Is my drinking normal, or could I be an alcoholic?
The trouble with alcohol is that it’s everywhere. We don’t treat any other drug the way we treat alcohol, marijuana included, and in part that’s because we mostly don’t think of it as a drug. It’s what you down a shot of to loosen up on the dance floor, or to ease your social anxieties at your company’s holiday party. You know it's not good for you, sure, but it's a part of daily life. It’s easy to stop thinking of alcohol like a drug—but it is one. And like any drug, you can become addicted to it without even realizing.
Nearly every group of people in the United States is now drinking more than they did a decade ago. Sure, it’s only 11.2 percent more who are drinking at all, but it’s also 30 percent more who are now high-risk drinkers—the ones who are in peril of becoming dependent. And as for full-on diagnosable alcoholism? That’s up 49.4 percent. This is all from a recent study in JAMA Psychiatry that used a massive long-term survey to see how drinking rates have changed between 2001-02 and 2012-13. Over 36,000 people took part, each of whom were interviewed face-to-face and asked detailed questions about their drinking habits.
Of all the groups, the ones facing the steepest increases in problematic drinking are women, those with low socioeconomic status, older adults, and racial or ethnic minorities. The increases were so severe across the population that the study authors wrote they “constitute a public health crisis.”
It’s easy to look at those statistics and think that the troubling findings only apply to other people. Other people have drinking problems—I’m fine. And maybe you are—but maybe you’re not. Even if you think your habits are controllable, you should know what problematic drinking looks like and whether you’re more at risk for developing an addiction than others.
“Just like people with risk for diabetes should know they may face trouble, people with potential alcohol problems should realize their problems,” says Marc Schuckit, a professor of psychiatry at UC San Diego specializing in alcohol and drug abuse. “It's just that people don't always do self-evaluation like they should.”
More than 50 percent of the risk for alcoholism is heritable, so anyone with a close relative—especially a parent—who has had alcohol abuse issues is much more likely to get into trouble. But genetics aren’t the only risk factor. Depression and other mental health conditions make you more likely to rely on alcohol, as does your social life. Having a close friend or partner who drinks heavily probably makes people liable to over-imbibe as well.
How much is a normal amount of alcohol?
Alcohol dependency is so much more than a particular number of drinks per week—but everyone still wants a number. We want some barometer by which to measure ourselves to see if we’re really that bad. So here it is:
The average male-bodied person should stay below four drinks per night, and consume no more than 14 drinks per week. For female-bodied people, it’s that generally drops to three drinks a night and seven per week.
If you’re regularly going over both of those limits, you might have a problem.
Here’s the part where we get into the nuance. Plenty of people who drink sometimes go on benders and have more than three or four old fashioneds. Way more. That doesn’t automatically make someone an alcoholic. Dependency and abuse are about the regularity with which you drink a certain amount, not how blackout drunk you get when faced with an open bar at a particularly boisterous wedding. That’s why there are those “ands” in there—because it’s not really about whether you push the limits, but rather how often it is you're pushing them.
At what point does it become a dependence, medically speaking?
Psychiatrists have a better way of defining alcohol problems than just a numerical limit. For professionals, it’s more about a set of behaviors.
Clinicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose disorders like alcoholism. It’s a book that standardizes what symptoms doctors should look for in every psychiatric illness, or at least all those that are officially recognized. Alcohol use disorder comes on a spectrum, but to qualify as abusing alcohol (which is less severe than alcohol dependence), you only have to have any two of the following issues:
- Had times when you ended up drinking more, or longer, than you intended
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t
- Spent a lot of time drinking, or being sick or getting over other aftereffects
- Wanted a drink so badly you couldn’t think of anything else
- Found that drinking—or being sick from drinking—often interfered with taking care of your home or family, or caused job troubles, or school problems
- Continued to drink even though it was causing trouble with your family or friends
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem, or after having had a memory blackout
- Had to drink much more than you once did to get the effect you want, or found that your usual number of drinks had much less effect than before
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure; or sensed things that were not there.
Having two or three symptoms would only constitute a mild alcohol use disorder, while six or more would considered be severe. Of course, you should not use this list to diagnose yourself with alcoholism. Only a licensed professional can do that. But if you answered “yes” to multiple items listed here, you should consider talking to a doctor about it. It doesn’t mean that you’re a lifelong alcoholic—this isn’t the end of your social life. But admitting that there’s a problem, and asking a professional to help you fix it, is the best way to keep things from getting out of hand later.
What should I do if I think I have a problem?
If you’re concerned, talk to a professional about it. Schuckit recommends the resources available from the National Institute on Alcohol Abuse and Alcoholism. They have options for everything from basic curiosity about where the limits are to phone numbers to call if you’re seeking treatment. They have a feedback form, where you can enter some information about how much you drink and compare yourself to the norm. It’s a basic screening test, but it can help give you a sense of how risky your patterns of behavior are.
There’s also a phone number you can call (301-443-3860) to get more information, including how you can get treatment, plus many more helplines that offer more specialized services. Maybe you’re the child of an alcoholic or you want to find a social worker to talk to—you can find both on the NIAAA help page.
The important thing to remember is that you’re not alone. 17 million adults have alcohol use disorder to some degree, and that’s just counting those who have been diagnosed. There are many more who are unable to get help. But the bright spot in all of this is that treatment works. A third of people who seek help have no symptoms a year later, and many of the remaining group still see significant reductions in the severity of their problems.