According to the 2017 National Survey on Drug Use and Health, more than 220 million people across the U.S. reported drinking alcohol in their lifetime.1 In 2016, 25.1% of adults over the age of 18 had at least one heavy day of drinking (4 or more drinks for women, 5 or more drinks for men) in the past year.2
Further, in 2016 more than 66 million Americans also reported binge drinking in the past month.1 Because alcohol is legal to consume in an adult population, is relatively easy to get, and is somewhat socially acceptable, it is one of the most addictive substances in the world. It has been estimated that around 18 million adults in the U.S. have an alcohol use disorder (AUD).3
Excessive alcohol abuse can lead to addiction and a host of additional emotional, physical, social, and behavioral issues as well. If you’re concerned about your level of alcohol use, or that of your loved one, below are some answers to common questions about problematic drinking and what constitutes “too much.”
What Is a Standard Drink?
In the U.S., per the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a standard drink contains around 14 grams (0.6 ounces) of pure alcohol.4 Generally, this amount of alcohol is found in:5
- 5 ounces of wine (12% alc. content).
- 8 ounces of malt liquor (7% alc. content).
- 12 ounces of beer (5% alc. content).
- 5 ounces or a “shot” of 80-proof (40% alc. content) distilled spirits or liquor (e.g., whiskey, vodka, gin, rum).
What Is Alcohol Abuse?
While isolated incidences of alcohol misuse alone do not necessarily meet the diagnostic criteria for an AUD, it can still point to problematic patterns of drinking that put individuals at risk for developing alcoholism. When a person begins to consistently abuses alcohol, it is frequently associated with issues at home, school or work and can put them in life-threatening situations (e.g., drunk driving, violence).
Though compulsive patterns of use vary, the concept of alcohol abuse also entails binge drinking and heavy drinking. The former is defined by NIAAA as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL.6 For men, that’s 5 drinks and 4 drinks for women in around 2 hours. Heavy drinking is when a person binge drinks on 5 or more days in a single month.6
Is There a Safe Level of Drinking?
The Dietary Guidelines for Americans 2015-2020 states that if alcohol is consumed, it should be done in moderation; according to these guidelines, this amounts to no more than 2 drinks per day for a man and 1 drink per day for a woman.7 For men, 4 or fewer drinks per day and 14 or fewer per week place them in the “low-risk” category for developing an AUD, according to the NIAAA. For women, it’s 3 per day and 7 per week. At these levels, roughly 2 out of every 100 people will develop an alcohol use disorder 6 About two out of every 100 people who consume alcohol within these limits suffer from alcohol addiction.6
What Is Considered Intoxicated?
Alcohol is a central nervous system depressant that interacts with several of the brain's chemical messengers to have mind-altering effects. In the United States, when a person's BAC is 0.08 g/dL or higher, they are considered above the legal limit for driving. However, this does not mean that a person can't be intoxicated at lower levels.
Per NIAAA, a general guideline of alcohol's effects based on BAC levels is as follows:8
- 0-0.05 g/dL: Mildly Impaired
- Speech, memory, balance, coordination, and attention are mildly affected.
- Sleepiness may set in.
- The person may feel happy and relaxed.
- 06-0.15 g/dL: Intoxicated
- Further impairment of speech, memory, balance, coordination, and attention occurs.
- Driving is significantly impaired.
- Increased aggression is possible.
- Judgment is compromised.
- There is elevated risk of injury to oneself and others.
- Increased drowsiness may occur.
- 16-0.30 g/dL: Severely Impaired
- Significant impairment of speech, memory, balance, attention, and coordination takes place.
- Blackouts or amnesia are possible.
- Dangerous impairment of decision-making abilities can occur.
- Loss of consciousness is possible.
- Nausea and vomiting are possible.
- 31-0.45 g/dL: Potentially Deadly
- Loss of consciousness is likely.
- Life-threatening suppression of vital life functions, such as breathing, heart rate, and blood pressure, is possible.
- There is a high risk of alcohol poisoning.
Does Alcohol Impact Everyone the Same Way?
Research shows that there are several factors that can influence how much, or how little, alcohol will affect people. Two people can drink the same amount in the same period of time, and one person may become more intoxicated than the other. Things like gender, metabolism, race, age, and how much food or water a person had before drinking all factor into the rate of onset and magnitude of intoxication.9 As such, genetics, biology, and environmental aspects all play a role in how alcohol is metabolized, and how quickly alcohol is metabolized influences intoxication levels.9,11 The more alcohol that remains in a person's system, the more impaired they will be, for instance.
