There are various definitions of alcoholism, depending on who you ask and how much reading you’re willing to do. This page exists as a quick resource to help explain some of the different points of view on alcoholism and what it means to be an alcoholic.
🔑 Key takeaways
- Alcoholism — clinically known as Alcohol Use Disorder (AUD) — is a chronic brain disease, not a moral failing or lack of willpower.
- It is defined by an inability to control drinking despite negative consequences to health, relationships, work, or finances.
- An estimated 29.5 million people in the United States meet the criteria for AUD, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
- Alcoholism exists on a spectrum — from mild to severe — and you do not need to have “hit rock bottom” to have a problem.
- It has biological, psychological, and social causes. Genetics account for approximately 50% of a person’s risk.
- Alcoholism is treatable. A combination of behavioural therapy, medication, and support groups has helped millions of people achieve lasting recovery.
Whether you call it having a drinking problem, alcohol use disorder, alcoholism, or “just having a drink or two after work to take the edge off”, alcoholism means different things to different people, which can make it harder to define.
Sometimes, it’s obvious when someone is an alcoholic. You see them passed out with a bottle in their hand, or they’re cleaning ruining their lives, and you think “Yep, that’s alcoholism.”
But not everybody who suffers from alcoholism is at the point where it’s ruining their lives, so having your life ruined isn’t a necessary prerequisite to being an alcoholic. Having said that, there is some debate about what it means to be a “functioning alcoholic”, where some people would argue that you don’t really have an addiction unless it’s causing measurable harm to your life.
Going by that definition, it would mean that unless you’re ruining your relationships, getting fired from work, or missing rent, or mortgage payments because you’re drinking too much, you don’t really have alcoholism. But that feels like a stretch – because somebody could come home every day, have 8 drinks, pass out on the couch, get up for work in the morning, and aside from drinking a lot, live a relatively normal life. Would you say that person isn’t an alcoholic? They’re drinking until they pass out every day, and that sure sounds like an alcoholic to us.
Definition
Alcoholism (noun)
A chronic, relapsing brain disorder characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. Also known as Alcohol Use Disorder (AUD).
Source: Adapted from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the American Psychiatric Association (APA).
The clinical definition of alcoholism
In medical and psychiatric settings, the term “alcoholism” has largely been replaced by Alcohol Use Disorder (AUD) — the official diagnosis used in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association.
According to the DSM-5, a person has AUD if they meet at least 2 of the following 11 criteria within a 12-month period:
- Drinking more alcohol, or drinking for longer, than intended
- Wanting to cut down or stop drinking but being unable to
- Spending a lot of time obtaining, drinking, or recovering from alcohol
- Experiencing strong cravings or urges to drink
- Failing to fulfil major responsibilities at work, school, or home because of drinking
- Continuing to drink despite it causing relationship or social problems
- Giving up important activities (hobbies, socialising, work) in favour of drinking
- Drinking in situations where it is physically hazardous (driving, operating machinery)
- Continuing to drink despite knowing it is causing or worsening a physical or mental health problem
- Developing tolerance — needing more alcohol to feel the same effect
- Experiencing withdrawal symptoms when alcohol is reduced or stopped
The severity of AUD is classified based on how many criteria are met:
- Mild AUD: 2–3 criteria
- Moderate AUD: 4–5 criteria
- Severe AUD: 6 or more criteria
This spectrum approach is important — it means you do not have to be drinking every day, passing out regularly, or experiencing severe health consequences to have alcoholism. Mild AUD is still a real, diagnosable condition that benefits from treatment.
The Dictionary Definition of Alcoholism
According to Oxford Languages, alcoholism is “an addiction to the consumption of alcoholic liquor or the mental illness and compulsive behavior resulting from alcohol dependency.”
In this case, they even separate the act of drinking from the mental compulsion to drink.
When it comes to the mental illness of addiction, it can be different for everybody, but some common traits are…
- Finding ways to justify drinking to yourself, even if you’ve already told yourself you won’t drink more.
- Drinking is the only thing you can think about until you give in and use alcohol.
- Keeping your drinking a secret from friends and family, either entirely or by downplaying how much and how often you drink.
