Reliable Information for Individuals, Families and Health Professionals

Alcohol Abuse, Alcohol Addiction and Alcoholism

A Simple Test: Signs of Alcoholism and Alcohol Abuse

If you answer yes to three of these four questions, you are probably addicted to alcohol.

Are you concerned about your drinking? Have you ever wondered if you are an alcoholic? You probably suspect the answer. But maybe you’re afraid to admit it. This is your chance to do something about it. Click here for a more detailed alcohol dependence test.

Is there a difference between alcoholism, alcohol dependence, and alcohol abuse? All these terms mean the same thing in the DSM 5 (The Diagnostic Manual of the American Psychiatric Association) and ICD-10 (International Classification of the World Health Organization). These names have fallen in and out of favor over the years, in an effort to avoid negative associations, but they are equivalent.

Table of Contents

Alcohol Withdrawal
Effects of Alcohol
Binge Drinking
Alcohol Poisoning
Helping Someone with Alcoholism

Stages of Alcoholism: The Functioning Alcoholic

In the early stage of alcoholism you regularly drink too much, but you haven’t suffered many consequences. This is when it’s easiest to make a change.

The middle stage of alcoholism is the classic functioning alcoholic. You still have a job and your relationships are intact, but your life is beginning to suffer. This is the most common scenario. You don't have to suffer major losses to have an addiction. Late stage alcoholism is the non-functioning alcoholic. By then you have lost your job and probably have to drink every day. It's what people think alcoholism is like, but this stereotype is rare.

Alcoholism is progressive. The consequences get worse over time. It's never easy to quit. But if you have already suffered some consequences and don't want them to get worse, there's never a better time to quit than now.

What is Moderate Alcohol Use?

How Much Drinking is Too Much?

Maximum limits for alcohol use set by the National Institute of Alcohol Abuse and Alcoholism.[1]

People who drink more than the maximum limits are at high risk of becoming alcoholics. [2]

How Common is Alcoholism or Alcohol Abuse?

Alcohol Withdrawal

Alcohol withdrawal occurs because your brain works much like a spring. Alcohol is a brain depressant that pushes down on the spring. When you suddenly stop drinking it is like taking the weight off the spring. Your brain is out of balance. The spring rebounds and your brain produces excess adrenaline which causes the withdrawal symptoms.

What goes on at the level of brain neurotransmitters? GABA is the calming neurotransmitter of the brain. GABA and adrenaline are supposed to be in balance in the brain. Drinking regularly causes the brain to produce less GABA, because the brain begins to rely on alcohol for part of the calming effect. When you suddenly stop drinking, your brain chemistry is out of balance. You don’t have enough GABA neurotransmitter, and you have a relative excess of adrenaline, which causes all the withdrawal symptoms.

Alcohol Withdrawal Symptoms

These are some of the symptoms of alcohol withdrawal:

Suddenly stopping alcohol can lead to seizures, strokes, or heart attacks in high risk patients. A medically supervised detox can minimize your withdrawal symptoms and reduce the risk of dangerous complications. Some of the dangerous symptoms of alcohol withdrawal are:

Alcohol Detox (detoxification) to Prevent Withdrawal

Detoxification, or detox, involves taking a short course of medication to help reduce or prevent withdrawal symptoms. Medications such as Valium (diazepam), Librium (chlordiazepoxide), or Ativan (lorazepam), the benzodiazepine family, are usually used for detox.

Detox can be done as either an inpatient or outpatient depending on the person’s health, their volume of drinking, and their past history of withdrawal. Detox is always done under close supervision. A common plan for outpatient detox is to prescribe a high dose of medication on the first day, and then gradually reduce the dose over the next 5-7 days. People with serious alcohol abuse may be admitted to hospital.

This is general medical information, and not tailored to the needs of a specific individual.

Effects of Alcohol - Alcohol Facts

Alcoholic Hepatitis/ Alcoholic Liver Disease

The liver filters toxins from the blood, including alcohol. If you drink excessively, the liver cannot keep up, and becomes damaged. This is called alcoholic hepatitis. In the United States, alcoholic liver disease affects more than 2 million people (approximately 1% of the population).

There are three stages of liver damage: 1) elevated liver enzymes, 2) alcoholic hepatitis or fatty liver, 3) cirrhosis.

The most common form of liver damage is elevated liver enzymes. Your doctor can do a blood test to check if you have elevated liver enzymes. The three enzymes tested are AST, ALT, and GGT. Your liver is able to repair itself, and at this stage liver damage is potentially reversible. If you stop drinking the liver enzymes may go back to normal.

