At least two perspectives can be address when discussion the signs of alcoholism, also known as Alcohol Use Disorder (AUD).   According to the National Institute on Alcohol Abuse & Alcoholism (NIHAA), AUD is a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.  We can look at symptoms and signs as a third person, observing a loved one or associate.  Or perhaps it is you, contemplating your own addiction and wondering what you should be considering.  For ease and brevity, ideas for both are broken into categories related to the Bio-Psycho-Social model of recovery.

This list is far from exclusive and fully comprehensive but will serve as a guide to begin your processing:

Biological Signs of Alcoholism

Let’s break biological (physical) symptoms into a few main areas:

  • A hallmark of addiction is increased tolerance.    Tolerance occurs when the person no longer responds to the drug in the way that person initially responded.  Stated another way, it takes a higher dose of the drug to achieve the same level of response achieved initially.  This also begins the foundation for insanity when it seems an affected person can not achieve the same results once created by the alcohol.  That never-ending craving of the original satisfaction is illusive and virtually nonexistent.
  • Withdraw symptoms and Delirium Tremens. Besides the normal hangover symptoms, alcoholism and problem drinking present a special consideration.  Rarely would a non-alcoholic experience Delirium Tremens (DTs).  DTs are caused by sudden alcohol withdrawal.  Symptoms include sweating, extreme shaking or tremors, anxiety, insomnia, possible seizures and rapid heart rate.  Unfortunately, a regular and simple solution to these symptoms is immediate introduction of more alcohol into the system.
  • Severe drinking will also lead to more severe damage to vital organs and result in several symptoms, many related and compounded with each affected organ. Liver issues can manifest as fluid buildup in the legs and abdomen, yellow skin, red palms, easy bruising, difficulty thinking.  Ulcers and vomiting blood may be an example of stomach issues.  Urinating blood may be an example of kidney failure.  Shortness of breath, fatigue, decreased alertness and irregular heartbeat signal issues with the heart.  And severe cognitive malfunctions, such as Wernicke-Korsakoff Syndrome (wet brain), can signal issues with the brain.  Again, every vital organ in the body s affected by alcohol and alcoholism.
  • Lack of personal hygiene. The progression of alcoholism will have a noticeable impact on personal hygiene.  An affected person will care less about basic needs and overall upkeep.  With more time dedicated to drinking and the time needed to recover, simple tasks such as laundering clothing, shaving and even showering will be sacrificed.

Sociological Signs of Alcoholism

  • Inability to control/stop drinking. A true test for an alcoholic (often a self-imposed attempt to moderate their life) is when an affected person bargains with themselves to be a “normal drinker”.  An attempt to go out on a Friday evening and “just have two” drinks turns into a blackout evening that the person can not remember.  Perhaps their desire to go to the holiday party and not end up dancing on the tables turns into exactly that; another embarrassing event when they were certain all could be controlled.
  • Maladaptive connections. In Pavlov’s famous experiment, through social conditioning, the scientist taught dogs to connect the satisfaction of their feeding time to the ringing of a bell.  An alcoholic will learn to build similar connections to drinking that an otherwise “normal” person would not.  For example, a normal person may like to golf; but an alcoholic likes to golf while they drink.  Another person may enjoy cooking; but an alcoholic likes to cook while they drink.  In a very maladaptive way, an alcoholic will condition themselves to only have enjoyment from a normally benign activity IF there is alcohol linked to the activity.  Without alcohol, the activity just does not produce the same enjoyment.
  • Shift in priorities. Similar to developing maladaptive connections to drinking, an alcoholic may also shift priorities for certain activities that used to be enjoyable or required in their life.  This could mean anything from eliminating the daily gym routine to avoiding pro social friends for coffee and connection.  On a more severe side, this could also mean missing work obligations and even family celebrations, birthdays or graduations.  A shift from positive, loving connections to isolation or associations to other alcoholics can easily be noticed over time.

Psychological & Emotional Signs of Alcoholism

As alcoholics progress through their disease, emotions become amplified, unpredictable and potentially antisocial.  Negative emotions that were already present, such as anger, resentment, guilt or sadness intensify and become even more self-fulfilling.  Mental health issues such as depression, anxiety, bipolar or schizophrenia may present as an affected person uses alcohol more and more to suppress emotions.  But to dive into the development of the craving response will show a powerful psychological sign of alcoholism that can not be denied:

Illustrating the Development of the Craving Response

In researching the development of craving response, it became evident that alcoholics may be unique in the progression of these stages.  A casual alcohol user would have minimal if not be completely abstinent of these progressive craving responses:

Introductory Phase:

The introductory phase of the craving response appears tame and benign as it may be how most of the general population perceives alcohol.  A long schedule evening with friends finds you at a local bar (the “using site” can be very personal and defined as any location, person or even emotion that triggers this response) having a cocktail and dinner discussing sports or the latest popular television shows.  After a drink or maybe even two, you begin to feel the physiological sensations of the alcohol.  You might even say you feel “buzzed” or “tipsy”.  And this is the extent of your alcohol use for a few more weeks, or until the next holiday or special occasion.  It may look like this:

Enter the Using Site (Bar) > Use Alcohol > Experience the Physiological Effects

Maintenance Phase:

The maintenance phase has a subtle but significant addition to the craving response process.  Even without taking a first drink, some activation for the neuropathways occurs automatically, just by being physically introduced to the “using site”.  This mild craving serves to push the person toward drinking.  Note the addition of physiological effects even before using alcohol:

Enter the Using Site (Bar) > Mild Physiological Effects > Use Alcohol > Experience the Physiological Effects

Disenchantment Phase:

The disenchantment phase is much more developed and as the name implies has an emotional impact on the affected person.  This is certainly an attribute of an alcoholic moving into dependency on the drug.  Note that mild physiological effects can be realized simply by the thought of using and/or the “using site”.  The craving has become a powerful event.   The craving response that occurs when the person is near a trigger (such as a bar) is almost as strong as the reaction to the actual ingestion of the substance itself.  This brings a large amount of cognition into the situation:

Think about Using > Mild Physiological Effects > Enter Using Site > Stronger Physiological Effects > Use Alcohol > Strong Physiological Effects

Disaster Phase:

The disaster phase is the beginning of the insanity of the disease of alcoholism.  Allowing oneself to merely think about drinking is almost the same as actually drinking alcohol.  People who are addicted to this degree and who are attempting to stop drinking, need to be able to practice thought stopping techniques in order to interrupt this process.

Think about Using > Strong Physiological Effects

A non-alcoholic does not progress through these psychological cravings for alcohol.   They have the proverbial light switch to turn off the desire for alcohol and avoid the consequences of the disease.  But an afflicted person with alcoholism progresses through these stages and finds themselves strongly effected at even the thought of alcohol, drinking and/or the very triggers of the event.


If only there were a blood test for addiction, but there is not.  A diabetic can look at A1C counts.  A person with cancer may be able to measure the size of a tumor.  But for all practical purposes, addiction is self-diagnosed.   We can look at all of these potential signs of alcoholism, but an alcoholic must be willing to diagnose and prescribe selfcare in order to begin treatment.  If you are exploring options for treatment, Pinelands has many options depending on your level of care needed.  As painful as it may be to witness, our hope is that this list revealed some insight to helping know yourself or a loved one better.