Blog
Alcohol use disorder
Covenant Metabolic Specialists Health Library
Covenant Metabolic Specialists
Physician Reviewed
Dec 3, 2025
Alcohol Use Disorder (AUD) is a medical condition marked by an impaired ability to stop or control alcohol use despite negative social, occupational, or health consequences. It exists on a spectrum—from mild to severe—and affects millions of Americans across every demographic. While often misunderstood as a matter of willpower, AUD is a brain-based disorder that can be treated with the right medical, behavioral, and social support.
What is Alcohol Use Disorder?
AUD is a chronic, relapsing brain disorder defined by a pattern of compulsive alcohol use, loss of control over drinking, and emotional distress when not drinking. It affects how the brain’s reward system, stress response, and decision-making circuits operate. Left untreated, it can lead to liver disease, cancer, heart problems, mental health decline, and early death. Early recognition and structured support can significantly improve recovery outcomes.
Symptoms
According to the DSM-5, a person may be diagnosed with AUD if they meet 2 or more of the following within a 12-month period:
Drinking more or for longer than intended
Unsuccessful attempts to cut down or stop drinking
Spending a lot of time drinking or recovering from drinking
Craving alcohol
Failing to meet responsibilities at work, school, or home due to drinking
Continuing to drink despite personal or social problems
Giving up activities or hobbies in favor of drinking
Drinking even when it’s dangerous (e.g., driving)
Continuing to drink despite physical or mental health issues
Developing a tolerance (needing more alcohol to feel the same effect)
Experiencing withdrawal symptoms (sweating, shaking, anxiety, nausea) when not drinking
Severity levels:
Mild: 2–3 symptoms
Moderate: 4–5 symptoms
Severe: 6 or more symptoms
Causes
AUD doesn’t have a single cause—it’s a combination of biological, psychological, and environmental factors:
Genetics:
Strong family history increases risk
Brain chemistry:
Alcohol triggers dopamine surges that reinforce use
Trauma or stress: Especially in early childhood
Co-occurring mental health conditions: Depression, anxiety, PTSD
Social environment: Peer pressure, work culture, or community norms
Early exposure: Beginning drinking before age 15 significantly raises lifetime risk
Risk Factors
You may be at greater risk for developing AUD if you:
Have a parent or sibling with alcohol problems
Began drinking at an early age
Experience high levels of chronic stress
Use alcohol to cope with anxiety, trauma, or depression
Work in high-stress or social-drinking-heavy industries
Have a history of other substance use disorders
Live in an environment where heavy drinking is normalized
Diagnosis
Diagnosing AUD typically involves:
Clinical interview: Reviewing history, symptoms, and drinking patterns
Screening tools like AUDIT (Alcohol Use Disorders Identification Test) or CAGE questionnaire
Physical exam and labs: Assessing liver function (ALT, AST, GGT), vitamin levels (B1, B6), and signs of liver damage
Mental health evaluation to identify underlying mood or anxiety disorders
Treatments
AUD treatment varies based on severity, support systems, and personal goals. Many patients improve with a combination of therapies:
Behavioral Interventions
Cognitive behavioral therapy (CBT)
Motivational interviewing (MI)
Contingency management
Trauma-informed care
Medical Treatment
Medications like naltrexone, acamprosate, or disulfiram
Medication-assisted treatment (MAT) for co-occurring opioid or benzo use
Treatment for withdrawal symptoms using benzodiazepines or anticonvulsants (for severe dependence)
Support Systems
Outpatient programs (IOP or PHP)
Inpatient or detox programs for acute cases
Peer support like AA or SMART Recovery
Family or couples therapy if dynamics are affected
Long-term follow-up is key to sustained recovery. AUD is often a chronic, relapsing condition, but remission is absolutely possible.
Prevention
Delay the age of first use—drinking before 15 dramatically increases lifetime risk. Know your family history and be honest with your provider.
Set and stick to boundaries around alcohol use and avoid binge drinking (4+ drinks for women, 5+ for men in 2 hours). Always seek help early if drinking feels hard to control, support a culture of open dialogue about alcohol and mental health.
Our Take
We don’t treat AUD like a moral failure. We treat it like what it is: a medical condition, often tied to trauma, stress, and metabolic dysfunction. At Covenant, we’ve helped patients break free from daily alcohol use, not through shame—but through accountability, structure, and support. You don’t have to hit rock bottom. If you’re asking yourself whether alcohol is affecting your life—you’re already ahead of it. Let us help you keep going.