How do liver enzyme tests work? The enzymes AST, ALT, and GGT normally occur inside liver cells. If your liver is damaged, the enzymes escape into your blood stream and show up in your blood test. Therefore the higher the enzyme count, the greater the liver damage. The most accurate of these tests for alcoholic liver damage is GGT.

The second most common form of liver damage is ‘fatty’ liver.
Some fat in the liver is normal. The liver is the main organ of fat metabolism in the body. But when your liver is damaged by alcohol abuse fat begins to deposit in your liver. If fat makes up more than 5% - 10% of the liver, it is considered a fatty liver.

Fatty liver can be identified by blood tests and a liver ultrasound. This stage of liver damage is also reversible with abstinence. However, fatty liver damage has a greater risk of turning into cirrhosis with continued alcohol abuse.

Significant liver damage can cause jaundice. Jaundice means that your skin and/or the whites of your eyes have turned yellow. This occurs when your liver can't remove a toxin called bilirubin from your blood. Bilirubin is yellow, therefore when it builds up your skin and the whites of your eyes turn yellow. Jaundice can be reversible if you stop drinking.

Alcoholic Cirrhosis

Repeated liver damage can cause cirrhosis. Your liver is a remarkable organ, but it can only repair itself so many times. After a while your liver won't be able to repair itself and it will turn into scar tissue. Cirrhosis is just the medical term that means part of your liver has turned into scar tissue.

Signs of Cirrhosis or Severe Hepatitis

There is good news. Your liver is a big organ and you have more liver than you need. People can lose 30 percent of their liver in a car accident and still lead normal lives. So if you have less than 30 percent cirrhosis and you stop drinking, you can still lead a normal life. Your doctor can do an ultrasound to see if you have cirrhosis, and estimate what percent of cirrhosis you may have.

Alcoholic Neuropathy

Nerve damage due to alcohol abuse is called alcoholic neuropathy. Alcohol is toxic to nerves cells, which can cause brain damage and peripheral nerve damage. A significant part of alcoholic neuropathy is also caused by the poor nutrition associated with alcoholism.

Alcoholic neuropathy usually has a reversible and irreversible component. The reversible components is caused by the poor nutrition, and can be treated by thiamine (vitamin B1), folic acid, and vitamin B12. The irreversible component is caused by the direct poisoning of nerve cells, and there is no known cure. Up to half of long-term, heavy alcohol abusers develop alcoholic neuropathy.

Symptoms of Alcoholic Neuropathy

Alcohol and Hypertension: High Blood Pressure

More than two drinks a day has been proven to cause high blood pressure.[4] Studies have also shown that reducing or eliminating alcohol use can reduce blood pressure.[5]

Alcohol Abuse and Cancer Risk

Alcohol abuse significantly increases the risk of most forms of cancer, including mouth, esophagus, breast, stomach, liver, prostate, and colon cancer.[6]

How does alcohol increase cancer risk? It is likely that there are several ways this happens. Acetaldehyde, a byproduct of alcohol metabolism is thought to be one of the main causes of alcohol related cancers.[7]

In the case of mouth, esophagus, and stomach cancer, alcohol appears to also act as a direct irritant that damages tissues. Alcohol may also allow harmful chemicals, such as tobacco smoke, to enter the digestive tract more easily. This explains why smoking and drinking combined are more deadly than either one alone.

Alcohol Abuse and Breast Cancer

Breast cancer, the leading cause of death in women, is strongly correlated with alcohol abuse. Drinking more than two drinks a day increases the risk of breast cancer by 50%! [8] This result has been confirmed in studies of over one hundred thousand women.

Depression and Alcohol Abuse

Depression is one of the most common, serious consequences of alcohol abuse. You may wonder if alcohol abuse leads to depression or if it’s the other way around? Do people drink to deal with depression, which then leads to alcohol abuse and addiction?  Research has shown that alcoholism and alcohol abuse usually lead to depression. [9]

Alcohol abuse doubles the risk of depression. One study looked at 2,945 alcoholics. 15% were depressed before they began abusing alcohol. 26% were depressed while they were using alcohol, and 15% remained depressed once they had stopped drinking for an extended period.[10]

Alcohol and Pregnancy: Fetal Alcohol Syndrome

All studies show that there is no safe amount of alcohol during pregnancy. Alcohol is toxic to the fetus and especially to the developing brain of the fetus. Drinking during pregnancy has a number of effects including low birth weight and increased risk of premature birth. The main serious side effect of drinking during pregnancy is fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) and alcohol-related developmental disorders combined occur in approximately one in 100 live births in the US and Great Britain. [11]

Some of the consequences of fetal alcohol syndrome include:

Binge Drinking

Why is binge drinking so risky? Drinking four or five drinks over a few hours will raise your blood alcohol concentration (BAC) quickly which makes you drunk quickly. Drinking the same amount over several hours, and accompanied by food, will not have the same effect on your blood alcohol concentration, and therefore will have less effect on your brain.

