Signs of Alcoholism: How to Recognize It and Get Help

Ethanol is the ingredient in beer, wine and liquor that causes intoxication. In small amounts many adults tolerate it, but in larger amounts it impairs judgment, lowers inhibitions and slows coordination. That combination is what leads to injuries, drunk driving and decisions people later regret.

Binge drinking is one of the most common ways alcohol use turns risky. NIAAA defines binge drinking as a pattern that brings blood alcohol concentration to 0.08% or higher, which for a typical adult means about five or more drinks for men, or four or more drinks for women, in about two hours [2]. In 2024, 57.9 million people ages 12 and older reported binge drinking in the past month [4].

Not everyone who binge drinks has alcoholism. But regular heavy or binge drinking changes how the brain and body respond to alcohol, and that is often where the early signs of alcoholism begin.

With repeated heavy drinking, the brain adapts to having alcohol around. Over time, a person may need more alcohol to feel the same effect, and may feel unwell or uneasy when they go without it. NIAAA lists both of these, needing much more to get the effect you want and having withdrawal symptoms as alcohol wears off, among the symptoms clinicians ask about [1].

Early signs of alcoholism are often quiet. They can include:

• Rising tolerance. You need more drinks than you used to in order to feel relaxed or buzzed [1].
• Drinking more than you planned. You mean to have one or two and end up having many more, or drinking for longer than you intended [1].
• Trouble cutting back. You have tried to cut down or stop more than once and could not [1].
• Strong cravings. You want a drink so badly it is hard to think about anything else [1].

As alcohol use disorder progresses, the signs usually become easier for others to notice. Common signs of alcoholism in everyday life include:

• Drinking heavily alone. Drinking in private, or hiding how much you drink from others.
• Drinking in inappropriate situations. Drinking before driving, at work, or in places and times where it clearly does not fit.
• Needing a drink in the morning. Drinking soon after waking up to steady your nerves or feel normal.
• Showing up to work or school intoxicated. Or finding that drinking, or being sick from it, is getting in the way of your job, school or home responsibilities [1].
• Craving alcohol when you are not drinking. Feeling restless, irritable or preoccupied until you can drink again.
• Concern from friends or family. Loved ones bring up your drinking, and you keep drinking even though it is causing trouble with them [1].
• Giving things up. Cutting back on hobbies and activities you used to enjoy so you can drink [1].

Clinicians look at how many of these kinds of symptoms a person has had in the past year. Two to three suggests mild AUD, four to five moderate, and six or more severe [1]. Even mild AUD is worth taking seriously, because it tends to be easier to address before it grows.

Because the body adjusts to regular alcohol, stopping suddenly can trigger withdrawal. Symptoms often begin within 8 hours after the last drink, but they can start days later [6]. Common symptoms include anxiety, shakiness, irritability, mood swings, nightmares and trouble thinking clearly [6].

The most serious form of withdrawal is delirium tremens. It can cause sudden, severe confusion, hallucinations and seizures [6]. MedlinePlus notes that alcohol withdrawal is a serious condition that may quickly become life-threatening [6], and NIAAA advises that people with severe AUD may need medical help to avoid withdrawal if they decide to stop drinking [1].

The good news is that alcoholism is treatable. NIAAA states that no matter how severe the problem may seem, evidence-based treatment with behavioral therapies, mutual-support groups and medications can help people with AUD achieve and maintain recovery [1].

• Medical detox. A safe, supervised start that manages withdrawal symptoms as alcohol leaves the body [6].
• Behavioral therapy. Counseling, also called talk therapy, aims to change drinking behavior and build skills for coping with cravings and preventing a return to drinking [1].
• Medications. Three medications are approved by the FDA to help treat AUD: naltrexone, acamprosate and disulfiram [1].
• Mutual support. Peer support groups, including 12-step groups, can add a valuable layer of support alongside professional treatment [1].

Alcoholism is a chronic condition, which means recovery is something you keep caring for over time, even after you stop drinking. Early recovery can bring mood changes, and it can bring underlying mental health or medical concerns to the surface. Treatment gives you a place to work through those changes with support.

Individual counseling helps you look at the reasons behind your drinking, and teaches practical ways to handle triggers, cravings and difficult emotions without reaching for alcohol.

Red Rock Recovery Center offers alcohol treatment in Lakewood and Morrison, Colorado, with a continuum of care that can meet you where you are. Care can begin with medical detox and continue through residential treatment, partial hospitalization (PHP) and intensive outpatient (IOP) programs.

Along the way, Red Rock includes individual and family therapy, 12-step work, an outdoor and adventure program that gets clients moving and connecting in the Colorado landscape, and an alumni program that keeps people connected after treatment ends.