Alcohol use disorder (AUD) is a condition that health care professionals diagnose when a patient’s drinking pattern causes significant distress or harm. Previously known as alcohol abuse or alcoholism, AUD can be mild, moderate, or severe. AUD can cause lasting changes in the brain that make patients vulnerable to relapse. The good news is that no matter how severe the problem may seem, most people with AUD can benefit from treatment with behavioral therapies, medications, or both.

AUD is diagnosed when a person answers “yes” to two or more of the questions below.

In the past year, have you:

• Had times when you ended up drinking more, or longer, than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
• Spent a lot of time drinking? Or being sick or getting over the aftereffects?
• Experienced craving—a strong need, or urge, to drink?
• Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
• Continued to drink even though it was causing trouble with your family or friends?
• Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout (i.e., forgetting, after drinking, where you were or what you did while drinking)?
• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, dysphoria, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

Any of these symptoms may be cause for concern. The more symptoms, the more urgent the need for change. A health professional can look at the number, pattern, and severity of symptoms to see whether AUD is present and help set a good course of action back to health.

It's up to you as to whether and when to change your drinking. You donʾt have to wait until you develop alcohol use disorder (AUD) or other alcohol-related problems to evaluate your relationship with alcohol. Even participating in events such as Dry January and Sober October can offer the opportunity to take a break from alcohol to understand how it is affecting your life. Other people may be able to help, but in the end, it’s your decision. Weighing your pros and cons can help.

Pros: What are some reasons why you might want to change your drinking?

• To improve my health
• To improve my relationships
• To avoid hangovers
• To do better at work or in school
• To save money
• To lose weight or get fit
• To avoid more serious problems
• To meet my own personal standards

Cons: What are some possible barriers, or reasons you might not want to change your drinking?

• I'd need another way to unwind.
• It helps me feel more at ease socially.
• I wouldn't fit in with some of my friends.
• Change can be hard.

Are you ready to change your drinking?

If so, choose whether to cut down or quit and make a change plan. Don't be surprised if you continue to have mixed feelings. You may need to remake your decision several times before becoming comfortable with it.

If youʾre not yet ready, consider these suggestions in the meantime:

• Keep track of how often and how much you're drinking.
• Notice how drinking affects you.
• Make or remake a list of pros and cons about changing.
• Deal with other priorities that may be in the way.
• Ask for support from your doctor, a friend, or someone else you trust.
• Review this site from time to time to refresh your memory about these tips.

If you're considering changing your drinking, you'll need to decide whether to cut down or quit. It's a good idea to discuss different options with a healthcare professional, a friend, or someone else you trust.

Please note, when someone who has been drinking heavily for a prolonged period of time suddenly stops drinking, the body can go into a painful or even potentially life-threatening process of withdrawal. Symptoms can include nausea, rapid heart rate, seizures, or other problems. Seek medical help to plan a safe recovery. Doctors can prescribe medications to address these symptoms and make the process safer and less distressing.

Quitting is strongly advised if you:

• Have tried cutting down but cannot stay within the limits you set.
• Have had alcohol use disorder (AUD) or now have any symptoms.
• Have a physical or mental health condition that is caused or being worsened by drinking.
• Are taking a medication that interacts with alcohol.
• Are or might be pregnant.

If none of the conditions above apply to you, then talk with your doctor to determine whether you should cut down or quit based on factors such as:

• A family history of alcohol problems
• Your age
• A history of drinking-related injuries
• Symptoms such as a sleep, pain, or anxiety disorder and sexual dysfunction

If you choose to cut down, see the 2020–2025 Dietary Guidelines for Americans and seek advice from a healthcare professional if needed.

Don't wait for a crisis or to "hit bottom."

When someone is drinking too much, making a change earlier is likely to be more successful and less destructive to individuals and their families.

Small changes can make a big difference in reducing your chances of having alcohol-related problems. If one approach doesn't work, try something else.

Here are some specific strategies to try, and you can add your own at the end. Check off perhaps two or three to try in the next week or two. Then click List my choices, and you can print or email them to yourself. If you haven't made progress in cutting down after 2 to 3 months, consider quitting drinking altogether, seeking professional help, or both.

• Keep track. Keep track of how much you drink. Find a way that works for you, such as using a drinking tracker card in your wallet, check marks on a kitchen calendar, notes in a smartphone or other mobile device; or notes on paper. Making note of each drink before you drink it may help you slow down when needed.

• Count and measure. Know the standard drink sizes so you can count your drinks accurately. Measure drinks at home. Away from home, it can be hard to keep track, especially with mixed drinks, and at times, you may be getting more alcohol than you think. With wine, you may need to ask the host or server not to "top off" a partially filled glass.

