The Facts About Alcohol Use Disorder

Alcohol use disorder (AUD) is a condition in which someone feels compelled to drink to the point of being dependent on drinking in order to function day to day. The condition may be mild, moderate or severe, and has both physical and mental components, including potential sexual side effects. 

While AUD is related to alcoholism and addiction, the consensus in the medical community appears to lean toward alcohol use disorder as an umbrella term to indicate a wide variety of manifestations and levels of severity of alcohol abuse.

Alcohol use disorder (AUD) is a condition in which someone feels compelled to drink to the point of being dependent on drinking in order to function day to day. The condition may be mild, moderate or severe, and has both physical and mental components, including potential sexual side effects.

While AUD is related to alcoholism and addiction, the consensus in the medical community appears to lean toward alcohol use disorder as an umbrella term to indicate a wide variety of manifestations and levels of severity of alcohol abuse.

While it's not entirely clear what causes AUD, there is evidence of a genetic, hereditary component to it, meaning people with a family history of alcohol use disorder are at higher risk themselves. Social factors are also at play, as friend groups can reinforce behaviors that may exacerbate alcohol use disorder.

Studies also suggest that people with AUD have a higher prevalence of mental health disorders. The research doesn't prove a direct causal correlation in either direction, but it does support the theory that there might be genetic links.

In addition to the risks listed above, alcohol use disorder can have particular effects on women:

• Breast cancer. AUD may increase a woman's risk of breast cancer.
• Fetal alcohol syndrome. Pregnant women who suffer from AUD may be at higher risk for fetal alcohol syndrome.
• Menstrual cycle problems. AUD may cause women to produce higher levels of the hormone cortisol, which may alter their estrogen levels and how their menstrual cycle functions, or stop it altogether.

The risks of AUD for men include exacerbating a number of conditions for which they are already at risk, including:

• Diabetes. Chronic alcohol use is associated with developing type 2 diabetes, a condition that's increasingly common in both older and younger men.
• High blood pressure. Men with hypertension can make it worse by drinking too much alcohol, although the effect is quickly reversible by cutting down alcohol intake.
• Weight gain. As men age, weight gain is worsened by the excess calories they take in when they suffer from AUD.

Preventing AUD may be a challenge, especially for people with a genetic predisposition for it, but there are some tried-and-true steps you can take.

Since over-imbibing can stem from nervousness about a social situation, getting help for general anxiety may be a valuable way to reduce the tendency toward AUD. In fact, generally speaking, for people with a tendency toward substance use problems, seeking help from professionals and social contacts can be a great tool.

Another tool is identifying triggers that have caused you to drink too much in the past and learning how to deal with them in a healthier way.

Evaluation of AUD should involve sessions with qualified healthcare providers. Screening involves focusing on a person's relationship with alcohol, including how, when and why they drink, and talking more about how it affects their life.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) includes alcohol as one of 11 drug classes that can be used to diagnose a substance use disorder. Criteria for diagnosis include suffering cravings, wanting to reduce use but not being able to, causing problems with other obligations, increased tolerance and continuing to use despite resultant life problems.

Once a person has been diagnosed with AUD, they may be referred for treatment. Depending on the severity of their problem and their financial position, legal disposition and personal preferences, and those of their loved ones, the person may be recommended for outpatient or inpatient treatment, therapy sessions on an individual basis or in a group, or self-help groups such as Alcoholics Anonymous (AA).

The goals of treatment usually include psychological or psychiatric sessions that seek to empower the patient by examining the underlying emotional factors that drive them to negative behaviors. In certain cases, medications may be prescribed to control withdrawal or craving symptoms.

Alcohol use disorder can lead to a number of physical and psychological effects.

Among the more common effects of AUD are:

• A literally shrinking brain
• Dehydration, which can lead to puffiness in the face and around the eyes
• Erectile dysfunction (ED)
• Gout, which is a buildup of uric acid in the blood that can cause painful toe joints or kidney stones
• Memory loss
• Weight gain

Chronic use of alcohol is associated with heart disease, liver disease and certain types of cancers, as well as other neurological impairments. Alcohol use also can cause issues like poor decision-making and blackouts.

Men can be particularly affected sexually by AUD. Alcohol affects a number of systems and the way they communicate with one another, and male sexual function is a direct target.

Alcohol is a depressant and can famously cause occasional, temporary ED, which is commonly referred to as "whiskey dick." But beyond that, long-term chronic alcohol use can affect the reproductive system and cause circulatory and blood flow issues such as:

• Blood circulation to the penis
• Premature ejaculation
• Reduced libido
• Reduced penis sensitivity
• Resultant complications in relationships

Since there's no universal number of drinks any man can have before alcohol affects his erectile function, guys should listen to their bodies.

A couple of important considerations:

• Check out your meds. A lot of medications can have sexual side effects, which may be exacerbated by alcohol. Certain medications cannot be paired with alcohol. Talk to your healthcare provider about how your meds work.
• Consider food. Be strategic about when and how much you eat if you plan to drink alcohol and have sex. An empty stomach can lead to quicker alcohol absorption
• Stay hydrated. Alcohol is a diuretic—a substance that promotes the passing of urine—and hydration is crucial to maintaining a solid erection.

Life with AUD is achievable and something that millions of people manage every day. It's important to understand that learning to live with AUD is an ongoing process.

Healthcare providers who work with substance use frequently cite the importance of keeping up with ongoing treatment and therapy, including regularly attending formal support group meetings as well as developing a strong informal support group among your family and friends.

For more help, reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline either online or by calling 1-800-662-HELP (4357). The helpline is available 24/7. Also, check out groups such as Alcoholics Anonymous and Narcotics Anonymous.

Is AUD the same as alcoholism?

Yes and no. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), substance use disorder is characterized by a mild, moderate or severe dependence on certain drugs (such as alcohol) or prescription medications. While previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) separated substance dependence under two headings—addiction and abuse—the fifth edition (DSM-5) now defines them all under one umbrella term: "substance use disorders," in this case, alcohol use disorder.

The difference in terminology is best thought of as a way to add more nuance and to talk about unhealthy alcohol use in a less judgmental way.

What are the warning signs of alcohol use disorder?

Some diagnostic measures of AUD include:

• Being unable to reduce use despite wanting to
• Missing obligations due to use
• Building tolerance and needing more alcohol over time
• Continuing to drink despite the life problems that may result
• Continuing to drink even though you know it's an issue
• Experiencing cravings
• Experiencing withdrawal symptoms
• Using more alcohol or over longer periods than you meant to

If you notice two or three of these signs, it could indicate a moderate alcohol use disorder that may develop into a more severe condition over time.

How is alcohol use disorder treated?

Therapy is a big component of any program for treating alcohol use disorder, as it helps uncover the triggers causing the behavior as well as address any underlying mental health challenges that may contribute to it. Treatment may involve a period in a residential, inpatient or outpatient facility, and may involve individual, group or family therapy. Oftentimes, joining a self-help group such as AA or NA and attending meetings is also recommended.