Am I An Alcoholic? Know The Signs
Alcohol is one of the most commonly used and abused substances in the world. In 2019, the National Survey on Drug Use and Health reported that 14.1 million American adults are estimated to have an alcohol use disorder (AUD). However, most people don’t receive treatment for their addiction.1 According to data from 2018, only 7.9% of adults received treatment in the past year.1
Although there is no single cure for alcoholism, there are several effective therapeutic interventions that can help a person stop problematic drinking. Most people with an AUD can benefit from professional treatment, which may help people to develop the skills needed to stay sober and live a healthier life without alcohol.2 Learn more about alcoholism, signs that you might have an AUD, withdrawal symptoms, and effective treatment for managing AUD.
Before assessing your own alcohol use, it’s good to understand what alcoholism is and how it is diagnosed. Alcoholism is a colloquial term used to describe problem drinking that takes over a person’s life.3 When a person meets specific diagnostic criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), they are said to have an alcohol use disorder.3 An AUD is a chronic medical disorder that results in brain changes that perpetuates a person’s problematic drinking behavior despite negative consequences.3
A person with an AUD is no longer able to control their drinking and cannot stop drinking out of willpower alone.
Drinking with increased frequency or in greater amounts over time puts a person at high risk of developing an AUD; however, there are many other factors associated with a higher risk of AUD. If you started drinking at a younger age or are in an environment where you’re constantly exposed to alcohol, you may have a higher risk of alcohol abuse.3 The risk may also increase among people who binge drink, which means consuming more than 5 drinks for men and more than 4 for women over a period of 2 hours.4
Additional factors that may increase the risk of developing AUD include genetics (which accounts for 60% of your risk), having family members with alcoholism, and having certain mental health conditions or being exposed to trauma during childhood.3 Mental health disorders associated with an increased risk of AUD includes depression, attention-deficit hyperactivity disorder, and posttraumatic stress disorder.3
Alcoholism Warning Signs
The symptoms and warning signs of an AUD include:5,6
- Drinking more than you originally intended.
- Being unable to cut down your alcohol use even though you want to do so.
- Experiencing cravings for alcohol, or strong urges to drink.
- Spending a lot of time drinking or recovering from the effects of alcohol.
- Being unable to meet obligations at work, school, or home because of your alcohol use.
- Continuing drinking even though you start having problems in your relationships that are caused by or worsened by your alcohol use.
- Giving up activities or hobbies you once enjoyed because of alcohol use.
- Drinking in situations where it’s physically dangerous or hazardous to do so (such as while driving or operating machinery; or having unsafe sex).
- Continuing to drink even though you have a physical or mental health condition that is likely due to or exacerbated by your alcohol use.
- Needing to drink more to experience previous effects (this is known as tolerance).
- Experiencing withdrawal symptoms (such as shakiness, insomnia, restlessness, sweating, or seizures) when you try to stop drinking.
If you or your loved one is experiencing any of these symptoms, be aware that being proactive and taking steps to reduce or stop drinking can prevent the problem from becoming worse and decrease your risk of negative mental and physical health consequences. The Centers for Disease Control and Prevention (CDC) reports that excessive alcohol use can lead to the development of long-term health issues such as:7
- High blood pressure.
- Heart disease.
- Liver disease.
- Digestive problems.
- Cancer of the mouth, breast, throat, liver, esophagus, colon, and throat.
- Decreased immune system functioning.
- Mental health problems.
Is There a Safe Level of Drinking?
There is no agreed-upon “safe” level of drinking, as any level of alcohol use can have a negative impact on your health.8 Knowing how much or how often you can consume alcohol can be difficult to grasp.
