Signs of Alcoholism | Paul Hutchinson, Ph.

Alcoholism

Signs and Symptoms of Alcoholism

When faced with a drinking problem, either in yourself or in someone close to you, you are probably asking yourself, "how serious is this problem," and "what is the best solution?" This article is designed to help you assess how serious a drinking problem is, and whether it makes sense to call it alcoholism.

There is some controversy about the word "alcoholism." The official diagnostic manual doesn't use that word, but instead uses the term "alcohol use disorder." What most people would call alcoholism is officially called "severe alcohol use disorder." To avoid getting tangled up in debates about definitions, let me simply tie the words more closely to the decisions that you may be trying to make. When I use the term "alcoholism," I mean a drinking problem serious enough that abstinence is the only realistic solution. For a less severe drinking problem, there may be other realistic solutions.

First I will describe some of the basic signs and symptoms of an alcohol use disorder, especially the symptoms that are part of the standard diagnosis used by physicians and therapists. Even after reading that, you may find yourself uncertain about whether a certain drinking problem is alcoholic or not. Certainty may be hard to come by, but a deeper perspective may help. I will spend some time discussing some of the signs and symptoms of alcoholism in more detail, and offer some ideas about the significance of various signs.

The Official List of Symptoms of Alcoholism

The distinction between heavy drinking and alcoholism is typically based not on the quantity you drink, but on how the drinking is affecting your life. In the official diagnostic list, there are eleven key signs of an "Alcohol Use Disorder."

The first three signs are things that indicate that a person's body has become very accustomed to having alcohol in it.

The person develops a "tolerance" for alcohol. This means that it takes more alcohol to feel the same level of intoxication. Usually the person drinks more he or she used to, and more than most other people, in order to get the same effect.
The person has withdrawal symptoms. Withdrawal means that you feel sick whenever there is no alcohol in your body. The symptoms include nausea, sweating, shakiness, and anxiety. Withdrawal is different from a hangover. It typically isn't at its worst first thing in the morning, but it gets worse through the day if the person tries to go all day without drinking, and it goes away if the person drinks again. (Having withdrawal symptoms is a very serious sign of addiction.)
When not drinking, the person craves alcohol, often wanting a drink so badly that it is hard to think of anything else.

The next two symptoms reflect the way that people start to lose control of the choices they are making about alcohol.

The person often drinks more than he or she had intended to.
The person has been planning to cut down on drinking, or attempting to control the drinking, but those attempts keep failing. ( Don't be too quick to say, "see, I cut down for a month" if your use always shoots back up to where it was before. )

The next six symptoms reflect the way that alcohol begins to dominate a person's life, push out other things, and bring on painful consequences.

The person has more than once gotten into situations after drinking that could have gotten them hurt. This includes driving drunk, swimming drunk, or having unsafe sex while drunk.
The person spends a lot of time and effort making sure that he or she can get alcohol. Often this takes the form of going to bars a lot, or planning lots of social events that involve alcohol, and avoiding social events where alcohol isn't served. It also may involve spending time alone drinking instead of doing something else that wouldn't allow as much drinking.
The person begins to give up or reduce important social, recreational or professional activities because of alcohol use. The person may be aware of being pulled in two directions, between alcohol and other priorities, and alcohol begins to win more and more often.
The person continues drinking even after being aware that it is making them depressed or anxious or that the drinking is making another health problem worse. Or the person keeps drinking even after having memory blackouts, not remembering the night before.
The person keeps drinking even though it is causing trouble in their relationships with their family or their friends.
The person is finding that drinking, or being sick from drinking, is getting in the way of responsibilities with their family, or with their work or their schooling.

The list of 11 symptoms above is adapted from the official diagnostic manual used by physicians and therapists (The DSM-5 diagnostic manual). If you have six or more of these 11 symptoms', then by official standards you have a "Severe Alcohol Use Disorder."

