The Warning Signs of Alcoholism

The most common warning signs of alcoholism include drinking more than intended, failed attempts to cut down, strong cravings, rising tolerance, withdrawal symptoms, and drinking despite harmful consequences, and these changes may develop gradually, making them easy to overlook until drinking begins to affect a person’s daily life.

Alcohol is one of the most commonly used substances in the United States. Approximately 25.7 million people ages 12 and older had alcohol use disorder (AUD) in 2025, according to the National Survey on Drug Use and Health (NSDUH), conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Despite its ubiquity in our culture, alcohol carries significant health risks. Excessive drinking caused approximately 178,000 deaths a year in the U.S., based on 2020 and 2021 data, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Harms may be associated with any amount of drinking, so it behooves those who drink regularly to recognize when their drinking is becoming difficult to control.

What Is Alcoholism?

Alcoholism is the common term for what doctors call alcohol use disorder (AUD), a medical condition in which a person struggles to stop or control their drinking despite its negative effects on their health, work, or relationships. AUD encompasses what many people refer to as alcohol abuse, alcohol dependence, and alcohol addiction. Even mild AUD is worth taking seriously, as lasting changes in the brain caused by alcohol misuse can leave people vulnerable to relapse, according to the NIAAA.

Early Warning Signs of Alcoholism

In the early stages, changes in drinking habits may seem too small to warrant concern, especially in a culture where alcohol is so common. Paying attention to the pattern, rather than one occasion, can help a person recognize when drinking is taking up more of their life, with early warning signs that include:

• Drinking more or for longer than planned. One or two drinks regularly turn into several more.
• Needing more alcohol to feel its effects. The same number of drinks no longer has the same effect.
• Drinking to cope with stress. Reaching for a drink to unwind, manage anxiety, or fall asleep.
• Hiding or downplaying drinks. Sneaking drinks or being less than honest about how much they’ve had.
• Losing interest in other activities. Hobbies and social events without alcohol start to feel less appealing.

These habits do not establish a diagnosis on their own, but they are worth discussing with a health care professional. It also helps to know how much drinking is considered heavy. The NIAAA defines heavy drinking as five or more drinks on any day or 15 or more per week for men, and four or more drinks on any day or eight or more per week for women. One standard drink contains about 14 grams of pure alcohol, the amount in a 12-ounce regular beer, a 5-ounce glass of wine, or a 1.5-ounce shot of distilled spirits.

The CAGE Questionnaire: 4 Warning Signs

A good place to start is with a common alcohol screening tool known as the CAGE questionnaire, described by Dr. John A. Ewing. CAGE is a screening tool, and two or more “yes” answers suggest that a person may have a drinking problem and should undergo a more in-depth assessment. Its questions ask about lifetime experiences, so the result alone does not establish whether a person currently has AUD. The four questions are:

1. Have you ever felt you should cut down on your drinking?

When people struggle with alcoholism, they are often acutely aware of the effects of alcohol on their lives. They may be saying things to themselves like “I can stop anytime I like.” At the same time, they may be experiencing a cycle of resolving to cut down on their drinking or quit drinking on their own and then failing to follow through. Alcoholism is a medical condition that can require professional treatment, so a failed attempt to cut down is no reflection of a person’s strength or willpower.

2. Have people ever annoyed you by criticizing your drinking?

Those who struggle with alcoholism may feel annoyed or irritated when a loved one expresses concern about their drinking. The conversation may bring up feelings of shame, guilt, or denial about their drinking on their lives. Feeling defensive doesn’t make the person struggling a bad person; the question helps open a conversation about why those comments feel uncomfortable.

3. Have you ever felt bad or guilty about your drinking?

A person may begin to feel guilty as they notice how their drinking affects their behavior toward loved ones, their jobs, and their relationships. Relaxing at a bar after work on a Friday, sharing wine on a dinner date, or having a beer at a barbecue does not tell the whole story. The concern is whether drinking repeatedly leads to regret or harm, although guilt alone does not establish AUD and a lack of guilt does not rule it out.

4. Have you ever had a drink first thing in the morning (an eye-opener) to steady your nerves or get over a hangover?

When a person becomes physically dependent on alcohol, they may experience withdrawal symptoms as its effects wear off, including shakiness, nausea, sweating, or anxiety. Having a drink in the morning may temporarily relieve those symptoms, but relying on alcohol for relief is a reason to seek medical help. Withdrawal can be dangerous, so someone who needs a drink to steady their nerves should speak with a health care professional before attempting to stop on their own.

