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Definition of an Alcoholic
If you're unsure whether you have a drinking problem or not, you're not alone.
Anyone who worries about their alcohol consumption probably has unhealthy drinking habits. However, problem drinking alone does not make you an alcoholic.
Alcohol use disorders (AUD) can affect anyone.
You can develop alcoholism regardless of your age, gender, body size, and background. But some people are more predisposed to it than others.
There are also differences between what classifies as a drink and how much alcohol you can consume within 'safe' and moderate drinking levels.
Unfortunately, most people never learn how to identify dangerous levels of alcohol use.
Here are some helpful ways to determine if you're an alcoholic or just someone who has a drinking problem.
DSM-5 Definition of Alcohol Use Disorder
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists down 11 criteria for alcohol use disorder.1 These are behavioral changes and warning signs that suggest the presence of an alcohol problem.
Health professionals use the DSM-5 to diagnose mental health conditions. This includes substance abuse disorders such as alcoholism and drug addiction. It's one of the best ways to determine if you have a drinking problem.
You must meet at least two (2) of the following criteria in the last 12 months to be diagnosed with AUD:
- Spending a significant amount of time obtaining, using, and recovering from alcohol use
- Being unable to reduce alcohol use despite having the desire to do so
- Experiencing cravings or the strong desire to consume alcoholic drinks
- Needing to consume alcohol more frequently or in larger amounts to reach its desired effects
- Developing alcohol withdrawal symptoms when you stop drinking
- Drinking more alcohol or drinking for longer periods than intended
- Giving up recreational, social, or occupational activities you enjoy in favor of alcohol
- Being unable to meet obligations at work, home, or school due to alcohol use
- Continuing to abuse alcohol despite its adverse effects on your relationships and social life
- Drinking alcohol in physically dangerous situations, like driving or operating heavy machinery
- Continuing to drink alcohol despite its consequences on your physical and mental health
Classifications of Alcohol Use Disorder
The DSM-5 removes the distinction between alcohol abuse and alcohol dependence. Instead, it classifies alcohol use disorders into the following three categories based on severity:2
- Mild alcohol use disorder: 2 to 3 symptoms are present
- Moderate alcohol use disorder: 4 to 5 symptoms are present
- Severe: 6 or more symptoms are present
If you have no more than one (1) symptom, you only have a drinking problem — not alcoholism.
How Much Alcohol is Too Much?
Alcohol affects each person differently. Factors that influence your reaction to alcohol include:
- The number of drinks you consume
- How fast you drink alcohol
- If you ate just before drinking
- Which food and drinks you had with alcohol
- Genetics (e.g., having alcoholic parents)
- Gender, body size, and hormonal levels
- If you were ill or in a bad mood while drinking
- Amount of sleep you had before drinking
- If you are taking other medications
- The health of your liver
Since many factors affect how your body digests alcohol, it may seem difficult to define what "too much alcohol" is for everybody.
What is a "Standard Drink?"
A standard drink is any alcoholic beverage that contains around 14 grams of pure alcohol. This equals 0.6 fluid ounces or 1.2 tablespoons of alcohol.
Alcoholic drinks have different serving sizes. Each of them contains different amounts of alcohol.
A larger serving size does not equate to more alcohol.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), "one standard drink" in the U.S. could mean any of the following:3
|Alcoholic Drink||Serving Amount||Alcohol Content|
|Regular beer||12 ounces||5%|
|Light beer||12 ounces||4.2%|
|Malt liquor||8-9 ounces||7%|
|Distilled spirits||1.5 ounces||40%|
Several health institutions provide recommendations on alcohol consumption.
You can use the guide above to determine how much alcohol you can drink based on the type of beverage.
The Dietary Guidelines for Americans recommend drinking moderately or not drinking at all.
Moderate drinking is defined as a maximum of 1 drink per day in women or 2 drinks per day in men.4
For people who regularly drink alcohol, the NIAAA recommends low-risk drinking. This limits your alcohol consumption to:
- No more than 3 drinks a day or 7 drinks per week for women
- No more than 4 drinks a day or 14 drinks per week for men
Studies show that only 2 in every 100 people who practice low-risk drinking develop alcoholism.5
0-0-1-3 Guidelines for Responsible Drinking
The Warren Airforce Base created the 0-0-1-3 program to prevent alcohol abuse among military personnel.6 However, anyone can use them as a guide for responsible drinking.
The 0-0-1-3 recommends limiting your alcohol consumption to:
- 0: Zero drinks for people below 21 years
- 0: Zero driving under the influence (DUI)
- 1: One drink per hour
- 3: No more than 3 drinks per event
Excessive Drinking & Binge Drinking Definitions
Binge drinking is the most common form of excessive drinking.
The NIAAA defines it as a pattern of drinking that raises your blood alcohol concentration (BAC) levels to 0.08% in a short amount of time.5
In most U.S. states, a person with a BAC of 0.08% is intoxicated. To reach this level of alcohol intoxication, it usually takes drinking 4 or more drinks (if you are a woman) and 5 or more drinks (if you are a man) within two hours.5
Heavy drinking is when you binge drink for 5 or more days in a month. This is based on the definition of Substance Abuse and Mental Health Services Administration (SAMHSA).7
NIAAA defines heavy drinking as the consumption of 4 or more drinks a day or at least 15 drinks per week in men, or 3 or more drinks a day or at least 8 drinks per week in women.5
Unhealthy drinking patterns such as heavy drinking and binge drinking may be signs of alcoholism.
