Am I An Alcoholic?

Alcoholism is one of the most destructive and commonplace substance abuse disorders in the United States today.  Despite the prevalence of alcoholism, many people fail to see when their own alcohol use has crossed the threshold from social drinking to alcoholism.  In this article, we’ll outline the key indicators that can be used to determine if you are an alcoholic.  Some of these indicators you may already know, but others you may not have thought about yet.  

Perhaps the most important step in determining if you are an alcoholic is to be honest with yourself about your alcohol use.  This can be a huge step for many, and for most alcoholics it takes time, or truly hitting rock bottom, for them to see the real effects that their substance abuse has had on their life and those around them.  We encourage those reading this article, and wondering whether they themselves are alcoholics, to approach this process with an open mind and objectivity in order to accurately determine if it may be time to get help.

Alcoholism vs.  Social Drinking

One of the foremost reasons that many people struggle with determining if they are an alcoholic is the prevalence of social drinking within the United States.  Alcohol has occupied a place in human civilization since the first humans learned to ferment alcohol.   Historical interpretation of the importance of fermented alcohol has changed over the past 30 years.  Prior to this, historians believed that although there is significant archeological evidence that alcohol consumption existed alongside ancient civilizations, it was a byproduct of the journey of those civilizations towards settled agricultural societies.  This theory argued that ancient civilizations formed around agriculture, as agrarian societies could support a much larger population base in a smaller area than a hunter-gatherer society could.  

While the argument that agricultural societies could support larger amounts of people is undoubtedly true, modern historians have since questioned whether the conclusion that alcohol fermentation was tangential to the formation of agricultural societies.  Rather, many modern historians believe that the brewing of beer or other types of fermented alcohol was the primary driving force that encouraged nomadic hunter-gatherers to settle and begin growing grain.  The archeological evidence supports this interpretation.  

Remnants of alcohol production exist alongside the earliest artifacts of nearly every civilization on the planet.  Some historians have expanded this theory backward in time, to encompass some of the earliest moments of human evolution.  This theory, coined the “drunken monkey” theory, argues that the pursuit of fermented fruit, and the extra energy source that fermentation provided through alcohol, encouraged our earliest ancestors to come down from the trees and begin foraging, leading in time to the earliest hunter-gatherer societies.

Whether or not one wholeheartedly supports these theories, what is inarguable is that alcohol has occupied a central place in human society for millennia.  As such, it is not surprising that social drinking is such an integral part of the way modern humans bond and celebrate.  Despite the prevalence and social acceptance of alcohol consumption, we now recognize that excessive consumption of alcohol has deleterious effects on the health of the individual, the social bonds with those closest to the individual, and on our society as a whole.  

The problem lies in determining when social drinking has developed into substance abuse and alcoholism.  Because social drinking is so accepted, and in some cases expected, in our modern society, the early stages of alcohol abuse can be easily masked or brushed off.  This is particularly true for the alcoholic and those closest to them.  For some, it can take years of substance abuse before loved ones and the alcoholic themselves come to the realization that they have a substance abuse problem.  

The DSM-5 and Alcohol Use Disorder

The most widely used metric by mental health professionals and addiction specialists for determining whether someone is suffering from alcohol use disorder (AUD) is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  Updated to version 5 in 2013, the DSM is the standard diagnostic manual for mental health disorders in the United States.  There are some important differences between the DSM-5 and prior editions, particularly when discussing alcoholism, that should be addressed in order to clear up confusion.  

Understanding the DSM-5 thresholds for AUD will also provide those wondering if they are an alcoholic with a base of knowledge from which they can accurately gauge their level of alcohol abuse.  The previous version of the DSM, DSM-IV, broke alcoholism into two disorders; alcohol abuse and alcohol dependence.  This made diagnosis confusing, for both the mental health professional and the potential patient.  The DSM-5 has combined both alcohol abuse and alcohol dependence under the umbrella of AUD.  AUD is then considered mild, moderate, or severe depending on the number of qualifications met.  

By combining alcohol abuse and dependency into a single disorder, this streamlines the process for getting alcoholics the treatment they need, while also making it easier for someone questioning whether their alcohol use is becoming a problem to determine if they meet the qualifications of a single disorder.   Under the DSM-IV, a person had to meet a certain number of criteria in the distinct categories of alcohol abuse or dependence in order to be considered for a diagnosis.  Under the DSM-5, if a person meets two of the 11 criteria they are considered to meet the threshold of AUD.  The more diagnostic thresholds that a person meets the more severe their AUD.  Someone with mild AUD will meet 2-3 of the thresholds.  A diagnosis of moderate AUD requires a person to meet 4-5 of the thresholds, and severe AUD results from 6 or more thresholds.