• Set goals. Decide how many days a week you want to drink and how many drinks you'll have on those days. It's a good idea to have some days when you don't drink.

• Find alternatives. If drinking has occupied a lot of your time, then fill free time by developing new, healthy activities, hobbies, and friendships, or renewing ones you've missed. If you have counted on alcohol to make you more comfortable in social situations, manage moods, or cope with problems, then seek other, healthy ways to deal with those areas of your life.

• Avoid triggers. What triggers your urge to drink? If certain people or places make you drink even when you don't want to, try to avoid them. If certain activities, times of day, or feelings trigger the urge, plan something else to do instead of drinking. If drinking at home is a problem, keep little or no alcohol there.

• Plan to handle urges. When you cannot avoid a trigger and an urge hits, consider these options: Remind yourself of your reasons for changing (it can help to carry them in writing or store them in an electronic message you can access easily, such as on a smartphone or other mobile device). Or talk things through with someone you trust. Or get involved in a healthy, distracting activity, such as physical exercise or a hobby that doesn't involve drinking. Or, instead of fighting the feeling, accept it and ride it out without giving in, knowing that it will soon crest like a wave and pass. Also, see the short activity to help you handle urges to drink.

• Know your "no." You're likely to be offered a drink at times when you don't want one. Have a polite, convincing "no, thanks" ready. The faster you can say no to these offers, the less likely you are to give in. If you hesitate, it allows you time to think of excuses to go along. Also, see the short activity to help you build drink refusal skills.

The following activity offers suggestions to support you in your decision to cut back or quit drinking. It can be used with counseling or therapy and is not meant as a substitute for professional help. If you choose to try it on your own and at any point feel you need more help, then seek support.

Plan ahead to stay in control

As you change your drinking, it's normal and common to have urges or a craving for alcohol. The words "urge" and "craving" refer to a broad range of thoughts, physical sensations, or emotions that tempt you to drink, even though you have at least some desire not to. You may feel an uncomfortable pull in two directions or sense a loss of control.

Fortunately, urges to drink are short-lived, predictable, and controllable. This short activity offers a recognize-avoid-cope approach commonly used in cognitive behavioral therapy, which helps people to change unhelpful thinking patterns and reactions. It also provides worksheets to help you uncover the nature of your urges to drink and to make a plan for handling them.

With time, and by practicing new responses, you'll find that your urges to drink will lose strength, and you'll gain confidence in your ability to deal with urges that may still arise at times. If you are having a very difficult time with urges, or do not make progress with the strategies in this activity after a few weeks, then consult a healthcare professional for support. In addition, some new, non-addictive medications can reduce the desire to drink or lessen the rewarding effect of drinking so it is easier to stop.

Recognize two types of "triggers"

An urge to drink can be set off by external triggers in the environment and internal ones within yourself.

• External triggers are people, places, things, or times of day that offer drinking opportunities or remind you of drinking. These "tempting situations" are more obvious, predictable, and avoidable than internal triggers.
• Internal triggers can be puzzling because the urge to drink just seems to "pop up." But if you pause to think about it when it happens, you'll find that the urge may have been set off by a fleeting thought, a positive emotion such as excitement, a negative emotion such as frustration, or a physical sensation such as a headache, tension, or nervousness.

Consider tracking and analyzing your urges to drink for a couple of weeks. This will help you become more aware of when and how you experience urges, what triggers them, and ways to avoid or control them.

Avoid tempting situations

In many cases, your best strategy will be to avoid taking the chance that you'll have an urge, then slip and drink. At home, keep little or no alcohol. Socially, avoid activities involving drinking. If you feel guilty about turning down an invitation, remind yourself that you are not necessarily talking about "forever." When the urges subside or become more manageable, you may decide to ease gradually into some situations you now choose to avoid. In the meantime, you can stay connected with friends by suggesting alternate activities that don't involve drinking.

Cope with triggers you can't avoid

It's not possible to avoid all tempting situations or to block internal triggers, so you'll need a range of strategies to handle urges to drink. Here are some options:

• Remind yourself of your reasons for making a change. Carry your top reasons on a wallet card or in an electronic message that you can access easily, such as on a mobile phone or a saved email.
• Talk it through with someone you trust. Have a trusted friend on standby for a phone call, or bring one along for support in situations where you might be tempted to drink.
• Distract yourself with a healthy, alternative activity. For different situations, come up with engaging short, mid-range, and longer options, like texting or calling someone, watching short online videos, lifting weights to music, showering, meditating, taking a walk, or doing a hobby.
• Challenge the thought that drives the urge. Stop it, analyze the error in it, and replace it. Example: "It couldn't hurt to have one little drink. WAIT a minute—what am I thinking? One could hurt, as I've seen 'just one' lead to lots more. I am sticking with my choice not to drink."
• Ride it out without giving in. Instead of fighting an urge, accept it as normal and temporary. As you ride it out, keep in mind that it will soon crest like an ocean wave and pass.
• Leave tempting situations quickly and gracefully. It helps to plan your escape in advance.

