How Much Drinking Is Too Much? Signs of Alcohol Use Disorder

How much drinking is too much depends on more than the number of drinks. Alcohol use may be a problem when it is heavy, when it keeps causing trouble in your health, relationships, work or safety, or when you cannot cut back even though you want to. That pattern is called alcohol use disorder. This article covers the warning signs, how clinicians think about severity, when stopping suddenly becomes an emergency, and what treatment looks like.

How much drinking is too much?

The amount of alcohol that is safe varies from person to person, and for some people the lowest-risk amount may be none. US health agencies define a standard drink by a fixed amount of pure alcohol, and they describe binge and heavy drinking by the number of drinks per occasion and per week. A clinician can apply those definitions to your situation. Risk also depends on how often you drink, your body size, your age, your health conditions, the medicines you take, and whether you are pregnant. Several factors contribute, and a drink count alone does not tell the whole story. MedlinePlus has background on alcohol and its effects on its alcohol page.

MedlinePlus, the National Library of Medicine's health information service, describes alcohol use disorder (AUD) as a pattern of drinking in which a person cannot control their alcohol use despite harm to their life. In other words, the question clinicians ask is often "what is alcohol doing to you?" as much as "how much are you drinking?"

Two drinking patterns are commonly linked to harm:

• Binge drinking: drinking enough in one sitting to reach a high blood alcohol level. It can cause blackouts, injuries, risky decisions and, in some cases, alcohol poisoning.
• Heavy, regular drinking: drinking often over weeks and months. It is associated with liver, heart, brain and mood problems, and it can lead to physical dependence.

You can have a problem without drinking every day. Some people drink only on weekends but cannot stop once they start, or have repeated trouble because of it. Others drink daily and function well on the surface while their body slowly adapts. Both patterns deserve attention.

Some people have a lower threshold for risk

Alcohol can be risky even at modest amounts for some people. Tell your clinician about your drinking if any of these apply:

• You are pregnant or trying to become pregnant. MedlinePlus explains in its pregnancy and substance use page that alcohol use during pregnancy can harm a developing baby.
• You have liver disease, high blood pressure, an irregular heartbeat or a history of pancreatitis.
• You take sedatives, sleep medicines, opioid pain medicines, or other drugs that can interact with alcohol. Ask your pharmacist about your specific medicines.
• You have a history of depression, anxiety or other mental health conditions.
• You are older, since the body often handles alcohol differently with age.
• You are going to drive or operate machinery.

What alcohol use disorder looks like

AUD is diagnosed by a clinician, who looks at a group of symptoms over time. It ranges from mild to severe, and in general, the more of these features are present, the more severe the disorder may be. The features include:

• Drinking more, or for longer, than you meant to.
• Wanting to cut down or stop and not being able to, or failing after several tries.
• Spending a lot of time drinking, getting alcohol, or recovering from its effects.
• Strong cravings or urges to drink.
• Missing work, school or family responsibilities because of drinking or hangovers.
• Continuing to drink despite arguments, relationship strain or social problems it causes.
• Giving up hobbies, friends or activities you once cared about.
• Drinking in situations that are physically risky, such as before driving.
• Continuing to drink even though it is worsening a health problem, anxiety or low mood, or after blackouts.
• Needing more alcohol to feel the same effect (tolerance).
• Feeling shaky, sweaty, anxious or sick when alcohol wears off (withdrawal), or drinking to relieve those feelings.

Having one of these does not establish AUD. A clinician combines your history, an examination and, when helpful, lab tests. If you recognize a few of these in yourself, that is a reason to talk with someone, not a reason for shame. Alcohol use disorder is a medical condition, and treatment exists for every level of severity.

Signs that can be easy to miss

Early signs are often subtle, and they can look like other problems.

• Sleep that feels worse: alcohol may make you drowsy at first, but it can fragment sleep and may worsen snoring and nighttime waking.
• Mood changes: irritability, anxiety or low mood can occur alongside heavy drinking, and drinking can make them worse. Cause and effect run in both directions.
• Stomach symptoms: heartburn, nausea, or indigestion that keeps returning can be associated with regular drinking.
• Hiding or minimizing: keeping count privately, drinking before social events, or feeling defensive when someone mentions it.
• Planning your day around alcohol: thinking about when you can drink, or feeling restless without it.
• Morning shakiness: a hand tremor that settles after a drink may be a sign of physical dependence, although tremor has many other causes, as described in MedlinePlus's tremor page.

