Should your own or someone else’s drinking be considered “alcoholism”? Often, this arises because of a feeling that you or someone else should cut back, a negative comment or event. Safe consumption is influenced by personal factors of biology, personal history, and general functioning. A rule of thumb is that no more than two drinks daily for men and one for women reduces the potential harms of alcohol use.
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How Many Drinks a Week Is Considered an Alcoholic?
Alcohol is ubiquitous in society and is associated with everything from relaxation to business to celebrations. It is heavily marketed and advertised despite the connection to negative personal and societal outcomes from abuse. Teasing out the differences between moderate and problematic use of alcohol is partly about the quantity of alcohol consumed but also about the pattern of use. In general, alcohol consumed in a way that places a high burden on the body to metabolize it, reduces decision-making capability, and the safety of the drinker could be considered abuse. The inability to control the amount or timing of alcohol consumption is what defines alcoholism.
The National Institute on Alcohol Use and Alcohol Addiction defines heavy drinking as the consumption of 15 or more drinks per week or five or more drinks on one occasion for men and 8 or more drinks per week or 4 or more drinks on a single occasion for women.1 Heavy drinking puts an individual at risk for alcoholism (alcohol use disorder).
An alcoholic is an individual who is unable, despite trying, to control when, where, why, and how much they drink. They have developed emotional, physical, and physiological dependence on alcohol. If someone has been drinking a large amount of alcohol for a sustained period of time, they may be unable to stop drinking without medical intervention safely.
Examples of standard drinks include:
Type of drink | Alcohol percentage | Amount (ounces) |
---|---|---|
Beer (regular) | 5% ABV | 12 ounces |
Malt Liquor or Hard Seltzer | 7% ABV | 8-10 ounces |
Wine | 12% ABV | 5 ounces |
Port or Sherry | 17% ABV | 3-4 ounces |
Brandy or Cognac | 40% ABV | 1.5 ounce jigger |
Distilled Spirits | 40% ABV | 1.5 ounce shot |
The Role of Quantity in Defining Alcoholism
The role of quantity in defining alcoholism can be confusing. Some people can safely drink daily as part of an evening ritual without negative consequences, and some can binge drink on a rare occasion without having trouble controlling alcohol use in the future. Other individuals are prone to abuse despite their best intentions. One hallmark of an alcohol use disorder is tolerance to its effects. Another is the use of alcohol negatively affecting someone’s daily life. Embarrassing incidents, poor relationships, or difficulty fulfilling obligations are examples.
Alcohol tolerance may drive an alcohol user to drink more drinks at a sitting or drink them more quickly. Tolerance is a “key motivational construct in allostatic theories of addiction, in which tolerance to the rewarding effects of a drug or tolerance to the relief effects of a drug (self-medication) engage a form of misregulation, whereby subjects “chase” drug seeking to recapture the previous reinforcement but fail because of tolerance, thus driving further tolerance.“2 Tolerance is in part driven by genetic influences on alcohol metabolism and in part by the individual’s history of use.
Alcohol craving and withdrawal symptoms caused by dependence will also affect the quantity of alcohol consumed. It is societally accepted to consume more alcohol than intended in certain settings. However, some people are unable to manage the quantity of alcohol they consume because of emotional or physical discomfort. These are differentiators in defining alcoholism from incidental alcohol overuse.
People Who Should Not Drink
Alcohol use at any level is contra-indicated for some people. The potential health benefits of light to moderate alcohol use are related to research on cardiac disease, rheumatoid arthritis, or diabetes. However, cancer risk is also higher in people who consume alcohol. Recent guidance from the World Health Organization states, “We cannot talk about a so-called safe level of alcohol use. It doesn’t matter how much you drink – the risk to the drinker’s health starts from the first drop of any alcoholic beverage.”3
While safety is debated, “The Alcohol-Related Disease Impact application estimates that each year there are more than 140,000 deaths (approximately 97,000 male deaths and 43,000 female deaths) attributable to excessive alcohol use, making alcohol one of the leading preventable causes of death in the United States, behind tobacco, poor diet and physical inactivity, and illegal drugs.“1 There are defined categories of those who should not drink at all.
