Alcohol Use Disorder: Signs, Withdrawal & Treatment

Alcohol-related problems do not always look like daily drinking. Someone may keep up with work and family responsibilities while drinking in ways that still affect their health, judgment, or relationships.

Understanding drink sizes, drinking patterns, and withdrawal risk can make it easier to recognize when a conversation with a healthcare professional may help.

What counts as one drink?

In the United States, a standard drink contains approximately 14 grams of pure alcohol. Examples include:

12 ounces of beer at 5% alcohol by volume (ABV)
5 ounces of wine at 12% ABV
1.5 ounces of distilled spirits at 40% ABV, or 80 proof

A container is not necessarily one drink. A 16-ounce beer at 8% ABV contains approximately 2.1 standard drinks. A generous wine pour or a cocktail containing several shots can also count as more than one. Check both serving size and alcohol percentage. [1]

What is considered binge or heavy drinking?

NIAAA defines binge drinking as a pattern that brings blood alcohol concentration to 0.08% or higher. For a typical adult, this corresponds to 4 or more standard drinks for women or 5 or more for men in about two hours. [12]

NIAAA defines heavy drinking as:

Women: 4 or more drinks on any day, or 8 or more per week
Men: 5 or more drinks on any day, or 15 or more per week

These are population screening thresholds, not personal safety limits or a diagnosis. Harm can occur below them, and individual risk varies with medications, medical conditions, age, and other factors. [1]

When does drinking become problematic?

The amount matters, but so does the effect on daily life. Warning signs include drinking more than intended, repeatedly struggling to cut down, strong cravings, neglecting responsibilities, or continuing despite relationship or health problems.

Alcohol use disorder (AUD) is diagnosed through a clinical assessment of symptoms and their impact, not a drink count alone. Diagnostic criteria include at least two of eleven symptoms within a 12-month period; severity ranges from mild to severe. Tolerance and withdrawal are possible symptoms, but neither is required for every diagnosis. Binge drinking does not automatically mean someone has AUD, and keeping up with responsibilities does not rule it out. [2]

Alcohol can affect more than the liver

Alcohol can affect mood, thinking, coordination, and the nervous system. Heavy use can contribute to high blood pressure, irregular heart rhythms, liver disease, and pancreatitis. Alcohol also increases the risk of several cancers, including breast, colorectal, liver, and certain head and neck cancers. Some cancer risk increases even at low levels of consumption. [3]

A blackout is not the same as passing out. During a blackout, someone may remain awake and interact with others while their brain fails to form memories of events. Memory gaps deserve attention even if the person appeared to be functioning at the time. [4]

Alcohol overdose is a medical emergency. Difficulty waking someone, slow or irregular breathing, seizures, or severe confusion after drinking are reasons to call 911. Do not assume a person can safely “sleep it off.” Combining alcohol with opioids or sedating medications can further increase overdose risk. [5]

What can alcohol withdrawal feel like?

Withdrawal can occur when a person who has become physically dependent on alcohol stops or sharply reduces intake. Early symptoms may include anxiety, shakiness, sweating, nausea, insomnia, and a racing heart. Symptoms may resemble a hangover or an anxiety episode, but their timing after a reduction in drinking matters. [6]

Symptoms often begin 6–24 hours after stopping or reducing alcohol. Timing varies, and withdrawal can occur even while alcohol remains in the bloodstream. Severe complications can develop later. [7]

Who is at risk, and when is urgent care needed?

Risk is especially important after prolonged heavy, regular drinking. Previous withdrawal seizures or delirium tremens, repeated withdrawal episodes, significant medical illness, and dependence on other sedatives can increase the risk of complications. There is no single drink count that reliably predicts whether stopping will be safe.

If dependence is possible, seek medical guidance before stopping or sharply reducing alcohol. A clinician can assess the appropriate setting and monitoring. Do not use a social media post or an online timeline as a home detox plan. [7]

Call 911 for a seizure, severe confusion, or hallucinations during suspected withdrawal. Persistent vomiting, worsening symptoms, or a rapid heartbeat also require prompt medical assessment. Alcohol withdrawal can be life-threatening. [6]

Medication options for alcohol use disorder

Treatment can include medication, counseling, recovery support, and care for co-occurring mental health concerns. Medication selection depends on treatment goals, medical history, current medications, and laboratory findings. [2]

Naltrexone

Oral naltrexone can reduce alcohol craving and drinking for some people. It blocks opioid receptors and does not produce an alcohol-disulfiram reaction. Possible side effects include nausea, headache, and dizziness. Liver health and opioid use must be reviewed before prescribing.

Naltrexone can trigger severe withdrawal in someone physically dependent on opioids and can interfere with opioid pain treatment. Tell your clinician about all opioid exposure, including buprenorphine, methadone, tramadol, and prescription pain medication. Do not stop prescribed opioid treatment on your own to start naltrexone. [8]

Vivitrol

Vivitrol is the extended-release injectable form of naltrexone, administered by a healthcare professional approximately once a month. It is not a separate type of medication from naltrexone; the delivery method is different.

For alcohol dependence, patients should be able to abstain before starting and should not be actively drinking at the first injection. Opioid precautions still apply. Side effects can include nausea and injection-site reactions; serious injection-site injury and liver problems are possible. Injections require coordination with an appropriate in-person provider. [9]

Acamprosate

Acamprosate helps support continued abstinence after a person has stopped drinking. It is generally taken three times daily and is used alongside psychosocial support. Diarrhea is a common side effect. Kidney function determines whether it is appropriate and whether the dose needs adjustment; severe kidney impairment is a contraindication. It does not treat acute alcohol withdrawal. [10]

Disulfiram, commonly known as Antabuse

Disulfiram supports an abstinence goal by causing an unpleasant, potentially dangerous reaction if alcohol is consumed. It does not directly reduce cravings. The reaction can include flushing, nausea, vomiting, palpitations, and low blood pressure, with severe complications possible.

Alcohol exposure must be avoided during treatment and for up to 14 days after the last dose. Some medicines and other products contain alcohol. Liver monitoring and a careful review of medical conditions and interactions are necessary. Disulfiram should never be given without the person’s knowledge or while they are intoxicated. [11]

These medications are treatments for AUD, not substitutes for medically managed withdrawal. When withdrawal risk is present, immediate safety comes first.

Getting support before problems become more severe

You do not need to wait for a crisis to discuss drinking. An evaluation can help clarify the pattern, assess withdrawal risk, and identify appropriate next steps without judgment.

ClearLane Behavioral Health offers telehealth assessment and ongoing care in Arizona, Florida, Ohio, and Washington. When in-person withdrawal management or another level of care is needed, that should be addressed first. Explore our substance use services, review insurance and pricing, or visit our scheduling page.

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Alcohol Use Disorder: Binge Drinking, Withdrawal, and Treatment Options