People who start drinking in their mid-teen years are at higher risk for alcoholism. However, most individuals who develop alcohol-related problems do so in their late 30s.
Who Should Not Drink Alcohol?
Moderate and low-risk drinking is safe for most people.
However, drinking is not recommended for:
- People under 15 years of age: Teenagers who drink at an early age were 5 times more likely to develop alcoholism than people who waited until they were 21 before they started drinking. Underage drinking also increases the risk for injury, sexual assault, alcohol overdose, and death.1,7
- People with a family history of alcoholism: Alcoholic parents can increase your risk for alcoholism.1
- Pregnant and breastfeeding women: Drinking increases the risk of miscarriage and fetal alcohol syndrome in pregnant women and their children.7
- People with medical conditions: Alcohol can worsen a number of pre-existing health issues. These include liver disease, diabetes, and kidney problems.
- People with trauma or mental health disorders: Drinking alcohol can trigger or worsen depression, anxiety, and other mental issues. Likewise, drinking while you have problems with mental health increases your risk for alcoholism.
- People taking over-the-counter and prescription medications: Alcohol interacts with antidepressants, antibiotics, and opioids. It can lessen their effects or increase your risk for drug overdose.
- People who need to be alert and coordinated: Such as when driving, operating machinery, and participating in other activities that require your full attention.
Risk Factors for Excessive Alcohol Use and Alcoholism
Chronic heavy drinking can lead to a wide range of consequences on your physical and mental health. It can affect your safety as well as those around you.
Short-Term Health Risks
Excessive alcohol use has immediate effects on the body. While they do not last long, they can be dangerous and harmful.
The short-term side effects and symptoms of alcohol abuse include:
- Frequent hangovers and memory loss (blackouts)
- Alcohol withdrawal symptoms (e.g., alcohol tremors)
- Physical injury and accidents (e.g., vehicle crashes, falls, drowning, and burns)
- Violence and crime (e.g., homicide, sexual assault, partner violence, and suicide)
- Risky sexual behaviors (e.g., unprotected sex or sex with multiple partners)
- Miscarriage and stillbirth in pregnant women
- Weakened immune system
- Alcohol poisoning and drug overdose
- Decreased mental capacity (e.g., poor school and work performance)
Long-Term Health Risks
With time, excessive drinking can lead to chronic diseases and other serious health issues. Social, financial, and relationship problems may also arise, which can affect a person's wellbeing.
Long-term side effects and symptoms of alcohol abuse include:
- Liver disease (e.g., liver pain and cirrhosis)
- Fetal alcohol spectrum disorders in children exposed to alcohol during pregnancy
- Unintended pregnancy or sexually-transmitted diseases (e.g., HIV)
- Cardiovascular problems (e.g., hypertension, heart disease, and stroke)
- Cancer of the breast, mouth, esophagus, liver, throat, and colon
- Repeating infections due to weak immune system (e.g., pneumonia)
- Mental health disorders (e.g., depression and anxiety)
- Learning and memory issues (e.g., alcoholic dementia)
- Relationship problems (e.g., divorce)
- Social issues (e.g., unemployment and homelessness)
Treatment Options for Alcohol Abuse & Addiction
Here are some of the best treatments for AUD:
Inpatient treatment is the most intensive and effective option for alcohol addiction treatment. These programs usually last 30, 60, or 90 days. They may be longer in some cases.
Throughout an inpatient program, you'll live on-site in a safe, substance-free environment. You'll go through medically supervised detox first, then behavioral therapy. Other services may be added to your regimen.
Many of these treatment programs assist you with an aftercare program afterward.
PHPs are the second most intensive alcohol addiction programs. They're sometimes called intensive outpatient programs (IOPs). PHPs provide comparable services to inpatient programs.
These services may include:
- Medical services
- Behavioral therapy
- Support groups
- Other holistic or custom treatments
The main difference between PHPs and inpatient programs is that you return home and sleep at your house during a partial hospitalization program.
Some PHPs provide food and transportation. This varies by program.
PHPs are ideal for new patients and those who have completed an inpatient program and still require intensive treatment.
Outpatient programs are less intensive than inpatient programs and PHPs. They're best for people who are highly motivated to achieve sobriety. Patients usually have responsibilities at work, home, or school.
These programs customize your treatment sessions around your schedule.
Outpatient programs may be part of aftercare once a patient completes an inpatient program or PHP.
Certain people qualify for medication-assisted therapy. Some medications can assist you throughout detox and withdrawal. Others can reduce cravings and normalize your bodily functions.
The most common medications used to treat AUD are:
- Disulfiram (Antabuse)
- Acamprosate (Campral)
- Naltrexone (Revia and Vivitrol)
MAT can help prevent relapse and increase your chance of recovery if combined with other therapies.
Support groups are peer-led organizations made of people dedicated to helping each other stay sober. They can be the first step towards sobriety or part of an aftercare plan.
Many of these programs follow the 12-step approach.