Alcoholism (alcohol-use disorder)

Your health expert: Dr Luke Powles, Clinical Director, Health Clinics Bupa Global and UK
Content editor review by Dr Kristina Routh, March 2022
Next review due March 2025

Problem drinking is when you regularly drink more than the recommended limits of alcohol. This can harm your mental and physical health and cause problems at home and at work. You may come to rely on alcohol and keep drinking even though it’s causing you harm. Doctors call this ‘alcohol-use disorder’, and you may also hear the term ‘alcoholism’.

If you think that you may be having problems with alcohol, contact a GP. They can talk to you about your drinking and help you get the help and support you need.

About alcohol-use disorder

Many people enjoy a drink of alcohol from time to time, with few ill effects. It may be part of your normal social life. There are national guidelines to help you drink safely and sensibly.

But some people struggle to control their drinking and alcohol becomes an important part of their lives. Their drinking habits, or their behaviour when drinking causes problems for them and for those around them. Alcohol may affect their mental or physical health. See our section on Complications of alcohol-use disorder for more information about this.

If you think you may have a problem with alcohol, you’re not alone. GPs see many patients in their surgeries who drink enough alcohol to cause themselves harm. As many as one in 10 people are thought to become dependent on alcohol at some point in their lives.

You may see lots of different terms used to describe problems with alcohol. These include alcohol dependency, alcoholism, harmful drinking, alcohol misuse and alcohol abuse. And alcohol-use disorder can be described as mild, moderate or severe. But what will be of importance to you is the way that your drinking affects your life, and how you can be supported to reduce the harm that alcohol is causing.

If you need help now

This page is designed to provide general health information. If you need help now, please use the following services.

Samaritans. 116 123 (UK and ROI) - This helpline is free for you to call and talk to someone.
NHS Services has a list of where to get urgent help for mental health.
Mind website. Click the ‘Get help now’ button on the page. This is a tool that is designed to help you understand what’s happening to you and how you can help yourself.

If you think you might harm yourself or are worried someone else might come to immediate harm, call the emergency services on 999 or go to your local accident and emergency department.

Symptoms of alcohol-use disorder

It can be difficult to be sure whether you have problems with drinking. You may think of yourself more as someone who ‘likes a drink’ than having a problem with it. And it can be hard to admit, to yourself and others, that you’re drinking too much.

Watch out for symptoms of problem drinking, which may include the following.

Secrecy. You may underestimate how much you drink or are secretive about drinking. You may even become angry when asked about it.
Drinking increasing amounts. You may be drinking more and more over time to get the same effects. This is called alcohol tolerance.
Needing alcohol. You may become agitated and anxious when alcohol isn’t available.
Alcohol becoming all-important. You may lose interest in activities and hobbies you used to enjoy as alcohol becomes the most important thing in your life.
Not being able to stop. You keep drinking alcohol, even though you feel it’s doing you harm.

If alcohol is causing difficulties with relationships, work, physical or mental health, then you should seek medical help.

There are specific questions that doctors ask to diagnose alcohol-use disorder. These are listed below in the section on diagnosis.

Diagnosing alcohol-use disorder

If you’re worried about your drinking, the first step is to contact a GP. Or your doctor may ask you about it when you are seeing them for something else.

If the doctor thinks you might have an alcohol problem, here are some questions they might ask you.

How often do you have a drink that contains alcohol?
How many standard alcoholic drinks do you have on a typical day when you are drinking?
How often do you have six or more standard drinks on one occasion?
How often in the last year have you found you were not able to stop drinking once you had started?
How often in the last year have you failed to do what was expected of you because of drinking?
How often in the last year have you needed an alcoholic drink in the morning to get you going?
How often in the last year have you had a feeling of guilt or regret after drinking?
How often in the last year have you not been able to remember what happened when drinking the night before?
Have you or someone else been injured as a result of your drinking?
Has someone been concerned about your drinking, or have you been advised to cut down?

The doctor will use your answers to these questions to check whether you have problem drinking, and how severe it is.

Your doctor may also examine you, because alcohol can cause particular medical problems, such as liver disease. They may arrange blood tests. They will also talk to you about how you’ve been feeling, to check for mental health conditions such as depression.

If you’re worried about someone else’s drinking

You may be concerned about someone else’s drinking, having recognised some of the things listed in our ‘symptoms’ section.

If you’re concerned about a loved one’s drinking, the best thing is to encourage them to seek help from a GP. If you decide to talk to them about their drinking, the following tips may help.

Choose somewhere safe, comfortable and private to talk.
When deciding what to say, think about how you would want someone to talk to you about your alcohol drinking.
Recognise that they may already be feeling bad about their drinking. Avoid criticism or sounding as though you’re judging them.
Make sure that neither of you has been drinking before you talk.
Try to sound concerned rather than disapproving. You could say you’re worried about their health and ask them to talk to a GP about it.
You may find it helpful to get advice and support yourself, before you speak with your loved one. See our section ‘Other helpful websites’ for organisations which can help.
Remember that a person needs to accept that there is a problem and want to change before treatment can work. Knowing that they have your support might be what they need to take the first step.

