How to Tell if Your Drinking is a Problem

If you're worried that you or someone you love may have a problem with alcohol, it's important to be aware of the warning signs.

Alcohol use disorder (AUD) is a serious condition that can have significant negative impacts on physical and mental health, relationships, and overall quality of life. It’s a pattern of use that interferes with your life.

Alcohol Use Disorder (AUD) Warning Signs

Doctors and psychologists use specific criteria to diagnose AUD. If you experience two or more of the following within a year, it could indicate a problem.

Here are the common signs that may indicate a drinking problem:

• Drinking more or for longer: If you find that you regularly drink more alcohol than you set out to or spend more time drinking than you intended, it could be a red flag.
• Difficulty cutting back or stopping: Have you tried to reduce your alcohol intake or quit drinking altogether but found you were unable to do so? This is a common sign of AUD.
• Alcohol cravings: Experiencing a strong urge or need to drink can indicate your body has developed an alcohol dependence.
• Neglecting responsibilities: If drinking is causing you to miss work, fall behind on tasks at home, or fail to meet other obligations, it may be a problem.
• Relationship issues: Alcohol misuse can lead to arguments with loved ones, damage friendships, and cause problems in romantic relationships.
• Dangerous behaviors: Engaging in risky activities like driving under the influence, having unprotected sex, or getting into physical altercations while drinking are major red flags.
• Tolerance: Over time, you may find that you need to drink more and more alcohol to achieve the desired effects. This increased tolerance is a sign of AUD.
• Withdrawal: Experiencing symptoms like anxiety, irritability, tremors, or insomnia when you stop drinking can indicate physical dependence.
• Isolation: Drinking alone, hiding alcohol use from others, or withdrawing from friends and family to drink are concerning behaviors that often accompany AUD.
• Health problems: Heavy drinking can lead to or worsen many health conditions, including liver disease, heart problems, depression, and certain cancers.

If you recognize these signs in yourself or a loved one, know that help is available. Speaking with a doctor or mental health professional is an important first step.

They can help determine if AUD is present and recommend an appropriate course of treatment, which may include therapy, medication, mutual support groups, or a combination of treatments.

Risk Factors of Alcohol Use Disorder (AUD)

About half of the risk of developing AUD is genetic. Variations in genes that affect how your body reacts to alcohol and influence brain chemistry can play a role. This doesn't mean you're destined to have a problem, but it means your family history might make you more vulnerable.

Exposure to heavy drinking at home while growing up, cultural attitudes towards drinking, stress, and having experienced trauma⁠—all these could make someone more likely to turn to alcohol in a way that becomes unhealthy. 

While genes and environment lay the groundwork, specific events, moods, and choices often interact with those factors to trigger problems. Think of risk factors as building blocks. The more blocks are stacked, the less stable the structure gets, leading to addiction.

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How is Alcohol Use Disorder Diagnosed?

Diagnosing AUD is a critical step in addressing alcohol-related health issues. It involves using standardized screening tools and assessing symptoms based on established diagnostic criteria.

The DSM-5 diagnoses alcohol use disorder (AUD) based on at least two criteria within a year, including craving, inability to cut down, and continued use despite negative consequences. Severity is classified as mild, moderate, or severe.

Here’s how screening can be done:

Alcohol Use Disorders Identification Test (AUDIT)

The AUDIT is a widely recognized screening tool developed by the World Health Organization (WHO) to identify people with unhealthy alcohol use, which includes risky or hazardous consumption and any alcohol use disorder.

It is designed for use by healthcare practitioners in various settings and can also be self-administered with proper instructions.

The AUDIT consists of 10 questions that cover aspects such as:

• The quantity and frequency of alcohol use
• Symptoms of dependence
• Alcohol-related consequences

It is available in both interview and self-report versions and includes illustrations and measures of standard drinks to aid in assessment.

CAGE Questionnaire

The CAGE questionnaire is a shorter screening tool that is best done face-to-face.