Approximately 12 percent of woman report having been sexually assaulted when either they or their assailant had been drinking.[12] Binge drinking increases the risk of unprotected sex, sexual assault, and sexually transmitted diseases.

Approximately one third of accidental deaths and one third of motor vehicle deaths are related to alcohol abuse.[13]

Binge drinking increases the risk of academic problems, fights, motor vehicle accidents, physical and sexual assault, and changes in brain development that may have long-term effects.

Binge drinking dramatically increases the risk of developing an addiction. College students who drink more than 5 drinks, more than twice in two weeks are 19 times more likely to develop alcoholism than non-binge drinkers.[14]

Resources for Binge Drinking

How Big is a Drink? The Definition of a Standard Alcoholic Drink.

A standard drink is defined as 14 grams of pure alcohol according to the US Department of Health and Human Services. However in Europe the most commonly used standard is 10g of pure alcohol.

Note that a 750ml bottle of wine contains 5 drinks. Therefore 2 drinks a day is less than half a bottle of wine a day.

The basic formula for calculating a drink is that each milliliter of pure alcohol weighs 0.79 grams. Therefore, for example, 12 oz of beer or 330 ml of beer x 5% alcohol x 0.79 = 13 grams of pure alcohol.

Blood Alcohol Concentration (BAC) Calculator

This information is provided as guideline only and should not be relied upon to determine if you can safely operate a vehicle. Many factors can affect BAC, including the amount of alcohol consumed, rate of consumption, food consumption, and factors such as gender, age, weight, height and metabolism. However these numbers apply over a broad range of body weights.

It can take up to 30 minutes after the last drink to reach the maximum BAC level.

To Keep BAC Less than 0.05 (g/dL or 50 mg/dL)

BAC Greater than 0.05 (g/dL or 50 mg/dL)

Alcohol Poisoning

Alcohol poisoning is a serious and potentially deadly consequence of drinking large amounts of alcohol over a short period of time. If you suspect someone has alcohol poisoning, call for emergency medical help right away.

There are many kinds of alcohol:

Alcohol Poisoning Symptoms

These symptoms can occur from poisoning by all forms of alcohol. Alcohol poisoning symptoms begin to occur when the blood alcohol concentration (BAC) is approximately 0.25. (Intoxication occurs at 0.05. Poisoning occurs at 5 times the blood alcohol level of intoxication.)

Alcohol Poisoning What to Do (Treatment)

What Not To Do

BAC and Growing Impairment

BAC (0.05 – 0.08)
Relaxation, euphoria, sociable, and talkative.
Impaired judgment, attention, and fine motor control.

BAC (0.08 – 0.1)
Slurred speech.
Poor muscle coordination.

BAC (0.1 – 0.2)
Impaired balance. Staggering.
Impaired vision, including ability to see detail and peripheral vision.

BAC (0.2 – 0.3)
Disoriented, confused.
Impaired perception of color, form, motion, and dimensions.
Increased pain threshold and lack of muscular coordination.
Near total loss of motor functions, inertia, little response to stimuli, inability to stand or walk, vomiting, and incontinence.
Possible loss of consciousness, stupor.

BAC (0.3 – 0.5)
Depressed or absent reflexes.
Reduced body temperature.
Impaired circulation and respiration.
Coma, death.

Treatment, Recovery and Relapse Prevention for Alcoholism

If you have decided you have an alcohol problem, you’ve taken an important step. The key to making change is to use the supports available. Self-help groups, online groups, your physician, therapist, rehab, websites like this are all potential supports.

Using supports helps you feel like you’re not alone. It gives you confidence that you can make changes. It helps you see techniques that have worked for others. It dramatically increases your chances of success.

To learn more about recovery skills and relapse prevention methods please follow these links. You can change your life. Your continued recovery depends on learning healthier coping skills and making better decisions.

Getting Help: Online Resources for Alcohol Problems

There are many online resources for dealing with alcohol problems. Here are a few select links:

Finding Treatment

Please click here for a more detailed list of addiction and recovery resources.

Helping Someone with Alcoholism or Alcohol Abuse

If someone you love has a drinking problem, you may be struggling between how to help the person and how to avoid being overwhelmed. You are probably feeling a combination of anger, fear, shame, and sometimes even guilt. I hope some of these suggestions will help you.