- Looking forward to drinking all day.
- Using alcohol as a coping mechanism to deal with something that happened to you.
According to WebMD, here’s their definition of what is an alcoholic: “For women, it’s having more than three drinks a day or seven a week. For men, it’s four or more per day or 14 a week. If you drink more than the daily or weekly limit, you’re at risk.”
WebMD’s definition would include most younger people, or people of any age, who go out on the weekends and have a few drinks with friends, even if they don’t drink for the other 5 days of the week. If you take a woman in college, for example, and she has a glass of wine with dinner on Tuesday, 3 drinks on Friday night, and 3 drinks on Saturday night, she would be considered “at risk” of being an alcoholic in this case.
That doesn’t seem like a lot to drink, does it? Now, these numbers don’t magically mean you’re an alcoholic, especially if you can easily just cease drinking at any time, but it’s still a warning sign that you should look at and take into consideration.
What Does Alcoholism Mean To You?
Dictionaries, and professional definitions of alcoholism, are all helpful as a starting point.
But what does alcoholism look like in your life? What does it mean to you?
It might mean that your parents weren’t there to watch your games, or to see your recital.
It might mean that you’re afraid to come home from work in case your partner has already started drinking and is going to yell at you.
It could mean that you don’t feel safe in your home.
Or, you could be the person battling with alcoholism and it could mean, “Nah, I don’t have a problem, I can stop when I want to…”
Or it could mean that people in your life just don’t understand how hard it is to quit drinking…
It could mean that you have demons that you’re battling, and you’re always looking for an escape from them, and often that escape ends up being getting blacked out.
Maybe it means that you’re still doing everything you need to do, but you just need a little help to take the edge off sometimes. Unfortunately, it’s never that simple.
Please accept this invitation to come and visit our community about alcoholism, where you can register for free and anonymously to share your views about what it means to be an alcoholic, what is alcoholism, and more.
Signs and symptoms of alcoholism
Alcoholism presents differently in different people, but there are common warning signs that span physical, behavioural, and psychological categories.
Physical signs
- Trembling hands, especially in the morning (a withdrawal symptom)
- Flushed or reddened face from chronic blood vessel dilation
- Unexplained weight loss or gain
- Frequent nausea, vomiting, or stomach pain
- Broken sleep and persistent fatigue
- Frequent illnesses due to a weakened immune system
- Yellowing of the skin or eyes (jaundice) — a sign of liver damage in severe cases
Behavioural signs
- Drinking alone or in secret
- Making excuses to drink or planning activities around alcohol
- Becoming irritable or aggressive when unable to drink
- Neglecting responsibilities at work, school, or home
- Continuing to drink despite negative consequences
- Hiding alcohol around the house or workplace
- “Blacking out” — having no memory of events while drinking
Psychological signs
- Using alcohol to cope with stress, anxiety, depression, or trauma
- Feeling unable to relax or have fun without alcohol
- Denial — genuinely believing you don’t have a problem despite evidence to the contrary
- Feeling guilt or shame about drinking, but continuing anyway
- Persistent preoccupation with drinking — thinking about it throughout the day
What causes alcoholism?
Alcoholism is not caused by any single factor. It develops through a combination of genetic, psychological, social, and environmental influences — which is why it is classified as a biopsychosocial disease.
Genetics
Research consistently shows that genetics account for approximately 50% of a person’s risk of developing AUD. People with a parent or close relative with alcoholism are 3–4 times more likely to develop it themselves. However, having a family history does not make alcoholism inevitable — and many people with no family history develop it.
Mental health
There is a well-documented link between alcohol use disorder and mental health conditions including depression, anxiety, PTSD, and bipolar disorder. Many people begin drinking heavily as a way to self-medicate emotional pain. Over time, alcohol worsens the very conditions it was used to treat, creating a cycle that is difficult to break without professional support. [1]
Environment and social factors
Growing up in a home where heavy drinking was normalised, peer pressure during formative years, high-stress occupations, and easy access to alcohol all increase risk. Cultural attitudes toward drinking also play a significant role — in cultures where heavy drinking is socially accepted or celebrated, rates of AUD tend to be higher.
