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On This Page

What is alcohol?

Alcohol is the common term for ethanol or ethyl alcohol, a chemical substance found in alcoholic beverages such as beer, hard cider, malt liquor, wines, and distilled spirits (liquor). Alcohol is produced by the fermentation of sugars and starches by yeast. Alcohol is also found in some medicines, mouthwashes, and household products (including vanilla extract and other flavorings). This fact sheet focuses on cancer risks associated with the consumption of alcoholic beverages.

According to the National Institute on Alcohol Abuse and Alcoholism, a standard alcoholic drink in the United States contains 14.0 grams (0.6 ounces) of pure alcohol. Generally, this amount of pure alcohol is found in

12 ounces of beer

8-9 ounces of malt liquor

5 ounces of wine

1.5 ounces, or a "shot," of 80-proof distilled spirits (liquor)

These amounts are used by public health experts in developing health guidelines about alcohol consumption and to provide a way for people to compare the amounts of alcohol they consume. However, they may not reflect the typical serving sizes people may encounter in daily life.

According to the federal government's Dietary Guidelines for Americans 2015-2020, individuals who do not drink alcohol should not start drinking for any reason. It recommends that if alcohol is consumed, it should be done in moderation and defines moderate alcohol drinking as up to one drink per day for women and up to two drinks per day for men. Heavy alcohol drinking is defined as having 4 or more drinks on any day or 8 or more drinks per week for women and 5 or more drinks on any day or 15 or more drinks per week for men. Binge drinking is defined as consuming 4 or more drinks for women and 5 or more drinks for men in one sitting (typically in about 2 hours).

What is the evidence that alcohol drinking can cause cancer?

There is a strong scientific consensus that alcohol drinking can cause several types of cancer ( 1, 2). In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen.

The evidence indicates that the more alcohol a person drinks-particularly the more alcohol a person drinks regularly over time-the higher his or her risk of developing an alcohol-associated cancer. Even light drinkers (those who have no more than one drink per day) and binge drinkers have a modestly increased risk of some cancers ( 3- 7). Based on data from 2009, an estimated 3.5% of cancer deaths in the United States (about 19,500 deaths) were alcohol related ( 8).

Clear patterns have emerged between alcohol consumption and the development of the following types of cancer:

Head and neck cancer: Moderate to heavy alcohol consumption is associated with higher risks of certain head and neck cancers. Moderate drinkers have 1.8-fold higher risks of oral cavity (excluding the lips) and pharynx (throat) cancers and 1.4-fold higher risks of larynx (voice box) cancers than non-drinkers, and heavy drinkers have 5-fold higher risks of oral cavity and pharynx cancers and 2.6-fold higher risks of larynx cancers (4, 9). Moreover, the risks of these cancers are substantially higher among persons who consume this amount of alcohol and also use tobacco (10).

Esophageal cancer: Alcohol consumption at any level is associated with an increased risk of a type of esophageal cancer called esophageal squamous cell carcinoma. The risks, compared with no alcohol consumption, range from 1.3-fold higher for light drinking to nearly 5-fold higher for heavy drinking (4, 9). In addition, people who inherit a deficiency in an enzyme that metabolizes alcohol have been found to have substantially increased risks of esophageal squamous cell carcinoma if they consume alcohol (11).

Breast cancer: Epidemiologic studies have consistently found an increased risk of breast cancer with increasing alcohol intake. Pooled data from 118 individual studies indicates that light drinkers have a slightly increased (1.04-fold higher) risk of breast cancer, compared with nondrinkers. The risk increase is greater in moderate drinkers (1.23-fold higher) and heavy drinkers (1.6-fold higher) (4, 9). An analysis of prospective data for 88,000 women participating in two US cohort studies concluded that for women who have never smoked, light to moderate drinking was associated with a 1.13-fold increased risk of alcohol-related cancers (mostly breast cancer) (5).

Colorectal cancer: Moderate to heavy alcohol consumption is associated with 1.2- to 1.5-fold increased risks of cancers of the colon and rectum compared with no alcohol consumption (4, 9, 14).

Numerous studies have examined whether there is an association between alcohol consumption and the risk of other cancers. For cancers of the ovary, prostate, stomach, uterus, and bladder, either no association with alcohol use has been found or the evidence for an association is inconsistent. However, evidence is accumulating that alcohol consumption is associated with increased risks of melanoma and of prostate and pancreatic cancers ( 4, 15).

Alcohol consumption has also been associated with decreased risks of kidney cancers ( 16- 18), and non-Hodgkin lymphoma ( 19, 20) in multiple studies. However, any potential benefits of alcohol consumption for reducing the risks of some cancers are likely outweighed by the harms of alcohol consumption. In fact, a recent study that included data from more than 1000 alcohol studies and data sources, as well as death and disability records from 195 countries and territories from 1990 to 2016, concluded that the optimal number of drinks to consume per day to minimize the overall risk to health is zero ( 21). That study did not include data on kidney cancer or non-Hodgkin lymphoma.

Alcohol consumption may also be associated with an increased risk of second primary cancers. For example, a meta-analysis of data from 19 studies showed that among patients with cancer of the upper aerodigestive tract (UADT)-which includes the oral cavity, pharynx, larynx, and esophagus-for every 10 grams of alcohol consumed per day before the first UADT cancer diagnosis there was a 1.09-fold higher risk of a second primary UADT cancer ( 22). It is less clear whether alcohol consumption increases the risk of second primary cancers at other sites, such as the breast ( 23- 25).

How does alcohol affect the risk of cancer?

Researchers have hypothesized multiple ways that alcohol may increase the risk of cancer, including:

metabolizing (breaking down) ethanol in alcoholic drinks to acetaldehyde, which is a toxic chemical and a probable human carcinogen; acetaldehyde can damage both DNA (the genetic material that makes up genes) and proteins

generating reactive oxygen species (chemically reactive molecules that contain oxygen), which can damage DNA, proteins, and lipids (fats) in the body through a process called oxidation

impairing the body's ability to break down and absorb a variety of nutrients that may be associated with cancer risk, including vitamin A; nutrients in the vitamin B complex, such as folate; vitamin C; vitamin D; vitamin E; and carotenoids

increasing blood levels of estrogen, a sex hormone linked to the risk of breast cancer

Alcoholic beverages may also contain a variety of carcinogenic contaminants that are introduced during fermentation and production, such as nitrosamines, asbestos fibers, phenols, and hydrocarbons.

The mechanisms by which alcohol consumption may decrease the risks of some cancers are not understood and may be indirect.

How does the combination of alcohol and tobacco affect cancer risk?

Epidemiologic research shows that people who use both alcohol and tobacco have much greater risks of developing cancers of the oral cavity, pharynx (throat), larynx, and esophagus than people who use either alcohol or tobacco alone. In fact, for oral and pharyngeal cancers, the risks associated with using both alcohol and tobacco are multiplicative; that is, they are greater than would be expected from adding the individual risks associated with alcohol and tobacco together ( 10, 26).

Can people's genes affect their risk of alcohol-related cancers?

A person's risk of alcohol-related cancers is influenced by their genes, specifically the genes that encode enzymes involved in metabolizing (breaking down) alcohol ( 27).

For example, one way the body metabolizes alcohol is through the activity of an enzyme called alcohol dehydrogenase, or ADH, which converts ethanol into the carcinogenic metabolite acetaldehyde, mainly in the liver. Recent evidence suggests that acetaldehyde production also occurs in the oral cavity and may be influenced by factors such as the oral microbiome ( 28, 29).

Many individuals of East Asian descent carry a version of the gene for ADH that codes for a "superactive" form of the enzyme. This superactive ADH enzyme speeds the conversion of alcohol (ethanol) to toxic acetaldehyde. Among people of Japanese descent, those who have this form of ADH have a higher risk of pancreatic cancer than those with the more common form of ADH ( 30).

