Signs To Spot An Alcoholic

Alcohol use disorder (AUD), commonly referred to as alcoholism, is a common medical condition. It is characterised by a person's inability to stop or control their alcohol consumption despite adverse social, occupational, or health consequences. While the amount and frequency of alcohol consumption are factors in determining alcoholism, they are not the sole determinants. A person may be diagnosed with AUD if they meet two or more specific criteria within a 12-month period, such as consuming more alcohol than intended, experiencing cravings, or engaging in risky behaviours while intoxicated. Treatment options for AUD include medication, behavioural therapy, support groups, and medical detoxification. It is important to recognise the signs of problematic alcohol consumption and seek help early to effectively address alcohol-related issues.

Understanding alcohol use disorder (AUD)

Alcohol use disorder (AUD) is a medical condition characterised by a person's impaired ability to stop or control their alcohol consumption despite adverse social, occupational, or health consequences. AUD can be mild, moderate, or severe, and is considered a brain disorder. AUD encompasses conditions that some refer to as alcohol abuse, alcohol dependence, alcohol addiction, and alcoholism.

A person with AUD may be unable to stop drinking even when it negatively impacts their health, safety, and personal relationships. They may also experience withdrawal symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, dysphoria, malaise, feeling low, or a seizure. AUD can be diagnosed by doctors when drinking causes health problems, distress, or harm to a person's life. A healthcare provider may also perform a physical examination to look for symptoms of conditions that AUD may cause.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is used to assess whether a person has AUD and to determine its severity. The DSM-5 criteria include questions such as whether drinking has interfered with taking care of one's family, caused job or school troubles, or led to dangerous situations. AUD can also be influenced by genetics, family history, mental health conditions, and trauma.

Treatment for AUD includes behavioural therapy, support groups, and medication. Evidence-based treatment approaches can help individuals with AUD achieve and maintain recovery, and studies show that most people with AUD can reduce their alcohol consumption or stop drinking entirely.

Recognising signs of binge drinking

Binge drinking is defined by the CDC as "when men consume five or more drinks or women consume four or more drinks in about two hours". This typically brings a person's blood alcohol concentration to 0.08 grams percent or above. Recognising binge drinking in yourself or others can be challenging, but there are some signs to look out for:

You go all out on the weekends

Binge drinking is often not a daily habit, and those who binge drink may be able to function well at work and at home. However, this does not mean that weekend binge drinking is not a problem. Binge drinking is inherently risky and can lead to serious health issues and alcohol poisoning.

You always binge drink

Even if you only drink occasionally, if you find that you are unable to drink in moderation and always consume a large amount of alcohol in a single session, this is a warning sign. Binge drinking negates any potential health benefits of alcohol and can lead to serious issues.

Your drinking is causing problems in your life

If your drinking is causing issues in your work, home, social, or school life, it is a problem. Alcohol use disorder is characterised by an inability to stop drinking even when it negatively impacts your health, safety, and personal relationships.

Your drinking is causing health problems

Shaking hands, esophageal bleeding, ulcers, raised blood pressure, and increased risk of cancer are all potential health consequences of binge drinking. If you are experiencing any health issues that you believe may be related to your drinking, it is important to seek medical advice.

Friends, family, or coworkers are worried about your drinking

If the people around you are expressing concern about your drinking, it is important to take their concerns seriously. They may recognise something that you do not, and it is crucial to seek help if your drinking is causing worry for those around you.

Knowing what constitutes excessive drinking

Excessive drinking is a term that covers binge drinking and heavy drinking, both of which are legal and socially encouraged. Excessive drinking can lead to alcohol use disorder (AUD) and alcoholism. While excessive drinking is common, it can be hard to keep track of how often one drinks alcohol.

Heavy drinking is defined as more than four drinks in a day or more than 14 drinks per week for men. For women, heavy drinking is defined as more than three drinks in a day or more than seven drinks per week. Binge drinking is defined as drinking with the specific purpose of getting drunk.

