Alcohol use disorder

There is no safe level of drinking alcohol that does not have bad effects on your health. The Australian National Health and Medical Research Council’s guidelines to reduce the health risks from alcohol state that we should have no more than 10 standard drinks in a week, and no more than four standard drinks on any one day, but even drinking at this level can have bad effects on your health.

Alcohol use disorder is the medical term for having a drinking problem. Someone has alcohol use disorder if two or more of these apply within a period of 12 months:

• Drinking more, or for longer, than intended
• Always feeling a need to cut down or control drinking, or being unsuccessful at cutting down or getting control of drinking
• Spending a lot of time getting alcohol, drinking or recovering
• Craving alcohol
• Repeated failures to fulfil obligations at work, school or home because of drinking
• Continuing to drink even though it creates ongoing social or relationship problems, or makes them worse
• Giving up or reducing important social, work or recreational activities because of drinking
• Ongoing drinking in situations made physically dangerous by alcohol
• Drinking even though it’s known to be causing ongoing physical or psychological problems, or making them worse
• Development of tolerance to alcohol (i.e. the same amount of alcohol has less effect, or drinking more is needed to feel the effects)
• Two or more withdrawal symptoms (sweating or heart rate above 100 beats per minute, hand tremor, insomnia, nausea or vomiting, hallucinations, anxiety, seizures or restlessness, fidgeting or racing thoughts) occur after heavy drinking, or alcohol (or related drug, like benzodiazepines) is needed to prevent withdrawal

The prevalence of alcohol use disorder seems to be higher in Australia than in other countries and is three times higher for Australian men than women. Overall, on any given day about one in 10 Australian men have alcohol use disorder, and one in three have it at some point in their lives.

In addition to the criteria used to diagnose alcohol use disorder, other symptoms include:

• Erectile dysfunction
• Gastrointestinal problems (e.g. stomach pain; diarrhea, constipation, or other problems with bowel movements)
• Muscle cramps
• High blood pressure
• Liver pain, jaundice (yellowing of the whites of the eyes or skin)

There are complex genetic, environmental, psychological and social causes of alcohol use disorder. Heavy drinking, even if it’s not all the time and your overall alcohol intake is low, seems to be a strong factor in the development of alcohol use disorder.
 

To diagnose alcohol use disorder, your doctor will ask you some questions about your drinking and might perform a physical examination.

There are no laboratory tests needed to diagnose alcohol use disorder, but your doctor might order tests to work out how much your health has been affected by your drinking, or to track progress during treatment.

Treatment for alcohol use disorder varies from person to person. Your doctor will work with you to identify the right treatment for you and track your progress. Treatments include:

• Conversations to help you set goals for your drinking behaviour
• Counselling
• Self-help groups
• Medication

Counselling and medication together can be more helpful than either type of treatment alone.

In addition to treatment for alcohol use disorder, many people also need treatment for diseases caused by alcohol. Treatment of physical or psychological health issues might be necessary.

Many people with alcohol use disorder successfully reduce their drinking or stop drinking altogether, but it can take a few attempts.

There are very serious health consequences of alcohol use disorder, including death. Complications of alcohol use disorder include:

• Bleeding from the oesophagus or stomach
• Delirium tremens (confusion, hallucinations, tremors, alterations in sleep, sweating, fever, high blood pressure, high heart rate, restlessness, fidgeting)
• Seizures
• Liver disease
• Nutrition disorders, decreased body weight
• Cancer of the mouth, throat, colon, rectum, liver, or breast
• High blood pressure
• Stroke
• Shrinking of some parts of the brain
• Increased heart size, reduced heart function
• Inflammation of the pancreas
• Thiamin (vitamin B1) deficiency resulting in problems with eye movements, confusion, clumsiness, speech and swallowing problems

If you have any concerns about your alcohol use, even if you drink within the alcohol guidelines, you should see your doctor. Tell them you want help to reduce your drinking. It is better to avoid problem drinking from the beginning, rather than treat it once it has begun. The earlier you reduce your drinking, the less harm it will do to you and the easier it will be to cut down or stop.