Another enzyme, called aldehyde dehydrogenase 2 (ALDH2), metabolizes toxic acetaldehyde to non-toxic substances. Some people, particularly those of East Asian descent, carry a variant of the gene for ALDH2 that encodes a defective form of the enzyme. In people who produce the defective enzyme, acetaldehyde builds up when they drink alcohol. The accumulation of acetaldehyde has such unpleasant effects (including facial flushing and heart palpitations) that most people who have inherited the ALDH2 variant are unable to consume large amounts of alcohol and therefore have a low risk of developing alcohol-related cancers.

However, some individuals with the defective form of ALDH2 can become tolerant to the unpleasant effects of acetaldehyde and consume large amounts of alcohol. Epidemiologic studies have shown that such individuals have a higher risk of alcohol-related esophageal cancer, as well as of head and neck cancers, than individuals with the fully active enzyme who drink comparable amounts of alcohol ( 31). These increased risks are seen only among people who carry the ALDH2 variant and drink alcohol-they are not observed in people who carry the variant but do not drink alcohol.

Can drinking red wine help prevent cancer?

The plant secondary compound resveratrol, found in grapes used to make red wine and some other plants, has been investigated for many possible health effects, including cancer prevention. However, researchers have found no association between moderate consumption of red wine and the risk of developing prostate cancer ( 32) or colorectal cancer ( 33).

What happens to cancer risk after a person stops drinking alcohol?

Most of the studies that have examined whether cancer risk declines after a person stops drinking alcohol have focused on head and neck cancers and on esophageal cancer. In general, these studies have found that stopping alcohol consumption is not associated with immediate reductions in cancer risk. The cancer risks eventually decline, although it may take years for the risks of cancer to return to those of never drinkers.

For example, ex-drinkers still had higher risks of oral cavity and pharyngeal cancers than never drinkers even 16 years after they stopped drinking alcohol, although it was lower than before they stopped drinking ( 34). One study estimated that it would take more than 35 years for the higher risks of laryngeal and pharyngeal cancers associated with alcohol consumption to decrease to the level of never drinkers.

Is it safe for someone to drink alcohol while undergoing cancer chemotherapy?

As with most questions related to a specific individual's cancer treatment, it is best for patients to check with their health care team about whether it is safe to drink alcohol during or immediately following chemotherapy treatment. The doctors and nurses administering the treatment will be able to give specific advice about whether it is safe to consume alcohol while undergoing specific cancer treatments.

If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions. In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., "Alcohol and Cancer Risk was originally published by the National Cancer Institute."

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On This Page What is alcohol? Alcohol is the common term for ethanol or ethyl alcohol, a chemical substance found in alcoholic beverages such as beer, hard cider, malt liquor, wines, and distilled spirits (liquor). Alcohol is produced by the fermentation of sugars and starches by yeast.

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What happens during withdrawal and what can be done about it

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What happens during withdrawal and what can be done about it

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If you drink alcohol heavily for weeks, months, or years, you may have both mental and physical problems when you stop or seriously cut back on how much you drink. This is called alcohol withdrawal. Symptoms can range from mild to serious.

If you drink only once in a while, it's unlikely that you'll have withdrawal symptoms when you stop. But if you've gone through alcohol withdrawal once, you're more likely to go through it again the next time you call it quits.

If your doctor thinks you might be going through alcohol withdrawal, they'll ask you questions about your drinking history and how recently you stopped. They'll want to know if you've ever gone through withdrawal before.

They'll also discuss your symptoms. During an exam, they'll look for other medical conditions to see if they could be to blame.

Unless you have a serious health condition or you've had severe withdrawals in the past, you probably won't need more than a supportive environment to help you through. That includes:

A quiet place

Soft lighting

Limited contact with people

A positive, supportive atmosphere

Healthy food and lots of fluids

If you decide to get treatment, your doctor can recommend the type of care that you need.

If your blood pressure, pulse, or body temperature rises, or if you have more serious symptoms like seizures and hallucinations, seek medical care immediately (dial 911). Your doctor could suggest inpatient care and drug treatment.

Common medications include benzodiazepines to help treat symptoms like anxiety, insomnia, and seizures. You might also take anti-seizure meds and antipsychotics, along with other drugs.

Treating alcohol withdrawal is a short-term fix that doesn't help the core problem. When you talk to your doctor about symptom relief, it's a good idea to discuss treatment for alcohol abuse or dependence. The doctor can give you advice to help you stop drinking.

Alcohol has what doctors call a depressive effect on your system. It slows down brain function and changes the way your nerves send messages back and forth.

Over time, your central nervous system adjusts to having alcohol around all the time. Your body works hard to keep your brain in a more awake state and to keep your nerves talking to one another.

When the alcohol level suddenly drops, your brain stays in this keyed up state. That's what causes withdrawal.

The symptoms of alcohol withdrawal can range from mild to serious. What yours are depends on how much you drank and for how long.

6 hours after you stop drinking: Mild symptoms can start as early as 6 hours after you put down your glass. They can include:

12-48 hours after your last drink: More serious problems, including hallucinations, can start in this timeframe and may include hallucinations (about 12-24 hours after you stop drinking) and seizures within the first 2 days after you stop. You can see, feel, or hear things that aren't there. Learn more about the timeline of alcohol withdrawal symptoms.

48-72 hours after you stop drinking: Delirium tremens, or DTs as you're likely to hear them called, usually start in this timeframe. These are severe symptoms that include vivid hallucinations and delusions. Only about 5% of people with alcohol withdrawal have them. Those that do may also have:

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Alcohol Withdrawal: What Happens When You Stop Drinking?

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If you drink heavily for a long time, you might have problems when you stop or cut back how much alcohol you drink. This is called alcohol withdrawal, and symptoms can range from mild to serious.

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Alcohol can interact with diabetes medications and impact your blood sugar. If you're living with diabetes, talk to your doctor about how alcohol may impact your condition management plan, even if you only have an occasional alcoholic beverage.

People with diabetes should be particularly cautious when it comes to drinking alcohol because alcohol can make some of the complications of diabetes worse. First of all, alcohol impacts the liver in doing its job of regulating blood sugar. Alcohol can also interact with some medications that are prescribed to people with diabetes. Even if you only rarely drink alcohol, talk with your healthcare provider about it so that he or she knows which medications are best for you.

Here's what you need to know:

Alcohol can cause blood glucose levels to rise or fall, depending on how much you drink. Some diabetes pills (including sulfonylureas and meglitinides) also lower blood glucose levels by stimulating the pancreas to make more insulin. Combining the blood-sugar-lowering effects of the medication with alcohol can lead to hypoglycemia or "insulin shock," which is a medical emergency.

The main function of your liver is to store glycogen, which is the stored form of glucose, so that you will have a source of glucose when you haven't eaten. When you drink alcohol, your liver has to work to remove it from your blood instead of working to regulate blood sugar, or blood glucose. For this reason, you should never drink alcohol when your blood glucose is already low.

Food slows down the rate at which alcohol is absorbed into the bloodstream. Be sure to eat a meal or snack containing carbohydrates if you are going to drink alcohol.

Alcohol impairs your liver's ability to produce glucose, so be sure to know your blood glucose number before you drink an alcoholic beverage.

Within a few minutes of drinking alcohol, and for up to 12 hours afterward, alcohol can cause your blood glucose level to drop. After consuming alcohol, always check your blood glucose level to make sure it is in the safe zone. If your blood glucose is low, eat a snack to bring it up.

Drinking too much alcohol can make you feel dizzy, sleepy, and disoriented-the same symptoms as hypoglycemia. Be sure to wear a bracelet that alerts people around you to the fact that you have diabetes, so that if you start to behave like you are intoxicated they know that your symptoms could be caused by hypoglycemia. If you are hypoglycemic, you need food and/or glucose tablets to raise your blood glucose level.

Your healthcare provider will tell you how much alcohol is safe for you to drink. Depending on your health condition, that may mean no alcohol at all. In some cases, women with diabetes may have no more than one alcoholic beverage a day. Men should have no more than two.

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If you drink alcohol as a diabetic, here are seven facts that you need to know to ensure that you drink safely and responsibly.

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They're often unrecognizable as alcoholics, walking among us, working alongside us, able to carry out (at least superficially) their responsibilities. Perhaps they're even members of our own families. The high-functioning alcoholic is very adept at concealing their alcoholism - even from themselves. But the signs are there. You just have to look for them.

