Alcohol Use Disorder

This is the last in my series of the most common psychological disorders in Australia. The list of common disorders had three entries for substance use – alcohol harmful use, alcohol dependence and drug use disorder. I have decided to collapse these entries into one disorder – alcohol use disorder. Alcohol is just one of many drugs that can be abused. It is available legally, without prescription. It is socially acceptable. I hope you’ve enjoyed this series.


Holly* is a 38-year-old mother of two. She has promised her husband and family multiple times that she would stop drinking, only to lapse again and again. “I guess I don’t really want to stop at all” she laments “If I really cared, why would I keep putting my family through this”.

Marcus is a happy drunk. “For a long time, I didn’t see the problem. I thought everyone else, and society, were too uptight”. Marcus’ wife finally came good on threats to leave and soon after he lost his licence which nearly cost him his job. “Now in recovery I can’t believe I didn’t see what a problem it had become”.

What does it mean?

Most Australian adults drink alcohol sometimes. The large minority (41%) of Australian adults drink weekly or more. If we are all drinking, do we all have a problem? If drinking is normal, what does it mean to have a problem?

One way to define a drinking problem is by using the criteria laid down in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-V). The DSM-V states that if you have a pattern of drinking which causes significant impairment or distress, you may have a problem.

The manual gives a list of 11 symptoms which may indicate impairment or distress, only two of which are needed to meet threshold for a minor disorder.

These symptoms include: Drinking more than was intended, repeated unsuccessful efforts to cut down drinking, spending a large proportion of life engaged in alcohol-related activities, presence of cravings and urges, impacts to work and other roles, impacts to relationships, giving up other activities in order to drink, increased tolerance, and withdrawal symptoms.

So, if you have a bit of a pattern of drinking more than you planned on a Friday night, then promising yourself you’ll never drink again on Saturday morning you might meet criteria 1 and 2.

And maybe you do have a problem. But the harm is pretty minor, and you’ve got that under control.

The issue of control

Except that you are only in control until the moment you are not.

Addictions tend to emerge slowly.  Like the frog boiling in a slowly warming pot, the loss of control is only noticed when it’s too late. Drinking almost always starts at a way to relax or celebrate. As the quantity and/or frequency of drinking increases, so increases the urge to continue consuming.

“I just really liked going out with friends in my 20’s, but when I became a mum I mainly drank to unwind and as a reward at the end of a hard day.” Holly started drinking socially but as a mother she had engaged in mostly solo drinking, and with no witnesses, quantity increased. “I guess on some level I knew it became a problem a while ago. I used to slip the empty wine bottles under the carboard in the recycling bin, or go out on bin night to put them in the neighbours rubbish”.

Denial, not just a river in Egypt

For alcohol consumption to increase this dramatically, we have to play some mental tricks with ourselves. Denial is a process of refusing to accept the truth; blocking facts in order to maintain a false subjective version of reality. People with addictive problems often maintain the misbelief that they in control or acting normally until it is too late.

“When my wife started having a problem with my drinking, I’d have a few drinks at work before leaving”. Marcus had started escalating drinking by deceiving his wife. “Then I had a few hiding spots in the shed, yard, around the house, all of which she found. Eventually I had a hiding spot in this little bushland park near the house. I can’t believe I thought it was normal! A grown man sneaking into the bush to polish off half a bottle of whisky and a pack of mints before driving home!”


The goal of treatment for alcohol use disorder could be abstinence or controlled use/harm reduction. There is no definitive way to work out which goal is more appropriate. Generally speaking, however, the more severe the alcohol disorder, the more likely that abstinence is an appropriate goal.

Although medications exist that decrease cravings, or that make one physically sick when drinking, most abstinence-based treatments involve rehabilitation therapy. For many people, this starts with an in-patient rehabilitation program. These programs usually consist of a detoxification component and a group therapy component.

For people with less severe problems, or for those post-rehab, support groups and individual therapy are the most common approaches. Groups like AA can be helpful when perceived as supportive (rather than punitive). Individual therapy focusses on strategies to manage urges and cravings, to prevent relapse.


* Name and key details changed

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