How do I know if I have a drinking ‘problem’?
Am I an ‘alcoholic?’
Many of us question whether we have a problem wtih alcohol and find ourselves googling whether we might be an alcoholic, particularly after a heavy session. And it can be hard to find definitive answers out there.
It might surprise you to know that the term alcoholic is considered outdated, unhelpful and actually isn’t even a medically correct term to use.
Many people find the ‘A’ label prevents them from help-seeking as it’s so heavily associated with pictures of someone who has hit rock bottom and experienced significant loss in their lives - financially, professionally, physically, environmentally and in their relationships.
There’s the stigma that comes with it.
They simply don’t identify with it because they’re people with houses, careers, families and often doing quite well. They might run marathons or be otherwise quite health conscious.
What’s the official take?
In the Diagnostic and Statistical Manual (5th version) which is used by psychiatrists and psychologists to diagnose in a standarised way, the correct term is alcohol use disorder (AUD).
Alcohol Use Disorder is considered a spectrum of sorts; as it runs from mild to moderate to severe.
In reality, people with alcohol use disorder may have a physical and psychological dependence/addiction with alcohol but not experience those significant losses, particularly not at the milder end of the scale.
Does this mean I officially have a problem with my alcohol use?
Simply, there’s a medical way to answer this question, and there’s a maybe more helpful way to answer. If you want the medical, feast your eyes over the next section, if you want to go straight to the crux of it, scroll on down.
We know that there is no safe level of alcohol consumption. However the official Australian guidelines recommend that to reduce the risk of harm from alcohol-related disease or injury for healthy men and women, drink no more than 10 standard drinks per week and no more than 4 standard drinks on any one day.
If you want to get the ‘official’ medical answer the following questions from the DSM-5 (latest version) and find out. The presence of at least 2 of these symptoms indicates Alcohol Use Disorder (AUD).
In the past year have you:
Had times when you ended up drinking more, or longer, than you intended?
More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
Spent a lot of time drinking? Or being sick or getting over other aftereffects?
Wanted a drink so badly you couldn’t think of anything else?
Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
Continued to drink even though it was causing trouble with your family or friends?
Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?
Scoring:
The severity of the AUD is defined as:
A mild alcohol use disorder is defined as the presence of 2-3 of the above symptoms.
A moderate alcohol use disorder is defined as the presence of 4-5 of the above symptoms.
A severe alcohol use disorder is defined as the presence of 6 or more of the above symptoms.
An online version of this test is available here: https://adis.health.qld.gov.au/getting-support/self-assessment/alcohol
Yeah, yeah. But what about in the ‘real world’?
You can see it actually doesn’t take much to fall into the category of mild alcohol use disorder.
Even people who consider themselves to be pretty sensible drinkers might fall on the AUD spectrum, and this is where people often dismiss these types of criteria.
Because it’s a bit like eating your 5 portions of fruit and veg or making sure you get 30 minutes exercise every day.
We all know what we should be doing - according to some boffin in a lab - but, as humans, we often just don’t want to.
We are hard wired for pleasure and for eating that fifth cookie and flirting with life choices we know we probably would be best not to, but we do anyway. This is part of what it is to be human.
Besides, most of us absolutely loathe being told what to do - especially if we’re neurodivergent. Judged, made to feel ‘less than’, that somehow we are failing is going to send us spiralling in self loathing and back to alcohol to make ourselves feel better again, temporarily.
We want to have autonomy over our own lives and decide what is right for us, not be dictated to by some ‘do gooder’ or held to impossible standards of perfection.
The upshot being that we frequently dismiss those official levels and sweep those uncomfortable truths under the carpet, while the cycle of flip flopping between thinking we don’t have a problem and then that maybe we do after all continues.
Perhaps it’s time to ask some better questions?
You can get started with these:
‘is alcohol serving me or I am serving it?’
‘is alcohol impacting the way I live my life? Am I showing up as the person I want to be (as a parent, as a partner, in my career, in my mental/physical health)?’
‘is alcohol taking more from me than it is giving?’
‘is alcohol a two faced friend? is it pretending to be my mate and then secretly stabbing me in the back?’.
If you’re asking yourself whether you have a problem with alcohol, consider this:
people who don’t have a problem with alcohol don’t question whether they have a problem with alcohol.
That’s the bottom line.
Think about it like this. Gambling can be seriously habit forming and people wind up losing a lot to it, as they become more and more hooked. I gamble maybe once or twice a year, if that.
Despite gambling being highly addictive for many I don’t spend any time at all contemplating whether I have a problem with gambling, because I categorically know I don’t. It doesn’t even enter into my thinking.
But with alcohol I bargained, negotiated and flip flopped on whether I had a ‘problem’ for a couple of decades. Same thing with smoking; it was a ‘later’ problem (although I eventually gave up in 2018).
And I did that because part of me knew.
The part that was sometimes small and sometimes loud. That knew I’d need to give up.
I just didn’t want it to be the answer - which is not the same thing as not knowing - but it fuels denial all the same because we’re not done yet. We push it down and get back to ‘business as usual’. This time we’ll make it work!
Take aways
Ultimately the label (of whether you are or aren’t an alcoholic) is less important in many respects than how you feel about your drinking.
If you are regularly feeling physically and mentally awful, cloaked in shame, guilt and remorse about your drinking then it’s probably time to explore that a bit further. To get curious.
Not to shame yourself, or beat yourself up, but allow for how you really feel about your drinking and the role it is playing in your life to bubble up into your awareness.
Because it’s got to come from you; until you’re ready changes won’t stick.
I’m not suggesting it’s pointless trying. We may have many attempts to moderate, take breaks, try stopping all together. These will still move the needle in terms of ‘seed planting’ and laying the foundations, but the reality is we are not ready until we’re ready. This is part of the process. Actually, this IS the process.
A problem with alcohol does not make you a weak or terrible human. It simply makes you human.
If this resonates with you, there is lots of help out there!
Go to my free resources page, go to your doctor or contact me.
But perhaps most importantly, have the honest conversation with yourself first.
Sources:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Australian Drug and Foundation: https://adf.org.au/reducing-risk/alcohol/alcohol-guidelines/
An online version of this test is available here: https://adis.health.qld.gov.au/getting-support/self-assessment/alcohol