What is a High-Functioning Alcoholic?

To function is to be capable of carrying out a specific action or activity, to operate or to work. High-functioning alcoholics, then, are those people who are able to convincingly go through their prescribed roles and carry out their duties - yet who continues to drink alcohol. They are able to maintain relationships with family, friends and colleagues, keep up with their job and home. In essence, they lead a double life: they are outwardly the successful, capable husband, wife, sibling, child or other relative, friend, or coworker, while inside they are alcoholics.

High-functioning alcoholics would never put themselves in the same consideration set as a skid-row drunk. In fact, while both have the same disease, with high-functioning alcoholics (HFAs) the progression is quite a bit different. With their extraordinarily high level of denial, they often find it extremely difficult to admit that they even have a problem with alcohol. Through years of success and achievement - despite drinking - the HFA isn't looked upon by others as an alcoholic.

In addition, due to the stigma and shame still associated with alcoholism, the HFA would be loathe to admit to others, let alone himself, that he has a problem with alcohol. Such personal denial is also accompanied by denial of others. "He can sure handle his liquor," some might say. Or, "I've never seen her drunk," might be another comment.

Since they won't or can't admit that they are alcoholics, HFAs often remain undiagnosed and slip through the cracks of America's health care system. They also are likely to be the last to seek treatment for the disease.

Warning Signs and Symptoms of HFAs

Although some of the warning signs and symptoms of HFAs are similar to those of other alcoholics, they often appear at different stages of the progression of alcoholism. Some signs may not be present in all HFAs, or may occur in clusters. One thing is certain: the longer the HFA goes without treatment, the more likely he or she will display some of these warning signs and symptoms.

* In the company of others who drink - The HFA surrounds himself with others who like to drink. This assimilation makes it difficult to pick out the HFA as being different from the rest. Besides, the HFA truly enjoys drinking and being around others with similar likes.

* Obsessing over alcohol - The thought of alcohol is never far from the mind of the HFA. Counting hours until the next drink, mentally savoring the mellowness and pleasure of the impending drink, calculating how much alcohol can be consumed without any outward signs of drunkenness - the HFA obsesses over alcohol.

* Consuming craving - One drink is never enough for the HFA. The lure is too strong, and the craving consumes the HFA until he or she can have the next drink - and the next, and the next. Before long, the HFA has lost control over total alcohol intake - even though he or she still may appear outwardly normal and in control. After all, they are masters of discipline and concealment.

* Alcohol is part of their lives - The HFA would no more give up alcohol than they'd give up their identity. Alcohol is so much a part of their lives that they cannot imagine a life without alcohol.

* Finishing drinks of others - If someone the HFA is with leaves a drink on the bar or the table, the HFA may pick it up and finish it. "Don't want to let this go to waste," he may say in a joking manner. Related to this is the example of the HFA downing his own drink when it's time to leave - to go to the table at the restaurant after waiting at the bar, for example - and then quickly ordering another. If a family member or friend doesn't touch his or her drink, the HFA often drinks it along with his own.

* Experiencing shame over drunken behavior - Being such masters of concealment, the HFA does often experience remorse and/or shame over instances where their behavior has become sloppy after drinking. Such behavior isn't part of their carefully crafted images and they consequently work even harder to avoid such mistakes in the future. But they won't quit drinking.
They'll just watch their behavior more.

* Self-deluding - Some HFAs drink only expensive wine or liquor in the mistaken belief that this means they're not an alcoholic. It's a self-delusion that allows them to continue to drink with impunity.

* Fit life into compartments - Another familiar sign of HFAs is that they are able to conveniently separate their drinking lives from the rest of their existence. Who they are at home, on the job, or to casual acquaintances is totally different from their drinking routine and environment.

* Tried to quit but failed - At some point the HFA may have tried to quit drinking but failed in the attempt. This pattern may often be repeated, but still the HFA refuses to seek treatment. It is part of their personality makeup, their self-constructed identity that they feel they can handle their drinking on their own. Such refusal to get help is difficult to overcome.

* Excuses and rewards - HFAs feel they work hard and deserve a drink as a reward. Drinking, to the HFA, is both an excuse and a reward. The HFA may even use those words in defense of his actions - to himself and to others.

* Hiding and sneaking - When others are going to be around - and watching - the HFA may sneak a drink early, drink before going out, or drink alone. Such secrecy is part of the concealment of the HFA's true problem. He or she has to get in the drinking, but can't take the risk of others finding out or suspecting the real problem.

* Emotional and physical consequences don't matter - Whether minor or severe, emotional and physical consequences of drinking don't make a difference to the HFA - who will continue to drink, regardless. It's only when things really spiral out of control that the HFA, or those closest to him, may seek help for the problem.

* Blackouts, memory losses, or worse - At the end of the HFA's downward spiral - just as with any other alcoholic - blackouts, memory losses, increasing physical, emotional, psychological, social and/or legal problems intensify. It's at this point that the HFA either gets treatment or continues to deteriorate.

Who are HFAs?

Look around you. High-functioning alcoholics are in every profession and walk of life. They're not all men, either. Alcoholism strikes men and women equally. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), there are more than 2.5 million female alcoholics, and one-third of women report regular consumption of alcohol.

Another pretty frightening statistic (which is borne out in recent stories of fatal automobile crashes) is that there has been a 28.8 percent increase in the number of women arrested for driving under the influence (DUI) in the past decade. Surprisingly, however, there was a 7.5 percent decrease in the number of males arrested for DUI over the same period.

When you consider that many of these millions of female alcoholics are also mothers, you begin to understand the magnitude of the problem - for the female HFAs as well as their families and others. Stigma and shame for HFA mothers keeps many from getting the treatment they so desperately need.

Risk Factors for Becoming an HFA - or Alcoholic

Research studies show several risk factors contribute to a person becoming an alcoholic, HFA or otherwise. These include, but are not limited to, the following:

* Drinking at an early age, such as before the age of 15

* Family history of alcoholism

* Presence of an underlying mental health disorder or condition (such as anxiety, depression, post-partum depression, etc.)

* History of trauma

* Impulsive personality

* Peer influence

* Other substance abuse (including cigarettes, street or prescription drugs)

How to Approach an HFA about Treatment

Family members or concerned others may try to convince the HFA that treatment is necessary, but they first have to overcome the obstinate denial and resistance from the HFA. Remember, the HFA has been able to go through life hiding their alcoholism. It won't be easy for them to admit that they have a problem, let alone a problem they can't resolve themselves.

Recognize the signs and symptoms of an HFA in your loved one? If you do, you've gotten past your own denial. It's often very difficult for those closest to the HFA to see the signs of alcoholism - even when they've been present for years. Once you do recognize your loved one is an HFA, what should you do?

Addiction experts say it is important - crucial, even - to let the HFA know how much their drinking behavior hurts you, how it negatively affects you and the family. Never approach them when they have been drinking or are suffering from the aftereffects of a bout of drinking. Wait until they are completely sober and, hopefully, have eaten a nourishing meal. It is also important that the conversation is not defensive. Start by stating how you would like things to be in the family, and emphasize your feelings and concerns. Expect the HFA to deny the problem. You could then talk about how people can function at home and at work and still be alcoholics, that they're called high-functioning alcoholics. Denial may still - and probably will - occur. Be prepared to show tangible evidence of alcohol-related problems. Such documentation is perhaps the only proof that will convince the HFA that there could be an issue with their drinking that needs addressing. Never put yourself or your children or other family members at risk, however. Avoid confrontation and conflict, as this will not solve the problem.

Intervention may be appropriate, as skilled professionals are often able to chip away at the HFA's denials and resistance and succeed in getting them into treatment.

You will need resources to do this. Check out the assessment tools, tips on cutting back, treatment referrals and services at the NIAAA site. For example, at-risk or heavy drinking involves consumption of more than 4 drinks per day or 14 per week for men and 3 drinks per day or 7 per week for women. Look through the FAQs for answers to common questions about alcoholism. Professional help to quit drinking may involve medications (naltrexone, acamprosate, and topiramate), alcohol counseling (12-step groups, cognitive-behavioral, motivational enhancement, or a combination), or specialized, intensive treatment programs. On the NIAAA site you can also download the 16-page NIAAA booklet Rethinking Drinking: Alcohol and Your Health.