In general, men are thought to process alcohol differently than women, leaving women more vulnerable to the adverse consequences of alcohol.10 Certain races may metabolize alcohol differently as well. For example, people of Asian descent may suffer from what is often termed the "Asian flush" when they drink, which is due to issues with alcohol metabolism related to a genetic variant; in these individuals, alcohol may have significantly more adverse impact.11
Taking other drugs while drinking alcohol can also increase alcohol's impact as can the presence of co-occurring mental health or medical disorders.
Can a Person Overdose on Alcohol?
An overdose or alcohol poisoning, occurs when alcohol reaches toxic levels in the bloodstream and begins to shut down basic life-support functions such as breathing, temperature and heart rate.8
Those who frequently binge drink are at a greater risk for an alcohol overdose. Alcohol dependence or alcoholism was identified as a factor in 30% of alcohol poisoning deaths in the U.S in 2015.12 The Centers for Disease Control and Prevention’s (CDC) latest estimates state that around 6 people per day died from alcohol poisoning in the United States from 2010 to 2012.
Signs of alcohol poisoning:
- Nausea and vomiting.
- Severe mental confusion.
- Weak pulse and irregular heart rate and blood pressure.
- Difficulties breathing, such as slow or irregular breathing.
- Bluish tinge to the skin and low body temperature.
- Loss of consciousness and inability to wake up.
If you suspect someone may be experiencing alcohol poisoning, call 911 immediately for emergency assistance.
What Is Alcoholism?
Alcohol addiction, or alcoholism, develops as a person becomes no longer able to stop drinking despite trying to, experiences emotional distress when not drinking, and continues to drink no matter the negative ramifications. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides diagnostic guidelines for an alcohol use disorder (AUD) based on individuals meeting two (or more) of the below outlined criteria within the same 12-month period:13
- Multiple attempts to stop drinking without success.
- Drinking more at a time and for longer than intended.
- Cravings for alcohol.
- Spending a lot of time getting alcohol, drinking it, and recovering from its effects.
- Giving up social or recreational activities to drink alcohol instead.
- Drinking interfering with fulfilling school, home, and/or work obligations.
- Continuing to drink despite negative interpersonal and social consequences of doing so.
- Knowing that drinking is causing physical and/or psychological issues and drinking anyway.
- Drinking in situations that are potentially dangerous (e.g., driving, using machinery, etc.).
- Developing a tolerance for alcohol that requires more to be consumed in order to feel its effects.
- Withdrawal symptoms when alcohol wears off.
Can a Person Be Dependent Without Being Addicted to Alcohol?
Alcohol dependence is often a sign of addiction, but in and of itself, it does not constitute addiction. Dependence is the physical manifestation of chronic drinking that occurs when the brain becomes accustomed to certain levels of alcohol being present and adjusts its chemistry accordingly.14 When alcohol wears off, a person can then feel acute withdrawal symptoms as the brain attempts to balance itself chemically. This may encourage a person to want to drink more in order to self-medicate these symptoms, which can lead to significant cravings and compulsive drinking.14 A person battling addiction may not only suffer from physical alcohol dependence and withdrawal, but may also be more likely to struggle with additional emotional, behavioral, and social consequences.
Is Alcoholism a Disease?
NIAAA defines alcoholism or an alcohol use disorder as a primary, chronic disease characterized by the inability to quit after attempts to do so, use despite its negative consequences, and a preoccupation with it.15 The American Society of Addiction Medicine (ASAM) goes on to explain that because it is a disease, it is an involuntary disability.16 This means, although individuals choose to drink initially, once they become addicted, it may out of their control to quit. Often, as the disease progresses, negative physical, emotional, and social changes are experienced such as repeated episodes of alcohol withdrawal, liver disease, changes in mood, marital problems, and/or job issues.16 For many, denial is also an integral part of the disease, making it harder for individuals to acknowledge their need for treatment.16
Can an Alcoholic Be Functional?
Although some individuals who regularly abuse alcohol may not meet the full DSM-5 criteria to be diagnosed with an alcohol use disorder, they may still show signs of problematic drinking behaviors. Even people who do meet criteria for AUD may continue to function surprisingly well in their lives up to a point. These types of people have colloquially been referred to as “functioning alcoholics,” which often implies that they can still fulfil career and social obligations while intoxicated. In fact, friends may jokingly approve of their high tolerance for alcohol during social situations.
