What is the Definition of a Drinking Problem?
According to US data, approximately 70% of adults (18+) consumed alcohol in the past year. Alcohol is frequently a part of social settings and many people are able to use it safely and within moderation. However, recent population data show over 14 million adults (18 and older) in the U.S. meet criteria for alcohol use disorder, and only 8% of them receive some form of treatment (see here for data on other countries). As a Clinical Psychologist and researcher who specializes in alcohol and substance abuse treatment and prevention, I am frequently asked what a drinking problem is exactly. Some individuals may question their drinking when it feels harder to manage or starts to negatively impact their lives. Other individuals may be concerned about the drinking patterns of someone they care about, but wonder if they are overreacting. What are the indicators someone has a drinking problem and what steps can they take?
What is an alcoholic?
To start, “alcoholic” is not a diagnostic term. It is a label used in society that encompasses a broad view of drinking issues. If you asked 5 people what an “alcoholic” is, you may very well get 5 different definitions. Therefore, I avoid using that label. The truth is, there is a vast range in severity when it comes to a drinking problem. In this post, I discuss indicators of an Alcohol Use Disorder and why it may look different across individuals who struggle with their alcohol use. Alcohol use disorder can develop all across the lifespan. We often think of alcohol use disorders as long standing patterns that develop over time, however studies show that nearly 17% of young adults (ages 19-21) in the US meet criteria for problematic alcohol use.
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), individuals meet criteria for alcohol use disorder when they have significant impairment or distress related to their alcohol use as demonstrated by at least 2 of the following 11 symptoms within one year (I will paraphrase for ease of reading):
Consumed more alcohol or drank for a longer duration than one intended.
Tried to cut down or control drinking but was unsuccessful.
Spent a lot of time obtaining alcohol, drinking, and recovering from the effects of alcohol use.
Experienced strong cravings or urges to drink.
Use of alcohol resulted in inability to fulfill responsibilities at work, home, or school.
Continued to drink even when it caused social or interpersonal problems.
Gave up important social, work, and pleasurable activities because of alcohol use.
Drank in situations in which it was physically hazardous (e.g., driving, operating machinery, risky physical activity, etc.).
Continued drinking despite having physical or psychological problems that were caused by or made worse by alcohol use.
Experienced tolerance to alcohol, that is, needing more alcohol to experience the desired effect or feel intoxicated.
Experienced physical withdrawal symptoms (e.g., shaking hands, sweating, nausea/vomiting, insomnia, etc.) when alcohol use is discontinued for a period of several hours to 3 days.
Based on these symptoms, an alcohol problem may look different depending on the symptoms someone is experiencing. As you can see, symptoms can range dramatically in severity and number. Some symptoms may be cause for concern and require a check-in about making changes (e.g., neglecting responsibilities, drinking more than you used to), while others are quite serious and can be life threatening (e.g., drinking despite hazards, medical conditions made worse by alcohol, alcohol withdrawal). Someone who endorses 2 items compared to 8 items will have different needs in terms of treatment and their need may be more obvious. However, catching and addressing drinking problems early, before they increase in severity, is extremely beneficial for long term outcomes.
It’s also possible to have concerns about drinking even if you don’t experience the symptoms listed. Perhaps you simply aren’t comfortable with your current drinking patterns and feel you want to make a change.
TIPS for doing an alcohol check-up:
Make an honest assessment of your drinking patterns. Is your drinking where you want it to be? Do you have concerns or simply feel you want to make a change in your drinking? It’s not uncommon to fall into patterns of drinking over time and suddenly realize you aren’t comfortable with them. Sometimes alcohol can interfere with our physical health (e.g., weight gain, diminish performance) or become more of a focus in our lives than might feel comfortable. If so, what do you envision as a more balanced way to incorporate (or not incorporate) alcohol into your life. The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screening measure to identify problematic drinking patterns. If you would like to do a self check in, you can take the AUDIT here.
Acknowledge others’ concerns. Have friends or loved ones expressed concerns about your drinking or has drinking interfered with important relationships in your life? If so, this is an important indicator your drinking may need some attention. It can be easy to dismiss concerns, however it usually isn’t easy for others to express concern, therefore it’s important to take it seriously. Alternatively, perhaps you are concerned about the drinking behavior of someone important to you. Expressing your concern (in a supportive manner) about their drinking can be a step in prompting change.
Avoid using alcohol to deal with distress. Drinking to cope with a variety of emotional stressors can be a risk factor for developing problematic drinking patterns. While alcohol can provide numbing effects, it is also a depressant and often can make us feel worse in the long term. Consider alternative methods of coping with difficulties such as exercise, talking to a friend/loved one, or engaging in other soothing activities (e.g., meditation, taking a bath, etc.).
Seek support. This may come in the form of talking to friends/loved ones, meeting with a professional, or joining a support group. If you feel you want to cut back your alcohol consumption it is helpful to let others know your intention. It can also be useful to get a formal evaluation and develop some specific goals for change.
Take a temporary break from alcohol. Sometimes taking a break from alcohol can provide a reset and allow you to assess your limits and the role you want alcohol to play in your life. What might it be like to not drink? How might it impact different areas of your life?
Seek medical care or a medical evaluation if there is ANY indication of physical dependency. When individuals report any type of withdrawal symptom, continued use even when they have tried to stop, continued use when they have a serious medical or mental health issue, or they consume a significant amount of alcohol daily, it is imperative to seek medical care. Alcohol withdrawal is very serious and trying to stop “cold turkey” without professional support can be very dangerous. Severe alcohol withdrawal can produce serious symptoms including seizures and even death. There are medical protocols in place to allow individuals to detox from alcohol safely. It is important to note that additional treatment and/or support (e.g., a support group) is recommended to address ongoing recovery.
Alcohol use disorder is a pervasive issue across many countries and cultures. It impacts the person struggling with the disorder as well as those around them, and society as a whole. Recognizing and addressing the warning signs early may reduce suffering and improve outcomes and overall well-being.