Other Alcoholism Signs to Look For and Ideas to Consider

The official diagnostic manuals try to make things more clear-cut, with lists of symptoms and rules for making a diagnosis, but it usually takes more information to really understand the subject. Here I will describe some of the patterns around alcoholism more fully, and give you some ideas to think about.

The Genetic Component in Alcoholism

Let me begin by mentioning something that is not part of the official diagnostic list, but is very important to consider: Alcoholism is partly genetic. Even if they are adopted away and raised by non-alcoholics, the biological children of alcoholics are at much higher risk for alcoholism themselves. Here's what that means if you are trying to assess your own problem: If some of your blood relatives are alcoholic, especially your parents, grandparents, aunts and uncles, or siblings, there is a much higher chance that you will have trouble controlling your drinking. If alcoholism runs in your family, you would be wise to watch your own drinking patterns all the more carefully.

The Power of an Addiction

When an addiction is operating, it is a powerful force. Alcohol is physically addicting, which means that if you drink consistently enough, you will get physically ill when you try to go without. You will have physical cravings for more. There is also a powerful psychological component to the addiction. For many people, alcohol is a way of feeling better, of turning off emotional pain, and of blurring their thinking so that they don't have to ponder the problems of their lives. It is very seductive to have something that can turn off your awareness of your problems and make you feel better. That is a powerful enough force that, even for someone who is not physically dependent on alcohol, the lure of alcohol can be hard to resist.

Even when a person actively wants to stop drinking, and actively wants to change his life, the physical and psychological power of the addiction is a strong force in the opposite direction. A person becomes like the proverbial "house divided against itself." A part of him deeply wants stop drinking, and forms all kinds of healthy plans and intentions, but the physical and psychological force of the addiction is always pulling the other way. A number of the signs and symptoms of addiction reflect this, as a person tries to do one thing, but gives in to the impulse to do the opposite.

People vow to cut down on their drinking, but find themselves giving in to the impulse to drink more.
People quit for periods of time, but go back to drinking in a weak moment.
People promise their loved ones that they will stop, but then don't (usually harming the relationship, even if it is one that they care about).
People know that drinking is damaging things that matter to them, like their health, or their careers, but still don't stop.

If these kinds of "house divided against itself" experiences are operating strongly, that suggests alcoholism, because there is clearly a force operating that is interfering with the process of making choices and managing one's life.

There is also another aspect to the "house divided against itself" experiences. To defend an addiction, people often begin to do things that are quite counter to the values they believe in. People who believe that lying is wrong lie to cover their drinking. People who believe in an honest marriage deceive their spouses. People who believe in being good parents are neglectful and inconsistent with their children. As these things begin happening, it is a serious sign that the people are losing control of the choices they are trying to make.

One particular version of this type of problem points toward abstinence as the only viable solution: Some people find that after about two drinks they lose all ability to resist having more, even if they have to drive home a few hours later. If a small amount of drinking triggers a binge, then no amount of drinking is safe.

The other question that is important here is, "has your difficulty controlling your drinking been affecting your self esteem?" Many people find themselves disheartened and ashamed as they try to control something that is affecting their lives, and perhaps the lives of those around them, but find themselves unable to follow through on their own choices.

The Role of Denial in Alcoholism

An important factor that isn't reflected in the standard symptoms of addiction is that way that people can begin to distort reality, defending their drinking and denying that there is a problem. This process can make it quite difficult for a loved one, or even a professional, to approach the problem, as a normally reasonable person refuses to admit that a problem exists.

There is a paradox about denial that makes the question harder: If you ask a "normal drinker" if she has a drinking problem, she will say "no." If you ask an alcoholic if she has a drinking problem, there is a good chance that she will also say "no." Assessing denial is more complicated than deciding, "if she denies having a problem, she probably has one."

