“Am I an alcoholic?” or “Do I have a drinking problem?” is something a person who drinks frequently or has problems because of alcohol might ask. The short answer is that anyone who experiences concerns or troubles due to alcohol use likely has a drinking problem. A problem with alcohol does not necessarily make a person an alcoholic, though. Exploring the differences between alcohol abuse and alcoholism can help people determine whether they have an addiction.
Pervasive Alcohol Use Within Society
Drinkers come in all shapes, sizes, genders and backgrounds. And often times, when looking at your own drinking behavior, it can be difficult to gauge whether the amount and frequency of such use constitutes relatively “safe” levels of drinking or perhaps has already crossed into more problematic or dangerous territory—that which might place you at higher risk of developing an alcohol use disorder (AUD) or alcoholism.
In today’s society, cultural norms, media exposure, societal factors, and social contexts play a big role in creating a drinking culture that glorifies excessive alcohol use.1 However, this kind of thinking can be problematic. Alcoholism affects more than 14 million people aged 12 and older across the globe, according to the 2017 National Survey on Drug Use and Health (NSDUH).2
This worldwide issue cost the U.S. almost a quarter trillion dollars in 2010 and excessive alcohol use is known to kill about 88,000 people in each year according to the Centers for Disease Control Prevention.3 More than that, however, alcoholism can cost individuals their jobs, family and/or their lives.
Below, we discuss alcoholism, how it is diagnosed, who may be at risk, what is considered a “safe” level of drinking, how to do a self-assessment test on your own, and what you should do if you believe you may have a problem with alcohol.
What is Alcohol Use Disorder?
This chronic, relapsing disorder is diagnosed based on an individual meeting certain criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Individuals must meet any two of the below criteria within the same 12-month period to be diagnosed with AUD:4,5
- Spending a lot of time obtaining, using, and recovering from the effects of alcohol.
- Cravings, or a strong desire to use alcohol.
- Being unable to cut down on alcohol use despite a desire to do so.
- Continuing to abuse alcohol despite negative interpersonal or social problems that are likely due to alcohol use.
- Using alcohol in physically dangerous situations (such as driving or operating machinery).
- Drinking more or for a longer time than originally intended.
- Continuing to abuse alcohol despite the presence of a psychological or physical problem that is probably due to alcohol use.
- Being unable to fulfill major obligations at home, work, or school because of alcohol use.
- Giving up previously enjoyed social, occupational, or recreational activities because of alcohol use.
- Having a tolerance (i.e. needing to drink increasingly large or more frequent amounts of alcohol to achieve the desired effect).
- Developing symptoms of withdrawal when efforts are made to stop using alcohol.
What Is Considered a “Safe” Level of Drinking?
According to the Dietary Guidelines for Americans 2015-2020, drinking up to 1 standard drink per day for women and up to 2 standard drinks per day for men is considered a “moderate” level of drinking.6 In the U.S., a standard drink contains around 14 grams (0.6 ounces) of pure alcohol which is typically found in:6
- 5 ounces of wine (12% alcohol content).
- 8 ounces of malt liquor (7% alcohol content).
- 12 ounces of beer (5% alcohol content).
- 5 ounces or a “shot” of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., vodka, whiskey, gin, rum).
The National Institute on Alcohol Abuse & Alcoholism (NIAAA) defines binge drinking as a pattern of consumption that brings blood alcohol concentration (BAC) levels to 0.08 g/dL.6 For men, this typically occurs after 5 drinks and 4 drinks for women within a 2-hour time frame.6 The Substance Abuse and Mental Health Services Administration (SAMHSA) defines heavy alcohol use as 5 or more days in the past month of binge drinking.6 While binge drinking and excessive use do not always mean a person has AUD, they do increase an individual’s risk of developing the disorder.7
Women who have no more than 3 drinks on a given day and no more than 7 per week are considered to be in a low-risk category for developing AUD, according to the NIAAA.6 For men, the low-risk group is defined as no more than 4 drinks on a given day and no more than 14 per week.6
What is Alcohol Withdrawal?
Acute alcohol withdrawal is an indication of physiological alcohol dependence, which itself is a potential indicator of alcohol use disorder and/or a sign of risky patterns of drinking. When a person struggling with chronic or long-term alcohol abuse quits drinking, they may experience symptoms of withdrawal.8 Symptoms may range from mild to physically dangerous, and may include:8
- Mood swings.
- Loss of appetite.
- Increased heart rate.
- High blood pressure.
- Shakes or tremors.
- Delirium tremens. (rare)
The full range of symptoms may persist for as little as a few hours up through several weeks after withdrawal has begun. Some relatively mild symptoms may be experienced as soon as 8 hours after the last time alcohol is consumed.9 Depending on the magnitude of physical dependence, additional symptoms may arise beyond 24 hours, with some potentially severe effects emerging 72 hours after abstinence.9 In many cases, symptoms will begin to resolve within 40-50 hours.10
Alcohol Use Disorder Assessment Tests
If you’re unsure if your drinking places you at risk for developing AUD, or if you think you may already be struggling with alcoholism, there are several assessment tests which can be completed to better understand your level of alcohol use. Some of these assessments include:
CAGE: CAGE is a simple assessment that can help to identify alcohol problems using a 4-question test.11
C – Have you ever felt you should cut down on your drinking?
A – Have people annoyed you by criticizing your drinking?
G – Have you ever felt bad or guilty about your drinking?
E – Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
Two positive responses indicate further assessment is necessary.
MAST: The Michigan Alcohol Screening Test (MAST) is a self-scoring questionnaire developed in 1971 to help identify alcohol dependent drinkers.12,13 Different forms of the test have been utilized over the years, with various iterations containing as few as 10 to more than 20 yes/no questions to assess the presence and severity of a person’s drinking. It is still considered one of the most accurate screening tests.