Alcohol’s effects vary from person to person and are dependent on a number of factors including family history, how much and how often they drink, age and current health status.8 Some people are advised to avoid drinking completely, including those who are pregnant, those who are under the legal drinking age, people with certain medical conditions, or those who take medications that interact with alcohol.8
If you choose to drink, the 2020-2025 Dietary Guidelines for Americans advises a limit of 2 drinks or less in a day for men or 1 drink or less in a day for women which is considered “moderate” drinking.7,9 Binge drinking is defined by 4 drinks per day for women and 5 for men; or consuming enough alcohol to increase your blood alcohol concentration (BAC) to 0.08% or higher.4 Heavy drinking means having 8 drinks or more per week for women and more than 14 drinks per week for men.4,7 Following the Dietary Guidelines for moderate drinking can reduce your risk of harming yourself or others.10
Drinking Levels and Blood Alcohol Content
When it comes to understanding drinking levels, the CDC explains that a standard drink in the U.S. contains 0.6 ounces of pure alcohol, which can typically be seen in:9
- 12 ounces of beer
- 8 ounces of malt liquor
- 5 ounces of wine
- 5 ounces of 80-proof liquor (e.g., vodka, gin, tequila, rum, or whiskey).
As your BAC increases, the more impaired you become. You may experience effects such as:8
- Slurred speech.
- Lack of muscle control and impairments in gait and balance.
- Reduced reaction time.
- Lowered inhibitions.
- Memory impairment.
- Breathing problems.
Additionally, men and women are affected differently by alcohol, and women begin to have alcohol-related problems sooner and at lower drinking levels than man for due to a variety of reasons. Differences in average body weight, body fat percentage, and body water content means that if a woman and man of the same weight drink the same amount of alcohol, the woman’s BAC will be higher than the man’s, and she will become intoxicated more quickly.11 There are additional biological factors at play as well. For example, women metabolize alcohol differently than men because of hormonal differences, especially estrogen.11
Alcoholism Screening Tests
If you’re unsure if your drinking places you at risk for developing AUD or are concerned that your drinking might be excessive, there are several assessment tests used by general physicians and addiction specialists alike which have demonstrated accuracy in assessing unhealthy alcohol use in adults 18 years or older.12 It’s recommended that these screening tests be conducted by a physician to more accurately understand your level of alcohol use.
Some of these assessments include:
The CAGE (cut down, annoyed, guilty, eye-opener) screening test consists of 4 questions that detect alcohol dependency. Positive answers of 2 or more of the following questions warrants further assessment by a physician or mental health professional.13
- Have you ever felt that you should cut down your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt bad or guilty about your drinking?
- Have you ever had the urge to drink first thing in the morning (e.g., eye-opener) to steady your nerves or get over a hangover?
Another screening tool, the Alcohol Use Disorders Identification Test (AUDIT), consists of 10 questions that help to identify alcoholism and alcohol problems. It is designed to be used as a brief, structured interview in a clinical setting or self-report survey. Each of the 10 questions is scored on a scale of 0 to 4 in terms of severity.14 For example, the question “How often during the last year have you failed to do what was normally expected from you because of drinking?” has several possible answers: never (0 points), less than monthly (1 point), monthly (2 points), weekly (3 points) and daily or almost daily (4 points).14 A person who receives a total score of 8 or more may have an alcohol problem; higher scores can indicate alcoholism or alcohol dependence.14
M SASQ is an alcohol use assessment tool that is made up of one question based out on AUDIT. This test was developed for use in emergency departments.15 Women are asked how often they’ve had 6 or more alcoholic drinks on a single occasion in the last year while men are asked if how often they’ve had 8 or more.15 A total of 0 to 1 indicates lower risk drinkers, 2 to 4 indicates increasing or higher risk drinkers, and an overall total score of 2 or above is M SASQ positive.15 If a person receives a 2 or more, they are encouraged to continue with the full AUDIT test.15
These tests are not designed for self-assessment but can be useful to spur discussions regarding your alcohol consumption with your physician or an addiction treatment professional.
How Do I Know if I Have a Problem?
Alcohol addiction can affect all areas of a person’s life. According to the CDC, drinking can be considered a problem when it impacts your relationships, school, work, social activities, and how you think and feel.16
A person with an AUD is a compulsive drinker, and they may be unable to think of much anything else. Certain behaviors can point to problematic alcohol use: If you are hiding your alcohol use, worrying about having enough alcohol, switching from one kind of drink to another to keep from getting drunk, sneaking drinks when no one is watching, having blackouts, or hurting someone else because of your drinking, then it may suggest your drinking has become a problem.17 Needing to drink to alleviate anxiety, sleep, feel at ease in social settings, or avoid thinking about sad situations also may indicate a problem.17
You may be drinking too much if you are: 17
- A male who has more than 14 drinks per week or 4 drinks on one occasion.