Here is how to use this factor as you are trying to assess the seriousness of the problem: The more someone seems to be distorting reality to defend the drinking, the more likely it is that a real problem exists. What do I mean by reality? Well, reality by consensus is a good place to start. If two or more people continually agree that someone's drinking is becoming unhealthy, but the person keeps defending and rationalizing it, that is probably denial. But even without the consensus of a crowd, it is possible to assess this kind of distortion. You may find that you and your spouse see most things the same way, or can at least understand and accept each other's views on most things. On the subject of alcohol, however, you find that you can't agree on anything, and that your spouse seems to be distorting and denying in a way that he or she just doesn't do with other subjects. This doesn't mean that you can be sure your perceptions are right, but you can certainly factor this in with any other warning signs you see.

If you are reading this to understand your own drinking, you will need to be ruthlessly honest to avoid any denial that may be going on in yourself. You may find yourself rationalizing or defending your drinking to yourself, but I suggest that you ask yourself again and again, "is this causing problems? Is this affecting my life in ways that I don't want? Regardless of what I have said to other people, can I honestly tell myself that my drinking is OK?"

Some Popular Rationalizations

Rationalizations are one of the most convenient ways that our minds defend the things we want to do, and the things we want to believe. We distort things, tell ourselves things that are partially true or even untrue. Everyone rationalizes a little. If you are trying to assess the degree to which rationalization is a problem, ask yourself these questions: How much distortion of the truth is involved? How much are you distorting your values to defend what you are defending? Here are some popular rationalizations:

Justifications for drinking, for how much you drink, or of why the drinking isn't a problem:

It's not a problem because I only drink beer, not hard liquor.
It's not a problem because I never drink before 5 PM.
It's not a problem because I can stop whenever I want to.
It's not a problem because I never miss a day of work.
It's not a problem because I drink, but I don't really get drunk.
It was ok to drink so much yesterday because I had an awful day at work.
It was ok to drink so much yesterday because it was a party.

Justifications for some of the behavior around your drinking:

I have to hide some of my drinking from my wife because she's so controlling.
I just feel like avoiding my family these days because they are so critical.
I'm a good driver. I've never had an accident after a couple of drinks.
Hangover days are really just the same as any other sick day.

Rationalizations that blame others for various problems that are developing, which may be caused or made worse by your drinking.

Work problems are the fault of your boss or your coworkers.
Problems at home are the fault of your spouse, or other family members.
Problems in friendships and relationships are there because they are all too critical or unreasonable or controlling.

Again, the more someone is distorting reality to defend their drinking, or their behavior, or to place blame for problems on everyone else, the more it indicates a problem.

The Significance of Quantity

Quantity is a loaded issue, about which there is little agreement. When someone drinks a fair amount, it raises the question of when quantity by itself is a reason for concern. As you can tell from the official symptoms listed above, the official diagnosis completely avoids the question of how much alcohol the person is drinking. So, what if someone consistently drinks two drinks a night? Is that alcoholic? How about four? Six?

Consensus about amount is hard to come by, so I'll start by mentioning amounts that most sources agree are excessive.

Five drinks in one day is generally considered a lot. That is the typical definition of "binge drinking." ( I'll add that binge drinking by itself doesn't make someone alcoholic. Alcoholism is more about what happens consistently than what happens on any particular night. )
Drinking every day of the week is generally considered a lot. A single glass of wine nightly with dinner is a less concerning habit than a nightly stiff cocktail for "happy hour," because the cocktail may easily contain 2 or 3 drinks worth of alcohol.
Anything over 15 drinks per week for men, and about 12 for women, is considered a lot.

But counting drinks risks missing the point. The point of being concerned about alcohol intake is to make sure that alcohol doesn't cause serious problems in your life. Quantity is important because as quantity goes up, it becomes more and more likely that alcohol will degrade the quality of your life. The quality of one's parenting changes after 3 drinks. The ability to talk something through with a loved one, or to be careful about how you treat other people, is much poorer if you are somewhat inebriated. And, if you typically drink 3 or more drinks per day, when do you drive?