People who should not drink include:
- Plan to drive or operate machinery, or participate in activities that require skill, coordination, and alertness
- Take certain over-the-counter or prescription medications
- Have certain medical conditions
- Are recovering from alcohol use disorder or are unable to control the amount that they drink
- Are younger than age 21
- Are pregnant or may become pregnant
- Individuals in recovery from another substance use disorder
- People suffering from suicidal ideation
Help for Alcohol Use
Ria Health: Effective, Evidence-Based Alcohol Treatment 100% Online Quickly change your relationship to alcohol with our at-home program. On average, Ria Health members reduce their BAC levels by 50% in 3 months in the program. Services are covered by many major health plans. Visit Ria Health
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Want to drink less? Sunnyside helps you ease into mindful drinking at your own pace. Think lifestyle change, not a fad diet. Develop new daily routines, so you maintain your new habits for life. Take a 3 Minute Quiz
Signs of Alcohol Abuse
Signs of alcoholism can be hard to spot. Often, the disordered use of alcohol is advanced before the individual or others recognize the issue. People may isolate themselves or hide their drinking. Often, the first sign of a problem is when one member of a family or peer group seems to drink differently than the norm for that group.
A simple screening tool is called the “CAGE-Aid.” The name is an acronym formed from the 4 questions in the assessment. The CAGE-Aid may be used by the person or a healthcare provider.
The four CAGE screening questions are:
- Have you ever felt you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt bad or guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or get over a hangover?
Signs of alcohol abuse include:
- Drinking in large quantities
- Lying about drinking
- Continuing to drink despite negative consequences
- Experiencing frequent hangovers or blackouts
- Missing work or activities due to alcohol consumption
- Experiencing physical symptoms such as nausea or sweating when unable to obtain alcohol
- Being unable to reduce or eliminate alcohol use when desired
- Reducing or changing activities to use alcohol
- Isolating oneself or hiding drinking from others
- Experiencing signs of tolerance
- Headaches or sleep disruptions related to alcohol use or withdrawal
- Reduced appetite or weight loss related to excessive alcohol use
- Using alcohol in unsafe situations
Dangers of Alcoholism
Alcoholism takes a heavy toll on the individual, family, and society. The heart, liver, and pancreas can all be damaged by heavy drinking. Alcohol is a toxin leading to overall inflammation in the body of the user. The user might experience emotional effects, including depression and anxiety.
Alcoholism is a family illness, meaning that family members tend to develop unhealthy patterns of interacting. These patterns may involve secrecy, controlling or manipulative behaviors inside and outside the family unit. Some families may also be affected by bouts of emotional or physical abuse that are exacerbated by alcohol use.
The inhibition-lowering effect of alcohol use can result in risk-taking. Car accidents, and home and work-related injury likelihood, rise with alcohol use. Blackouts and intoxication result in poor coordination and decision-making.
Dangers of alcoholism include:
- Vocational or educational disruption
- Family problems
- Depression
- Cancer: breast, colorectal, esophageal, head and neck
- Liver Disease: fibrosis, cirrhosis
- Cardiomyopathy, arrhythmia, stroke, high blood pressure
- Accident proneness
Blackouts
Alcohol use impairs memory, leading to the inability to recall events that transpired during a bout of heavy drinking. This is common in binge drinking situations where a large amount of alcohol may be consumed rapidly. The memory impairment may be partial or total during the period in question. A person may be unable to recall their conversations or actions during that period.
Dependence
Alcohol dependence occurs when a person is emotionally or physically impaired without the use of alcohol. At this level of consumption, the person is unable to control the amount of alcohol consumed, despite negative consequences and even awareness of the excessiveness of their drinking. The person experiences cravings and will go out of their way to obtain alcohol.
Damage to Relationships
Alcoholism affects families in many negative ways. In some families, the financial costs of impaired drinking are severe and persistent. The family may experience a reduced socio-economic status and be vulnerable to unfavorable social determinants of health. Families may try to compensate for the behavior of the alcoholic, resulting in poor family functioning. The alcoholic may become isolated from others due to impaired trust.
Alcohol Poisoning
Alcohol poisoning can occur in a bout of heavy drinking. Alcohol consumed quickly, in large amounts, can impair breathing, heart rate, body temperature, and gag reflex. Sometimes, this can lead to coma or even death. This is an emergency situation where the affected person may become unconscious, experience seizures, gray skin tone, vomiting, and shallow or irregular breathing. Sometimes alcohol poisoning occurs by accident when a child accidentally drinks alcohol or a household product containing alcohol.
Withdrawal
Alcohol withdrawal symptoms can range from mild to very serious. Symptoms may occur around 6-12 hours after the last drink. Daily binge drinkers may experience severe symptoms after 24 hours. Symptoms may include visual, auditory, or tactile hallucinations. Extreme cases of withdrawal may require medical detox. Delirium Tremens is a severe condition that is marked by the onset of sudden and intense psychological and neurological symptoms during withdrawal that can be fatal. Chronic, heavy drinkers are at the highest risk for medically complicated withdrawal.
