How can you tell when you have crossed the line from social drinking to problem drinking?
As a therapist who specializes in addiction, I often get asked the question: “Do I have a problem with drinking if I drink every day?” Frequently, the questions concern a loved one who seems to be drinking more or whose character changes after two drinks. The answer is never straightforward. No single road leads to problem drinking. It can develop subtly over time or it can escalate profoundly with major changes in life. Retirement, bereavement, a new job, or relocation can all be triggers for “self-medication.”
To understand the process, it is important to know what is considered moderate or safe drinking as well as the behavior that indicates alcohol abuse. Moderate or safe drinking is generally defined as two drinks a day for men and one drink a day for women. For individuals who are 65 or older, the safe level of drinking for both men and women decreases to only five to seven drinks a week. So it becomes very easy to cross the line into problem drinking.
Several clinical assessments have been developed to help health-care professionals to screen for problem drinking.* The simplest of these assessments is the CAGE test, which consists of four questions. An individual likely has a drinking problem if he or she has a positive response to one to the following four questions:
- Have you ever felt that you should cut down on your drinking?
- Have people annoyed you by criticizing your drinking?
- Have you ever felt guilt about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves?
Alcohol or substance abuse is defined in the Diagnostical and Statistical Manual of Mental Disorders IV as drinking that produces one or more of the following situations within a year:
- Repeatedly failing to fulfill major work, school, or home responsibilities
- Drinking in situations where it is physically dangerous to do so, such as driving a car, boat, or operating machinery
- Recurrent alcohol-related legal problems
- Continued drinking despite ongoing relationship problems either caused or worsened by drinking
If you don’t meet the criteria for problem drinking, it doesn’t mean you should congratulate yourself and pour another drink. Problem drinking can lead to the development of many diseases involving the liver, pancreas, digestive system, and the heart. It contributes to impaired judgment as well as falls, fights, or motor vehicle accidents. It is also unhealthy because of all the empty calories it adds to your diet.
Maybe it is time to cut back? Keep a journal of how much you’re drinking each week and then set a drinking goal. Select a few days a week to be alcohol-free and steer clear of people, places, and events that are triggers for drinking. You may be surprised by how different you feel after you have stopped drinking alcohol for just a few days or weeks. If you or someone you love is developing a problem with drinking or even with other forms of self-medication, sit down with him or her and express your concerns. If the problem persists, remember to take care of yourself and don’t make it easier for your loved one by protecting him or her from the consequences of drinking. If it is clearly apparent that there is ongoing alcohol abuse which is escalating, consider arranging an intervention and finding a treatment center covered by your insurance. Florida has one of the largest number of addiction recovery treatment centers in the U.S., with many treatment options available.
Two other clinical tests are the Michigan Alcohol Screening Test or MAST and/or the AUDIT which was developed by the World Health Organization. Clicking on either of those mental health links will take you to the clinical tests described.