Alcohol Abuse: Understanding, Overcoming, and Recovery Guide

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Whether you call it Alcohol Use Disorder, alcohol abuse, excessive drinking, alcoholism, or alcohol addiction, heavy drinking of alcohol is a widespread issue that permeates the globe and affects individuals from all walks of life. According to a 2021 Substance Abuse and Mental Health Administration (SAMHSA) report, 16.3 million people aged 12 and older reported heavy alcohol use in the past 30 days. That’s approximately 5% of the entire population, or, put another way, more than the populations of Illinois, Montana, Hawaii, and Vermont combined! That’s a whole lot of hangover!

Before we dive too deeply into the repercussions of Alcohol Use Disorder, how to tell if you or someone you love might be experiencing alcohol abuse, and what types of help are available, let’s clarify definitions. 

Table of Contents

Defining Alcohol Use Disorder
What Does Alcohol Use Disorder Look Like in Day-to-day Life?
Why Do Some People Struggle With Alcohol Addiction and Others Don’t?
What is the Harm of Excessive Drinking?
How Do I Know When It’s Time to Reach Out for Help?
What Can I Expect From Working With a Therapist?
Types of Professional Help for Alcohol Use Disorder

Defining Alcohol Use Disorder

Alcohol misuse or Alcohol abuse – Excessive and harmful use of alcohol involving behaviors that have negative consequences, such as neglecting responsibilities, experiencing legal issues, or otherwise causing harm to oneself or others.

Alcohol Use Disorder (AUD), Alcoholism, Alcohol Addiction – A chronic condition that often consists of relapses characterized by an inability to control or stop drinking alcohol, despite harmful consequences. AUD is a diagnosis found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Heavy alcohol use – Per SAHMSA’s definition, a pattern of drinking that involves binge drinking five or more times per month.

Binge Drinking – Per SAHMSA’s definition, consuming 4 (for women) or 5 (for men) alcoholic drinks within a 2-hour time frame

What Does Alcohol Use Disorder Look Like in Day-to-day Life?

Problematic drinking patterns vary in intensity and presentation, depending on the individual and their lifestyle. For example, alcohol abuse looks different in a stay-at-home mom of 3 than in a college frat bro. However, some common characteristics are experienced by people who struggle with alcoholism. 

Because drinking alcohol to excess often comes with a sense of shame that leads one to act in secrecy, these characteristics are most easily understood when looking at them from the separate viewpoints of the person who is doing the drinking and the people who care about them. 

Identifying Alcohol Abuse in Yourself

Recognizing alcohol dependence in oneself can be challenging as it involves deep self-reflection and honesty, something alcohol often might be helping you escape from. Some signs that indicate your relationship with alcohol might be problematic include

  • Drinking alone and in secrecy.
  • Keep alcohol stashes hidden so others won’t find them, and you’ll always have access. 
  • Frequently exceeding the amount of alcohol you intended to drink.
  • Feeling a strong urge or craving for alcohol
  • Developing a high tolerance and needing more drinks to achieve the same effect.
  • Being preoccupied with thoughts about drinking, including when you get to have your first drink of the day and where you’ll have it. 
  • Consistently making or avoiding social plans to prioritize your drinking.
  • Difficulty adhering to boundaries you set for yourself around drinking (how often and how much) when you try to cut down. 
  • Neglecting responsibilities and obligations due to alcohol consumption.
  • Experiencing withdrawal symptoms when attempting to cut down or quit drinking.

Identifying Problem Drinking in a Family Member or Loved One

Because people with alcohol problems often try to hide their drinking or lie about it, looking for signs of problematic drinking in someone you care about can feel emotionally consuming and confusing. Here are a few signs to look for

  • Difficulty depending on your loved one due to them regularly neglecting personal and professional responsibilities
  • Alcohol affects our behavior, by causing irritability, mood swings, aggression, or euphoria.
  • Your loved one frequently blacking out or unable to remember their interactions with you or others because of drinking.
  • Relationship problems and tension, especially around discussing alcohol.
  • Social withdrawal and isolation – for your loved one who might be drinking more and more, as well as for you if you feel you need to keep the behavior a secret so others don’t judge them or you.
  • Finding alcohol bottles hidden in random places.
  • Your loved one gets defensive when you inquire about their drinking, mention hidden alcohol bottles you found, or ask them to stop or cut back.
  • Your loved one says they can stop or cut back at any time but always find a reason not to.
  • You suspect your loved one is avoiding you in order to drink without you knowing. 