While drinking heavily or binge drinking occasionally may not cause lasting damage to a healthy person, regular heavy drinking can cause harm both physically and mentally. Alcohol is a toxin that the liver has to flush out of the body. Regular heavy drinking can lead to liver damage, including alcoholic fatty liver disease and cirrhosis. It can also cause heart disease, gout, pancreatitis, and mental health issues such as depression and dementia. Alcohol can damage the cells in the mouth, throat, voice box, and oesophagus, and there is a clear link between heavy alcohol use and many types of cancers.

The NHS advises that drinking more than 14 units of alcohol a week risks damaging one's health. This is considered low-risk drinking, as there is no safe drinking level. The less one drinks, the lower the health risks.

Identifying high-functioning alcoholics

High-functioning alcoholics are individuals who seem to have their lives together but are secretly battling alcohol addiction. They are often successful in their professional and personal lives, making it difficult for them and those around them to recognize that they have a problem. They may be able to carry out daily tasks such as work, hygiene, childcare, and social activities without exhibiting the full range of clinical impairments associated with alcohol use disorders (AUD).

However, despite their outward success, they may be dealing with inner turmoil or challenging circumstances, turning to alcohol for temporary relief. They often consume alcohol in quantities that exceed the recommended limits but manage to hide their dependence due to their ability to function effectively. They might exhibit patterns such as abstaining from drinking during the week and binge drinking on weekends, further complicating the identification of their condition.

• Personality changes: High-functioning alcoholics may experience significant personality changes when consuming alcohol. These changes can range from becoming more outgoing and sociable to exhibiting aggressive or depressive behavior. Alcohol can impair cognitive function, leading to altered judgment and increased impulsivity.
• High tolerance: High-functioning alcoholics often have a high tolerance for alcohol, meaning they can consume large amounts without appearing intoxicated. Their bodies have adapted to the regular intake of alcohol, requiring more and more to achieve the same effects.
• Denial and defensiveness: Admitting to an alcohol addiction is not easy. High-functioning alcoholics may deny having a drinking problem and justify their habits by focusing on their ability to function in daily life. They may also be defensive about their drinking habits, downplaying their consumption or avoiding conversations about getting help.
• Using alcohol as a coping mechanism: High-functioning alcoholics often use alcohol to cope with stress, anxiety, and other uncomfortable emotions. While this may seem effective in the short term, it can result in a cycle of dependence that exacerbates existing problems and leads to further emotional distress.
• Impact on relationships and professional life: Despite maintaining a facade of normalcy, high-functioning alcoholism can negatively affect relationships and professional life. The consistent consumption of alcohol can lead to decreased motivation and poorer performance over time.

If you or someone you know is exhibiting signs of high-functioning alcoholism, consider seeking advice from a doctor or another medical professional. Early intervention can help prevent further progression of the disease and the development of alcohol-related physical or mental health complications.

Seeking professional assessments

If you are concerned about your drinking or someone else's, a good first step is to see a healthcare provider. Doctors can diagnose alcohol use disorder (AUD) or alcoholism by performing a physical examination and looking for symptoms of conditions that heavy drinking may cause. They will use the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which classifies AUD as mild, moderate, or severe.

Mild AUD is characterised by the presence of two to three symptoms from a list of criteria. These include drinking more than intended, trying to cut down on drinking without success, spending a lot of time drinking or hungover, craving alcohol, engaging in risky activities while intoxicated, and continuing to drink despite problems with relationships. Moderate AUD is characterised by four to five symptoms, and severe AUD is characterised by six or more symptoms.

AUD treatment depends on the severity of the condition. Mild cases may be treated with behavioural therapy, counselling, or self-help groups. For severe cases, healthcare providers may recommend inpatient medical treatment or residential rehabilitation. Medication such as naltrexone and acamprosate can also be used to treat AUD.

There are also some self-assessment tools available to help determine if someone has a problem with alcohol. One such tool is the AUDIT, a 10-question test developed by the World Health Organization (WHO) to help identify unhealthy alcohol use, alcohol dependence, and any consequences associated with alcohol consumption. However, it is important to note that these self-assessment tools are not a substitute for professional medical advice, diagnosis, or treatment. While they can be a good starting point, it is always best to seek the guidance of a professional to perform a comprehensive assessment and determine the most appropriate treatment plan.

Frequently asked questions