For an interventionist, review referral information from the Association of Intervention Specialists.

Another helpful resource is the National Institute on Drug Abuse (NIDA).

Also check out the highly-recommended book, Understanding the High-Functioning Alcoholic: Professional Views and Personal Insights, by Sarah Allen Benton, a licensed mental health counselor. Also check out her blogs on Psychology Today and her interview and excerpt from the book on Oprah.com.

Bottom line: don't give up - on the high-functioning alcoholic. But do encourage them to get the necessary help to overcome their problems with alcohol. Set boundaries and insist on open and honest discussion of the HFA's situation. Be safe, supportive, and persistent.

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They're often unrecognizable as alcoholics, walking among us, working alongside us, able to carry out (at least superficially) their responsibilities. Perhaps they're even members of our own families. The high-functioning alcoholic is very adept at concealing their alcoholism - even from themselves. But the signs are there.

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Alcohol's impact on your body starts from the moment you take your first sip. While an occasional glass of wine with dinner isn't a cause for concern, the cumulative effects of drinking wine, beer, or spirits can take its toll.

Read on to learn the effects of alcohol on your body.

A glass a day may do little damage to your overall health. But if the habit grows or if you find yourself having a hard time stopping after just one glass, the cumulative effects can add up.

Drinking too much alcohol can cause abnormal activation of digestive enzymes produced by the pancreas. Buildup of these enzymes can lead to inflammation known as pancreatitis. Pancreatitis can become a long-term condition and cause serious complications.

The liver is an organ which helps break down and remove harmful substances from your body, including alcohol. Long-term alcohol use interferes with this process. It also increases your risk for chronic liver inflammation and liver disease. The scarring caused by this inflammation is known as cirrhosis. The formation of scar tissue destroys the liver. As the liver becomes increasingly damaged, it has a harder time removing toxic substances from your body.
Learn more about alcohol-related liver disease "
Liver disease is life-threatening and leads to toxins and waste buildup in your body. Women are at higher risk for developing alcoholic liver disease. Women's bodies are more likely to absorb more alcohol and need longer periods of time to process it. Women also show liver damage more quickly than men.

The pancreas helps regulate your body's insulin use and response to glucose. When your pancreas and liver aren't functioning properly, you run the risk of experiencing low blood sugar, or hypoglycemia. A damaged pancreas may also prevent the body from producing enough insulin to utilize sugar. This can lead to hyperglycemia, or too much sugar in the blood.

If your body can't manage and balance your blood sugar levels, you may experience greater complications and side effects related to diabetes. It's important for people with diabetes or hypoglycemia to avoid excessive amounts of alcohol.

One of the easiest ways to understand alcohol's impact on your body is by understanding how it affects your central nervous system. Slurred speech is one of the first signs you've had too much to drink. Alcohol can reduce communication between your brain and your body. This makes coordination more difficult. You may have a hard time balancing. You should never drive after drinking.

As alcohol causes more damage to your central nervous system, you may experience numbness and tingling sensations in your feet and hands.

Drinking also makes it difficult for your brain to create long-term memories. It also reduces your ability to think clearly and make rational choices. Over time, frontal lobe damage can occur. This area of the brain is responsible for emotional control, short-term memory, and judgement, in addition to other vital roles.

Chronic and severe alcohol abuse can also cause permanent brain damage. This can lead to Wernicke-Korsakoff syndrome, a brain disorder that affects memory.

Some people who drink heavily may develop a physical and emotional dependency on alcohol. Alcohol withdrawal can be difficult and life-threatening. You often need professional help to break an alcohol addiction. As a result, many people seek medical detoxification to get sober. It's the safest way to ensure you break the physical addiction. Depending on the risk for withdrawal symptoms, detoxification can be managed on either an outpatient or inpatient basis.

Symptoms of alcohol withdrawal include:

Seizures, hallucinations, and delirium may occur in severe cases of withdrawal.

The connection between alcohol consumption and your digestive system might not seem immediately clear. The side effects often only appear after there has been damage. And the more you drink, the greater the damage will become.

Drinking can damage the tissues in your digestive tract and prevent your intestines from digesting food and absorbing nutrients and vitamins. As a result, malnutrition may occur.

Heavy drinking can also lead to:

For people who drink heavily, ulcers or hemorrhoids (due to dehydration and constipation) aren't uncommon. And they may cause dangerous internal bleeding. Ulcers can be fatal if not diagnosed and treated early.

People who consume too much alcohol may also be at risk for cancer. People who drink frequently are more likely to develop cancer in the mouth, throat, esophagus, colon, or liver. People who regularly drink and use tobacco together have an even greater cancer risk.

Alcohol can affect your heart and lungs. People who are chronic drinkers of alcohol have a higher risk of heart-related issues than people who do not drink. Women who drink are more likely to develop heart disease than men who drink.

Circulatory system complications include:

Difficulty absorbing vitamins and minerals from food can cause anemia. This is a condition where you have a low red blood cell count. One of the biggest symptoms of anemia is fatigue.

You may think drinking alcohol can lower your inhibitions and help you have more fun in bed. But the reality is quite different. Men who drink too much are more likely to experience erectile dysfunction. Heavy drinking can also prevent sex hormone production and lower your libido.

Women who drink too much may stop menstruating. That puts them at a greater risk for infertility. Women who drink heavily during pregnancy have a higher risk of premature delivery, miscarriage, or stillbirth.

Women who drink alcohol while pregnant put their unborn child at risk. Fetal alcohol syndrome disorders (FASD) is a serious concern. Other conditions include:

learning difficulties

long-term health issues

increased emotional problems

physical development abnormalities

Long-term alcohol use may prevent your body from keeping your bones strong. This habit may cause thinner bones and increase your risk for fractures if you fall. And factures may heal more slowly.

Drinking alcohol may also lead to muscle weakness, cramping, and eventually atrophy.

Drinking heavily reduces your body's natural immune system. This makes it more difficult for your body to fight off invading germs and viruses.

People who drink heavily over a long period of time are also more likely to develop pneumonia or tuberculosis than the general population. About of all tuberculosis cases worldwide can be tied to alcohol consumption. Drinking alcohol also increases your risk for several types of cancer, including mouth, breast, and colon. Click here to learn the basics of alcoholism. You can also read about the stages of alcoholism and recognizing an addiction.

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Alcohol's impact on your body starts from the moment you take your first sip. While an occasional glass of wine with dinner isn't a cause for concern, the cumulative effects of drinking wine, beer, or spirits can take its toll. Read on to learn the effects of alcohol on your body.

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The effect alcohol has on your body depends on your age, gender, weight and the type of alcohol you've taken.

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How drugs affect families

This section looks at the effects on the family when someone is abusing alcohol or other drugs. In many cases the person is not an addict or an alcoholic. They are just drinking or taking drugs in a way which upsets others. With this in mind we look at the following five scenarios:

1. How a parent with a drug or alcohol problem affects the whole family

2. How a partner with a drug or alcohol problem affects the other partner

3. How a parent's addiction may affect their son or daughter

4. How a son or daughter with an addiction problem affects the whole family

5. Family support

How a parent with a drug or alcohol problem affects the whole family

It is well known that a parent with a drug or alcohol problem can have a negative effect on their family members. You could say that the person with the problem is like someone stuck in a bog. The other family members, in their efforts to help, often get pulled down into the bog too. The first step in putting things right is when the others start to get their own feet on solid ground. Only after they have done this will they be able to help tackle the addiction problem.

Sharon Wegscheider (USA) has pointed out some of the ways in which other family members can be affected. (Reference: Sharon Wegscheider, The Family, Trap Johnson Institute, Minnesota U.S.A., 1976).

How a partner with a drug or alcohol problem affects the other partner

It is not easy to live with a person whose drinking or drug use is causing problems. The drinker or drug user is often full of conflict, torn between wanting their drug or alcohol and not wanting the harm that always seems to follow. They often blame others when things go wrong.