Why stopping suddenly can be dangerous

With regular heavy drinking, the brain adapts to the constant presence of alcohol. If drinking stops or drops sharply, the nervous system can become overactive. Symptoms may include shaking, sweating, a racing heart, anxiety, trouble sleeping, nausea and headache. In some people withdrawal progresses to seizures or to delirium, a severe state of confusion with hallucinations, fever and unstable vital signs. This can be life-threatening and needs emergency care.

Because it is hard to predict who will have a severe reaction, do not try to quit abruptly on your own if you drink heavily or have had withdrawal symptoms before. Talk with a clinician first. They can judge whether you need medically supervised withdrawal, sometimes called detox, and which medicines may make it safer. Do not change or skip any prescribed medicine on your own while doing this; ask your prescriber.

What heavy drinking can do to your body

Alcohol affects nearly every organ system. Outcomes vary from person to person, and the following are associations, not certainties.

• Liver: heavy drinking can lead to fat building up in the liver, inflammation, scarring and, over years, cirrhosis. MedlinePlus covers this in its steatotic liver disease page. Fatty liver also has causes unrelated to alcohol.
• Heart and blood pressure: a review in PubMed Central, Alcohol's Impact on the Cardiovascular System, discusses links between alcohol and high blood pressure, irregular heart rhythms and weakened heart muscle.
• Brain and mood: alcohol can contribute to memory problems, blackouts, depression and anxiety.
• Digestive tract: irritation of the stomach lining, reflux and pancreatitis can occur.
• Cancer risk: MedlinePlus's oral cancer page lists heavy alcohol use among the risk factors for cancers of the mouth and throat, and alcohol is associated with a higher risk of several other cancers too. Ask your clinician how this applies to you.
• Injuries and safety: falls, car crashes and other accidents are a major way alcohol causes harm, including in people who do not have AUD.

A quick self-check

These questions are not a diagnosis, but they can help you decide whether to talk with a professional:

• In the past year, have you had times when you drank more than you planned?
• Have you tried to cut back and found it harder than expected?
• Have other people, such as family, friends or a doctor, voiced concern?
• Do you drink to feel calmer, sleep, or get through the day?
• Has drinking caused problems at home, at work or with your health, and you kept drinking anyway?

If you answered yes to any of these, consider telling a clinician. They may use a validated screening tool such as the AUDIT-C to assess your pattern and talk through options.

How alcohol use disorder is treated

MedlinePlus outlines options on its alcohol use disorder treatment page. Treatment is individualized, and outcomes vary. Many people do best with a combination of approaches:

• Medically supervised withdrawal when needed, in an outpatient or hospital setting depending on risk.
• Counseling and behavioral therapies, such as cognitive behavioral therapy and motivational approaches, which can help with cravings, triggers and coping skills.
• Medicines, which a prescriber may consider. Naltrexone, acamprosate and disulfiram are among those used for AUD, and each has label cautions. Naltrexone blocks opioid medicines and can trigger withdrawal in people who use opioids, so tell your prescriber about every opioid you take; liver tests may be checked before and during treatment. Acamprosate needs kidney function to be considered. Disulfiram's label carries a boxed warning that it should never be given to someone who is intoxicated or without their knowledge, and it can cause a serious reaction with any alcohol, including some foods, medicines and products. A prescriber decides which, if any, is appropriate, so discuss them with your prescriber and pharmacist.
• Mutual-help and peer groups, which some people find valuable alongside professional care.
• Treatment for other conditions, such as depression, anxiety or sleep problems, since these can fuel drinking and respond to care.

Relapse is common in many chronic conditions, and it does not mean treatment has failed. It can be a signal to adjust the plan with your care team.

How to start the conversation

You do not need to have a label ready. A primary care clinician can ask a few screening questions, check your blood pressure and liver tests if appropriate, review your medicines, and connect you with treatment. Consider telling them:

• How often and how much you typically drink, including your heaviest days.
• Whether you have had shakiness, sweating, seizures or confusion when you stopped drinking.
• Any medicines, supplements or other substances you use.
• How your mood, sleep and anxiety have been.

If you are worried about someone else, choose a calm moment, describe specific things you have noticed, and express concern without blame. They may not be ready the first time, and that is common. Keep the door open, and call for emergency help if you see any of the warning signs in the box below.

The national helpline run by SAMHSA at 1-800-662-HELP (4357) offers free, confidential information and treatment referrals. If thoughts of suicide come up at any point, call or text 988, the Suicide and Crisis Lifeline.

When to Seek Medical Care