It’s incredibly challenging to be the person who struggles with an inability to control their problematic drinking. It is equally challenging to witness a loved one battling Alcohol Use Disorder. The stark contrast between those who can enjoy a half glass of wine with dinner and move on while others face the relentless grip of addiction is undeniably one of life’s profound injustices. Understanding the causes of alcohol addiction can shed light on this complex issue and help us explore it more compassionately. 

Why Do Some People Struggle With Alcohol Addiction and Others Don’t?

Alcohol Use Disorder, like many other addictive disorders, is a multifaceted condition. Any individual chronically engaging in excessive alcohol use is likely prone to multiple of these risk factors. 

Genetic Influences 

In an extensive review of research, scientists found genes play a clinically significant role in a person developing addiction. (Deak, J., Johnson, E., 2022). While genetics alone don’t determine one’s fate, biological and family history can greatly contribute to an individual’s vulnerability to addiction. 

Environmental Effects

The environment one lives in can increase their risk of addiction. Factors such as exposure to substance use and drinking, availability of alcohol, socioeconomic conditions, peer influence, and lack of access to support all play a crucial role in shaping an individual’s vulnerability to developing addictive behaviors. 


In his 2018 book, In the Realm of Hungry Ghosts: Close Encounters with Addiction, Gabor Maté, a renowned physician and author, offers a unique and compassionate approach to understanding the connection between trauma and addiction. Maté’s perspective centers on the belief that unresolved trauma lies at the core of many addictive behaviors. He posits that individuals consume alcohol and other substances to self-medicate the pain or fill the void created by traumatic experiences. 

Depression, Anxiety, and Stress

Feeling guilty, depressed, anxious, and stressed frequently coexist with alcohol abuse, creating a complex and intertwined relationship. For many, alcohol temporarily helps manage the persistent desire to avoid feeling bad—it temporarily relieves symptoms of depression and anxiety, providing a way to self-medicate in a socially acceptable manner. However, this self-medication can quickly spiral into a destructive long term cycle, as alcohol is a depressant that can exacerbate symptoms and worsen conditions. This leads to heightened symptoms, greater distress, and an increased desire to experience symptom alleviation.

These risk factors highlight that an individual is not at ‘fault’ for having an Alcohol Use Disorder. They didn’t do anything wrong to have this addiction. However, the consequences of their drinking, including the harm they caused when drunk, are their responsibility.

What is the Harm of Excessive Drinking?

It’s not uncommon for individuals struggling with persistent desire to use alcohol to defend their drinking habits by telling others to ‘lighten up’ or ‘it’s all in good fun.’ All the while denying that their drinking is physically dangerous or potentially harmful. While it’s true that alcohol can initially provide a sense of enjoyment and temporary relief, it is crucial to recognize that behind this seemingly lighthearted facade lies a complex reality of the multilayered harms caused by excessive drinking, which can later become fodder for low self-esteem.

Physiological Effects – Heavy drinking takes an extensive toll on the body, leading to a wide range of severe health problems, including increased risk of liver diseases, such as cancer, cirrhosis, and hepatitis, as well as heart problems like high blood pressure, heart disease, and stroke. The health problems that accompany alcohol abuse often mean a lot more appointments with health professionals than would otherwise be necessary.

Neurological Damage – Alcohol abuse can lead to long term effects including cognitive impairment, memory loss, and an increased risk of dementia. 

