Having a drink is a popular part of spending time with friends, enjoying a party, or even unwinding after work. Social drinking is not only common, but it’s also an extremely popular part of socializing among adults, and unless you have religious or personal restrictions, you’ve probably partaken in it at least once in your life.
This can make recognizing when social and casual drinking has taken the step into alcohol abuse a challenge – after all, if everyone is doing it, how can it be harmful?
What is Alcoholism?
Alcoholism is often used as a catchall phrase that encompasses heavy drinking, binge drinking, and alcohol use disorder. However, these are all separate terms, with their own definitions.
According to the National Institutes of Health’s (NIH) National Institute on Alcohol Abuse and Alcoholism (NIAAA):
- Low risk drinkingfor men consists of not more than 14 drinks a week, not exceeding more than 4 drinks a day. For women, low-risk drinking is considered to be not more than 7 drinks in a week, not exceeding more than 3 drinks in a single setting.
- Binge drinkingis defined as a pattern of drinking in which 5 or more drinks are consumed by men or women consume 4 or more drinks over the course of 2 hours. The Substance Abuse and Mental Health Services Administration (SAMSHA) takes this definition further to include having consumed 4 or more drinks (women) or 5 or more drinks (men) during the same occasion at least once during the past month.
- Heavy alcohol usefor men is defined as having four or more drinks on any one day. For women, it is defined as having 3 or more drinks in one day. SAMSHA, on the other hand, defines it as binge drinking 5 or more times in one month.
Alcohol use disorder, on the other hand, is defined by the Mayo Clinic as a pattern of drinking alcohol, which also includes difficulties in controlling your drinking, being preoccupied with thoughts of alcohol, drinking alcohol even when you are aware that it is causing problems, finding that you need to drink more than you once had to in order for it to affect you in the same way, and having withdrawal symptoms when you decide to reduce or stop drinking.
Alcohol use disorder, or alcohol abuse, is the second most common substance abuse disorder in the United States, only ranking behind tobacco addiction. It is estimated that up 10% of all adult men and 5% of all adult women have some form of alcohol use disorder.
Alcoholism is considered a severe form of an alcohol use disorder in which a person has a physical or physiological dependence on alcohol and finds that they cannot function without it.
What Constitutes One Drink?
Alcoholism and alcohol abuse disorder is usually defined in terms of the number of drinks that an individual has over a fixed period of time. However, in order to effectively identify whether or not you are suffering from a problem with alcohol, you need to first understand what is meant by one drink.
According to the NIAAA, one ‘standard’ drink consists of:
- 12 ounces, or 355 ml, of beer (which is usually about 5% alcohol)
- 8-9 ounces, or 237-266 ml, of malt liquor (usually about 7% alcohol)
- 5 ounces, or 148 ml, of wine (usually about 12% alcohol)
- 5 ounces, or 44 ml, of 80-proof hard liquor or distilled spirits (usually about 40% alcohol)
Identifying the Steps to Alcoholism
Alcoholism or alcohol abuse usually starts as moderate drinking. Understanding the steps that lead to severe alcoholism can help individuals identify if they have a problem and allow them to seek help before they develop a dependence on alcohol.
Step 1: Occasional Abuse and Binge Drinking
This stage includes experimentation with alcohol and testing of an individual’s limits and tolerance for the substance. It is particularly common amongst young adults who are drinking alcohol for the first time, but individuals of any age may recognize themselves in this definition.
Individuals in this step are frequent binge drinkers. Even if they do not drink regularly, they might find themselves binge drinking when they do.
While binge drinking does not necessarily mean that a person has an alcohol abuse disorder, it is still dangerous to the drinker’s health. In extreme cases, it can lead to a coma or death. Even in less severe cases, it is the first step to developing full-blown alcohol use disorder.
Step 2: Increased Drinking
In this step, drinking becomes a far more frequent activity. Instead of being part of your life only once in a while, it can increase to a weekly activity.
This step is not the same as regular moderate drinking. A moderate drinker might drink a glass of wine with a meal or consume one or two drinks during a social occasion. An individual who finds themself on this step, on the other hand, will find that they are drinking simply in order to feel good or combat sadness and loneliness.
Step 3: Problem Drinking
Problem drinking specifically refers to drinking to a level where you are feeling the negative impacts of alcohol.
This does not refer to an occasional hangover – instead, it refers to prolonged negative effects. These include feeling more depressed, more anxious, or losing sleep. In this step, even if a person recognizes the negative effects of their drinking habit, they will find that they enjoy the feeling of drinking and being drunk too much to care.
Individuals in this step of the cycle may also find themselves experience legal repercussions due to their drinking, for example, during drinking and driving.
Other effects at this step include social changes, including relationship issues with friends, family, and partners, a reduction in social activity due to erratic behavior patterns, changes in social groups, difficulty talking to people or socializing unless doing so while drinking, among others.
