Alcohol Use Disorder

Understanding Alcohol Use Disorder

Alcohol use disorder is associated with excessive and uncontrollable drinking that significantly affects a person’s ability to go about their normal activities at work and home, and which can have a severe impact on their overall health.

Alcohol use disorder overview

People with alcohol use disorder consume alcohol in large amounts, which affects how they behave and can cause serious health issues.1 People with the disorder are often aware of the harm it is causing, but still find it difficult to reduce their drinking.1

 

Long-term exposure to alcohol is thought to cause changes in the brain circuits involved in reward, motivation, memory, and self-control, which increase a person’s drive to consume alcohol.2 A person with alcohol use disorder can no longer feel the pleasurable effects of drinking, and yet they find themselves craving alcohol.3 Individuals therefore drink to avoid the effects associated with alcohol withdrawal (‘negative reinforcement’), rather than to feel pleasure (‘positive reinforcement’).3

Facts About Alcohol Use Disorder

Alcohol use disorder is associated with excessive and uncontrollable drinking that significantly affects a person’s ability to go about their normal activities at work and home, and which can have a severe impact on their overall health. The burden on loved ones, health-care services, and the wider community can be considerable.

A person with alcohol use disorder will normally want to reduce their drinking, but is unable to because of cravings and withdrawal symptoms, such as feeling sick or anxious.3

Symptoms

Core signs of alcohol use disorder are that a person is drinking large amounts of alcohol, for longer periods than intended, and that this is having a significant impact on their ability to go about normal daily activities.1 A person with alcohol use disorder will normally want to reduce their drinking, but is unable to because of cravings and withdrawal symptoms, such as feeling sick or anxious.1

 

A person’s drinking can lead to them neglecting their responsibilities at home, such as child care or doing the chores, and missing days at work.1 They may continue to drink alcohol even when it puts themselves or others in danger, for example, by driving or operating machinery under the influence of alcohol.1

 

Physical symptoms of alcohol use disorder may include shaking, difficultly walking, and difficulty sleeping.1 Severe alcohol use disorder is associated with higher rates of suicidal thoughts and attempts.1

107 million

people worldwide suffer from alcohol use disorder.1

26 years

is the average age of onset.2

Epidemiology and burden

Worldwide, 107 million people suffer from alcohol use disorder.4 Alcohol consumption varies according to religious and cultural attitudes, and tends to be higher in high-income countries.5 Alcohol use disorder normally develops in people’s 20s and 30s, although affected individuals typically start to drink too much in their mid-teens.1,6 Men are twice as likely to have alcohol use disorder as women.6

 

Alcohol consumption is a causal factor in more than 200 disease and injury conditions, including mental and behavioral disorders, liver cirrhosis, cancer, and cardiovascular disease.7 In a multinational survey, 77% of people with alcohol use disorder suffered from at least one comorbid condition.8

 

Alcohol use is the seventh biggest risk factor for early death and disability worldwide, accounting for 2.2% of all deaths in women and 6.8% of all deaths in men.5 Among people aged 15–49 years, alcohol use is the leading risk factor for premature death, responsible for 3.8% of deaths in women and 12.2% of deaths in men.5 Many of these deaths are from injuries relating to road traffic accidents and violence.7

 

A global survey by the World Health Organization (WHO) found that people with alcohol use disorder miss an average of two extra days of work or activities per year.9 The disorder affects a person’s mental health, emotions, and relationships with their partner, family, and colleagues.6

Facts About Alcohol Use Disorder

Alcohol use is the seventh leading risk factor for early death and disability worldwide.4

Among people aged 15–49 years, 3.8% of deaths in women and 12.2% of deaths in men can be attributed to alcohol.4

People who are concerned that they – or their loved ones – are experiencing symptoms of alcohol use disorder should see their doctor for help and advice.

Diagnosis and care

People who are concerned that they – or their loved ones – are experiencing symptoms of alcohol use disorder should see their doctor for help and advice. Alcohol use disorder can be diagnosed after discussion with a doctor about a person’s habits and behaviors with alcohol, as well as looking at any physical symptoms that may be present.1

 

An important part of the treatment of alcohol use disorder is setting a treatment goal, which can include abstinence or reduction. Whereas abstinence provides the greatest health benefits, many people are reluctant or unable to stop drinking altogether, and the option of reducing alcohol consumption may be an alternative way to reduce the harms associated with alcohol use.10

 

Alcohol use disorder has the widest treatment gap (i.e., proportion of untreated patients) of all mental disorders; only one in five of those with alcohol use disorder will seek treatment.6,11 Many people avoid treatment because they feel there is a stigma surrounding the disorder.12 Support groups are an important part of treatment for alcohol use disorder, both for the individual and their loved ones. Of those who do receive treatment, many make a recovery in the long-term.13

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
  2. Volkow ND, Fowler JS, Wang GJ. The addicted human brain viewed in the light of imaging studies: brain circuits and treatment strategies. Neuropharmacology. 2004;47(Suppl 1):3–13.
  3. Gilpin NW, Koob GF. Neurobiology of alcohol dependence. Alcohol Res Health. 2008;31(3):185–195.
  4. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–1858.
  5. GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10152):1015–1035.
  6. Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, et al. Epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72(8):757–766.
  7. World Health Organization. Alcohol fact sheet. 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/alcohol [accessed 26 September 2019].
  8. Odlaug BL, Gual A, DeCourcy J, Perry R, Pike J, Heron L, Rehm J. Alcohol dependence, co-occurring conditions and attributable burden. Alcohol Alcohol. 2016;51(2):201–209.
  9. Alonso J, Petukhova M, Vilagut G, Chatterji S, Heeringa S, Üstün TB, et al. Days out of role due to common physical and mental conditions: results from the WHO World Mental Health surveys. Mol Psychiatry. 2011;16(12):1234–1246.
  10. Ambrogne JA. Reduced-risk drinking as a treatment goal: what clinicians need to know. J Subst Abuse Treat. 2002;22(1):45–53.
  11. Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82(11):858–866.
  12. Keyes KM, Hatzenbuehler ML, McLaughlin KA, Link B, Olfson M, Grant BF, Hasin D. Stigma and treatment for alcohol disorders in the United States. Am J Epidemiol. 2010;172(12):1364–1372.
  13. Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ. Recovery from DSM-IV alcohol dependence: United States, 2001–2002. Addiction. 2005;100(3):281–292.

  1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–1858.
  2. Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, et al. Epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72(8):757–766.
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
  4. GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10152):1015-1035.

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