The partner or spouse of the addict or alcoholic often doubts themselves: Am I not a good enough partner? How can I get them to stop taking that drug? How can I protect my children? How can I hide this from my family and neighbours?

The partner often feels hurt, ashamed, afraid, and has an overwhelming sense of failure. Unfortunately, many partners then work even harder to 'fix' the situation, taking on extra responsibilities, trying to cover up the mess... fighting a losing battle.

If you are that partner, the first step towards putting things right is to take some time for yourself, and get the support you need. A good friend or a counsellor can be a great help. See 'family support' below.

How a parent's addiction may affect their son or daughter

The son or daughter of a parent abusing alcohol or drugs can also end up bogged down. They often adopt a role which helps the family, but they may get stuck in the role and neglect their own needs. Sharon Wegscheider describes some of these roles. Can you see yourself in one of these roles, or in elements of a couple of them? You can change! It's easier if you get support.

The Family Hero This is often the eldest in the family. This person is responsible, works hard for approval, and often appears successful. But inside, this person often feels insecure, as if things are always going to go wrong, and feels incompetent, confused and angry.

The Scapegoat This person feels blamed when things go wrong. Everyone focuses on this person's faults, which provides the family with a distraction from the real problem. So this person often seems rebellious, troublesome, law-breaking, tough... and may be at risk of abusing drugs themselves. Inside, this person is often full of fear, hurt, rejection and loneliness, feeling angry at the unfairness of how they are treated.

The Lost Child This son or daughter appears as a dreamer, drifting above the troubled waters that bother other people. But inside, the person is not as contented as they appear. They are quietly hurt, angry, lonely, with a feeling of being inadequate.

The Mascot Sometimes also referred to as the clown, the person in this role is often charming and cute, fun to be with, quick to make a joke. Sometimes they are quite hyper-active and flit from one interest to another; sometimes quite fragile and easily hurt. But they are good at hiding the hurt, and other feelings of loneliness, insecurity, fear and low self-esteem.

If you recognise any of these roles as being 'you', the first step to putting things right is to take time for yourself, to talk to a friend or a counsellor. Stop thinking about the addicted person for a while (easier said than done!) and pay attention to your own real needs. See the 'family support' section below.

How a son or daughter with an addiction affects the whole family

Whole families can seem to go to pieces when there is a son or daughter using drugs or alcohol. Parents fall out with each other over how to handle the situation, while other sons or daughters can get blamed for being a bad example. The drug user gets so much attention that others are neglected. Rows and bad language upset the peace. If peace and love are the oxygen of life, then the whole family is gasping for breath.

In an airplane, if the oxygen masks are released, parents are supposed to put on their own masks before attending to their children's masks. The same is true here. You must look after your own needs before helping the one causing the problem.

Even if you are the only person in the family who recognises the alcohol or drug problem, it is worth while getting support for yourself, from a friend or a trusted teacher or a counsellor.

Family support

Support for families is available from a number of sources:

The National Family Support Network has a network of family support groups throughout Ireland. Family support groups have helped many families to hold their heads up again, when they had been bowed down with embarrassment and shame due to a son or daughter using drugs and causing trouble for neighbours. For more information on The National Family Support Network visit their website at www.fsn.ie or call (01) 8980148.

Community Alcohol Services and Community Drug Services are run by the HSE and are generally free. Many provide support and information for families to maintain their dignity and sanity when a family member is abusing drugs or alcohol.

Many addiction treatment services provide support for families.

See the Drugs.ie Services Directory for a list of services.

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This section looks at the effects on the family when someone is abusing alcohol or other drugs. In many cases the person is not an addict or an alcoholic. They are just drinking or taking drugs in a way which upsets others.

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Drinking too much - on a single occasion or over time - can take a serious toll on your health. Here's how alcohol can affect your body:

Brain:
Alcohol interferes with the brain's communication pathways, and can affect the way the brain looks and works. These disruptions can change mood and behavior, and make it harder to think clearly and move with coordination.

Heart:
Drinking a lot over a long time or too much on a single occasion can damage the heart, causing problems including:

Cardiomyopathy - Stretching and drooping of heart muscle

Arrhythmias - Irregular heart beat

Stroke

High blood pressure

Liver:
Heavy drinking takes a toll on the liver, and can lead to a variety of problems and liver inflammations including:

Steatosis, or fatty liver

Alcoholic hepatitis

Fibrosis

Cirrhosis

Pancreas:
Alcohol causes the pancreas to produce toxic substances that can eventually lead to pancreatitis, a dangerous inflammation and swelling of the blood vessels in the pancreas that prevents proper digestion.

Cancer:
Source: National Cancer Institute -- see https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet:

Based on extensive reviews of research studies, there is a strong scientific consensus of an association between alcohol drinking and several types of cancer. In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen. The research evidence indicates that the more alcohol a person drinks-particularly the more alcohol a person drinks regularly over time-the higher his or her risk of developing an alcohol-associated cancer. Based on data from 2009, an estimated 3.5 percent of all cancer deaths in the United States (about 19,500 deaths) were alcohol related.

Clear patterns have emerged between alcohol consumption and the development of the following types of cancer:

Head and neck cancer: Alcohol consumption is a major risk factor for certain head and neck cancers, particularly cancers of the oral cavity (excluding the lips), pharynx (throat), and larynx (voice box). People who consume 50 or more grams of alcohol per day (approximately 3.5 or more drinks per day) have at least a two to three times greater risk of developing these cancers than nondrinkers. Moreover, the risks of these cancers are substantially higher among persons who consume this amount of alcohol and also use tobacco.

Esophageal cancer: Alcohol consumption is a major risk factor for a particular type of esophageal cancer called esophageal squamous cell carcinoma. In addition, people who inherit a deficiency in an enzyme that metabolizes alcohol have been found to have substantially increased risks of alcohol-related esophageal squamous cell carcinoma.

Liver cancer: Alcohol consumption is an independent risk factor for, and a primary cause of, liver cancer (hepatocellular carcinoma). (Chronic infection with hepatitis B virus and hepatitis C virus are the other major causes of liver cancer.)

Breast cancer: More than 100 epidemiologic studies have looked at the association between alcohol consumption and the risk of breast cancer in women. These studies have consistently found an increased risk of breast cancer associated with increasing alcohol intake. A meta-analysis of 53 of these studies (which included a total of 58,000 women with breast cancer) showed that women who drank more than 45 grams of alcohol per day (approximately three drinks) had 1.5 times the risk of developing breast cancer as nondrinkers (a modestly increased risk). The risk of breast cancer was higher across all levels of alcohol intake: for every 10 grams of alcohol consumed per day (slightly less than one drink), researchers observed a small (7 percent) increase in the risk of breast cancer.
The Million Women Study in the United Kingdom (which included more than 28,000 women with breast cancer) provided a more recent, and slightly higher, estimate of breast cancer risk at low to moderate levels of alcohol consumption: every 10 grams of alcohol consumed per day was associated with a 12 percent increase in the risk of breast cancer.

Colorectal cancer: Alcohol consumption is associated with a modestly increased risk of cancers of the colon and rectum. A meta-analysis of 57 cohort and case-control studiesthat examined the association between alcohol consumption and colorectal cancer risk showed that people who regularly drank 50 or more grams of alcohol per day (approximately 3.5 drinks) had 1.5 times the risk of developing colorectal cancer as nondrinkers or occasional drinkers. For every 10 grams of alcohol consumed per day, there was a small (7 percent) increase in the risk of colorectal cancer.

Immune System:
Drinking too much can weaken your immune system, making your body a much easier target for disease. Chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much. Drinking a lot on a single occasion slows your body's ability to ward off infections - even up to 24 hours after getting drunk.

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Drinking too much - on a single occasion or over time - can take a serious toll on your health. Here's how alcohol can affect your body: Brain: Alcohol interferes with the brain's communication pathways, and can affect the way the brain looks and works.

