What Are The 4 Symptoms Of Alcoholism

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Cravings, impaired control, alcohol tolerance, and alcohol withdrawal symptoms are the four primary symptoms of alcoholism.

Defined by the most recent Diagnostic and Statistical Manual (DSM-5) as alcohol use disorder (AUD), the medical condition affects approximately 14.1 million individuals across the globe [1].

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Signs And Symptoms Of Alcoholism

Symptom 1: Cravings

The first symptom of alcoholism is an increased and intense compulsion to drink alcohol [2].

Cravings are also expressed as a mental preoccupation with acquiring alcohol for consumption, e.g. obsessing about alcohol, and how or when the next drink will be acquired.

This symptom of alcoholism was added to the most updated version of the Diagnostic and Statistical Manual in 2013, and has since become one of the chief criteria for alcohol use disorder [3].

Alcohol cravings are caused by:

  • Alterations in neurotransmitters that occur after protracted or heavy drinking
  • Drinking five or more drinks within two hours
  • Emotional triggers
  • Social anxiety
  • Physical alcohol dependence
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Symptom 2: Impaired Control

Loss of control is the second leading symptom of alcoholism [4].

Loss of control is characterised by:

  • An inability to stop drinking alcohol despite the negative consequences that have ensued in several major domains: home, professional life, interpersonal relationships, and school.
  • Continuing to drink despite the onset of a health problem, such as liver disease, or an alcohol-related problem, such as getting a DUI
  • Unsuccessful attempts to switch alcoholic drinks--from regular beer to malt liquor, for example--in order to reduce alcohol intake.
  • Frequently drinking more than planned/being unable to manage alcohol intake.
  • Increased impulsiveness, such as leaving an event quickly to obtain, and consume, alcohol [5].
  • Being unsuccessful in attempts to moderate alcohol consumption or quit drinking altogether.
  • Changes in drinking habits, such as drinking in the morning, spending more time drinking alone, abandoning obligations in order to drink, or drinking for longer periods of time than intended [6].

Symptom 3: Alcohol Tolerance

Alcohol tolerance is defined by the need to increase alcohol intake to achieve the desired physical and psychological effect--or the same effect alcohol once provided [7].

Alcohol tolerance occurs not only from excessive drinking but also because of the physical changes alcohol abuse triggers [8].

These alterations are separated into two categories: Pharmacokinetic and pharmacodynamic.

Pharmacokinetic alcohol tolerance refers to alterations that occur on the enzymatic level and lead to accelerated alcohol clearance.

Pharmacodynamic alcohol tolerance involves the physiological adaptation to alcohol: The more alcohol that is consumed, the more the body becomes reliant on it to function.

If interventions are not made at this point in the progression of alcohol use disorder, this reliance on alcohol leads to alcohol dependence--a precursor to the final primary symptom of substance abuse, alcohol withdrawal symptoms [9].

Symptom 4: Alcohol Withdrawal Symptoms

Alcohol withdrawal symptoms arrive after the cessation--or significant reduction--of alcohol consumption [10].

Alcohol affects nearly every vital organ in the body, from the brain to the heart.

Accordingly, experiencing withdrawal symptoms is unpleasant and distressing--and felt on mental, physical, and psychological levels.

The severity of alcohol withdrawal symptoms runs the gamut from mild to severe:

  • Nausea and vomiting
  • Headaches
  • Racing thoughts
  • Excessive sweating
  • Shakiness
  • Insomnia and/or sleep disturbances
  • Mood changes, such as anger and irritability
  • Anxiety and depression
  • Seizure
  • Delirium tremens

Additional Warning Signs Of Alcoholism

Additional symptoms of harmful drinking outside of the four primary symptoms identified above include:

  • Neglecting personal hygiene and physical appearance
  • Experiencing more than one memory blackout
  • Changes in social life, or disregarding social life altogether
  • Alterations in working memory
  • Increasing isolation to drink in private
  • Refusing to admit the need for addiction treatment despite increasing alcohol-related problems
  • Exacerbated symptoms of pre or coexisting mental disorders, such as heightened anxiety and increased depression
  • Engaging in reckless behaviour and dangerous situations, such as having unprotected sex and driving while impaired

Consequences Of Symptoms Of Alcohol Abuse

If alcohol addiction is not treated, it has the potential to result in several health problems:

  • Mental health problems, such as depression and alcohol-induced psychosis
  • Increased alcohol dependence, and, with it, more acute alcohol withdrawal symptoms, including delirium tremens
  • High blood pressure
  • Dementia
  • Cirrhosis of the liver
  • Bleeding in the gastrointestinal tract
  • Brain damage
  • Neuropathy, or nerve damage
  • Heart failure
  • Death

Risk Factors For Experiencing The 4 Symptoms Of An Alcohol Problem

There's a higher risk of alcohol addiction among those who have a genetic predisposition to problem drinking, such as a parent or a close relative with alcohol use disorder.

In fact, genetics increase the risk of substance use disorder by 60%.

Additional risk factors include:

  • Excessive or binge drinking: more than 15 alcoholic drinks per week for males, and more than 12 alcoholic drinks per week for females
  • Underage drinking, or starting to drink young in life. Females who began drinking before 21 years are at an increased risk of alcohol addiction.
  • A pre or coexisting mental health disorder, such as anxiety, depression, or bipolar
  • Trauma

Secondary risk factors for alcohol use disorder include chronic high stress, low self-esteem, and living in an environment where heavy drinking is the norm.


How Are The 4 Symptoms Of Alcoholism Assessed?

A medical professional will use a criteria scale and specialist tests to determine the level of alcohol use disorder:

  • Mild AUD
  • Moderate AUD
  • Severe AUD
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About the author

Robyn Russell

Robyn Russell, has appeared in PsychCentral [1] [2] [3], Women's Health, Livestrong, She Knows, and Brevity, among others. She holds an MFA in writing from the University of San Francisco.

Content reviewed by Laura Morris (Clinical Lead).

Last Updated: November 8, 2023