What Not To Do

Things You Can Do For Yourself

Helpful Links for Family and Friends of Alcoholics


1) National Institute of Alcohol Abuse and Alcoholism, Helping Patients Who Drink Too Much: A Clinicians Guide. 2005.
2) Dawson, D.A., B.F. Grant, and T.K. Li, Quantifying the risks associated with exceeding recommended drinking limits. Alcohol Clin Exp Res, 2005. 29(5): p. 902-8.
3) Dawson, D.A. and L.D. Archer, Relative frequency of heavy drinking and the risk of alcohol dependence. Addiction, 1993. 88(11): p. 1509-18.
4) MacMahon, S., Alcohol consumption and hypertension. Hypertension, 1987. 9(2): p. 111-21.
5) Puddey, I.B., et al., Evidence for a direct effect of alcohol consumption on blood pressure in normotensive men. A randomized controlled trial. Hypertension, 1985. 7(5): p. 707-13.
6) Bagnardi, V., et al., Alcohol consumption and the risk of cancer: a meta-analysis. Alcohol Res Health, 2001. 25(4): p. 263-70.
7) Poschl, G. and H.K. Seitz, Alcohol and cancer. Alcohol Alcohol, 2004. 39(3): p. 155-65.
8) Seitz, H.K., et al., Epidemiology and pathophysiology of alcohol and breast cancer: Update 2012. Alcohol Alcohol, 2012. 47(3): p. 204-12.
9) Fergusson, D.M., J.M. Boden, and L.J. Horwood, Tests of causal links between alcohol abuse or dependence and major depression. Arch Gen Psychiatry, 2009. 66(3): p. 260-6.
10) Schuckit, M.A., et al., Comparison of induced and independent major depressive disorders in 2,945 alcoholics. Am J Psychiatry, 1997. 154(7): p. 948-57.
11) Sampson, P.D., et al., Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder. Teratology, 1997. 56(5): p. 317-26.
12) Abbey, A., et al., Alcohol and sexual assault. Alcohol Res Health, 2001. 25(1): p. 43-51.
13) Hingson, R.W., et al., Age of drinking onset and unintentional injury involvement after drinking. JAMA, 2000. 284(12): p. 1527-33.
14) Courtney, K.E. and J. Polich, Binge drinking in young adults: Data, definitions, and determinants. Psychol Bull, 2009. 135(1): p. 142-56.


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Last Modified: May 20, 2016

Included Information: Find out about alcoholism, Alcohol Abuse, and Alcohol Addiction in addition to learning useful information about alcohol dependence, Signs of Alcoholism and the Symptoms of Alcoholism. Topics covered include alcohol withdrawal, detox, and alcohol withdrawal symptoms as well containing information on effects of alcohol, alcoholic hepatitis, and alcoholic neuropathy.
The website contains facts on alcohol facts, long term Effects of Alcohol, alcoholic liver disease, as well as providing material on alcohol and blood pressure, facts about alcohol, and how does alcohol affect the body. There is important information on what is alcoholism, the definition of alcoholic, and signs of an alcoholic and there are also helpful advice key facts about what is an alcoholic, am I an alcoholic, and alcoholism definition.
There are key facts on Alcohol Poisoning, Blood Alcohol Level, alcohol poisoning symptoms and discover important facts about signs of alcohol poisoning, and Symptoms of Alcohol Poisoning. Gain a deeper understanding of stages of alcoholism, alcoholism statistics, and functioning alcoholic and discover key facts about alcohol tolerance, and alcoholism facts.
The website has information on How to Stop Drinking Alcohol, alcoholism treatment, and alcohol rehab and you will learn details about substance abuse treatment, how to stop drinking, and quit drinking. You will learn about living with an alcoholic, How to Help an Alcoholic, and Alanon and included material on how to stop drinking, How to Quit Drinking, and Alcoholics Anonymous.
You will learn about Alcohol and Pregnancy, Fetal Alcohol Syndrome, and alcohol withdrawal and included material on effects of alcohol on the brain, how does alcohol affect the brain, and does alcohol kill brain cells. Topics covered include how much alcohol is too much, Binge Drinking, and Underage Drinking as well containing information on symptoms of alcoholism, a blood alcohol calculator, Alcohol Detox, and Alcohol Withdrawal Symptoms.
The website contains facts on how to stop drinking, how to quit drinking, and signs of alcoholism, as well as providing material on binge drinking, effects of alcohol, and alcoholic hepatitis. Gain a deeper understanding of stages of alcohol poisoning, blood alcohol levels and poisoning, symptoms of alcohol poisoning and discover key facts about signs of alcohol poisoning, alcohol detox and withdrawal. The content is provided by Dr. Steven M. Melemis addiction medicine specialist.