AUDIT: The Alcohol Use Disorders Identification Test (AUDIT) was created by the World Health Organization as a tool to detect alcohol problems experienced within the past year. A score of 8 or more on typically indicates harmful or hazardous drinking.
While helpful, self-assessment with these tests should not be considered as a final diagnosis but can be useful in determining whether your current drinking habits may put you at risk of an AUD.
Financial Benefits of Quitting Drinking
While it may seem difficult or impossible, quitting drinking is achievable. Along with regaining control of your life, there are financial benefits to abstinence that can help you save more money daily, weekly, monthly or yearly.
According to the Centers for Disease Control and Prevention (CDC), Americans spent around $249 billion on alcohol in 2010.14 Per person, that breaks out to about $807 a year.14 However, that number is likely much higher for binge drinkers and heavy alcohol users since they are consuming considerably more drinks per day than the average consumer.
To calculate how much money you spend on alcohol, online tools such as an alcohol spending calculator can be helpful in seeing how much you could potentially be saving by quitting drinking. For example, if you drink 7 days a week and 5 drinks a day at $8 a beverage, you’re likely spending around $280 a week, $1,213 a month, and $14,560 a year. With what you could be saving a year, it could mean a new car, vacation with your loved ones, or used for unexpected expenses that may arise in the future.
Further, anyone caught drinking and driving may be charged with a DUI which can be extremely costly. There are a number of fees associated with a DUI, and while they vary state-to-state, they typically include fees for bail, attorneys, court fines, court-mandated classes, and public transportation costs due to the loss of a license. You can also expect to pay higher insurance rates and pay for DMV administrative hearings and fees to reinstate your license.
While exact amounts may vary, below are some rates you can expect to incur if charged with a DUI:15
- Bail from jail can range from $100 to $2,500.
- Car towing or impound fees may be around $600+ a day.
- Attorney fees can vary, but for first-time offenders, rates may be around $1,500-$5,000.
- Court fines can range anywhere from $1,500-$2,100.
- Court-mandated DUI education and counseling classes can range from $1,000-$3,000.
- Some states require all DUI offenders to have their vehicles fitted with an ignition interlock device that may range between $500 and $1,500.
- DMV administration hearings may cost around $850.
- Licensing fees and license reinstatement can range from $20 to $200.
- Insurance premiums will go up and increase anywhere between $1,000 and $10,000, depending on the situation, the insurance company, etc.
Altogether, a first-time DUI offense could potentially cost an individual anywhere from $10,000 to $25,000 when all is said and done.
Treatment for Alcoholism
No matter how serious the problem seems, anyone can recover from alcoholism. Though earlier treatment may help prevent the accumulation of many of the adverse consequences of compulsive drinking—it’s never too late to get help. According to NIAAA, research showing that rehab can be very effective, with about 1/3 of people showing no further symptoms 1 year after alcohol treatment.16 Many others also significantly reduce their drinking after treatment and have fewer alcohol-related problems.16
A wide range of treatment options exist for the treatment of alcohol use disorder, including inpatient and outpatient settings. Inpatient treatment facilities offer stays within a residential facility for the duration of treatment where you’ll receive round-the-clock care and monitoring. Some require long-term residential stays while others may attend shorter-term treatment for 3–6 weeks.17
Outpatient treatment may be an option if there is no need for intensive medical detox and withdrawal management (such as for those cleared by a physician as being low risk for complicated withdrawal) or otherwise for people with strong systems of support, less severe addictions, and fewer addiction-related issues. This level of treatment often provides the same types of programming as inpatient facilities but is relatively less time intensive. Individuals in recovery are able to return home or to other living situations outside of treatment hours.
Amenities and services vary by facility and treatment setting, but most offer a variety of recovery programming that includes behavioral therapy, individual and group counseling sessions, and relapse prevention skills training.18
If you are 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, any co-occurring medical and/or mental health conditions, and your current living situation.
. U.S. National Library of Medicine. (2016). Social and Cultural Contexts of Alcohol Use.
. Substance Abuse and Mental Health Services Administration. (2018). 2017 National Survey on Drug Use and Health.
. Centers for Disease Control Prevention. (2018). Excessive Drinking is Draining the U.S. Economy.
. National Institute on Alcohol Abuse and Alcoholism. (2018). Alcohol Use Disorder.
. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing; 490-491.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Drinking Levels Defined.
. Centers for Disease Control and Prevention. (2018). Frequently Asked Questions.
. Bayard, M., Mcintyre, J., Hill, K.R., Woodside, J. Alcohol Withdrawal Syndrome. American Family Physician 69(6): 1443-1450.
. MedlinePlus (2016). Alcohol Withdrawal.
. National Clinical Guideline Centre. (2010). Acute Alcohol Withdrawal.
. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Screening Tests.
. Selzer, M.L. (1971). The Michigan Alcoholism Screening Test (MAST): The Quest for a New Diagnostic Instrument. American Journal of Psychiatry, 3:176-181.
. Substance Abuse and Mental Health Services Administration. (n.d.). Michigan Alcohol Screening Test.
. Centers for Disease Control and Prevention. (2018). Excessive Drinking is Draining the U.S. Economy.
. The Department of Administration Division of Motor Vehicles. (n.d.). DUI Consequences & Alternatives.
. National Institute on Alcoholism and Alcohol Abuse. (2014). Treatment for Alcohol Problems: Finding and Getting Help.
. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
. National Institute on Drug Abuse. (2018). Principles of Effective Treatment.