How To Know If You Have A Drinking Problem

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KEY TAKEAWAYS

You know you have a drinking problem if you consume:

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What Is Considered A Drinking Problem, According To...

DSM V

The diagnostic and statistical manual of mental disorders (DSM V) defines that out of the 11 criteria for alcoholism:

  • 2-3 indicates mild alcohol use disorder
  • 4-5 indicates moderate alcohol use disorder
  • 6 + indicates severe alcohol use disorder
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The 11 criteria for alcohol use disorder are:

  • Have you drank for longer or consumed more than you intended to?
  • Have you thought about stopping drinking or cutting down on alcohol but been unable to?
  • Have you spent a lot of time drinking, or being sick and getting over the aftereffects of drinking?
  • Have you wanted to drink alcohol so badly that you could not focus on anything else?
  • Have you found that drinking or the after-effects of drinking have made you unable to complete tasks at work or at home?
  • Have you continued to drink alcohol even if it has caused arguments with friends or family members?
  • Have you prioritised drinking alcohol over hobbies and other interests?
  • Have you engaged in drunk driving, operating machinery, or unsafe sex more than once?
  • Have you continued to drink alcohol even if it caused depression, anxiety or memory blackouts?
  • Have you found that you have to drink more to achieve the same effects of alcohol?
  • Have you experienced withdrawal symptoms after drinking alcohol; including nausea, restlessness, sweating or a rapid heart rate? [2]

Alcoholics Anonymous

Alcoholics Anonymous defines a drinking problem as the physical desire to consume alcohol beyond the capacity to control it; as well as the inability not to give in to cravings for alcohol [3].

NIAAA

The NIAAA defines a drinking problem as consuming:

  • more than 5 drinks per day or 15 per week as a man,
  • more than 4 drinks per day or 8 per week as a woman [4].

WHO

WHO states that moderate alcohol consumption is less than:

  • 1.5 litres of wine per week
  • 3.5 litres of beer per week
  • 450ml of spirits per week [5]

Any consumption over these levels is classed as a drinking problem.

CDC

The CDC define alcohol use disorder as:

  • Consuming more than 14 drinks a week for a man,
  • Consuming more than 7 drinks a week for a woman, over the last year [6].

How To Tell If Someone Has A Drinking Problem

Drinking Pattern & Intake Level

Drinking patterns and intake levels that indicate potential alcohol addiction include:

  • Drinking to intoxication - 3 or more days per week
  • Binge drinking - 3 or more days per week [7]

Physical Symptoms

Physical withdrawal symptoms, such as nausea, vomiting, and shakiness occur in all casual drinking patterns, but symptoms that indicate a drinking problem include:

Behavioural & Emotional Symptoms

  • Secrecy or denial about drinking problem - 67% of alcoholics either completely deny or downplay alcohol abuse [8]
  • Impulsivity - drinking problems disrupt neurotransmitter levels that induce and magnify impulsive behaviour [9]
  • Anger - chronic alcoholics are in the 98th percentile for anger [10]
  • Obsessing over the next drink
  • Only attending social events where drinking will occur
  • Being unable to stop drinking before intoxication, illness or memory blackouts occur

Work

A 1-litre increase in alcohol consumption leads to a 13% increase in sickness absences; with absenteeism and poor work performance also being clear indicators of a drinking problem [11].

Financial issues

  • Credit card debt - acquiring new credit cards
  • Borrowing money from payday loans or loan sharks
  • Impulsive spending - gambling, shopping whilst drunk and purchasing unnecessary items

Relationship Issues

  • Arguments - public arguments, not speaking to partner for long periods of time
  • Secrecy - hiding drinking behaviours
  • Shifting the blame - accusing partner of causing drinking

Health Problems

  • Jaundice - 60% of alcoholic hepatitis sufferers [12]
  • Ascites - 30% of alcohol-induced cirrhosis sufferers [13]
  • Sclera discolouration - 38% of alcoholic liver failure sufferers [14]

Trauma/Accidents/Hospitalisation

More than 1 in 10 visits to A&E departments are due to alcohol-related illnesses, including:

  • Road traffic accidents
  • Falls or broken bones
  • Losing driving license due to drink driving [15]

This manifests in the body as more frequent visible bruises or cuts.

The likelihood of a fatal motor vehicle injury increases by 1.74% for every 0.02% increase in blood alcohol concentration [16].

Negative Consequences

30-50% of alcoholics demonstrate:

  • Denial or downplaying alcohol consumption
  • Attributing job loss, losing driving license or lack of money to issues other than alcohol use (cognitive distortion) [17]

Coping Mechanism

Alcohol becomes a habitual coping mechanism when used repeatedly as self-medication for stress, anxiety and depression.

Alcohol use becomes a drinking problem when it stops being one of many coping mechanisms used, and becomes the only way to cope.

Avoiding Responsibility

A problem drinker typically avoids responsibility by:

  • Blaming others for excessive drinking
  • Claiming to have 'bad luck' instead of accepting responsibility for the consequences of drinking
  • Blaming past trauma - childhood trauma, divorce or physical injury
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Legal Trouble

  • Shoplifting alcohol or items to exchange for alcohol
  • Stealing money to pay for alcohol - taking money from parents' wallet or stealing card
  • Drink driving - points or loss of license
  • Assault on others whilst intoxicated - leading to prison time

Family/Friends Concerned

Friends and family members notice:

  • Unstable moods
  • Poor judgement
  • Slurred speech
  • Memory problems
  • Having to take on financial, household or childcare responsibilities [18]

Isolation

Isolation due to a drinking problem is shown by a combination of:

  • Drinking alone
  • Poor self-care
  • Relief when plans are cancelled
  • Not engaging in conversation during social events
  • Eating less food

Although drinking alone can be attributed to being introverted, repeatedly voluntarily isolating indicates alcohol use disorder.

