Alcohol Use Disorder (AUD) Overview

AUD is a chronic medical condition that is characterized by difficulty stopping or regulating alcohol consumption, despite negative social, occupational, or health consequences. It exists along a continuum of severity, encompassing mild, moderate, and severe forms.^{1 - 3} AUD affects almost one-third of adults in the United States at some point during their lives, although the majority of these individuals (about 67%) meet the criteria for mild AUD.^{4 , 5} AUD can lead to cardiovascular disease and liver diseases such as steatosis and cirrhosis. It also increases the risk for breast cancer and other forms of cancer. In addition, AUD can weaken the bones, increasing the risk for osteoporosis, and it can cause sleep disturbances, dementia, memory loss, and other adverse effects on the brain.^{2 , 6 - 9} Consuming alcohol during pregnancy can harm the fetus; there is no known safe level of alcohol consumption during pregnancy.^{10 , 11}

AUD is classified as a brain disorder and can cause lasting changes in the brain.¹ These changes can perpetuate AUD and increase a person's susceptibility to relapses following treatment. Symptoms of AUD include:^{1 , 3 , 10 , 12}

• Drinking more or longer than intended
• Continued drinking even when it causes problems with jobs, school, family, or friends
• Giving up enjoyable activities in order to drink alcohol
• Developing alcohol tolerance so that the same amount of alcohol has a diminished effect
• Experiencing withdrawal symptoms when the effects of alcohol are wearing off. These include trouble sleeping, shakiness, nausea, dysphoria, elevated heart rate, and malaise.

The risk factors for AUD include drinking at an early age (especially for females); a family history of AUD; and mental health conditions, including depression or a history of trauma.^{1 , 12} Engaging in binge drinking (defined as consuming four or more drinks for a female, or five or more drinks for a male in about 2 hours) and heavy alcohol use (defined as consuming more than four or five drinks in one day or more than eight or 15 drinks in 1 week for females and males, respectively), both of which are termed “alcohol misuse,” also increase the risk for AUD.^{2 , 13}

While the prevalence of AUD is higher in men than women, this gap has narrowed in recent years.^{2 , 4 , 11 , 14} In addition, women may be more likely than men to experience alcohol-related risks, such as hangovers, alcohol-induced blackouts, hospitalizations, and death. This can happen for a few reasons, including the fact that women have a smaller percentage of water in the body and that women usually have a lower body weight than men. Compared to men, women with AUD also experience higher rates of alcohol-associated liver injury and have higher risks of developing cancer and cardiovascular disease.⁴ In addition, emerging research supported by NIH suggests that AUD may harm the brain’s immune system earlier in women than in men.¹⁵ Moreover, women are less likely than men to be treated for AUD.¹¹

Treatment for AUD includes behavioral therapies; medications; and support groups, including some that are tailored specifically for women, such as The Women’s Recovery Group and Women for Sobriety.^{1 , 5 , 16 - 18} Treatment guidelines are also available for pregnant women with AUD.¹⁹ Three medications are approved by the Food and Drug Administration for treating AUD: naltrexone, acamprosate, and disulfiram.^{1 , 2 , 5 , 12 , 16 , 17} People can recover from AUD, but many do not seek treatment.⁹ In addition, setbacks are common, especially in response to triggers such as divorce or the death of a family member.^{1 , 16} Combining treatment modalities increases the likelihood of lasting change.¹⁷

Current research efforts focus on gaining a deeper understanding of the neurobiological, psychological, social, and environmental factors––including sex and gender differences––that influence AUD risk and support recovery.^{5 , 9} Research is also needed to identify the barriers that limit AUD treatment utilization and inform effective strategies to enhance treatment engagement, especially among women.⁹ In addition, there is a need to identify promising biological pathways and treatment targets for novel AUD medications, as well as to evaluate the benefits and risks of pharmacologic treatment for AUD during pregnancy. ^{5 , 20}

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) sponsors the Interagency Work Group on Drinking and Drug Use in Women and Girls. This group is comprised of representatives from federal agencies, academia, and heath care provider organizations that are working together to expand access to high-quality alcohol prevention, treatment, and recovery services for women and girls. Recent activities include convening the 2022 National Conference on Alcohol and Other Substance Use Among Women and Girls, which laid the groundwork for building a coalition of stakeholders to create a framework for a comprehensive public-private response to reduce harmful substance use among women and girls.