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While alcohol is widely used in the United States, it can have an array of harmful effects. A 2019 survey reported that 85.6% of Americans aged 18 and over had consumed alcohol at some time in their life, nearly 70% of people had consumed alcohol within the last 12 months, and almost 55% had consumed alcohol within the last 30 days. ¹

A 2020 survey showed that nearly 139 million Americans aged 12 or over were current drinkers of alcohol, almost 62 million of these (44.4%) engaged in binge drinking within the last month, and almost 18 million of these (12.8%) were heavy drinkers within the last month. ² There were more than 28 million Americans aged 12 and over who had an alcohol use disorder (AUD) in 2020. ²

This article will discuss what an AUD is and the warning signs to be aware of, the difference between moderate drinking and alcohol misuse, the short-term effects of alcohol on the body and brain, the long-term effects of alcohol on the body and brain, effects of drinking alcohol while pregnant, what to expect from alcohol withdrawal, how to find treatment for AUD, and what happens in treatment.

Signs of an Alcohol Use Disorder

Addiction to any substance, including alcohol, is a medically recognized disease that can affect multiple areas of a person's life. It is a chronic, often relapsing disease that occurs as a result of various complex factors, including circuits in the brain, a person's unique genetics, their environment, and their lived experience. 3, 4 Alcohol use changes how the circuits in the brain work, especially in the areas of rewards, stress, and impulse control, and can persist even after substance use has stopped. 4, 5 People who have an AUD commonly develop compulsive behaviors surrounding alcohol, and are unable to stop drinking even after experiencing negative and harmful outcomes related to their alcohol use. 3, 5

Commonly referred to as addictions, these are formally diagnosed as substance use disorders (SUDs). When a person has an alcohol addiction, it is known as alcohol use disorder (AUD). Healthcare providers are able to make a diagnosis of AUD by referring to criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and asking questions about your drinking habits, as well as identifying how severe the disorder is. ⁵ Criteria for an AUD include: ⁶

Drinking more or for longer than originally planned.

Wanting to or trying to cut back or stop drinking without success.

Spending a lot of time getting or drinking alcohol, or being hungover.

Having cravings to drink.

Alcohol use repeatedly getting in the way of important responsibilities at home, school, or work.

Inability to stop drinking even after having ongoing issues with other people that are caused or worsened by drinking.

Stepping back from or quitting important hobbies, social, or work activities due to drinking.

Repeatedly drinking when it can be dangerous, such as while driving.

Continuing to drink even when you know it has caused or contributed to an ongoing physical or mental health issue.

Developing a tolerance to the effects of alcohol.

Experiencing withdrawal symptoms when alcohol use is significantly reduced or stopped abruptly.

The severity of an AUD is determined by the number of criteria that are met. ⁶ If a person has 2 or 3 symptoms, the disorder is mild, while 4 or 5 symptoms indicate the disorder is moderate, and 6 or more symptoms indicate the disorder is severe. ⁶

Moderate Drinking vs. Alcohol Misuse

United States Dietary Guidelines state that adults who are 21 or over drink moderately by consuming up to 1 alcoholic drink daily for females, or 2 alcoholic drinks daily for males. 7, 8 An "alcoholic drink" can be further explained as a "standard drink size," where 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of liquor is considered to be one drink. 7, 8 Excessive drinking and alcohol misuse can take various forms, including:

Binge drinking: For men, binge drinking involves having 5 or more drinks containing alcohol within approximately 2 hours in the last month, and for women, it involves having 4 or more drinks.2, 7

Heavy drinking: This can involve binge drinking 5 or more times within the last month, using the definition above for binge drinking for men and women.² Heavy drinking can also involve having at least 15 drinks containing alcohol weekly for males, or at least 8 drinks containing alcohol weekly for females.7, 9

Alcohol misuse: This involves any alcohol consumption by people who should not be drinking, such as individuals who are underage, and pregnant women.7, 8

Excessive drinking: This encompasses binge drinking, heavy drinking, and alcohol misuse using the definitions listed above.⁹

Short-Term Effects of Alcohol Use

When consuming alcohol, effects on the body and mind vary depending on your blood alcohol content (BAC). ⁷ Alcohol enters the bloodstream from the digestive tract, but if you drink more than you can process, the remaining alcohol stays in your bloodstream, where it can be measured as a percentage known as BAC. 7, 10 The higher your BAC, the stronger the side effects of alcohol are. ⁷ Short-term side effects of alcohol can include:

At higher BAC levels, breathing issues, nausea, vomiting, sedation, reduced body temperature, coma, and death can result. 11, 12 Physical effects of alcohol in large amounts can impact the heart, leading to major issues like abnormal heart rhythms, damage to the heart muscle, stroke, or hypertension, which can impair your immune system for up to a day after drinking, and can impair your kidneys' ability to function properly or even lead to acute kidney failure. 13, 14 Consuming too much alcohol can place you at risk for alcohol poisoning, which can be life-threatening. ⁹

Since alcohol impairs judgment, people who are under the influence are more likely to engage in dangerous or risky behaviors. People who are drunk are at greater risk for: ⁹

Injuries, such as car crashes, falls, or drownings.

Unsafe sexual behaviors, including unprotected sex, unplanned pregnancy, or sexually transmitted infections.

Violence, such as homicide, domestic violence, or sexual assault.

One common side effect of alcohol is a hangover. This is a cluster of symptoms that occurs after consuming an excess of alcohol, and typically involves symptoms like: ¹⁵

Aching muscles

Anxiety

Dizziness or feeling like the room is spinning

Fatigue

Feeling weak

Headaches

Increased sensitivity to light and sound

Irritability

Nausea

Raised blood pressure

Stomach pain

Sweating

Thirst

There are various factors that combine to create a hangover, including: ¹⁵

Dehydration: Alcohol causes the body to release fluids, leading to symptoms like fatigue, headache, and thirst the following day.

Disturbed sleep: Alcohol interferes with how well you sleep. You may not feel well-rested the next day and are more likely to feel fatigued.

Stomach irritation: Alcohol is an irritant to the stomach, stimulating more acid to be released, leading to symptoms like nausea and upset stomach the next day.

Inflammation: Alcohol increases inflammation throughout the body, leading to a general feeling of unwellness, muscle aches, and feeling weak the next day.

Mini-withdrawal: Consuming alcohol causes chemicals to be released in the brain, causing pleasant effects, such as feeling calm, relaxed, and euphoric. The brain works to compensate for these changes to keep the chemicals in balance, so when the effects of alcohol wear off, you may feel more anxious, irritable, or restless.

Long-Term Effects of Alcohol Abuse

Over time, the negative effects of alcohol can impact nearly every organ system in the body. Alcohol can be harmful to various organs and systems and increase the risk of developing diseases. ¹ These can include:

AUD: One of the major risks of long-term alcohol use is developing an AUD.⁹

Cancer: Alcohol is known to be a carcinogen and has been linked to various types of cancers, including the mouth, throat, larynx, esophagus, liver, colon, rectum, and breast or prostate.14, 16, 17 The more a person drinks, the more their risk increases.¹⁴

Dementia: Alcohol can cause changes in how the brain functions and has been linked to the development of dementia.⁹

Digestive system: Alcohol can raise the risk of gastric (stomach) bleeding and digestive issues.1, 9 It can also make diabetes more difficult to manage.¹ Breaking down alcohol also causes the pancreas to form toxic byproducts that can cause painful and dangerous inflammation known as pancreatitis that can interfere with digestion.¹⁴

Heart disease: Alcohol misuse raises the risk of developing heart disease and hypertension, as well as making these conditions harder to manage.1, 9 Alcohol can damage the heart muscle, causing it to stretch, in a condition known as cardiomyopathy, or cause the heart to beat irregularly.¹⁴

Immune system: Alcohol suppresses the immune system, so people who drink regularly are less able to fight off contagious diseases like pneumonia.¹⁴

Kidney issues: Chronic alcohol use makes the kidneys work harder, which can harm the kidneys and place you at twice the risk for developing chronic kidney disease.¹³

Liver disease: People who are chronic drinkers are at risk for developing liver problems, starting with inflammation which can result in scarring and loss of functioning known as cirrhosis.9, 14