When It Looks Like A Drinking Problem, But Isn't

Drinking Patterns That Are Not Problematic Drinking

Social Drinking

Unlike those with a drinking problem, social drinkers:

  • Drink for enjoyment rather than seeking to avoid withdrawal symptoms
  • Know drinking limits and do not exceed them
  • Do not drink drive

Binge Drinking

Unlike those with a drinking problem, binge drinkers:

  • Drink socially and for enjoyment
  • Only exceed limits on less than 5 days per month [19]
  • Do not drink drive
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Non Drinkers

Social Drinking

Binge Drinking

Chronic Alcoholism

Amount Consumed

0 drinks

1/2 drinks per
day [20]

4/5 drinks in 2
hours [21]

4/5 drinks per
day [22]

Consumption Frequency

Never

Only at social events

At least 1 day
per month [23]

5 or more days
per month [24]

Alcohol Cravings?

No

No

Yes

Yes

Needing Alcohol To Socialise

No

Yes

No

No

Relationship Problems

No

No

Yes

Yes

Liver Issues

No

No

Yes

Yes

Legal Issues

No

No

Yes

Yes

Unusual Changes In Routine

No

No

No

Yes

Overreacting To Questions About Drinking

No

No

No

Yes

Reduced Exercise Or Healthy Diet

No

No

No

Yes

Conditions Mistaken For A Drinking Problem

Dementia

Dementia may be confused with a drinking problem due to:

  • Memory loss
  • Difficulty concentrating
  • Changes in mood
  • Anxiety

Conversely, alcoholism includes these factors, where dementia does not:

  • Withdrawal symptoms - nausea, vomiting and shakiness
  • Inability to stop drinking - unsuccessful detoxes or tapering off alcohol use

Auto-Brewery Syndrome

Auto-brewery syndrome may be confused with a drinking problem due to:

  • Slurred speech
  • Dizziness
  • Loss of motor function

Unlike auto-brewery syndrome, alcoholism shows a sharp increase in alcohol use, as well as prioritising alcohol above all other responsibilities.

Tourette's Syndrome

Tourette's syndrome may be confused with a drinking problem due to:

  • Repeating specific words or phrases
  • Swearing
  • Jerking the head or limbs
  • Grimacing

Unlike Tourette's syndrome, alcoholics do not always outwardly show physical signs of drinking, especially if they are actively trying to avoid detection.

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Multiple Sclerosis

Multiple sclerosis (MS) may be confused with a drinking problem due to:

  • Difficulty pronouncing words - MS affects how the tongue and lips move
  • Difficulty controlling volume - MS causes a weakened diaphragm
  • Not remembering words
  • Not understanding what is being said
  • Muscle spasms

Alcoholics experience full body or hand tremors, rather than muscle spasms seen in MS sufferers.

Self-Tests To Evaluate If You Have A Drinking Problem

CAGE Questionnaire

The CAGE questionnaire asks about:

  • Criticism from others about drinking habits
  • Guilt caused by drinking
  • Drinking in the morning as the cure for a hangover

Answering yes to two or more, out of four questions indicates a 91% sensitivity to alcoholism [25].

AUDIT Questionnaire

The AUDIT questionnaire asks about:

  • Injuries to the person and others as a result of alcohol use
  • Whether others are concerned about drinking levels
  • Feelings of guilt and remorse after drinking

The questionnaire asks 10 questions and defines the scores as:

  • 0-7 meaning low risk of alcoholism
  • 8-5 meaning increasing risk of alcoholism
  • 16-19 meaning higher risk of alcoholism
  • 20 or more meaning possible alcohol dependence [26].

Alcohol Screening Test (AST)

An aspartate aminotransferase screening test [AST] level of 4 times above the normal range [8-33 U/L], indicates liver disease or chronic hepatitis as a result of alcohol abuse [27] [28].

Severity Of Alcohol Dependence Questionnaire

The severity of alcohol dependence questionnaire asks about:

The questionnaire asks the alcoholic to quantify alcohol use as either a quarter, half or full bottle of spirits per day [29].

MAST - Michigan Alcohol Screening Test

The MAST has questions asking:

  • Whether alcohol has caused delirium tremens, shakiness or hallucinations
  • Whether drinking has caused problems with friends and family members, colleagues or the police
  • If others have commented on alcohol use

The MAST has 22 questions with yes or no answers, with scores over 6 indicating problem drinking [30].

Am I An Alcoholic Checklist

Abbeycare's Am I an Alcoholic checklist asks about:

  • Experiencing withdrawal symptoms
  • Whether social life is motivated by drinking
  • Missing obligations due to alcohol use

The checklist has 10 questions, with mostly A's indicating problem drinking, mostly B's indicating some alcohol abuse and mostly C's indicating controlled drinking [31].

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About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health, and is a member of the Burney Society. Content reviewed by Laura Morris (Clinical Lead).

Last Updated: December 27, 2023