When someone you know has a drinking problem, you might wonder at what point he or she would be considered an alcoholic or someone with an alcohol addiction. Precisely defining those terms can be difficult.
Stephen Gilman, MD, an addiction specialist in New York City, said that alcohol addiction is a broad term. Medically, psychiatrists look at alcohol abuse and alcohol dependence in different ways. In contrast to alcohol abuse, people with alcohol dependence experience physical withdrawal symptoms when they stop drinking. As Dr. Gilman pointed out, “Dependence includes everything that defines abuse plus physical dependence, tolerance, and withdrawal.”
Alcoholism: Understanding Abuse
Medical experts consider abuse to be the regular use of a substance that leads to serious psychological and/or physical disability. If the person demonstrates one or more of the following during the same year, he or she is considered to be a substance abuser:
Repeated substance use to the point of not being able to meet responsibilities — not performing well at work, being suspended from school, being repeatedly late or absent from required duties, or neglecting household tasks.
Repeated substance use when there is risk involved, like operating equipment or driving a car while under the influence.
Repeated difficulties with the law related to substance use — being arrested for physical aggression or drunk driving, for instance.
Insisting on using the substance regardless of continued or repeated personal or social difficulties because of it, verbal or physical aggression with a loved one, or frequent arguments about the substance use.
Alcoholism: Understanding Dependence
When heavy alcohol use leads to an actual physical need to drink, people are said to have alcohol dependence. Dependence is defined as habitual use leading to significant psychological/physical impairment demonstrated by three or more of the following within the same year:
Needing greater amounts of alcohol to satisfy cravings.
Going through withdrawal when not using alcohol, with symptoms such as tremors, restlessness, and agitation.
Taking the substance or a similar one to avoid the effects of withdrawal.
Using the substance longer than planned or more frequently and in greater amounts.
An inability to reduce use, despite a sincere wish to do so.
Spending a significant amount of time trying to acquire the substance.
Spending less time at work or on other activities because of substance use; a person may completely abandon previously enjoyable activities.
Continuing to drink despite being aware that alcohol is causing psychological or physical difficulties.
Alcoholism: Severity Differences and Signs
James Garbutt, MD, professor of psychiatry at the University of North Carolina at Chapel Hill and a researcher at the Bowles Center for Alcohol Studies, said that a person can experience many alcohol-related problems, or just two or three, and nevertheless be considered an alcoholic. “One can drink four to five beers and meet diagnostic criteria, or drink two fifths of bourbon a day and meet the criteria.”
The more problems a person has in his daily life, the more severe the addiction. To determine the severity of alcohol addiction, Gilman said to ask yourself the following questions:
Does he frequently say inappropriate things?
Is his balance off when he walks?
Is his speech often slurred?
Is he often noticeably drunk?
Does he miss work?
Has he gotten into trouble with the law for drinking and driving?
Is he having health issues related to alcohol addiction, such as heartburn, liver problems, high blood pressure, or insomnia?
Alcoholism: Looking in the Mirror
If you suspect that you have a drinking problem, there are steps you should take right away. “The CAGE is a brief questionnaire that you can take to help determine if you have a problem with alcohol,” explained Dr. Garbutt. If the answer to two or more of the four CAGE questions is yes, it is likely you have a problem.
C stands for cut-down: Do you ever feel that you should cut down on your drinking?
A stands for annoyed: Have people annoyed you by criticizing your drinking?
G stands for guilty: Have you ever felt guilty about your drinking?
E stands for eye-opener: Have you ever had to drink as soon as you wake up to steady your nerves or get over a hangover?
Gilman also suggested adding these additional questions to the list: Is your drinking causing you problems in any area of your life? Do you use alcohol despite repeated negative consequences in your relationships, at work, and with the law? “Any negative consequences in just one area of your life, regardless of how much or how often you drink, are cause for concern and an indication that you need the help of a professional,” he explained.
If you feel like you have to drink or drink too much at a time, or even if you meet only one of the CAGE criteria, you should seek professional help. Ask your doctor to refer you to a therapist who specializes in addiction.