Am I an alcoholic? Don’t just think about quantity, but how you use it

By Daniel Hochman, MD

TL;DR

Since you’re reading this you probably have a clinical diagnosis of alcoholism. But to know whether it’s something that requires psychological attention requires asking yourself how you use it. If you depend on alcohol to numb or wash away your woes, it’s likely that your mind is a greater risk to you than the alcohol.


 

If all you’re wondering is whether your alcohol use is harming you physically, please don’t try to figure that out with Google. I’ve seen one drink a day rip people’s bodies up, and I’ve seen people who drink like a fish live long, healthy lives. Your life is precious. Do yourself a favor and go see a doctor.

But if you’re wondering something more like: “Is my level of drinking psychologically healthy?” then you’ll enjoy my psychiatric perspective.

Let’s first look at the traditional alcoholism criteria, then I’ll show you a more meaningful framework to answer your question.

 

ALCOHOL USE DISORDER CRITERIA

Clinically we call alcoholism “Alcohol Use Disorder.” The 11 criteria are set by the American Psychiatric Association, and are as follows:

In the past year, have you:

  1. AmountHad times when you ended up drinking more, or longer, than you intended?
  2. Loss of controlMore than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  3. Time lost Spent a lot of time drinking? Or being sick or getting over other aftereffects?
  4. CravingsWanted a drink so badly you couldn’t think of anything else?
  5. Failed responsibilitiesFound that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  6. Relational problemsContinued to drink even though it was causing trouble with your family or friends?
  7. Loss of interestsGiven up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  8. Physically hazardousMore 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)?
  9. Health consequences – 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?
  10. ToleranceHad 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?
  11. WithdrawalFound 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?

You count up how many of these symptoms you have, and if you have more than even one, you’re considered medically to have Alcohol Use Disorder. It’s divided into three categories:

 

Severity           Symptoms

Mild 2-3
Moderate 4-5
Severe 6 or more

 

HOW MUCH IS TOO MUCH?

If you’re thinking there’s a magic number of drinks that’s bad for you, then you’re pretending that everyone’s biology is the same. We all have different levels of alcohol dehydrogenase (the enzyme that breaks alcohol down), are different sizes, and our organs have different sensitivities. If you don’t know whether you’re causing yourself physical harm, go see a doctor.

Now that I said that, here is a quick rule of thumb:

How many times in the past year have you had five (for men) / four (for women) or more drinks in a day?

If you answered one or more, there is a 79% chance you have a diagnosable alcohol use disorder. (yes, you read that correctly)

There’s almost a guarantee that if you have any concern about your drinking, you meet criteria for alcohol use disorder. Right now you’re probably thinking: “Oh s%#t this is bad, why did I just confirm what I didn’t want to confirm?!”

If that’s the case, know that you’ve got 29% of Americans in this camp with you who at some point in their lifetimes will meet alcoholism criteria.

It’s OK, please read on.

 

WHAT THE CLINICAL CRITERIA CATCHES

The criteria make it all too easy to qualify as an alcoholic based on the simple fact that anybody who drinks regularly develops a normal, biological adaptation to it (physical dependence). Thankfully, the body is wise enough to anticipate regular drinking and defend your body from alcohol’s threat to your alertness and coordination, so you need to drink more and more over time to have the same effect (this is called tolerance).

Almost anyone who drinks most days automatically meets criteria related to amount, tolerance, and withdrawal. That already puts you just one symptom away from moderate alcoholism.

From a public health perspective it’s great to catch nearly any possible case of alcohol use disorder so it can be recognized and treated.

 

THE DOWNSIDE TO DETECTING EVERY POSSIBLE CASE OF ALCOHOLISM

Consider that about 90% of people who regularly drink never become addicted. Or consider that even for people who have 5 or more drinks a day, only 7% of them become addicted. That doesn’t mean people who drink don’t have real risks. It takes one unlucky evening to lose your family or your life. And even if you say it causes several serious health issues (which it absolutely does), the more recent and larger studies show that a couple drinks a day amount to a lower life expectancy of just six months. Most people I know aren’t very interested in giving up a vice in their life to eek out an extra few months of life. As much as we’re tempted to immediately shame risky habits, we have to do so with a fuller understanding than just: “alcohol is bad.”

 

WHAT THE CLINICAL CRITERIA MISSES

By far the most common issue for people who struggle with alcohol isn’t the physical part, it’s the psychological part. If all you have is a physical dependence, then you’re also the type who can decide one day to stop or slow your drinking down and not skip a beat. But the fact is that over 90% of people who detox aren’t successful. That’s because the underlying drivers of drinking are what we need to be addressed.

If you can’t stay away from alcohol after a short period of abstinence, you know it’s psychological. You also know it’s psychological when you feel shame and guilt because you know you’re using alcohol to numb and escape difficult things you know you need to face in life.

 

WHY PSYCHOLOGICAL DEPENDENCE MATTERS

You could say to yourself that psychological dependence is just in the mind, and justify that it isn’t causing tangible harm. But that’s where I’d like to put this into context. If you depend on alcohol to numb or wash away your woes, it’s likely that your mind is a greater risk to you than the alcohol.

Why do I claim that? Evidence. We just reviewed that 2 drinks a day won’t, on average, change your life expectancy by even a year. That picture changes dramatically when we turn to the underlying psychological issues you may be using alcohol to avoid. For example, depression is associated with an average of 10 (for women) to 14 (for men) years of life lost.

So if we were to quantify the risk of someone who’s depressed and relies on two drinks a day to get by, we could say their depression is a 20 times greater risk than their drinking.

 

MY SIMPLE CRITERION

Here’s my definition of any addiction that puts this together in a way that makes sense for most people:

“Addiction is a learned behavior of looking outside of ourselves to relieve distress and control our emotional state.”

Just ask yourself: Do I drink to relieve distress and control my emotional state? I don’t care if it’s one drink, rare blackouts, or a bottle a night. If you’re escaping life with alcohol then it’s a problem, and you need to take it very seriously. Notice that I am inviting you to focus on your psychological health, not just the amount and outward consequences.

 

WHAT THIS MEANS FOR YOU

  1. Go see a doctor if you have concerns about physical damage from alcohol. You might be able to feel your gastritis, but you can’t feel your hypertension, blood cell abnormalities, hepatitis, or enlarged heart.
  2. Ask yourself if you use alcohol to numb or avoid life’s challenges. If you think you are, make sure to address your underlying psychological state. That could be diagnosable depression, but it also could be toxic relationships, a feeling of emptiness, or carrying past burdens.

The reason I created Self Recovery is to make that second route available to anyone privately and conveniently. I find that not enough people focus on the underlying drivers or don’t find the right type of help to make meaningful and lasting change. It’s common to avoid that emotional process, but it’s actually something that can be stimulating and deeply transformative.

 

See How Self Recovery Works

 

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Laursen, T. M., Musliner, K. L., Benros, M. E., Vestergaard, M., & Munk-Olsen, T. (2016). Mortality and life expectancy in persons with severe unipolar depression. Journal of affective disorders, 193, 203-207.

Daniel
I have always been obsessively curious about what actually causes human suffering to progress or continue. As a nationally respected leader in the addiction field, I created Self Recovery to bring the best available approaches to addiction to anyone online. The program draws on my medical training as a physician, my psychological expertise as a psychiatrist, and research from thousands of studies to provide a holistic approach to addiction care that can help you.

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