Signs of alcohol use disorder
Clinical review pending. This guide was written from the sources it cites but has not yet been reviewed by a licensed clinician.
Alcohol use disorder (AUD) is diagnosed when at least 2 of 11 specific problems show up within the same 12 months. Two or three is mild, four or five is moderate, and six or more is severe. In 2025, 25.7 million people in the US aged 12 and older met that bar, about 8.9% of that age group.
The signs below aren’t a diagnosis; only a clinician can make one.
The 11 signs
These are the DSM-5 diagnostic criteria. NIAAA phrases them as questions about the past year. We’ve reworded them and grouped them by theme.
Losing control over how much you drink
- You often end up drinking more, or for longer, than you meant to.
- You’ve wanted to cut back or stop more than once, or tried to, and couldn’t.
- A lot of your time goes to drinking, or to being sick and recovering afterward.
- You’ve had cravings so strong it was hard to think about anything else. (Craving was added in DSM-5.)
Drinking getting in the way of your life
- Drinking, or being sick from it, has often interfered with home, family, work or school.
- You’ve kept drinking even though it was causing trouble with family or friends.
- You’ve dropped or cut back on things you used to care about or enjoy so you could drink.
Taking risks
- More than once, drinking has put you in situations where you could get hurt, such as driving, swimming, using machinery or having unsafe sex.
- You’ve kept drinking even though it made you depressed or anxious, made another health problem worse, or after you’d had a memory blackout.
Physical dependence
- You need much more alcohol than before to feel the effect, or your usual amount does much less. That’s tolerance.
- As alcohol wears off, you get withdrawal symptoms: trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or even a seizure, or you sense things that aren’t there.
Count the ones that fit the past year, not your whole life. If it’s two or more, that’s worth raising with a clinician.
If number 11 fits, stopping suddenly can be dangerous. Read how to stop drinking safely before you quit.
How much is “heavy” drinking?
The criteria above are about consequences, not quantity. But quantity matters, and NIAAA gives definitions.
First, a US standard drink has about 14 grams of pure alcohol. That’s 12 fl oz of regular beer at about 5%, 5 fl oz of wine at about 12%, or 1.5 fl oz of 80-proof spirits. A pint of strong craft beer or a generous pour of wine is more than one.
| NIAAA definition | Men | Women |
|---|---|---|
| Binge drinking (raises blood alcohol to 0.08% or higher, usually within about 2 hours) | 5 or more drinks | 4 or more drinks |
| Heavy drinking | 5 or more on any day, or 15 or more per week | 4 or more on any day, or 8 or more per week |
Heavy drinking and AUD aren’t defined the same way. One is a count of drinks; the other is a count of problems in your life.
If you’re not sure how much you actually drink, the drink counter converts what you pour into standard drinks.
What the dietary guidelines say now
The 2025 to 2030 Dietary Guidelines for Americans, dated January 2026, dropped the old numeric limits of up to 2 drinks a day for men and 1 for women. The general advice is now simply to drink less: “Consume less alcohol for better overall health.” The guidelines say some people should avoid alcohol completely, including pregnant women and people who are recovering from AUD or can’t control how much they drink.
How a clinician checks
The US Preventive Services Task Force recommends that primary care screen all adults for unhealthy alcohol use and offer brief counseling to people drinking at risky levels. One tool it names is a single question: how many times in the past year have you had 5 or more drinks in a day (4 or more for women and for adults over 65)? Another is the AUDIT-C, a short questionnaire. If you’d like to see a full screening questionnaire, NIAAA and the World Health Organization publish their own.
If you’re on Medicare and drink but don’t meet criteria for dependence, Part B covers one alcohol misuse screening a year, and you pay nothing if your provider accepts assignment.
A positive screen isn’t a diagnosis. It means a clinician will ask about the 11 signs.
Talking to a clinician
Start with a primary care clinician. You don’t need a specialist to get started, and primary care can prescribe the FDA-approved medications for AUD along with brief counseling. It helps to bring an honest count of what you drink in a typical week.
Mild AUD doesn’t automatically mean residential rehab. NIAAA’s advice is to start with the least intensive care that fits and move up only if you need it. Our guide to alcohol treatment options walks through the levels, and medications for alcohol use disorder explains the four approved drugs.
To find programs near you that prescribe AUD medication, use the ZIP code finder or browse treatment by state.
If you’re reading this about someone else, see how to help someone who drinks.
Sources
- NIAAA, Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5 (updated April 2021)
- SAMHSA, Key Substance Use and Mental Health Indicators in the United States: Results from the 2025 National Survey on Drug Use and Health (July 27, 2026)
- NIAAA, What Is a Standard Drink? (updated December 2025)
- NIAAA, Drinking Levels Defined (updated January 2026)
- USDA/HHS, Dietary Guidelines for Americans, 2025-2030 (January 2026)
- USPSTF, Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions (Nov 13, 2018)
- Medicare.gov, Alcohol misuse screenings & counseling (no date shown)
- NIAAA Core Resource on Alcohol, Recommend Evidence-Based Treatment: Know the Options (last revised May 8, 2025)
- NIAAA Alcohol Treatment Navigator, FAQs (no date shown)