Age of first drink
People who begin drinking before the age of 15 are 4 times more likely to develop alcohol dependence than those who wait until age 21 or older, according to NIAAA research. Adolescent brains are more vulnerable to alcohol’s effects on the developing reward and decision-making systems. [2]
The stages of alcoholism
Alcoholism typically develops gradually. Understanding the stages can help people recognise where they or a loved one might be on the spectrum.
Stage 1 — Pre-alcoholic
Drinking begins as a social activity. The person starts to notice that alcohol relieves stress or anxiety and begins to seek it out for that purpose. Tolerance starts to build. There may be no visible signs of a problem at this stage.
Stage 2 — Early alcoholism
Drinking becomes more frequent and the person begins to think about alcohol more often. They may experience their first blackout, start drinking alone, and feel guilt about their consumption. Denial is common at this stage.
Stage 3 — Middle alcoholism
Physical and behavioural consequences become more apparent. Relationships, work performance, and health begin to suffer. The person may try to hide their drinking or make promises to cut back that they cannot keep. Physical dependence begins — withdrawal symptoms appear when alcohol is reduced.
Stage 4 — Late-stage alcoholism
The person drinks compulsively and is physically dependent on alcohol. Severe health problems may develop including liver disease, brain damage, and cardiovascular problems. Withdrawal at this stage can be life-threatening and must be managed under medical supervision. Despite all consequences, the person feels unable to stop.
How alcoholism affects the body
Long-term heavy drinking causes damage to nearly every organ system in the body:
- Liver: Progresses from fatty liver → alcoholic hepatitis → cirrhosis. Cirrhosis is irreversible and potentially fatal.
- Brain: Alcohol shrinks brain tissue, impairs memory and cognitive function, and can cause Wernicke-Korsakoff syndrome (a severe form of brain damage caused by thiamine deficiency).
- Heart: Heavy drinking raises blood pressure, weakens the heart muscle (cardiomyopathy), and increases the risk of stroke and irregular heartbeat (atrial fibrillation).
- Immune system: Chronic alcohol use suppresses immune function, making heavy drinkers more susceptible to infections including pneumonia and tuberculosis.
- Cancer: Alcohol is classified as a Group 1 carcinogen by the World Health Organization (WHO). It is linked to cancers of the mouth, throat, oesophagus, liver, colon, and breast. [3]
Is alcoholism treatable?
Yes — and this is one of the most important things to understand. Alcoholism is a chronic disease, but it is highly treatable. Millions of people recover from AUD every year and go on to live full, healthy lives without alcohol.
Effective treatment options include:
- Medically supervised detox: For people with physical dependence, the first step is safely managing withdrawal under medical care. Alcohol withdrawal can be dangerous — even life-threatening — and should never be attempted alone in severe cases.
- Behavioural therapies: Cognitive Behavioural Therapy (CBT), Motivational Enhancement Therapy (MET), and 12-step facilitation therapy are all evidence-based approaches that help people change their relationship with alcohol.
- Medication: FDA-approved medications including naltrexone, acamprosate, and disulfiram can reduce cravings and support abstinence.
- Support groups: Alcoholics Anonymous (AA), SMART Recovery, and other peer support groups provide ongoing community and accountability.
- Inpatient or outpatient rehab: Structured treatment programmes provide intensive support, particularly for moderate to severe AUD.
Recovery is not linear and relapse is common — but relapse does not mean failure. It is a recognised part of the recovery process for many people, and returning to treatment after a relapse is always an option.
How is alcoholism different from alcohol abuse?
These terms are often used interchangeably, but they have distinct meanings in a clinical context. Alcohol abuse (sometimes called “harmful drinking”) refers to a pattern of drinking that causes harm — to health, relationships, or responsibilities — but without the characteristic physical dependence seen in full AUD. The person can still choose to stop, even if they don’t.
Alcoholism (severe AUD) involves physical and psychological dependence — the brain and body have adapted to the presence of alcohol to the point where stopping causes withdrawal symptoms. The person feels genuinely unable to stop, even when they want to.