Although the thresholds presented in the DSM-5 are intended to help codify AUD and thereby assist medical professionals in making an accurate diagnosis, the thresholds can also be used as a self-screening tool.  Self-screening can be an important step for an alcoholic by allowing them to see that their use of alcohol has transcended social drinking.  In many cases, this realization can be a critical first step towards getting the help they need to take back control of their life and stop drinking.  One of the first steps include finding the right treatment center that best fits your needs.

Diagnostic tools such as the screening thresholds for AUD require absolute honest from the participant in order to be effective.  This can be a barrier for many that struggle with AUD, particularly if they don’t want to recognize that they have a drinking problem.  When looking over the list of screening questions, be sure to be completely honest with yourself about whether you have met any of these qualifications.  The DSM-5 qualifications require you to answer honestly whether you have experienced any of the following thresholds within the last 12 months.

1. Had times when you ended up drinking more, or longer, than you intended?
2. More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
3. Spent a lot of time drinking? Or being sick or getting over other after effects?
4. Wanted a drink so badly you couldn’t think of anything else?
5. 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?
6. Continued to drink even though it was causing trouble with your family or friends?
7. Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
8. 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)?
9. Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having a memory blackout?
10. 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?
11. 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?

In a broad sense, these questions ask the person to look at the most common ways that alcoholism affects the lives of those that suffer from it, and then apply those situations to their own experiences.  For many people, some of these questions may seem fairly innocuous.  For example, the first question asks if you have had times, at any point in the last year, where you drank more or longer than intended.  For those that drink socially on a regular basis, the experience of having “one too many” can seem to be a hazard of the inhibition lowering properties of alcohol itself combined with poor judgment in the moment, rather than an indication of a problem.  

However, many of the other questions are framed on the basis of key indicators of alcoholism in the vast majority of people.  These questions ask the participant to look at how alcohol has affected their life in the last year.  It asks them to look back and determine if alcohol has led to them being sick, impacted their work performance or social life in a negative way, or put them into dangerous situations.  Some of the questions also ask the participant to objectively see if alcohol has had a negative impact on the lives of those around them.  

These questions are threads that tie together the many ways that alcohol can negatively impact the lives of those that abuse it.  Although many people that drink with friends on a regular basis may answer the first question in the affirmative, those times of having more to drink than intended may have led to situations where they were sick, blacked out, missed work, or placed themselves in to a dangerous situation.   The reality is that many people that qualify for a mild AUD diagnosis don’t even realize they have a problem.  For those that binge drink or frequently drink with others that have similar consumption patterns, the social acceptance of their drinking leads to the belief that they are fine.  This is especially dangerous with alcohol abuse, as mild dependency or abuse can quickly have a negative impact on the life of the alcoholic.

For families and loved ones of an alcoholic, getting them to objectively see how their alcohol abuse has affected their lives, and the lives of those around them, can be exceptionally difficult.  At the same time, for someone that regularly drinks, it can be hard at times to see the long-term effects of their alcohol use.  In many instances, it can be so difficult to see the slow damage caused by their addiction, that alcoholics fail to confront it until something bad happens to them as a result of their drinking.  Despite this, once an alcoholic recognizes that they have a problem, they can then begin the work of reclaiming control of their life with the help of programs.

 Alcohol abuse is extremely damaging to the health and life of the alcoholic.  Getting help for alcohol abuse or dependency early is critical to having the best chances of a successful recovery and to avoid any further damage to the body.  Determining if you are an alcohol requires honest reflection and an open mind, both of which are necessary to pursue a course towards sobriety.  As a first step, we encourage those wondering if they are an alcoholic to honestly answer the questions posed in the DSM-5.  

This will allow you, or your loved one, to accurately assess whether your alcohol use is a problem and may encourage you to take stock of how alcohol has been affecting your life.   That being said, a self-assessment is no replacement for an assessment by a qualified medical professional to find an appropriate treatment center.  If you believe that you or your loved one may be suffering from AUD, speaking to a medical professional will allow you to receive an accurate diagnosis, and explore treatment options if necessary.

Sources:

“Am I an Alcoholic?” Alcohol.org. 15 Mar. 2019. https://georgiadrugdetox.com/resources/am-i-an-alcoholic/

“Are You Drinking Too Much.” Drinkaware. 15 Mar. 2019. https://www.drinkaware.co.uk/selfassessment

“Bienvenu, Melissa. “Are You a High-Functioning Alcoholic?” WebMD. 15 Mar. 2019. https://www.webmd.com/mental-health/addiction/features/high-functioning-alcoholic#1