The following activity offers suggestions to support you in your decision to cut back or quit drinking. It can be used with counseling or therapy and is not meant as a substitute for professional help. If you choose to try it on your own and at any point feel you need more help, then seek support.

Plan ahead to stay in control

Even if you are committed to changing your drinking, "social pressure" to drink from friends or others can make it hard to cut back or quit. This short activity offers a recognize-avoid-cope approach commonly used in cognitive-behavioral therapy, which helps people to change unhelpful thinking patterns and reactions. It also provides links to worksheets to help you get started with your own plan to resist pressure to drink.

Recognize two types of pressure

The first step is to become aware of the two different types of social pressure to drink alcohol—direct and indirect.

• Direct social pressure is when someone offers you a drink or an opportunity to drink.
• Indirect social pressure is when you feel tempted to drink just by being around others who are drinking—even if no one offers you a drink.

Take a moment to think about situations where you feel direct or indirect pressure to drink or to drink too much. Then, for each situation, choose some resistance strategies from below, or come up with your own. When you're done, you can print the form or email it to yourself.

Avoid pressure when possible

For some situations, your best strategy may be avoiding them altogether. If you feel guilty about avoiding an event or turning down an invitation, remind yourself that you are not necessarily talking about "forever." When you have confidence in your resistance skills, you may decide to ease gradually into situations you now choose to avoid. In the meantime, you can stay connected with friends by suggesting alternate activities that don't involve drinking.

Cope with situations you can't avoid

Know your "no"

When you know alcohol will be served, it's important to have some resistance strategies lined up in advance. If you expect to be offered a drink, you'll need to be ready to deliver a convincing "no, thanks." Your goal is to be clear and firm, yet friendly and respectful. Avoid long explanations and vague excuses, as they tend to prolong the discussion and provide more of an opportunity to give in. Here are some other points to keep in mind:

• Don't hesitate, as that will give you the chance to think of reasons to go along
• Look directly at the person and make eye contact
• Keep your response short, clear, and simple

The person offering you a drink may not know you are trying to cut down or stop, and his or her level of insistence may vary. It's a good idea to plan a series of responses in case the person persists, from a simple refusal to a more assertive reply. Consider a sequence like this:

• No, thank you.
• No, thanks, I don't want to.
• You know, I'm (cutting back/not drinking) now (to get healthier/to take care of myself/because my doctor said to). I'd really appreciate it if you'd help me out.

You can also try the "broken record" strategy. Each time the person makes a statement, you can simply repeat the same short, clear response. You might want to acknowledge some part of the person's points ("I hear you...") and then go back to your broken-record reply ("...but no, thanks"). And if words fail, you can walk away.

Script and practice your "no"

Many people are surprised at how hard it can be to say no the first few times. You can build confidence by scripting and practicing your lines. First imagine the situation and the person who's offering the drink. Then write both what the person will say and how you'll respond, whether it's a broken record strategy (mentioned above) or your own unique approach. Rehearse it aloud to get comfortable with your phrasing and delivery. Also, consider asking a supportive person to role-play with you, someone who would offer realistic pressure to drink and honest feedback about your responses. Whether you practice through made-up or real-world experiences, you'll learn as you go. Keep at it, and your skills will grow over time.

Try other strategies

In addition to being prepared with your "no thanks," consider these strategies:

• Have non-alcoholic drinks always in hand if you're quitting
• Keep track of every drink if you're cutting back so you stay within your limits
• Ask for support from others to cope with temptation
• Plan an escape if the temptation gets too great
• Ask others to refrain from pressuring you or drinking in your presence (this can be hard)

If you have successfully refused drink offers before, then recall what worked and build on it.

Remember, it's your choice

How you think about any decision to change can affect your success. Many people who decide to cut back or quit drinking think, "I am not allowed to drink," as if an external authority were imposing rules on them. Thoughts like this can breed resentment and make it easier to give in. It's important to challenge this kind of thinking by telling yourself that you are in charge, that you know how you want your life to be, and that you have decided to make a change.

Similarly, you may worry about how others will react or view you if you make a change. Again, challenge these thoughts by remembering that it's your life and your choice, and that your decision should be respected.