That said, alcohol abuse can progress to alcoholism over time, particularly if left unaddressed.
Frequently asked questions about alcoholism
What is the definition of alcoholism?
Alcoholism is a chronic, relapsing brain disorder characterised by an impaired ability to stop or control alcohol use despite negative consequences to health, relationships, work, or finances. Clinically, it is diagnosed as Alcohol Use Disorder (AUD) using criteria from the DSM-5. It is classified as a disease — not a character flaw or lack of willpower — and is influenced by genetic, psychological, social, and environmental factors.
What is the difference between alcoholism and alcohol use disorder?
Alcoholism and Alcohol Use Disorder (AUD) refer to the same condition. “Alcoholism” is the older, more commonly used term in everyday language, while “Alcohol Use Disorder” is the current clinical term used by doctors and the DSM-5. AUD exists on a spectrum of mild, moderate, and severe — “alcoholism” most closely corresponds to moderate or severe AUD, but all levels of AUD are real medical conditions that benefit from treatment.
How do you know if you are an alcoholic?
The clearest signs that you may have alcoholism include: drinking more than you intended or for longer than planned; being unable to cut down despite wanting to; spending a lot of time drinking or recovering from drinking; experiencing cravings; neglecting work, family, or responsibilities; continuing to drink despite relationship or health problems; and experiencing withdrawal symptoms like shaking or anxiety when you stop. If two or more of these apply to you within the past year, speaking to a doctor is strongly recommended.
Is alcoholism a disease?
Yes. Alcoholism is officially classified as a chronic brain disease by the American Medical Association (AMA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the World Health Organization (WHO). It changes the structure and function of the brain — particularly the reward, stress, and self-control circuits — in ways that persist long after a person stops drinking. Calling it a disease does not remove personal responsibility, but it does mean that willpower alone is rarely sufficient treatment.
What are the stages of alcoholism?
Alcoholism generally progresses through four stages. The pre-alcoholic stage involves drinking socially but beginning to rely on alcohol for stress relief. The early stage sees drinking become more frequent, with the first blackouts and growing preoccupation with alcohol. The middle stage brings visible consequences — relationship and work problems, physical dependence, and failed attempts to quit. Late-stage alcoholism involves compulsive daily drinking, severe physical health problems, and withdrawal symptoms that can be life-threatening without medical supervision.
Can alcoholism be cured?
Alcoholism cannot be “cured” in the same way a bacterial infection can, but it can be successfully treated and managed. Many people with AUD achieve long-term or permanent sobriety through a combination of therapy, medication, support groups, and lifestyle changes. Because it is a chronic condition, ongoing management is often needed — relapse is common but does not mean treatment has failed. With the right support, recovery is absolutely possible.
How many drinks per day makes you an alcoholic?
There is no single drink count that definitively makes someone an alcoholic — alcoholism is defined by behaviour patterns and loss of control, not just quantity. That said, the NIAAA defines heavy drinking as more than 4 drinks on any single day or 14 drinks per week for men, and more than 3 drinks per day or 7 per week for women. Consistently drinking above these thresholds significantly increases the risk of AUD. More important than the number, however, is whether drinking is causing problems in your life that you cannot stop despite trying.
What is a functioning alcoholic?
A functioning alcoholic (more accurately called a “high-functioning person with AUD”) is someone who drinks heavily and meets the criteria for Alcohol Use Disorder, but appears to maintain their career, relationships, and daily responsibilities. They may hold a job, pay their bills, and seem fine on the surface. However, functioning alcoholism is still alcoholism — the physical dependence, health risks, and underlying psychological patterns are present, even if the outward consequences haven’t become visible yet. The “functioning” label can unfortunately make it harder for people to seek help, because they don’t feel “bad enough.”
Sources
- National Institute of Mental Health. Alcohol Use Disorder. nimh.nih.gov
- National Institute on Alcohol Abuse and Alcoholism. Underage Drinking. niaaa.nih.gov
- World Health Organization. Alcohol Fact Sheet. who.int
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: APA, 2013.
- National Institute on Alcohol Abuse and Alcoholism. Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5. niaaa.nih.gov