Psychological Effects – Even though people usually consume alcohol to avoid feeling bad, it is ultimately a depressant. In the short and long term, alcohol abuse can worsen mental and psychological health conditions and trigger new ones. In severe cases, substance-induced psychosis can develop, causing an individual to experience hallucinations and delusions, which are physically dangerous.

Social and Familial Effects – Alcoholism affects everyone, including those who love and live with the person who is addicted—which is one of the reasons family history is an important variable in understanding alcoholism. Alcohol misuse leads to lost trust among family members and friends and disrupted family dynamics. Strained relationships can result from financial instability due to job loss, legal issues from alcohol-related charges, like DUIs, and an overall decline in functioning and reliability.

Understanding the comprehensive range of harms caused by regularly drinking too much emphasizes the importance of seeking support if needed. But knowing when to reach out and what types of support are available can be confusing. 

How Do I Know When It’s Time to Reach Out for Help?

Recognizing that your alcohol dependence requires you to reach out for help for Alcohol Use Disorder can be a pivotal moment on the path to recovery. Several signs may indicate that your alcohol use is alcohol abuse—and that it’s time to seek assistance. These include

  • Acknowledging that you have lost control over your drinking
  • Experiencing an inability to cut back or stop drinking, even though you want to.
  • Persistent cravings or intense urges to drink.
  • Experiencing withdrawal symptoms when you try to cut down or stop drinking.
  • Recognition of heart problems or other adverse health effects.

People are typically more motivated to seek support for their alcohol abuse after a very negative event occurs. This is often referred to as a ‘rock bottom’ experience, which refers to the low point of negative consequences one undergoes as a result of their drinking. However, it’s worth noting that change is a process. Everyone moves through life and accepts change differently, including the decision to stop or cut down on drinking.

If you have a loved one who suffers from Alcohol Use Disorder, you may see they need help, but knowing how to bring it up with them can be challenging. 

Tips for Talking to a Loved One About Their Drinking Problem

When approaching someone you believe may have a problem with alcohol, it is crucial to do so with empathy, compassion, and a non-judgemental stance. Nothing can make this process emotionally easier, but following these tips for addressing concerns about alcohol abuse is an excellent place to start. 

  • Start by expressing your care and concern for your loved one’s well-being, emphasizing you’re coming from a place of love and support.
  • Keep your voice and tone calm and non-threatening.
  • Have what you want to say written down in front of you to help you stay on track.
  • Use ‘I’ Statements to convey your observations and feelings, such as ‘I have noticed that you’ve been drinking every night, and it worries me.’
  • Avoid criticizing or blaming language like “problem drinker”. It’s possible that low self-esteem is already a cause.
  • Offer to listen without judgment.
  • Reassure them they are not alone, and that help is available whenever they are ready to take it.

Even with thorough planning and preparation, this discussion may go differently than you had intended. The reaction you get may range from angry and bitter to sad and remorseful. In the best-case scenario, your loved one is open to discussion. In the worst case, they become defensive and aggressive. However, their response is out of your control. This can lead to feelings of powerlessness, anger, fear, and deep frustration. 

Caring for someone with Alcohol Use Disorder can have devastating impacts on a person’s emotional and mental well-being. These family members and friends must prioritize their self-care practices and seek support, including therapy and support groups such as Al-Anon.

What Can I Expect From Working With a Therapist?

Whether you’re seeking support from a therapist for your excessive drinking or that of a loved one, you can expect a shame-free experience where you can talk about everything without fear of judgment. Therapists understand the complexities of alcohol-related challenges and provide a safe environment for exploration and healing.

If you’re a person in the caretaker role for a loved one with heavy drinking patterns, a therapist can help you…

  • Focus on your needs and self-care practices.
  • Resolve any feelings about the dynamics in your family growing up that may be arising in your current situation. 
  • Identify common relationship patterns in families with an alcoholic present.
  • Explore the emotional impact of your loved one’s drinking on you and those surrounding you.
  • Role-play communication strategies, including setting boundaries.
  • Process fears related to your loved one’s drinking.