11 Signs of Alcohol Use Disorder (DSM-5 Criteria)

While CAGE helps identify concerns that deserve further assessment, health care professionals use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to diagnose AUD. The manual, published by the American Psychiatric Association, lists 11 criteria that cover loss of control, the consequences of drinking, tolerance, and withdrawal, and the questions below paraphrase the criteria described by the NIAAA.

In the past year, have you:

1. Ended up drinking more, or for longer, than you meant to?
2. Repeatedly wanted to drink less or quit drinking, or tried to, but been unable to?
3. Spent a lot of time drinking, or being sick and recovering from drinking?
4. Had cravings so strong that it was hard to think about anything else?
5. Been unable to keep up with work, school, or family obligations because of your drinking?
6. Kept drinking even though it was causing trouble with your friends or family?
7. Given up or cut back on hobbies and activities you enjoy in order to drink?
8. More than once gotten into risky situations while or after drinking, such as driving, swimming, or having unsafe sex?
9. Kept drinking even though it made you feel depressed or anxious, worsened another health problem, or caused a memory blackout?
10. Had to drink much more than before to feel the effects, or found that your usual amount had much less effect?
11. Had withdrawal symptoms as the alcohol wore off, such as trouble sleeping, shakiness, nausea, sweating, a racing heart, or even a seizure?

A health care professional assesses whether a person meets at least 2 criteria within the same 12-month period, with the number of criteria met determining severity:

• Mild: 2 to 3 criteria
• Moderate: 4 to 5 criteria
• Severe: 6 or more criteria

Physical Signs and Symptoms of Alcoholism

Not every sign of alcoholism is behavioral, as physical changes may appear during intoxication or when alcohol wears off. Common physical signs and symptoms include:

• Signs of intoxication, such as slurred speech and poor coordination, along with frequently smelling of alcohol.
• Withdrawal symptoms when not drinking, including anxiety, headaches, nausea, sweating, tremors, and a rapid heart rate.
• Changes in sleep and appetite, such as insomnia or a loss of appetite.

In severe cases, withdrawal can progress to delirium tremens, a dangerous condition that can cause confusion, hallucinations, and seizures. Alcohol withdrawal should be managed under medical supervision. If seizures, severe confusion, or hallucinations occur, call 911 or go to an emergency department, according to MedlinePlus guidance on alcohol withdrawal. You can also learn more about how long alcohol withdrawal lasts.

How to Tell if a Loved One Is Struggling With Alcohol

It can be difficult to talk about a loved one’s drinking, especially when they are reluctant to discuss it. Changes such as repeatedly missing family commitments or continuing to drink despite relationship problems are reasons to encourage a professional assessment. Drinking alone or becoming defensive, however, does not establish AUD.

A good place to start is a calm conversation when the person is sober. Describe a specific concern, such as a missed obligation, rather than labeling the person or trying to diagnose them. Approaching the conversation with patience and compassion can help keep the focus on their well-being. You can also learn more about how alcoholism affects families.

Seeking Help for Alcoholism

Alcoholism is a difficult condition to manage, but it is one that can be treated. If you’re concerned about your own or a loved one’s drinking, it may be time to consider treatment. Sunshine Behavioral Health offers inpatient alcohol rehab and outpatient treatment to help people on the journey to recovery. Luxury inpatient rehab is another option within our network. Take the first step toward recovery today by calling our team at Sunshine Behavioral Health at 833-838-9161, available 24/7.

Sources:

• SAMHSA: Release of the 2025 NSDUH
• NIAAA: Alcohol-Related Emergencies and Deaths
• NIAAA: Understanding Alcohol Drinking Patterns
• NIAAA: What Is a Standard Drink?
• NIAAA: Understanding Alcohol Use Disorder
• NIAAA: A Comparison Between DSM-IV and DSM-5
• Ewing: Detecting Alcoholism, the CAGE Questionnaire
• Item Bias in the CAGE Screening Test
• Mayo Clinic: Alcohol Use Disorder Symptoms
• MedlinePlus: Alcohol Withdrawal