Alcohol Problems in Adults: Risks, Signs, and Getting Help

Alcohol becomes a problem when use leads to harm—physical, mental, social, or legal. It’s not about a specific number of drinks; it’s about consequences.

Health Risks of Excessive Drinking

• Liver: Steatosis → hepatitis → cirrhosis → HCC.
• Cardiovascular: Hypertension, cardiomyopathy, atrial fibrillation, stroke.
• Cancer: Oral, esophageal, liver, breast, colorectal (Group 1 carcinogen).
• Neurologic: Neuropathy, cerebellar atrophy, dementia, Wernicke-Korsakoff.
• GI: Gastritis, pancreatitis, malnutrition.
• Mental Health: Depression, anxiety, suicide risk, sleep disruption.

Behavioral & Social Consequences

• Impaired driving → DUI, crashes, fatalities.
• Work: absenteeism, errors, accidents, job loss.
• Relationships: conflict, domestic violence, isolation.
• Financial: direct costs, legal fees, lost income.
• Legal: public intoxication, assault, custody loss.

DSM-5 Alcohol Use Disorder (AUD) Criteria (2+ in 12 mo = AUD)

• Impaired control (can’t stop, craving).
• Social impairment (role failure, interpersonal conflict).
• Risky use (driving, machines).
• Physical dependence (tolerance, withdrawal).

Getting Help

• Screening: AUDIT-C (3 questions) or single question: “How many times in past year have you had 5/4 (M/F) drinks in a day?”
• Levels of care: Brief intervention → outpatient counseling → IOP/PHP → residential → medically managed detox.
• Medications: Naltrexone, acamprosate, disulfiram, topiramate, gabapentin (off-label).
• Mutual support: AA, SMART Recovery, LifeRing, Women for Sobriety.
• Integrated care: Treat co-occurring depression, anxiety, trauma.

Low-Risk Drinking Limits (NIAAA)

• Men: ≤4 drinks/day, ≤14/week.
• Women: ≤3 drinks/day, ≤7/week.
• Older adults (≥65): ≤3/day, ≤7/week.
• **No alcohol** if pregnant, driving, on interacting meds, certain medical conditions.

Problem drinking is treatable. Early intervention changes trajectories.