It really is no laughing matter, however. Such a designation could be additionally counterproductive, as a so-called functional alcoholic may be even more likely to deny that an issue exists and be less likely to seek help for alcohol abuse.
Can Alcoholism Be Inherited?
Alcoholism is believed to have a strong heritable component, according to the DSM-5, with between 40–60% of the variance of risk being attributable to genetic factors.17 That being said, there is no one explanation for AUD. While someone may inherit a predisposition to the disorder, genes do not fully determine a person’s outcome. Alcoholism is thought to be equally tied to a person's environment, however, and not to genetics alone.18 High levels of stress, childhood trauma, and a lack of a supportive and stable home environment can all contribute to the onset of alcohol abuse and alcohol-related problems.
Is There a Cure for Alcoholism?
Alcoholism is a chronic disease that can be managed with medications, therapies, and support. As with many chronic illnesses, there is no easy cure. Specialized and professional treatment can help to manage symptoms of withdrawal and minimize relapse, while support groups and aftercare programs help to promote long-term recovery.
What Are the Symptoms of Alcohol Withdrawal?
Alcohol withdrawal can have significant physical and emotional effects that are best managed with the supervision and support of a medical detox program. The signs and symptoms of acute alcohol withdrawal may include:19
- Jitteriness and feeling "on edge."
- Depression and trouble feeling pleasure.
- Difficulties thinking straight, concentrating, and making decisions.
- Memory issues.
- Decreased appetite and possible anorexia.
- Muscle aches.
- Irregular heart rate and blood pressure.
Can I Quit Cold Turkey?
It’s easy to underestimate the amount of alcohol you consume daily or weekly. Especially in the setting of consistent drinking, it can also be hard to gauge whether you’ve developed significant physical dependence until attempts are made to cut back or quit. While stopping cold turkey is possible, for those with a severe physical dependence, it is ill-advised to do so.
Alcohol’s withdrawal symptoms may include extremely unpleasant and/or dangerous side effects, such as agitation or seizures. Typically, the more you drink regularly, the more likely you are to develop symptoms of withdrawal when stopping use.19 People who have previously experienced severe withdrawal may be at risk for going through it again. For those at risk of a severe or complicated withdrawal, medical supervision can provide a safe and more comfortable withdrawal process.
Is Detox Enough to Treat Alcoholism?
Following a period of chronic use, a person looking to quit alcohol use may need to need to first go through a detoxification or withdrawal management period.20 Since detox from alcohol, can be uncomfortable or dangerous when not managed properly, a supervised medical detox help minimize discomfort and ensure a safe withdrawal. Detox alone, however, is not a substitute for longer-term rehabilitation efforts.
Following detox, you may be encouraged to transition into an inpatient or outpatient rehabilitation program to continue your recovery work. A comprehensive treatment program that includes counseling and therapy sessions can address the psychological, behavioral, and social ramifications of addiction that detox alone is incapable of.21
What is Rehab?
Rehabilitation is the term used for a structured program of various treatment interventions designed to help individuals quit using drugs or alcohol. Once you’ve acknowledged the need for change and successfully go through detox, treatment is typically the next path toward sobriety. Regardless of your level of alcohol abuse, enlisting the aid of medical and mental health professionals can make your journey to a life without alcohol easier.
Group therapy, individual and family counseling, support group meetings, wellness activities, and medication treatments may be included as part of a comprehensive treatment plan.22 Behavioral therapies may also be used to help people recognize and change maladaptive thoughts and behaviors, respond better to triggers and stressors, and avoid relapse.22 Depending on the level of treatment needed, you may be treated in an inpatient or outpatient rehab setting.
Are Medications Used in Treatment?
There are three FDA-approved medications to treat alcohol addiction: naltrexone, acamprosate, and disulfiram. Naltrexone is an opioid receptor antagonist medication thought to block some of the reinforcement/reward that comes with continued alcohol use and may therefore help decrease drinking behavior.23 Acamprosate aids in reducing long-term withdrawal symptoms to decrease relapse risks, whereas disulfiram is used as a deterrent medication, as it can make drinking alcohol unpleasant by interfering with its breakdown.23
Topiramate is sometimes used off-label for the purpose of treatment alcohol dependence.23 Other medications may address specific symptoms of alcohol withdrawal during detox and treatment, such as antidepressants, sleep aids, or anti-nausea medications.
How Common Is Relapse?