- A female who has more than 7 drinks per week or more than 3 drinks per occasion.
- Over 65 and have more than 7 drinks per week or more than 3 drinks per occasion.
Experiencing Symptoms of Withdrawal
Another sign that a person’s drinking has become a problem is when they experience symptoms of alcohol withdrawal when they stop drinking alcohol or substantially reduce their consumption of alcohol.18
When a person is alcohol-dependent, their body has adapted to the presence of alcohol and they need to drink more to feel the effects of alcohol (i.e., tolerance) and they experience physical and mental withdrawal symptoms when they try to stop drinking suddenly (i.e., go “cold turkey”) or reduce their alcohol intake.
Withdrawal symptoms can be unpleasant, uncomfortable, and even dangerous and life-threatening.18 Alcohol withdrawal can begin as soon as 6 hours after your last drink.19 Common signs of mild-to-moderate alcohol withdrawal include:20
- Mood swings.
In moderate to severe cases of withdrawal, people can develop symptoms such as:20
- Low-grade fever.
- Rapid breathing.
- Profuse sweating.
- Delirium tremens, (DTs), which causes hallucinations, confusion, and disorientation, and in rare cases may be fatal.
People at risk of moderate to severe withdrawal are encouraged to seek medical guidance prior to abstinence or reducing their use of alcohol significantly.21 A doctor may require that person detox in a hospital setting or detox facility where their medical safety may be monitored 24/7.20
An inpatient detox facility can provide medical supervision, monitoring, and medications to help you stay comfortable and safe until withdrawal is complete.20 People with mild to moderate withdrawal symptoms can often be treated at an outpatient facility where they receive daily monitoring and medication to ease withdrawal symptoms and reduce cravings.19
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Tips to Cut Back on Drinking
Cutting back or eliminating drinking can help minimize the risks associated with alcohol use. Even small changes can make a difference. Some tips to help you become more aware of your drinking and help you cut back or stop drinking include:22
- Keep a record of how much you drink.
- Measure your drinks at home.
- Set goals for how much you want to drink and plan some days where you don’t drink at all.
- Choose an alternative to drinking that brings you pleasure, such as finding a hobby or renewing an old friendship.
- Stay away from triggers such as people you drink with or places where you drink.
- Say no if someone offers you a drink when you really don’t feel like drinking.
Treatment for Alcohol Use Disorder (AUD)
Effective treatment for alcoholism includes a variety of behavioral therapies, medication, mutual support groups such as 12-step groups like Alcoholics Anonymous or may consist of a combined approach using multiple therapeutic modalities.3 The FDA has approved three medications that help people stop drinking or abstain from alcohol use which include naltrexone, acamprosate, and disulfiram.23
Behavioral therapies, often referred to as talk therapy, include brief counseling, cognitive-behavioral therapy (to help you make positive changes to your thoughts and behavior), motivational interviewing (to increase your desire to change), coping skills education, and relapse prevention.2,23
At an addiction rehab facility, the first step is usually detox, followed by engagement in treatment. You’ll receive a customized treatment plan based on your specific needs while taking into account any additional considerations you may have, such as co-occurring mental or physical health conditions, legal issues, or vocational problems.
You’ll receive monitoring, support, and medication as needed throughout the program and participate in treatments that are appropriate for you, such as individual, group, and family counseling.23,24 In addition, your treatment will be adjusted as you progress through the program.24
Recovery from alcohol addiction is a lifelong process that doesn’t end once you’ve completed treatment. Having an aftercare plan is advisable to help you stay sober and avoid the temptation to resume alcohol use and relapse. Your treatment team will advise you about aftercare options, such as mutual-help groups or sober living houses, which are alcohol- and drug-free residences designed to help you transition back to your normal life.25
Getting Help For Alcoholism
If you’re ready to seek treatment for alcoholism, American Addiction Centers (AAC) can help. AAC is a nationwide provider of addiction treatment centers and operator of AlcoholRehab.com.
Fill out the form below to see if your insurance covers treatment with an AAC facility. Or call our admissions navigators at ; they’re available 24/7 to discuss your treatment options with you. All calls are 100% confidential.