Some of the warning signs of alcoholism are directly related to quantity, even if the number of drinks is never mentioned. All of the questions below are really questions about excessive quantity.

Have you developed a tolerance for alcohol?
Do you have withdrawal symptoms on days when you don't drink?
Do you drink in the morning?
Do you have cravings for alcohol?
Do you ever have blackouts? ( Blackouts are times when you were conscious, but you don't remember what happened. A typical example is not remembering the last half of a party the previous night, or not remembering how you got home. It takes a lot of alcohol to produce a blackout.)
Do you ever try to get "extra" drinks at a party because the amount others are drinking isn't enough for you? Do you "pre-drink," having a couple of extra drinks before getting together with friends, becauuse they don't drink enough?
Do you ever find yourself wishing that the people around you would drink more, so that the amount you drink won't stand out?
Have your friendships started tending towards heavy drinkers, so that your drinking patterns fit right in?

Another quantity question that is extremely important is this one: Has your drinking been increasing over time? If so, if it has been increasing even as you have been trying to keep it down, it is a virtual certainty that it will cause problems in your life as it continues to increase.

When Drinking Governs Your Relationships

One significant sign that alcohol has begun to distort a person's priorities is when alcohol begins to push aside or corrode relationships, or when a person chooses friendships based more on the opportunity to drink than on the other qualities of the person. These are some of the signs that alcohol is affecting your social life or corroding your relationships.

Do you drink alone?
Do you find your friendships gravitating toward other heavy drinkers whether or not you have anything else in common?
Do you find yourself irritated when it turns out that there isn't alcohol at a social event?
If you have kids at home, do you find that time outside of work focuses on drinking more than parenting?
Do you find yourself lying or keeping secrets rather than being open with the people you love?
Do you wish people would mind their own business about your drinking?
Is alcohol the subject of your arguments with your spouse or family?

It has become common knowledge that being raised by alcoholic parents often has very negative effects on a child. When someone is frequently under the influence, it is terribly hard not to be selfish, neglectful, and inconsistent as a parent. Carefully consider the role the alcohol is playing in your relationships, and ask yourself if you are comfortable with the effects.

What to Do With Your Conclusions

All of the signs, symptoms, and information above is designed to help you assess whether an alcohol problem exists. As you might expect, the more signs that you see pointing in the wrong direction, the more serious the problem is.

If there seems to be a significant problem, the next question is what to do about it. Does it make sense to set a goal of reducing drinking to a more moderate level, or is abstinence the more reasonable goal? Most people who drink would prefer not to give up drinking. The main question here is, what is likely to work? If you look at the lists above, and notice that there are a few negative signs, but not a large number of them, it may be reasonable to make a goal of reducing drinking rather than abstinence. If you would like to work on that in therapy, feel free to call me about doing therapy to accomplish that goal. If we begin to work on that, it will become clear over time whether reducing your drinking is going to work.

If you notice that you have many signs of addiction, it is quite unlikely that you will be able to return to moderate, "normal" drinking. You may also have tried to moderate your drinking several times before without success. In that case, the only reasonable goal is abstinence. The question becomes, how to accomplish that. Alcoholism can be very powerful. Depending on the strength of the addiction, a variety of things may be needed, including therapy, 12 step groups or other support groups, and perhaps inpatient treatment. You may want to look at my web page on Therapy for Alcohol and Drug Issues. That web page also has links to other resources, especially in the Seattle area. If you are looking for treatment centers anywhere in the U.S., and excellent resource is www.findtreatment.samhsa.gov.

As you may already know, alcoholism can be very destructive, and there is much at stake. Many people have made the mistake of denying the extent of a drinking problem until it seriously damaged their lives. My recommendation is that you be ruthlessly honest with yourself about any drinking problem you might have, and take steps to deal with it earlier rather than later.

I hope you have found this article helpful. If so, feel free to link your website to this one to allow others to find this article more easily.

Paul Hutchinson, Ph.D.

Clinical Psychologist