Step 4: Alcohol Dependence
Alcoholism involves both dependence on the substance, as well as an addiction to it. It is possible to have a dependence on alcohol without being fully addicted.
If an individual is dependent on alcohol, their attachment to the substance will have taken over their daily routine. Even if they are aware of the negative effects of being dependent on alcohol, they will find that they can no longer control their consumption of it.
Individuals on this step can find that they have an increased tolerance for alcohol. This means that they find that they need to drink larger quantities of alcohol to feel the same effects or get drunk. The more you drink, the worse the effects are for your body, so this can also be physiologically dangerous.
Dependence essentially means that your body is craving the substance that you are dependent on, in this case, alcohol. When an individual is dependent on alcohol, they will start experiencing withdrawal symptoms as they stop drinking. These symptoms include:
- Racing heart
- Body tremors
- Trouble sleeping
- Jumpiness or shakiness
- Mood swings
The most significant form of alcohol withdrawal leads to an individual experiencing delirium tremens – that is, severe withdrawal symptoms that include extreme confusion, high blood pressure, hallucinations, and liver failure, amongst others. This is a relatively rare condition, and only 3% to 5% of people who experience alcohol withdrawal symptoms also suffer from delirium tremens.
Step 5: Addiction and Alcoholism
This is the final step in the cycle. In this step, the person is suffering from alcoholism and is addicted to alcohol.
Individuals addicted to alcohol no longer simply want to drink for pleasure or to satisfy a physical need for the substance. Instead, they find that they have both a physical and a psychological need to drink.
Individuals addicted to alcohol can also be ‘high-functioning alcoholics.’ These people are able to function well in their normal lives and do not seem to be as impacted by the negative effects of alcohol addiction. They are often able to maintain relationships and may not have had any negative legal repercussions as a result of their drinking.
‘High-functioning’ or ‘functional’ alcoholics can come across as “normal” to other people, even while they are drinking or drunk. It is easy for individuals who fit this description to minimize their alcoholism, as they do not fit the stereotype of an alcoholic. Instead, they may simply consider themselves to be heavy drinkers. This denial can prevent them from seeking help or even acknowledging that they have a problem.
However, regardless of how these individuals appear to the outside world and how their use of alcohol impacts their personal life, they are still suffering from alcoholism in the same way that someone who experiences more immediate or severe issues is.
Signs of Alcoholism
One of the most common questions that people who think that they have a problem with alcohol ask themselves is, ‘Am I an alcoholic?’ While the symptoms will differ from individual to individual, there are some general signs that will point to the fact that you are suffering from alcoholism or alcohol use disorder:
- An inability to moderate your alcohol intake once you start to drink
- A desire to or unsuccessful attempts at cutting down on your alcohol intake
- A realization that you are spending a lot of time drinking, retrieving alcohol, or recovering from drinking alcohol
- An urge or a craving to consume alcohol
- Being unable to fulfill obligations at work, school, or home as a direct result of your alcohol intake
- Using alcohol even when you are aware that it is causing negative effects to your body and social life
- Cutting down on socializing and time spent on hobbies in favor of alcohol
- Consuming alcohol in unsafe or inappropriate situations, such as while driving or at work
- Finding that you need more alcohol in order to experience the same effects, or finding that there is a reduced effect despite consuming the same amount
- Withdrawal symptoms when you don’t drink or start to become sober, and finding that you are drinking in order to avoid these effects
- Binge drinking frequently
- A refusal to acknowledge that you have a dependence on alcohol or minimizing your dependence on it
- Drinking to excess daily
- A craving for alcohol
Individuals who believe that they have a problem may also find themselves looking up options for treatment online. This includes the phrases ‘best long-term residential treatment center for alcoholism in Texas,’ ‘alcohol medical detox program for men near me,’ and ‘90-day inpatient alcohol rehab center for women in Texas.’ For those, we suggest looking into Stonegate Center!
For individuals who seek professional help for alcohol issues, they may find that their healthcare provider is using the current 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in order to diagnose whether or not they have alcohol use disorder.
The DSM-5 is a common tool used by healthcare professionals in order to diagnose a variety of mental illnesses. The diagnostic criterion for alcohol use disorder, according to the DSM-5, involves asking the individual a set of questions.
If your answer to at least 2 of these questions is affirmative, you are considered to be suffering from alcohol use disorder. The presence of 2 or 3 of the symptoms indicates that you have a mild form of the disorder, the presence of 4 or 5 symptoms indicates that you have a moderate form of the disorder, and individuals who have 6 or more symptoms are considered to have a severe form of the disorder.
The questions that you will be asked according to the DSM-5 are:
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 other aftereffects?
- Wanted a drink so badly you couldn’t think of anything else?
- 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?
- 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, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?
This criterion can also help you better determine if you have a problem with alcohol and need to see a professional for help.
Is There a Test to See If You Are an Alcoholic?