Stroke: Alcohol misuse increases the likelihood of experiencing a stroke.1, 9

Long-term alcohol misuse has also been linked to an increased risk of developing anxiety and depression. 1, 9 Alcohol can also lead to issues with learning and memory. ⁹ It can affect relationships with family members, causing problems at home and with your ability to function at work, and in some cases lead to unemployment. ⁹

Alcohol may alter hormone production in men, leading to erectile dysfunction and problems with fertility. ¹⁷ Since alcohol affects women differently than men, they are at greater risk for developing liver, heart, and brain issues, as well as cancers, even if they drink less than men and for shorter periods of time. 18, 19 Women who are chronic or heavy drinkers are at greater risk for blackouts as well as menstrual problems and lower fertility. 19, 20

Alcohol Use During Pregnancy

If you are pregnant or planning to become pregnant, there is no known safe amount of alcohol to consume. ¹⁹ Drinking while pregnant has been linked to a greater likelihood of miscarriage, stillbirth, low birth weight, and early delivery. 18, 20 It can also cause fetal alcohol spectrum disorders (FASD), a group of conditions that range from mild to severe, which cause physical, intellectual, and behavioral issues. 20, 21 Babies born to mothers who drank alcohol while pregnant are more likely to die from Sudden Infant Death Syndrome (SIDS). ¹⁸

Alcohol Withdrawal Symptoms

When alcohol is consumed regularly over time, the brain and body can become physically dependent on it to function normally, and if you stop drinking suddenly, you will experience withdrawal symptoms. ⁶ Since it can be life-threatening, it is important to go through alcohol withdrawal and detox under medical supervision, especially if your withdrawal symptoms are likely to be severe or complicated. ¹² Symptoms include:

Symptoms can range in severity, depending on age, how much and how often you drink, how long you have been drinking, and whether you've detoxed from alcohol before. 6, 12 Withdrawal symptoms typically begin within 4 hours to a day after your last drink, becoming most intense after 2 days, and resolving within 4-5 days. 6, 12

While medical detox is important to help you get through withdrawal safely, it is equally important to follow it up with further treatment in order to maintain sobriety. Detox is a beginning step toward lasting sobriety. 12, 22 Detox is also a good way to get linked to further treatment and make transitioning into alcohol addiction treatment a smooth process. ¹²

Medication is used during detox to manage symptoms and prevent complications. ¹² Benzodiazepines are the standard treatment for alcohol withdrawal, and long-acting medications such as chlordiazepoxide (Librium) or diazepam (Valium) are frequently used. ¹² These medications reduce withdrawal symptoms while preventing symptoms from worsening to seizures or delirium tremens (DTs). ¹² Once symptoms begin to resolve, the medication is slowly tapered down until you are able to discontinue it. ¹²

Finding Treatment for Alcohol Use Disorder

In order to best help you, treatment should be tailored to meet your needs. The best way to do this is to talk with your doctor or a treatment professional, so they can help guide you toward a decision that is best for you. Their first step is to conduct a thorough evaluation, where you will be asked questions about your current and past substance use, physical and mental health, and how your addiction has affected various areas of your life, including your relationships, family, work, and home life. ¹² This will help you and the treatment professional determine what kind of treatment setting would be most effective for you, based on your needs, followed by an intake at a treatment center to begin care. Treatment settings can include:

Detox: For withdrawal from alcohol, this is commonly done on an inpatient basis, so staff can monitor your symptoms around the clock, be alerted for any developing complications, and ensure your safety.⁵

Inpatient: This involves staying at the facility around the clock for the duration of treatment.22, 23

Outpatient: This involves attending regularly scheduled appointments at a facility while you can still work, go to school, and live at home, and can vary in intensity depending on your needs.22, 23

Therapy: This can take place in a group or individual setting, and helps you develop the skills needed to prevent relapse, communicate more effectively, improve your ability to resolve problems, and practice healthy behaviors.4, 5 Cognitive behavioral therapy (CBT) is used to help you identify triggers and manage them, as well as learn how to cope with your emotions in a healthy way.4, 22 Contingency management (CM) uses tangible rewards to help increase motivation towards staying in treatment and maintaining sobriety.4, 24 Motivational interviewing (MI) is a technique used to help resolve any mixed feelings you may have about treatment and abstinence.22, 24

Aftercare: This can involve recovery housing, attending self-help meetings, joining alumni groups, and going to individual or group therapy, all of which provide additional support to you after you complete treatment.²²

Medications can be used in combination with behavioral therapy to treat AUD. There are three medications that are FDA-approved to treat AUD: acamprosate (Campral), disulfiram (Antabuse), and naltrexone. ⁵ Acamprosate can lessen lingering symptoms of withdrawal, known as protracted withdrawal. 22, 23 Disulfiram reduces the body's ability to metabolize alcohol, causing uncomfortable symptoms if you consume alcohol, such as flushing, nausea, and heart palpitations. 22, 23 Naltrexone binds to receptors in the brain that make drinking feel rewarding, and blocks cravings to drink. 22, 23

Many addiction treatment plans encourage participation in mutual support groups, such as Alcoholics Anonymous or other 12-Step programs. These allow you to develop a sober network of peers, learn new skills, and receive additional support outside of the treatment setting. 5, 25 Studies show that individuals who attend 12-Step meetings have greater levels of long-term sobriety. 25

If you are concerned about your alcohol use or that of a loved one, treatment is available. Rehab facilities are located throughout the U.S., and many offer specialized treatment that can cater to individual needs. American Addiction Centers (AAC) is a leading provider of addiction treatment programs and has trusted treatment centers across the country. You can use our treatment directory to find an alcohol use disorder program near you or verify your health insurance coverage using the form below. You can also call us free now at .

Recommended Alcohol Misuse-Related Articles

Recommended Alcohol Rehabilitation-Related Articles

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Alcohol Effects: Short-Term, Long-Term, & Finding Help | DrugAbuse.com

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Learn about the short-term and long-term effects of alcohol misuse and addiction, and how to find treatment for alcohol use disorder.

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Story highlights

Definition of heavy drinking varies slightly and is different for men and women

Heavy drinking is defined as 8 or more drinks a week for women, 15 or more for men

Heavy drinking is the third leading cause of preventable death

Sheldon Shiraki sits at the bar in the trendy Fritti restaurant in Atlanta, happily sipping an ice cold cocktail.

Asked how many drinks it would take for the government to consider him a "heavy drinker," he laughs.

"I don't know - maybe 25 to 30 drinks," Shiraki says.

"A month?" I ask.

"A week," Shiraki says with a smile.

"Let me do the math," his friend Pamela Gjerde says from the next bar stool over. A local, she calls the bartender by name and says she will sip a glass of white wine a couple days a week. For a woman to be considered a "heavy drinker" she thinks she'd have to have 15 to 20 drinks weekly.

They both looked shocked to learn they seriously overestimated the number.

Women are considered "heavy drinkers" if they have eight or more drinks a week, according to the Centers for Disease Control and Prevention. Men can have 14. At 15, you, my friend, are a "heavy drinker" in the eyes of the CDC.

World Cup survival glass tells you when to stop drinking

One in 10 deaths among adults between the ages of 20 and 64 are due to excessive alcohol consumption, the CDC says in a report released Wednesday. That means some 88,000 people die a year as a result of drinking too much. The majority of those are men - about 70%.

Do you consider yourself a light, moderate or heavy drinker? Health agencies have these definitions to help you understand when your drinking may become a health problem.

The definition is different for women because women's bodies are typically smaller than men's. They also metabolize less alcohol in the stomach, meaning more ends up in their blood stream.

A standard "drink," by the way, is not that big frosty mug or that giant Hurricane glass you kept from Mardi Gras. The CDC says a drink is 12 ounces of beer (5% alcohol content), 8 ounces of malt liquor (7% alcohol content), 5 ounces of wine (12% alcohol content), or 1.5 ounces of 80-proof (40% alcohol content) distilled spirits or liquor - the fancy term for gin, rum, vodka, whiskey etc.