Car Accidents
Driving under the influence of alcohol is unsafe and a common cause of serious accidents. When someone is impaired by alcohol, they have difficulty focusing, impaired reaction times, and physical coordination due to alcohol’s effects on the central nervous system. A Blood Alcohol level of .08 g/DL raises the likelihood of an accident exponentially.
Injury or Death
The loss of inhibition, coordination, and reduced decision-making ability makes the likelihood of injuries or accidental death higher when alcohol use is involved. Falls, drowning, physical altercations, and other accident incidences rise where intoxication is a factor. A significant proportion of Emergency Room utilization around the world is due to the impact of intoxication on injuries requiring medical intervention.
Treatment Options For Alcohol Abuse
Treatment for alcohol abuse depends upon the severity of the alcohol dependence and any co-occurring conditions that the person may have. ASAM criteria are used to determine the appropriate level of care.4 Best practices in care for addictions involve a holistic approach due to the difficulties inherent in staying sober under stress or when in certain contexts or with certain people. Often, approaches are staged with more intensive approaches in the initial stages of recovery and less intensive approaches as the person develops greater coping skills.
Want to drink less? – Sunnyside helps you ease into mindful drinking at your own pace. Think lifestyle change, not a fad diet. Develop new daily routines, so you maintain your new habits for life. Take a 3 Minute Quiz.
Some treatment options for alcohol abuse include:
- Cognitive Behavior Therapy (CBT): CBT for substance abuse involves learning to manage the thoughts, feelings, and behaviors a person experiences that lead them to use alcohol. Developing recovery-oriented self-talk leads to successful abstention from alcohol.
- Motivational Interviewing: Motivational Interviewing is a technique that leverages a person’s internal interest in making changes or becoming sober to help them choose and invest in their goals and interventions.
- Family Therapy: Family therapy treats the internal family dynamics that underlie and maintain addictive behaviors. Family members gain coping and communication skills.
- 12-Step Programs: AA and Al-Anon are peer support programs to support the person suffering from alcoholism and the family members of that person. They are free and available online and in person.
- Medication Assisted Treatment: Medications can be used to support recovery and to treat any underlying mental health conditions. These are best prescribed in addition to other interventions.
- IOP or PHP: Intensive Outpatient or Partial Hospitalizations are intensive approaches to substance use disorder that are indicated when the person has moderate to severe concern with alcohol.
- In-Patient Residential: Residential treatment is the most intensive approach and will include a variety of treatment approaches. Individual, group, and family approaches, as well as medication, are part of this level of care.
When to Seek Professional Help
When you have had unsuccessful attempts to reduce or stop drinking alcohol, repeatedly find yourself in unsafe situations, making excuses to consume alcohol, or lying to explain why you have not taken care of important responsibilities, it may be time to seek treatment.
An online therapist directory or online therapy platform may help you find a therapist who specializes in alcohol use; however, if you have severe withdrawal or cravings, you may require a higher level of care. Consider seeing a psychiatrist if you have cravings, withdrawal, co-occurring mental health disorders, or have been unsuccessful with outpatient therapy alone. Online psychiatrist options can be a good choice for finding alcohol use medication management, especially for maintenance after IOP, PHP, or Residential treatment.
In My Experience
Additional Resources
To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below.
Alcohol Treatment – Cut Back or Quit Entirely
Ria Health – Quickly change your relationship to alcohol with our at-home program. On average, members reduce their BAC levels by 50% in 3 months in the program. Services are covered by many major health plans. Visit Ria Health
Drinking Moderation
Sunnyside – Want to drink less? Sunnyside helps you ease into mindful drinking at your own pace. Think lifestyle change, not a fad diet. Develop new daily routines, so you maintain your new habits for life. Take a 3 Minute Quiz
Detox or Rehab Center Covered by Insurance
Recovery.com – Find the best local detox or rehab center covered by your insurance. Search our unbiased and thorough list of the best mental health and addiction treatment centers. Read reviews. Start Your Search
Treatment for Mental Health Conditions That Coexist With SUD
Talkiatry – Get help from a doctor who can treat the mental health conditions that commonly lead to or coexist with substance use disorders. Take our online assessment and have your first appointment in days. Take Assessment
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Best Online Medication-Assisted Treatment Programs
Online medication-assisted treatment programs are fairly new to the telehealth industry, but existing companies are expanding quickly with new programs emerging every day. It’s important to explore your options and understand the level of virtual care available so you can choose the best addiction treatment program for you.
Best Mindful Drinking Apps
If you’re thinking about joining the sober curious movement and you’d like to cut back on drinking, mindful drinking apps are a great place to start. Practicing mindful drinking can take some time, attention, and patience, but with the help of the right app, you can completely transform your relationship with alcohol.