Quick Summary
If you are worried about a loved one’s drinking, the warning signs of alcohol use often show up across physical, behavioral, and pattern-of-use indicators. This guide walks through what to look for, how to have an honest conversation, and what concrete next steps exist.
Key Takeaways
- Alcohol use disorder shows up across physical, behavioral, and pattern-of-use signs, not any single symptom.
- Physical signs include changes in skin, weight, sleep, and appearance.
- Behavioral signs include secrecy, defensiveness, mood swings, and withdrawal from relationships.
- Pattern signs include drinking more than intended, drinking alone, and drinking despite consequences.
- A clinical assessment is the right next step if multiple signs are present.
Alcohol use disorder is often invisible from the outside until it has progressed significantly. People who are struggling are often very practiced at hiding it. This article walks through what to actually watch for, drawing on the clinical criteria in the NIAAA core resource on alcohol use disorder.
Physical Signs to Watch For
- Changes in skin: redness in the face, broken capillaries, jaundice in advanced cases.
- Weight gain or loss.
- Sleep changes: difficulty falling asleep, waking through the night, exhaustion in the morning.
- Tremor, especially in the hands in the morning.
- Smell of alcohol on breath at unusual times.
- Frequent headaches or unexplained illnesses.
- Decline in personal hygiene or grooming.
- Elevated liver enzymes on blood work, if available.
Behavioral and Emotional Signs
- Defensiveness when alcohol is mentioned.
- Mood swings that track with drinking and not drinking.
- Irritability or anxiety between drinks.
- Withdrawing from family, friends, or activities that used to matter.
- Secrecy about whereabouts, social events, or schedule.
- Lying about how much they have had.
- Increased conflict in relationships.
- Declining work or school performance.
- Financial problems that do not match the household situation.
Patterns of Use to Notice
- Drinking more than they intended on multiple occasions.
- Drinking alone or at unusual times (morning, during work).
- Hiding drinks around the house.
- Empty bottles or cans found in unexpected places.
- Drinking before social events to “pre-game.”
- Drinking to manage emotions, stress, or sleep.
- Continued drinking despite obvious negative consequences.
- Inability to enjoy events without alcohol.
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What the Clinical Definition Says
Alcohol use disorder is defined in the DSM-5 by problematic alcohol use patterns that meet at least 2 of 11 criteria within a 12-month period. These include drinking more than intended, persistent desire to cut down, tolerance, withdrawal, continued use despite negative consequences, and cravings. Meeting 2 to 3 criteria indicates mild AUD, 4 to 5 moderate, and 6 or more severe. About 28 million U.S. adults have AUD, according to NIAAA estimates.
How to Have the Conversation
If the signs are adding up, talking to your loved one is harder than it sounds. A few principles:
- Pick a calm, sober moment. Not during drinking or argument.
- Lead with concern, not accusation. “I am worried about you” works better than “You have a problem.”
- Be specific. Share what you have noticed, not what you suspect.
- Avoid ultimatums in the first conversation.
- Offer to help with the next step. An assessment, a doctor’s visit, an Al-Anon meeting for yourself, anything that is concrete.
- Do not expect a single conversation to fix it. Change often happens over multiple conversations.
Taking Care of Yourself
Worrying about a loved one is exhausting. Family support resources exist for you, not just for them. Al-Anon is a peer support fellowship specifically for adults whose lives have been affected by someone else’s drinking. Therapy can also help you think through your role and your limits.
What to Do Next
If multiple signs are present, a clinical assessment is the right next step. An assessment with a qualified clinician can clarify what is happening and recommend a path forward, whether that is outpatient counseling, medication-assisted treatment, residential treatment, or some combination. For severe alcohol use disorder, supervised medical detox is usually the right starting point because withdrawal can be medically dangerous.
Talking With a Professional
The admissions team at Discovery Point Retreat can talk through what an assessment involves and what options exist for your loved one and for you.
Resources
- 988 Suicide and Crisis Lifeline. Call or text 988, or chat at 988lifeline.org. Free, confidential support 24/7.
- SAMHSA National Helpline. Call 1-800-662-HELP (4357) or visit the SAMHSA National Helpline page for free, confidential referrals to local treatment.
- 911. For any medical emergency, call 911 immediately.
This article is general education and is not medical advice.