Addiction is a chronic condition with estimated relapse rates between 40-60%—similar to other chronic diseases like hypertension, type I diabetes, and asthma.21 Those who struggle with AUD may relapse multiple times, yet it does not mean that treatment didn't work. For many people, relapse is a part of recovery. Should relapse occur, it could signal the need for some treatment adjustments and a re-commitment to recovery efforts with professional help and support.24
A big part of helping to reduce relapse is also adequate addiction treatment length.24 Although there is no predetermined length of time that works for every person, research shows that 90 days is effective in providing more positive outcomes.24 Rehab recovery programming that includes behavioral therapy helps teach healthy coping mechanisms for potential stressors that can be used long into recovery to reduce relapse.
Regular attendance of support group meetings, such as Alcoholics Anonymous (AA), can also help to manage relapse risks.25 Making healthy peer connections while avoiding people, places, and things that might be triggers for relapse is highly beneficial during recovery. Family therapy is another way to ensure that all members of the household are on the same page and understand how to reduce possible stressors and communicate more effectively. Peer and family support can go a long way in minimizing relapse and fostering ongoing recovery.
Does a Person Need to Hit Rock Bottom to Get Help?
Alcoholism is a treatable disease, with a variety of available treatment options, ranging from outpatient services to residential treatment programs. Anyone struggling with alcohol abuse can benefit from some level of substance abuse treatment program. Relatively milder cases of compulsive alcohol use may be circumvented at an earlier stage with appropriate screening and intervention, and more severe cases of alcoholism can be managed through an appropriate level of rehabilitation or treatment to improve overall quality of life.
Contrary to the long-held belief that a person needs to get arrested; lose their job, family, or home; or otherwise hit “rock bottom” in order to benefit from, or perceive the need for, alcohol treatment; anyone at any stage of the disease can get help.
If you or someone you know is ready to discuss treatment, our admissions navigators are available 24/7 to speak with you today. The type of treatment that will be most suitable for you will likely be influenced by your alcohol history, other substance use history, previous attempts at treatment, level of physical dependence, any co-occurring medical and/or mental health conditions, and your current situation.
. Substance Abuse and Mental Health Services Administration. (2018). 2017 National Survey on Drug Use and Health.
. Centers for Disease Control and Prevention. (2017). Alcohol Use.
. MedlinePlus. (2019). Alcoholism and Alcohol Abuse.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). What Is A Standard Drink?
. Centers for Disease Control and Prevention. (2018). Frequently Asked Questions.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Drinking Levels Defined.
. Office of Disease Prevention and Health Promotion. (2015). Dietary Guidelines for Americans 2015-2020.
. National Institute on Alcohol Abuse and Alcoholism. (2018). Understanding the Dangers of Alcohol Overdose.
. National Institute on Alcohol Abuse and Alcoholism. (2007). Alcohol Metabolism: An Update. Alcohol Alert.
. National Institute on Alcohol Abuse and Alcoholism. (2017). Women and Alcohol.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Ethnicity and Health Disparities in Alcohol Research.
. Centers for Disease Control and Prevention. (2015). Alcohol Poisoning Deaths.
. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing; 490-491.
. Becker H. C. (2008). Alcohol Dependence, Withdrawal, And Relapse. Alcohol research & health : The Journal of the National Institute on Alcohol Abuse and Alcoholism, 31(4), 348–361.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Use Disorder.
. American Society of Addiction Medicine. (1990). Public Policy Statement on the Definition of Alcoholism.
. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing; 490-491.
. Anstee, Q., Knapp, S., Maguire, E., Hosie, A., Thomas, P., et. al. (2013). Mutations in the Gabrb1 gene promote alcohol consumption through increased tonic inhibition. Nature Communications, 4 (2816).
. MedlinePlus. (2019). Alcohol Withdrawal.
. National Institute on Drug Abuse. (2016). Medical Detoxification.
. National Institute on Drug Abuse. (2018). Treatment and Recovery. Drugs, Brains, and Behavior: The Science of Addiction.
. National Institute on Drug Abuse. (2018). Principles of Effective Treatment.
. National Institute on Drug Abuse. (2018). Alcohol Addiction.
. National Institute on Drug Abuse. (2018). How Long Does Drug Addiction Treatment Usually Last?
. National Institute on Alcohol Abuse and Alcoholism. (2011). The Role of Mutual-Help Groups in Extending the Framework of Treatment. Alcohol Research & Health, 33(4).