Featuring Jonathan Avery, MDReviewed by Alexandra Schwarz, MD | September 30, 2024

Alcohol is one of the most commonly used substances. While health experts define safe and moderate drinking as no more than two drinks per day for men and one drink per day for women, many people in the United States exceed these recommendations. Where does it cross the line to alcohol use disorder?

Drinking too much alcohol is concerning, and there are many negative health effects of binge-drinking, but this itself does not qualify for alcohol use disorder, or AUD.

“A lot of people will use substances. They'll drink, they'll smoke weed, or whatever, and they'll be able to self-regulate. They'll be able to stop. It won't be something that takes a prominent role in their life,” says Jonathan Avery, MD, director of Addiction Psychiatry at Weill Cornell Medicine and NewYork-Presbyterian Hospital.

Defining alcohol use disorder

Alcohol use disorder is a brain disease linked to:

Compulsive drinking
Loss of control over intake
Negative effects when not drinking

About 15 million people in the U.S. live with AUD, making it the most common substance use disorder in the country.

The effects of AUD

There are a lot of misconceptions and stigmas surrounding AUD — and substance use disorders in general — but it’s important to remember that AUD is a brain disease that requires professional treatment.

“What's happening, really, when one's using alcohol or any substances chronically, is that you need it to sleep or not feel anxious just because it's become a part of your brain,” says Dr. Avery. “Drinking or using substances becomes the answer to [everything] because your brain is sort of wired in that direction.”

The effect on the brain is “cruel,” according to Dr. Avery: “Your brain is motivating you to drink, and then alcohol impairs your cognition, lowers your IQ, lowers your ability to think well.”

One of the defining features of AUD is that it impairs the life of the patient—their work life, their relationships, their finances, and so on. These things can be more obvious to the patient, as they struggle to keep a job or a healthy relationship.

While that’s going on, the body is silently suffering from the damage of alcohol. “The body's not meant to metabolize those levels of alcohol in an ongoing way, and so the liver suffers, the stomach suffers, the esophagus suffers, really all organ systems,” says Dr. Avery. “It's a poison, and for those that are drinking in an ongoing way, it poisons everything.”

Getting treatment for AUD

Unfortunately, many people do not seek help for AUD until it’s forced upon them after something tragic happens, such as a car accident while intoxicated, a lost job, a divorce, or a health complication.

“You want to intervene early, when you're thinking, ‘Hey, maybe I'm drinking too much to medicate sleep or anxiety, or I should listen to my significant other or family when they're saying I'm drinking too much,’” says Dr. Avery. “You want to be the captain of your ship and make these changes before you're forced to.”

Find out how AUD is treated.

References

American Addiction Centers. (2024). Alcohol and drug abuse statistics (facts about addiction).

National Institute on Alcohol Abuse and Alcoholism. (2024). Understanding alcohol use disorder.

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