"That seems awfully low," Shiraki says. "I would think someone is a heavy drinker if they get drunk all the time. Two or three a night wouldn't do that."

"That definition is crazy."

Drinking heavily

"The definition of 'heavy drinker' has evolved over the last 20 years and it is based on scientific evidence about the harmful consequences of drinking too much," says George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism, who has sat on the committees that create those definitions.

The definition on NIAAA's website of "heavy" or "at-risk" drinking is the same as the CDC's.

But the National Survey on Drug Use and Health has another. They say "heavy use" is "five or more drinks on the same occasion, on each of five or more days in the past 30 days."

So which one is it?

"It's imprecise and not quantitative. I try to avoid using terms like 'heavy,' 'light' and 'moderate' for that reason in my publications," says Dr. Arthur Klatsky who has been studying alcohol and its impact on humans for decades. "The problem is everyone always wants to know if they fit into one of those categories."

Koob says the definitions vary because they're "not handed down to Moses from God on Mount Olympus." They are based on epidemiological studies that show the long-term negative consequences of heavy drinking.

The 2012 National Survey on Drug Use and Health found that heavy drinking was reported by 6.5% of the population over 12. That's about 17 million people. The rate was the same in 2011.

Those statistics are probably undercounting the real numbers, both Koob and Klatsky say.

Heaving drinking can lead to chronic diseases, including problems with your liver, throat, larynx and esophagus. It can lead to high blood pressure, psychological problems, and pancreatitis. It even puts you at an increased risk for becoming a victim of violence.

And of course you ultimately risk becoming an alcoholic.

Too much - or not enough?

One in 4 people who fall into the "heavy drinking" category already have an alcohol abuse problem, according to the NIAAA. Binge drinkers - women who drink more than four drinks in an outing and men who drink more than five - are a growing concern.

"The real worry these days is the number of young people who binge drink in college," Koob says. "We were all 21 once, we all drank, but what this generation considers intoxicated has doubled over the last 20 years.

How to cut back

Join the conversation

"Binge drinking has become a disturbing norm."

Not only does this put students at risk for violence, sexual assault, and all the above mentioned diseases, it can damage their brains. The frontal cortex - the part of the brain that helps you make decisions and control impulsivity - doesn't develop fully until you are 25. Binge drinking, studies show, can delay development of executive function.

Klatsky says the pattern of when you drink is just as important to your health as the total number. Abstaining much of the week and then having all seven drinks on Saturday is also bad for your health.

In addition to knowing what defines "heavy drinking," people should also know what "light" and "moderate" drinking is, Koob says.

Studies show the mortality rate for people who drink moderately on a daily basis is actually lower than those who don't indulge.

"There are health benefits to a lower level of drinking."

Klatsky says it is more important to focus on the broader issue of alcohol problems than getting caught up in semantics.

"There is an old joke all of us went to medical school used to hear," Klatsky says. "The definition of something like what is a 'heavy drinker' is one more than the upper limit of what the person making the definition drinks."

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Are you a heavy drinker? You'd be surprised

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Definition of heavy drinking varies slightly and is different for men and women Heavy drinking is defined as 8 or more drinks a week for women, 15 or more for men Heavy drinking is the third leading cause of preventable death Sheldon Shiraki sits at the bar in the trendy Fritti restaurant in Atlanta, happily sipping an ice cold cocktail.

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Hollywood actor and comedian Robin Williams talks to Kerry O'Brien about his battles with addiction and his career in stand-up comedy.

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Craig Ferguson one of the person I have lot of respect for, speaks on his past problems as an alcoholic and why he will not ridicule Britney Spears and her shaved head crisis. Must watch! [Original Air Date: 20-Feb-2007] YouTube:http://www.youtube.com/user/TVsCraigFerguson http://www.youtube.com/user/DrPinch2190 Brought To You By Your Friendly Neighborhood MONKE :)

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Alcohol Use Disorder: treatment through psychadelics

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Alcohol Use Disorder: treatment through psychadelics

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Recovery: an alcoholic's story | Robert Rhatigan | TEDxABQ

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National Institute on Alcohol Abuse and Alcoholism (NIAAA)

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Problem drinking that becomes severe is given the medical diagnosis of "alcohol use disorder" or AUD. AUD is a chronic relapsing brain disorder characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.

An estimated 15 million people in the United States have AUD. Approximately 5.8 percent or 14.4 million adults in the United States ages 18 and older had AUD in 2018. This includes 9.2 million men and 5.3 million women. Adolescents can be diagnosed with AUD as well, and in 2018, an estimated 401,000 adolescents ages 12-17 had AUD.

To be diagnosed with AUD, individuals must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Under DSM-5, the current version of the DSM, anyone meeting any two of the 11 criteria during the same 12-month period receives a diagnosis of AUD. The severity of AUD-mild, moderate, or severe-is based on the number of criteria met.

To assess whether you or loved one may have AUD, here are some questions to ask. In the past year, have you:

Had times when you ended up drinking more, or longer than you intended?

More than once wanted to cut down or stop drinking, or tried to, but couldn't?

Spent a lot of time drinking? Or being sick or getting over the aftereffects?

Experienced craving - a strong need, or urge, to drink?

Found that drinking - or being sick from drinking - often interfered with taking care of your home or family? Or caused job troubles? Or school problems?

Continued to drink even though it was causing trouble with your family or friends?

Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?

More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?

Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?

Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?

Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

If you have any of these symptoms, your drinking may already be a cause for concern. The more symptoms you have, the more urgent the need for change. A health professional can conduct a formal assessment of your symptoms to see if AUD is present.

However severe the problem may seem, most people with AUD can benefit from treatment. Unfortunately, less than 10 percent of them receive any treatment.

Ultimately, receiving treatment can improve an individual's chances of success in overcoming AUD. The NIAAA Alcohol Treatment Navigator can help you recognize and find high quality treatment for alcohol use disorder. If you drink excessively, seek medical help to plan a safe recovery as sudden abstinence can be life threatening.

Talk with your doctor to determine the best course of action for you, and for more information see NIAAA's resources:

Rethinking Drinking Treatment for Alcohol Problems: Finding and Getting Help

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Problem drinking that becomes severe is given the medical diagnosis of "alcohol use disorder" or AUD. AUD is a chronic relapsing brain disorder characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.

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The Sinclair Method: using opioids to treat alcohol use disorders

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The Sinclair Method: using opioids to treat alcohol use disorders

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How I overcame alcoholism | Claudia Christian | TEDxLondonBusinessSchool

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Alcoholism and Alcohol Abuse are Not the Same

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Alcoholism and Alcohol Abuse are Not the Same

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Question:

Will you explain the difference between alcohol abuse and alcohol dependence?

Answer:

In short, alcohol abuse is too much, too often and alcohol dependence is the inability to quit. Alcohol abuse is a pattern of drinking that leads to the failure to fulfill responsibilities at work, home or school and/or repeated drinking in situations in which it is physically hazardous.

Alcohol dependence may include a drinker's increase in tolerance, withdrawal syndrome, unsuccessful attempts to cut down or even quit drinking altogether, lose control of their alcohol use and consistently drink more and for longer than intended. The cardinal features of alcohol dependence are compulsion (inability to refrain from taking that drink), loss of control over alcohol (can't quit) and continued drinking no matter what the consequences.

"Sober Days" ran in the Palm Springs daily newspaper, the Desert Sun, for several years in the 1990s-2000s. The popular Q&A column was written by Dr. James West, the Betty Ford Center's first medical director. He remained with the Betty Ford Center until 2007, when he retired at age 93.

The Hazelden Betty Ford Foundation is a force of healing and hope for individuals, families and communities affected by addiction to alcohol and other drugs. It is the nation's largest nonprofit treatment provider, with a legacy that began in 1949 and includes the 1982 founding of the Betty Ford Center. With 17 sites in California, Minnesota, Oregon, Illinois, New York, Florida, Massachusetts, Colorado and Texas, the Foundation offers prevention and recovery solutions nationwide and across the entire continuum of care for youth and adults.

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What is the Difference between Alcohol Abuse & Dependence

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Learn what makes these behaviors different and whether they indicate alcoholism.