Treatment for alcohol-use disorder

If you’re concerned about problem drinking, your treatment options will depend on how much you drink and how much you depend on alcohol. You’re more likely to be successful at overcoming alcohol problems with support. It may be your GP who plans and monitors your treatment. Or, more likely, it will be a healthcare professional specialising in alcohol problems. We’ll just use the word ‘doctor’ below, for convenience.

Your doctor will talk to you about your drinking to get a full picture of how it’s affecting you. They’ll need to know how motivated you are to address your problems. Then they’ll discuss a treatment plan with you, help you set goals and monitor your progress. It’s important that you’re fully involved in your treatment.

Reducing or stopping alcohol drinking

It’s your decision whether to stop drinking alcohol altogether (abstinence) or to just drink less (moderation).

If you’ve become dependent on alcohol, or it’s harming your mental or physical health, it’s best to stop drinking alcohol completely. If you only have a mild problem with alcohol, you may consider just reducing how much you drink. If so, support from family or friends may help to stop your drinking creeping up again.

If you’re dependent on alcohol, stopping suddenly can be dangerous. Sudden withdrawal from alcohol can cause medical problems, including seizures. Your alcohol specialist or doctor can advise on how to stop drinking alcohol safely. Some people can manage this at home, but some need to do this in hospital. Medicine may be recommended to ease any withdrawal symptoms. This is usually a medicine called chlordiazepoxide. Or your doctor may recommend diazepam (Valium), especially if you’re in hospital.

Talking therapies

Once you’ve got the alcohol out of your system, you may be offered a ‘talking therapy’. The aim of this therapy is to help you maintain the change you’ve made to your drinking. Talking with a therapist may help you:

talk about what things in your life make you want to drink
cope with stress, and the situations that make you drink
form positive relationships that don’t revolve around drinking

It may be helpful to involve your partner, if you have one, and see the therapist together.

Medicines to help stop you from drinking again

There are some medicines that can help a person not to drink. These medicines work in the following ways.

Medicines, such as naltrexone, acamprosate and nalmefene help stop you craving alcohol.
Disulfiram (Antabuse) reacts with alcohol to make you feel sick, flushed and have palpitations if you do drink.

Your doctor may recommend one of these as part of your treatment. Ask your doctor to explain the possible side-effects of any medicine they offer. And always read the patient information leaflet that comes with your medicine.

Support groups

There are many support groups for people with problem drinking, both in the NHS and through charities. Examples include Alcoholics Anonymous (AA) and Self-management and Recovery Training (SMART). There is more information in our sections on ‘Support’ and ’Other helpful websites’. A GP or therapist will be able to tell you about groups in your area.

Relapse

As with a lot of other addictions, it can take several attempts to give up alcohol for good. That isn’t to say that this will happen to you. But it’s best to be prepared. Your doctor will talk to you about this and make sure you both have a plan in place to deal with a relapse if it should happen. It may be helpful to discuss it with your therapist too.

Causes of alcohol-use disorder

Like many conditions, alcoholism has multiple causes. Men are more likely to be heavy drinkers. Your genes have some effect on whether you develop alcohol-use disorder. But there are also often psychological and social factors. People with alcohol-use disorder often have mental health problems, such as depression or anxiety. And the amount you drink may be linked to your environment – for instance, drinks industry workers are likely to drink more.

Complications of alcohol-use disorder

There are many health risks from drinking alcohol because it affects just about all systems of the body.

Drinking excessive amounts of alcohol can cause:

mental health problems
diseases of the digestive tract, including liver disease
cancers of the liver, oesophagus, stomach, mouth, tongue and throat
heart problems and high blood pressure
damage to nerves in the brain and elsewhere in the body

Support for people with alcohol problems

If you have alcohol-use disorder, it can be difficult to give up drinking. You may need help from your family and friends to support you. You may also find it helpful to join a support group. There, you’ll be able to talk to people who are going through the same thing as you.

As well as those within the NHS, there are charitable alcohol support groups all over the country that you can join. The best known is probably Alcoholics Anonymous (AA). But there are others, including one called SMART Recovery. There are also groups, such as Al-Anon Family Groups, which support the families of those with problem drinking.

You can ask a GP or your therapist if they know of local alcohol support groups. And you can search online through the NHS website. See our section ‘other helpful websites’ below for organisations that can help you find the support you need.

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If you’re concerned that someone you care about is drinking too much, it’s natural to want to help them. The best thing to do is encourage them to see a GP. Their drinking can then be assessed properly. For tips and advice on how to have the conversation with them, see our section ‘If you’re worried about someone else’s drinking’. But remember, a person needs to accept that they have a problem with alcohol, and want to change, before treatment can work.

You may have a problem if you’re regularly drinking more than the recommended limits of alcohol. Alcohol may be harming your mental or physical health, or your drinking habits may be causing problems at home or work. If you’re not sure whether you have a problem with alcohol, see our Symptoms section for things to watch out for. If you’re concerned, contact a GP. They can talk to you about your drinking, and help you get the support you need to stop or reduce your drinking.