Aside from independently applying the DSM-5 criteria to yourself, there are several self-assessment tests and quizzes that you can take in order to determine whether you are an alcoholic and help you better understand your drinking habits.
Some of these include:
- MAST: The Michigan Alcohol Screening Test was first developed in 1971. Despite its age, it is still one of the most accurate alcohol screening tests available and has an accuracy rate of 98% when it comes to identifying dependent drinkers.
- AUDIT: The Alcohol Use Disorders Identification Test was developed by the World Health Organization (WHO) in 1989 and is based on data collected through a multinational WHO study. It is a 10-question, multiple-choice questionnaire that has an effectiveness rate of 92% when it comes to identifying drinking patterns that are hazardous and harmful to an individual.
- CAGE: This is a short series of four questions that are usually asked by medical practitioners in order to determine whether or not a person has alcohol dependency. The questions are simple, yes or no questions, and two or more ‘yes’ answers generally indicates that the individual in question is suffering from alcohol use disorder or is a heavy user of alcohol.
Types of Alcoholics
Identifying whether you or a loved one is suffering from alcoholism or alcohol use disorder can be a challenge, especially when you do not fit the common stereotype of an alcoholic who is homeless or is forced to steal money in order to buy alcohol.
To help identify alcoholism, researchers at NIAAA have identified 5 subtypes of alcoholics. If you feel you or someone you know fits one of these subtypes, you may have an alcohol problem.
- Young Adult: This subtype encompasses 31.5% of all U.S. alcoholics and consists of young adult drinkers. These drinkers are a low risk of comorbidities, usually have a low rate of family history of alcoholism and are the least likely to seek help. Though they drink less often than those in the other subtypes, they are more likely to binge drink when they do drink.
- Young Antisocial: Makes up 21% of all U.S. alcoholics. They are usually in their mid-20s, started drinking early, and frequently have a family history of alcoholism. More than half have also been diagnosed with another mental illness. More than 33% of alcoholics in this subtype seek help.
- Functional: This subtype makes up 19.5% of all U.S. alcoholics. Individuals in this subtype are usually middle-aged, and more than a third come from families with a significant and multigenerational history of alcoholism. More than a quarter have been diagnosed with depression. They are perhaps the furthest removed from the alcoholic stereotype – more than half work full time, and more than a quarter possesses a college degree or higher.
- Intermediate Familial: Making up 19% of all U.S. alcoholics, individuals in this subtype are usually middle-aged, and more than half come from families that have a significant and multigenerational history of alcoholism. Nearly half have been diagnosed with clinical depression, and many have been diagnosed with bipolar disorder. Only about a quarter of people in this subtype seek help.
- Chronic Severe: The rarest subtype, individuals in this subtype, make up 9% of all U.S. alcoholics. Those in this subtype are usually middle-aged and started drinking early. Most come from families with a significant and multigenerational history of alcoholism, and they have the highest rates of suffering from other psychiatric disorders and are most likely to abuse other substances. More than 66% of individuals in this subtype seek help, making them the most likely to seek help for their alcoholism.
Treatment for Alcoholism
If you believe that you or a family member are suffering from alcohol use disorder, there are a variety of treatment programs that you can try. These include:
- Support Groups: These include groups like Alcoholics Anonymous (A.A.) and other programs that work to provide support for people who are quitting alcohol or reducing their intake. It is usually recommended that you use support groups in addition to treatment by a healthcare provider in order to add an extra layer of support during the process.
- Counseling: Psychological counseling and therapy can help individuals better understand their problem with alcohol and can help support recovery from the psychological dependence (and other psychological effects) of alcohol use.
- Medications: There are currently three drugs that have been approved for use in the U.S. in order to help individuals stop or reduce drinking and prevent the likelihood of relapse. These drugs produce a negative physical reaction when you drink alcohol while being treated with them, reduce the urge to drink, and help you combat a craving for alcohol.
- Outpatient rehab: These are part-time treatment programs that allow you to continue going to work or school while being treated for alcoholism. Programs can last between 3 months to 1 year, and this form of rehab is more effective if you have a mild version of alcohol use disorder.
- Inpatient rehab: These are full-time, intensive programs during which the individual under treatment lives at the rehab facility. It offers individuals with alcoholism the benefit of full-time medical and psychological support and can last anywhere between 28 days to six months. This is the preferred treatment for individuals with severe alcohol use disorder and has a higher success rate.
For those who believe that they are suffering from alcoholism or alcohol use disorder, the first step usually involves talking to a primary care physician. They can help provide the necessary referrals for you to get started with your treatment and better help you evaluate whether your drinking patterns are risky and require intervention.
John Eckelbarger is a Business Development Representative for Stonegate Center. With a BSA in Chemistry from the University of Texas at Austin, he has an interest in the neurobiology of addiction as well as the pharmacology of drugs. He hopes to bolster Stonegate Center’s status at the forefront of addiction medicine through bold, innovative content creation. He is currently pursuing his MBA in Finance from Texas Christian University.