If you’re a person engaging in problematic drinking, there are many routes a therapist might take to support you. These include:

  • Helping you explore your motivation for changing your patterns.
  • Evaluating whether or not a higher level of care, such as inpatient or outpatient rehab, is needed and offering treatment recommendations.
  • Educating on addiction and substance misuse issues.
  • Assessing whether or not other co-morbid mental health issues are present.
  • Supporting you in identifying triggers leading to excessive use.
  • Teaching coping mechanisms to decrease use or managing risky situations related to overconsumption

Some therapists use the harm reduction model, which focuses on decreasing drinking instead of complete sobriety. This is not a good fit for everyone, but it might be worth discussing with your therapist if you’re not ready to give up drinking entirely but want to make a change. 

Making significant life changes, such as cutting down on or stopping drinking, takes time and courage. Remember, you’re not alone in this process, and many different types of help are available.

Types of Professional Help for Alcohol Use Disorder

When seeking professional support for alcohol addiction, various avenues are available to assist individuals on their journey to recovery. 

Individual TherapyTherapists specializing in alcohol addiction treatment can provide a safe and confidential space to explore the underlying causes of alcohol misuse, develop helpful coping strategies, and work toward sustainable change. Therapists can also offer referrals and recommendations for when other levels of care are needed. 

Psychiatry – Medical interventions can be crucial in treating Alcohol Use Disorder. When drinking is chronic and intense, detoxing or stopping alcohol without medical support can be life-threatening. Psychiatrists specializing in addiction medicine can provide comprehensive assessment, offer guidance on managing withdrawal symptoms from a medical perspective, and prescribe medications when appropriate for reducing cravings or managing alcohol withdrawal.

Outpatient Rehab – Outpatient rehab offers a moderate level of care with flexibility, allowing individuals to receive support while living at home and maintaining their daily routines. Outpatient programs typically involve scheduled therapy sessions, educational groups, and group therapy. This form of treatment is suitable for individuals with a lower level of alcohol dependence, a stable home environment, and a robust support system. 

Inpatient Rehab – Also known as residential treatment, inpatient rehab provides a structured and immersive program where individuals reside at a facility for a designated period. This intensive level of care provides a supportive environment, 24/7 medical supervision, and a range of therapies, including individual, group, and family, as well as holistic, adjunctive approaches, such as yoga and meditation. Inpatient rehab is particularly beneficial for individuals with severe Alcohol Use Disorder and co-occurring psychological concerns.

12-Step Programs – Alcoholics Anonymous (AA) and similar 12-step programs offer a structured framework for individuals to connect with others with firsthand experience managing alcohol addiction. It can be beneficial to hear the experiences of others who have been there and to have a community for support and accountability. 

Each person’s journey to recovery is unique, and the most effective approach may vary from individual to individual. If one form of treatment didn’t work for you, try another. Most people require a blend of the above-mentioned options to create lasting change. 


Recognizing the signs of alcohol abuse in ourselves or loved ones is a vital first step towards recovery, even if it does not lead to immediate change. The journey of navigating Alcohol Use Disorder is a complex and challenging one, both for the people experiencing it and those who love them. Alcohol addiction recovery is not linear, and neither is the emotional process that goes with it. Reaching out for help from others, especially to talk through your fears, worries, and hopes for you or your loved one is a necessity on this path. Therapist-finding services like Mental Health Match make finding a therapist specializing in Alcohol Use Disorder simple. 

Remember, the road to recovery is long, but you don’t have to go at it alone. 


The NSDUH report. 2021. Rockville, Md. :Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Dept. of Health & Human Services.

Deak JD, Johnson EC. Genetics of substance use disorders: a review. Psychol Med. 2021 Oct;51(13):2189-2200. doi: 10.1017/S0033291721000969. Epub 2021 Apr 21. Erratum in: Psychol Med. 2022 Mar 02;:1. PMID: 33879270; PMCID: PMC8477224.

National Institute on Alcohol Abuse and Alcoholism, Taken June 28, 2023. 

Maté, G. (2018). In the realm of hungry ghosts: Close encounters with addiction. Vermilion.

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