Are You an Alcoholic?
The term “alcoholic” not only is confusing – but it can also be harmful to those who really need help but don’t seek it out due to shame and stigma. Labeling someone as an “alcoholic” or an “addict” defines a person by their behavior, creating the illusion that the problem drinker is powerless and cannot take responsibility to change.
Before we define healthy drinking, it’s important to understand how alcohol is measured. In the United States, a standard drink is any drink that contains 0.6 ounces (14.0 grams or 1.2 tablespoons) of pure alcohol. Generally, this amount of pure alcohol is found in:
12-ounces of regular beer or wine cooler.
8-ounces of malt liquor.
5-ounces of wine.
1.5-ounces of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).
Most people underestimate their drinking – not because they are lying to themselves – but because they do not correctly measure the amount of alcohol they are consuming.
Let’s say you go to the bar and order a vodka-tonic. Even though a standard drink of vodka is only 1.5 ounces, bartenders often overpour. Jiggers used to measure liquor for cocktails may not accurately measure the amount.
One group of researchers studied bars and restaurants in Northern California, observing the bartenders and measuring the size of their pours (Kerr, Patterson, & Greenfield, 2008). In total, 480 drinks were measured among 80 bars and restaurants. On average, bartenders poured a glass of wine that was 43% larger than a standard 5 ounces of wine, mixed drinks that were 43% larger than a standard 1.5-ounces of liquor, and draft beers that were 22% larger than the standard 12 ounces of beer. Authors of the study concluded that those who think they have had four drinks may, in fact, have had six.
Even if you prepare your own drinks, ask yourself how often you actually measure your intake. For most people, the answer is “never.” Without measuring the actual amount of alcohol, your moderate drinking can turn into problem drinking without you even realizing it.
TYPES OF PROBLEM DRINKING
Overdrinking. Much like overeating, overdrinking is when consumption exceeds safe or reasonable limits. Not all overeaters become obese, and not all overdrinkers become chemically dependent. That said, overdrinking presents a greater risk of immediate harm than the gradual development of chemical dependency. CDC guidelines define excessive alcohol consumption, or “overdrinking,” at 4 drinks for women and 5 drinks for men during a single occasion. Why the gender difference? Women metabolize alcohol differently from men do to biology and body composition.
Let’s look at one example of overdrinking. Wendy is a 36-year-old lawyer who is an associate at a prestigious firm. Wendy and her fiancé, Mark, share a condo in a neighborhood they love. Wendy and Mark enjoy cooking together and having wine with dinner. Sometimes, the two of them will polish of a bottle of wine each, although they are careful to not drink that amount more than twice a week. One bottle of wine contains 5 standard drinks.
Using CDC criteria, Wendy would be characterized as an overdrinker, whereas Mark would not. In this example, the guidelines of “overdrinking” may seem unfair. Why is Wendy the one who appears to have a drinking problem? The bottom line is that criteria for overdrinking aren’t meant to diagnose someone as being an alcoholic. The criteria ARE intended to help people understand the point at which alcohol begins to damage the human body. It is well known that chronic overdrinking can lead to disability, decreased quality of life, and early death.
Mindless Drinking. Not all drinking situations are created equal. There is nothing unusual about drinking at a house party where others are drinking. However, the situation becomes mindless drinking when you get behind the wheel and drive yourself home after that party. Even if your BAC is within the legal limit and less than .08, it is likely that your judgment, perception, attention, and other mental functions have been compromised if you consumed alcohol before you got behind the wheel.
Mindless drinking is all about the situation and whether or not drinking is safe and appropriate. If you drink before operating heavy machinery or performing a task where others have put their lives in your hands, you are engaging in dumb drinking. Other forms of dumb drinking include drinking games, contests, or hazing rituals. Most people are unable to use their better judgment when they are in these kinds of peer-pressure situations – regardless of their age.
“Pre-gaming,” or drinking before leaving the house, often sets people up for dumb drinking because they feel less inhibited once they arrive at the social event. The same effect of alcohol that allows people to feel “at ease” and “more comfortable” when they attend social occasions also increases the likelihood of mindless drinking. Mindless drinking can lead to negative consequences such as saying something embarrassing or doing something humiliating.
Abusive Drinking. You use alcohol as a crutch to deal with stress, anxiety, and feelings of depression. Perhaps you drink alcohol even though it interacts poorly with your medications. People who engage in alcohol abuse drink in spite of negative consequences, often drinking as a way to "cope." Unfortunately, sometimes the negative consequences of substance abuse are not immediately apparent. A young adult may go to his doctor for a blood test and learn that his liver enzymes are "slightly elevated," which indicates early signs of fatty liver disease. You also engage in alcohol abuse if drinking frequently leads to your use of illicit drugs that you would not otherwise use if sober. Abusive drinking always hurts you.
Dependent Drinking. Contrary to popular belief, dependent drinkers don’t always show classic signs of alcohol withdrawal such as tremors, shakiness, rapid heartbeat, or sweating. Instead, a sure sign of dependence is that drinking has taken over your life. The insidious process leading to alcohol dependence can happen gradually, over months or years, but once it arrives, it’s there to stay.
If you are alcohol dependent, you may spend increasingly more time drinking, being intoxicated, or recovering from being drunk. You may spend more money on alcohol than you did when you first started drinking. Over time, as your priorities shift to drinking, you slowly become isolated from friends, family, and neighbors. Alternatively, you may notice that you are spending more time with people who are also heavy drinkers. The idea of going to an event where there is no alcohol makes you uncomfortable. You may lose interest in hobbies or activities that you once enjoyed. Even if you have a spouse, children, or grandchildren who want to spend time with you, your primary relationship is the one you have with alcohol.
At this stage of drinking, alcohol really DOES feel like a friend or a loved one. Alcohol is always there for you. It is a reliable friend that provides consistent effects. Alcohol doesn’t argue, fight, make demands, or tell you that you are inferior. You feel that alcohol has unconditional love for you at a time when other people are pulling away. If you are a dependent drinker, you may have made attempts to cut down or quit. The problem is that even after cutting down or going without alcohol for a while, when you drink again you always end up right where you left off– dependent drinking.
Although it may seem as though most people drink, about one-third of Americans don’t drink alcohol – ever (Miller and Munoz, 2013). Half of Americans drink less often than once a month. If you engage in problem drinking and want to regain control of your life, you have two options: total abstinence or moderation. Which one is right for you? SS
Center for Disease Control (nd). Alcohol and public health. Retrieved January 21, 2014 from http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm Kerr, W.C., Patterson, D., Koenen, M.A., Greenfield, T.K. (2008). Alcohol content variation of bar and restaurant drinks in Northern California. [Electronic version].
Alcoholism Clinical and Experimental Research, 510, 597-3440. Miller, W. & Munoz, R. (2013). Controlling your drinking: tools to make moderation work fir yiu (Second Edition). New York, NH: Guilford Press National Institute on Alcohol Abuse and Alcoholism (nd). What is a standard drink? Retrieved January 21, 2014 from http://www.niaaa.nih.gov/alcoholhealth/overview-alcohol-consumption/standard-drink