How to Recognize Alcohol Use Disorder

You may have heard about Canada’s updated Guidance on Alcohol and Health, introduced in January 2023. This new guidance replaces Canada’s previous–and more tolerant–low-risk drinking guidelines and now suggests that more than two drinks per week put you at an elevated risk of health and social harm from alcohol.

Even though this report was more focused on how alcohol can affect your health rather than compulsive or addictive alcohol use (what we now call Alcohol Use Disorder or AUD), it might have made you reconsider your drinking habits.

Unlike excessive or high-risk alcohol use, which generally does not have a strong psychological component, people with AUD typically struggle with controlling or cutting down alcohol use despite the negative consequences it has on their day-to-day lives.

I previously wrote about the facts around high-risk drinking, and the following is the latest information on the more serious cousin, AUD. I have years of experience helping people as an addiction medicine physician and researcher. I also co-chaired the Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder funded by Health Canada. Here’s what I know.

The difference between AUD and an “alcoholic”

In the past, a person who clearly drank to excess and struggled to control or quit heavy alcohol use might be referred to as an alcoholic. Since this term was viewed by many as being stigmatizing, clinicians now refer to problematic alcohol use that causes “clinically significant impairment or stress” as Alcohol Use Disorder (AUD).

AUD can be graded as mild, moderate or severe depending on the number of symptoms a person has. As the name implies, mild AUD is consistent with very mild problems, whereas severe AUD is consistent with a definition of alcohol addiction.

Signs of alcohol use disorder

If you’re reading this, perhaps you’ve already thought about your relationship with alcohol. Maybe others have told you they’re concerned about your drinking, or you feel embarrassed or guilty about your drinking but find it hard to stop.

Understanding your drinking habits and the associated risks is an important first step if you’re ready to cut down or quit altogether.

Signs to look out for:

• Regularly drinking more than you intended, such as planning to have just one, but end up drinking much more
• Regularly but unsuccessfully trying to cut down or quit
• Having cravings or strong feelings about the need to drink alcohol, such as to deal with emotions like stress or anxiety
• Recognizing alcohol is contributing to worse physical or emotional health but drinking anyway
• Neglecting important things in your life, like work, school or relationships, or having interpersonal problems because of alcohol use
• Experiencing withdrawal symptoms like shaky hands or feeling anxious when you take a day off from drinking 
• Missing out on social, workplace or recreational activities because you are drinking or recovering from drinking
• Taking risks, such as driving or unsafe sex, or putting yourself in other situations where you are at increased risk of harm because of alcohol

You can find helpful assessment tools on the helpwithdrinking.ca website under the “screening tools” tab.

The impact of AUD on your health

Here’s how alcohol can impact different parts of your body.

Brain

• Regular alcohol use often makes us more anxious or depressed when we don’t drink and interferes with sleep
• It can acutely lead to alcohol poisoning and, in the long term, brain damage and memory problems like dementia

Liver

• It can cause permanent liver damage (also known as cirrhosis) and liver failure

Heart 

• Raises your blood pressure and puts you at risk of a range of heart problems
• Greatly increases your risk of having a stroke

Other organs

• Alcohol negatively affects many parts of our bodies leading to premature aging and risks of various cancers
• It can cause problems like inflammation of the pancreas (known as pancreatitis), a very painful condition that is also a risk for future pancreatic cancer

More information on understanding the health risks of alcohol.

How to get help

Find a healthcare provider

You should visit your doctor or healthcare professional whenever you have a serious health problem. The same is true if you’re concerned about alcohol use. A family doctor, nurse practitioner, walk-in or virtual clinic, or mental health professional will provide professional support and help guide you toward the next best steps. 

Healthcare providers can do a screening test and provide a diagnosis to help you figure out if your drinking is putting you at high risk of health impacts and if you have AUD. If you have AUD, it is important to understand if it is mild, moderate or severe.

Treatment and support options

If you struggle with alcohol use, counselling is usually recommended to help improve your ability to gain control over alcohol use and develop non-alcohol-related coping skills. It can also help you address underlying stresses or trauma that may contribute to drinking behaviours.

If you have moderate to severe AUD and require extra help, there are medications proven to support reducing or quitting alcohol. These treatments have helped thousands of people get control over their alcohol use. The various medications that can be helpful and those to avoid are described in the guideline itself. 

When talking to your healthcare providers about medications, it’s essential to be aware of which medications work and which are not helpful. Studies have suggested that certain medications–like some commonly prescribed antidepressants–are ineffective in persons with AUD and may lead to increased drinking in some individuals.

Consider community support

Being isolated can make it challenging to reduce or quit alcohol, so community support is often a part of a long-term plan. It can also be the first step on your journey. This might be simply the support of friends and family, depending on how severe your challenges with alcohol are. The following supports may also be helpful:

• Peer groups, like Alcoholics Anonymous or SMART Recovery can be invaluable for some
• Where available, health authority or community groups or drop-in centres for people struggling to find non-alcohol-involved social relationships
• Substance use disorder treatment services such as specialty clinics or inpatient services, which your doctor may recommend
• Counselling or psychotherapy from a skilled mental health professional
• Although it’s best to talk to local experts in your community, a complete list of Canada-wide services can be found here

Quitting on your own

If you’re trying to wean yourself off alcohol, it’s essential to be aware of certain potential risks. If you use alcohol excessively daily (e.g. greater than 4-6 drinks per day), and you suddenly stop or dramatically cut back on your drinking without a doctor’s help, you could end up with serious, and in rare instances, even life-threatening withdrawal symptoms.

Generally, the risks of severe withdrawal depend on how much you have been drinking and for how long without stopping, as well as past experiences with stopping alcohol. 

Most people who need help with alcohol use will not develop severe withdrawal symptoms requiring the use of medications. However, if you’re a heavy drinker or have had past serious withdrawal symptoms, it’s recommended that you cut down over the course of a week or two. Or, even better, speak to a healthcare provider so they can assess your risk of possible severe alcohol withdrawal and provide support.

Helping a friend or cutting down as a group

Like shared fitness goals, committing to a healthier relationship with alcohol is often easier with friends, within a group, or through other forms of peer support. While the decision to reduce or stop drinking is up to the individual, support from a friend or family member can be invaluable. Support becomes even more critical for those with serious AUD concerns to help navigate services and treatment plans.

The benefits of getting help

A better understanding of the risks of alcohol and the motivation and support to change is often all that is needed to reduce or quit unhealthy patterns in persons with mild to moderate AUD. 

If that is not enough support, working with your doctor, a therapist, or another mental wellness professional can provide further benefits. For those with more severe alcohol use disorder, getting help through more intensive interventions, including the use of evidence-based medications and more intensive treatment, can be highly effective.

Even as a doctor at a withdrawal management clinic, where we see some of the most serious and severe cases of AUD, the illness can be a highly treatable condition when effective evidence-based treatments are offered.

Asking for help is not easy, but in my experience, no one ever regrets the decision once they’ve made it.

For more information, visit the helpwithdrinking.ca website. This website offers reliable information based on the complimentary guidelines I put together, the Canadian Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder, that describe best practices for the treatment of high-risk drinking and alcohol use disorder (AUD).