Alcohol use disorder: signs, withdrawal, treatment and where to get help

The NHS defines alcohol use disorder as drinking alcohol in a way that is harmful. It is not a matter of willpower alone: the condition affects control over drinking and, in people who are dependent, the body adapts so that stopping causes withdrawal symptoms. It can develop gradually over years and exists on a spectrum, so help is relevant well before someone becomes physically dependent.

NICE guidance distinguishes harmful drinking, mild dependence and moderate to severe dependence. The distinction matters because the safest way to stop, and the level of support needed, depends on where someone sits on that range.

The NHS lists the following as signs of alcohol use disorder.

• Regularly drinking more than you intend to.

• Finding it hard to stop or cut back, even when you want to.

• Feeling guilty or remorseful afterwards.

• Other people expressing concern about your drinking.

• Carrying on even though it causes problems for your health, work or relationships.

• Cravings, for example needing a drink when you wake up.

• Needing more alcohol to get the same effect.

• Withdrawal symptoms when you stop or reduce.

The NHS says one unit equals 10ml or 8g of pure alcohol, and that units are a simple way of expressing the quantity of pure alcohol in a drink. To keep health risks from alcohol low if you drink most weeks, men and women are advised not to drink more than 14 units a week on a regular basis, to spread drinking over 3 or more days if you regularly drink as much as 14 units, and to have several drink-free days each week if you want to cut down. The NHS says 14 units is equivalent to 6 pints of average-strength beer or 10 small glasses of lower-strength wine.

You can work out units by multiplying a drink’s volume in ml by its strength (ABV, as a percentage) and dividing by 1,000. Alcohol use disorder is not defined by a number of units, though. The NHS says to see a GP or an alcohol support service if you are worried about your drinking, and points to the Alcohol Change UK website if you want to check your drinking and are not sure how serious it is.

Withdrawal is a sign that the body has become dependent. The NHS lists anxiety, difficulty sleeping, nausea and vomiting, a racing heartbeat, sweating, shaking, hallucinations, confusion and seizures. Mild to moderate symptoms such as anxiety on waking, sweating, mild tremor and morning nausea or retching suggest a person may need medicine to stop safely.

The NHS says withdrawal symptoms begin within 6 to 12 hours of your last drink and usually last from 3 to 7 days, but some symptoms may last for a few months, especially if you drink heavily. It says it can be very dangerous to stop drinking suddenly if you are dependent on alcohol, and that you should get medical help before you try to stop if you get withdrawal symptoms.

The NHS says to call 999 or go to A&E for severe withdrawal: visible shaking, unusual restlessness or irritability, confusion, seeing or hearing things that are not there, or a seizure. It also advises not driving yourself. See the separate guide on alcohol withdrawal for detail.

A GP or alcohol service will ask about your drinking and how it affects your life, may use a questionnaire, and may offer blood tests to see whether alcohol is affecting your health. NICE recommends formal tools such as AUDIT to assess severity and the Severity of Alcohol Dependence Questionnaire to measure dependence. A comprehensive assessment is considered for people referred to specialist services who score more than 15 on the AUDIT, and it covers physical health, mental health, social circumstances and thinking skills.

Being accurate about how much you drink matters. The NHS advises being honest with the GP about quantity and about any problems, since the safest treatment plan depends on it.

The NHS says treatment is available from a GP or a specialist alcohol service and can include talking therapies such as cognitive behavioural therapy, medical help with withdrawal at home or in hospital, medicines to prevent relapse, help with relationships, and help with practical issues such as work or housing.

The NHS says most people get support to stop drinking in the community, and medicine to help can often be taken at home or with daily visits to a local service. Some need a short stay in a medically supported unit. NICE suggests considering inpatient or residential withdrawal for people who drink very heavily, have a history of withdrawal seizures, have significant physical or mental health problems, or are in vulnerable groups such as people who are homeless or older.

Intensive rehabilitation, either in the community or residential, is usually reserved for people with medium or high levels of dependence or those who have not responded to other help. Local authorities are responsible for alcohol treatment services, residential rehabilitation can require a funding assessment, and it is also possible to pay privately; some medical insurers fund it for a limited period.

Short-term risks include accidents, injuries and alcohol poisoning. Longer-term risks named by the NHS include alcohol-related liver disease, many types of cancer, high blood pressure and stroke, cardiomyopathy and heart failure, acute and chronic pancreatitis, anxiety and depression, and alcohol-related brain damage. In pregnancy the NHS recommends not drinking alcohol at all, because it raises the risk of miscarriage, stillbirth and premature birth and can lead to fetal alcohol spectrum disorder.

A GP or local community alcohol service is the usual starting point, with longer-term support from groups such as AA or SMART Recovery in most areas. Private clinics and residential units exist; the NHS notes that relying on family and friends alone is often not enough, so a plan to maintain progress is worth asking about whichever route you take.