Alcohol is a widely enjoyed part of the American culture. It acts as a social lubricant, lowers anxiety and inhibitions, and smooths the conversation. It is glamorized in movies as being an expected ‘rite of passage into adulthood and a requirement for ‘having a good time.’ Men tend to drink more than women, but the number of female drinkers is on the increase. 

Researchers have tried to quantify the amount of alcohol that indicates a physiological addiction, but professional opinions vary. Problem drinking is measured on a continuum, from mild alcohol use disorder (binge drinking, functional alcoholics) to severe alcohol use disorder (a daily drinker whose health is suffering from the quantity of alcohol consumed and whose relationships with partners and children are suffering.)

“There’s no quantity or frequency of alcohol included in the definition” (in the DSM-V), says Anne Fernandez, Ph.D., a clinical psychologist for the University of Michigan Addiction Treatment Services. “Essentially, it’s really about certain features of alcohol use becoming a problem in your life — you’re starting to lose control or not being able to cope without a drink.” Family members or employers are often the first to notice a problem with alcohol or drugs, though the alcoholic thinks their behavior hasn’t changed at all. And no single diagnostic method exists: “We can’t do an X-ray or rely on a blood test alone,” Fernandez says. It’s a pattern established by how impaired your functioning is in your role at work, at play, and at home, in addition to how much you are consuming and what you are using your drinking to manage. 

Doctors and mental health professionals rely on a list of 11 criteria that could signal the presence of alcohol use disorder.  

In the past year, have you:

• Had times when you ended up drinking alcohol more or longer than intended?

• More than once wanted or tried to reduce or stop drinking but couldn’t?

• Spent a lot of time drinking or being sick from the aftereffects?

• Wanted a drink so badly you couldn’t think of anything else?

• Found that drinking — or being sick from drinking — often interfered with work, family, or school duties?

• Continued to drink alcohol even though it was causing trouble with your family or friends?

• Given up or cut back on activities that were important, interesting, or pleasurable to you in order to drink?

• More than once gotten into situations while or after consuming alcohol that increased your chances of getting hurt (such as swimming, driving, using machinery, walking in a dangerous area, or having unsafe sex)?

• Continued to drink alcohol even though it was making you feel depressed, 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 the usual number of drinks had much less effect?

• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, racing heart, or a seizure? Or sensed things that were not there?

According to the DSM-5, a patient who answers yes to two to three questions is considered to have mild alcohol use disorder. Those with four to five yeses are moderate cases. Those who say yes to six criteria or more are believed to be severely affected by their alcohol consumption.

The criteria come from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). https://healthblog.uofmhealth.org/signs-of-alcohol-use-disorder-perfcon 

There is an additional category called a high-functioning alcoholic. A high-functioning alcoholic might not act the way you would expect him/her to act, Sarah Benton says. He might be responsible and productive. He could even be a high achiever or in a position of power. In fact, his success might lead people to overlook his drinking. He could also be in denial. He might think, “I have a great job, pay my bills, and have lots of friends; therefore, I am not an alcoholic,” Benton says. Or he might make excuses like, “I only drink expensive wine” or “I haven’t lost everything or suffered setbacks because of drinking.” (The High Functioning Alcoholic, by Sarah Benton). 

But he isn’t doing fine, says Robert Huebner, Ph.D. of the National Institute on Alcohol Abuse and Alcoholism. No one, he warns, “can drink heavily and maintain major responsibilities over long periods of time. If someone drinks heavily, it is going to catch up with them.”

There are some other red flags. You might:

• Say you have a problem or joke about alcoholism

• Not keep up with major responsibilities at home, work, or school

• Lose friendships or have relationship problems due to drinking, but you don’t quit alcohol

• Have legal problems related to drinking, such as a DUI arrest

• Need alcohol to relax or feel confident

• Drink in the morning or when you’re alone

• Get drunk when you don’t intend to

• Forget what you did while drinking

• Deny drinking, hide alcohol, or get angry when confronted about drinking

• Cause loved ones to worry about or make excuses for your drinking

What do you do if you fit the description? If you are in the mild alcohol use category, you might try going without alcohol for 30 days. As all ‘habits’ are hard to change, you’ll want to plan for the added stress of going without. This might be where working with a professional can be crucial. Do you need a temporary 12-step program to fill the void? It could be AA, Celebrate Recovery, SMART Recovery, Secular Organizations for Sobriety (SOS), or any host of other programs. You may fear that the members will judge you or be critical, but they are just glad you’ve joined them for the hour and are very welcoming.  

Because you’ve likely been using alcohol to manage stress or other difficult emotions, the planned ‘substitution’ can vary, but group activities will boost your depleted dopamine and help you over the crunch period. Other ways to lift your dopamine might be to get more exercise, get more sleep, eat some chocolate, get a massage, spend time socializing, drink more caffeinated beverages, or spend time in nature. Spiritual support can be helpful as well. And if you’ve quit before and been unsuccessful at maintaining full sobriety, don’t feel too disheartened. It takes most people several tries before it ‘sticks.’ But it's worth it. Your health and quality of life can be reclaimed, and you will likely feel better than you ever did before if you fully embrace a recovery state of mind. 

https://medicine.umich.edu/dept/psychiatry/anne-fernandez-phd

https://pubs.niaaa.nih.gov/publications/Treatment/treatment.htm#chapter01

https://www.psychiatry.org/psychiatrists/practice/dsm

https://www.webmd.com/mental-health/addiction/understanding-alcohol-abuse-basics

Benton, Sarah, The High Functioning Alcoholic; Rowman&Littlefield Publishers, Inc, New York, 2009.