It focuses on four key questions related to attempts to cut down on drinking, annoyance by criticism of drinking, feelings of guilt about drinking, and the need for a morning drink (eye-opener).

However, it is less reliable when given after questions on frequency and is not useful for diagnosing hazardous drinking.

Other Screening Tools

The US Preventive Services Task Force (USPSTF) recommends screening all adults for alcohol misuse. They provide various tools for this purpose, including the abbreviated AUDIT-Consumption (AUDIT-C) and single-question screening.

The AUDIT-C is a shorter version of the AUDIT that assesses the frequency and quantity of alcohol consumption.

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What are the Treatment Options for AUD?

The treatment plan for AUD may include medical interventions, behavioral therapies, and support groups, each playing a unique role in the recovery journey. Let’s take a look at them:

Medical Treatments for AUD

There are three primary medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of AUD:

• Disulfiram (Antabuse): This medication acts as a deterrent to drinking by causing unpleasant symptoms like nausea and skin flushing when alcohol is consumed.
• Naltrexone: It works by blocking the brain receptors that produce the pleasurable effects of alcohol, reducing cravings and helping to maintain abstinence.
• Acamprosate (Campral): This medication helps stabilize the brain chemistry that is disrupted by alcohol dependence, reducing cravings, particularly after an individual has stopped drinking.

Behavioral Therapies for AUD

Behavioral treatments are designed to change drinking behavior through counseling and can be delivered in various formats:

• Cognitive-behavioral therapy (CBT): This approach focuses on altering thought patterns to change behavior, teaching clients to foster healthy thought and behavior patterns that are not reliant on alcohol.
• Motivational Enhancement Therapy: A short-term therapy that builds motivation to change drinking behavior.
• Marital and family counseling: Involves family members in the treatment process to repair and improve relationships.
• Brief interventions: Time-limited, focused counseling sessions aimed at reducing alcohol misuse.

Support Groups and Mutual Help

Support groups play a crucial role in the recovery process by providing peer support:

• Alcoholics Anonymous (AA): A well-known mutual-support group that encourages progress along 12 steps with a strong spiritual component.
• LifeRing, Secular Organizations for Sobriety, and SMART Recovery: These are secular alternatives to AA that offer various approaches to support abstinence and sobriety.
• Women for Sobriety: A program designed specifically for women, focusing on emotional and spiritual growth.

Prevention and Education Initiatives

AUD is a public health issue. Here's a breakdown of how prevention efforts work on several levels to address the problem:

Policy Changes

Several policy changes can influence alcohol consumption.

Studies have shown a direct link between affordability and drinking levels, with cheaper alcohol leading to increased consumption, especially among young people. To address this, raising alcohol taxes, even by a small amount, can be an effective deterrent.

Additionally, restricting the availability of alcohol through measures like limited sales locations and hours can make it less convenient to obtain, especially for underage drinkers.

Finally, regulating alcohol advertising through stricter rules on where and how it can be displayed can help reduce its overall appeal, particularly for young audiences more susceptible to marketing influences.

Community Support

Supporting partnerships between schools, businesses, law enforcement, and health services creates a unified front against unhealthy drinking.

Events like Alcohol Awareness Month raise public awareness, not just of the risks but also the solutions and where to get help.

School Programs

Just saying "don't drink" doesn't work. Effective school programs engage students in discussions and skill-building to manage peer pressure and make healthy choices.

Helping parents talk openly with their kids about drinking can reinforce what's taught in school.

Focus on High-Risk Group: Pregnant Women

Pregnant women may not realize the dangers of even small amounts of alcohol. Doctors and nurses asking about drinking habits can open the door to intervention.

Sometimes, women need clear explanations about how alcohol can harm a developing fetus to motivate change.

Alcohol use disorder (AUD) is a serious condition with significant negative consequences, but help is available. It is important to seek help from a doctor or mental health professional if you recognize these signs in yourself or someone you love.

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