Nine practical tips

1. Get right back on track. Stop drinking—the sooner the better.
2. Remember, each day is a new day to start over. Although it can be unsettling to slip, you don't have to continue drinking. You are responsible for your choices.
3. Understand that setbacks are common when people undertake a major change. It's your progress in the long run that counts.
4. Don't run yourself down. It doesn't help. Don't let feelings of discouragement, anger, or guilt stop you from asking for help and getting back on track.
5. Get some help. Contact your healthcare provider or a sober and supportive friend right away to talk about what happened, or go to a mutual-help meeting, such as Alcoholics Anonymous (AA) or Secular AA.
6. Think it through. With a little distance, work on your own or with support to better understand why the episode happened at that particular time and place.
7. Learn from what happened. Decide what you need to do so that it won't happen again, and write it down. Use the experience to strengthen your commitment.
8. Avoid triggers to drink. Get rid of any alcohol at home. If possible, avoid revisiting the situation in which you drank.
9. Find alternatives. Keep busy with things that are not associated with drinking.

Change can be hard, so it helps to have concrete reminders of why and how you've decided to do it. Some standard options include carrying a change plan in your wallet or posting sticky notes at home. If you have a computer, smartphone, or other mobile device, consider these ideas:

• Fill out a change plan, email it to your personal (non-work) account, store it in a private online folder, and review it weekly.
• Store your goals, reasons, or strategies as notes in your smartphone or other mobile device so you can retrieve them when an urge hits.
• Set up automated phone, smart device, or electronic calendar alerts that deliver reminders at a time of your choosing, such as a few hours before you usually go out.
• Create passwords that are motivating phrases in code, such as 1Day@aTime or 1stThings1st! The act of typing in your password each time you log in reinforces the motivational message.

If you think you might have alcohol use disorder (AUD) and decide to stop drinking completely, don’t go it alone.

Evidence-Based Treatment Approaches
Evidence-based treatment approaches (medications, behavioral therapy, and mutual-support groups) are available to help people stop drinking. One size doesn’t fit all, however. It’s a good idea to do some research to find peer, social, and professional support options that appeal to you, as you are more likely to stick with them. You may find that a treatment strategy that combines evidence-based approaches can be effective for you. Chances are excellent that you’ll pull together an approach that works for you.

Consider seeking help from your faith leader or joining Alcoholics Anonymous (AA) or another mutual-support group. People in recovery who attend groups regularly do better than those who do not. Mutual-support groups can vary widely, so search around for one that’s comfortable. You’ll get more out of it if you become actively involved by having a sponsor and reaching out to other members for assistance.

There are many options for mutual-support groups, with AA being the most common. Meetings either occur in person or online and involve participants sharing their personal histories with drinking and recovery, encouraging progress along “12 steps,” many of which, but not all, have a strong spiritual component. Because group dynamics can vary from meeting to meeting, people often visit several meetings before they find one where they feel comfortable.

Recent advances in treatment for alcohol use disorder (AUD) have provided more choices for patients and healthcare professionals. Evidence-based AUD treatment settings come in many forms and include:

• Outpatient. Regular office, virtual, or telehealth visits for counseling, medication support, or both.
• Intensive outpatient or partial hospitalization. Coordinated outpatient care for complex needs.
• Residential. Low- or high-intensity programs in 24-hour treatment settings.
• Intensive inpatient. Medically directed 24-hour services; may manage withdrawal.

Medications to treat alcohol use disorder. The U.S. Food and Drug Administration has approved three medications for treating alcohol use disorder (AUD): naltrexone, acamprosate, and disulfuram.

Naltrexone and acamprosate can help a person quit drinking by offsetting changes in the brain caused by AUD. Disulfiram works by causing unpleasant reactions when a person drinks while taking this medication. None of these medications is addictive. They can be combined with mutual-support groups or behavioral treatments.

Behavioral treatments. Research has shown that behavioral treatments, including cognitive-behavioral therapy, motivational enhancement, marital and family counseling, or a combination of approaches, can be very effective in treating AUD.

Getting help in itself appears to be more important than the particular approach used, as long as it offers empathy, avoids heavy-handed confrontation, strengthens motivation, and provides concrete ways to change drinking behavior.

Feeling depressed or anxious?

It's common for people with alcohol problems to feel depressed or anxious. Mild symptoms may go away if you cut down or stop drinking. See a doctor or mental health professional if symptoms persist or get worse. If you're having suicidal thoughts, call your healthcare provider or go to the nearest emergency room right away. You can call or text the 988 Suicide & Crisis Lifeline or chat at 988lifeline.org. Effective treatment is available to help you through this difficult time.

One potential challenge when people stop drinking is rebuilding a life without alcohol. It may be important to:

• Educate family and friends
• Develop new interests and social groups
• Find rewarding ways to spend your time that don’t involve alcohol
• Ask for help from others

When asking for support from friends or significant others, be specific. This could include:

• Not offering you alcohol
• Not using alcohol around you
• Giving words of support and withholding criticism
• Not asking you to take on new demands right now
• Going to a group like Al-Anon