calm shaky hands, or if someone has told you they are worried.

For more support, see our help page.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.