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Jaime works a high stress job and likes to drink a glass of wine or two in the evenings to relax from the day. Monica prefers to avoid drinking during the work week, but regularly binge drinks with her friends on the weekend. Since college, Kris reports drinking at least one 24-can pack of beer each week. Are they alcoholics?
It may surprise you that the answer to this question is not simple.
Perceptions of Alcoholism
Although it is not uncommon to hear the terms “alcoholic” or “alcoholism”, such terms are more cultural labels than official diagnostic categories. In the last decade, there has been a significant push by mental health professionals to move away from ambiguous language like “alcoholism” towards less stigmatized terminology to describe certain forms of drinking behavior. In 2013, the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) combined two diagnoses, “substance abuse” and “substance dependence”, into a single, narrower diagnosis called “alcohol use disorder” (AUD), with mild, moderate, and severe subcategories. With the new AUD criteria, most of what society may consider “problematic drinking” is not necessarily clinically diagnosable.
Simply put, heavy or excessive drinking alone does not automatically mean a person has a diagnosable problem. In the cases of Jamie, Monica, and Kris, we just don’t know enough about their drinking patterns and life contexts to determine if their behavior is clinically significant enough to warrant a diagnosis.
What do the statistics say?
According to the 2019 National Survey on Drug Use and Health (NSDUH), only a relatively small portion of the U.S. population meets the criteria for Alcohol Use Disorder (AUD).
Approximately 5.3% of individuals in the U.S. aged 12 and older meet the criteria for alcohol use disorder (AUD).
Approximately 1.7% of individuals in the U.S. aged 12 to 17 meet the criteria for alcohol use disorder (AUD) [3].
"A diagnosis is simply a guideline for treatment and not having an official diagnosis does not mean a person’s relationship with alcohol could not benefit from change" - Kelly McCray, RCSWI, RSW
How do I know if I have AUD?
The DSM-5 defines AUD as a “problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period”:
Alcohol is often taken in larger amounts or over a longer period of time than intended.
There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
Craving, or a strong desire or urge to use alcohol.
Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
Recurrent alcohol use in situations where it is physically dangerous.
Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
Increased tolerance.
Withdrawal symptoms
The severity is defined as: mild: the presence of 2 to 3 symptoms, moderate: the presence of 4 to 5 symptoms, and severe: the presence of 6 or more symptoms.
But, let’s be clear, though not all heavy, excessive, and binge drinking patterns qualify for an AUD diagnosis, it does not mean that such behavior is not problematic or that a person has a healthy relationship with alcohol. Excessive drinking (4-5 or more drinks on occasion) and heavy drinking (8-15 or more drinks on occasion) is a precursor to clinically significant life distress, such as several cancers, heart and liver disease, and anxiety and the third-leading cause of preventable death in the U.S [3] [4].
Self-Assess: Ask Yourself These Questions
Had times when you ended up drinking more, or longer, than you intended?
Spent a lot of time drinking? Or being sick or getting over other after effects?
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? [5]
If you answered “yes” to any of the above questions, even if you may not meet the criteria for alcohol use disorder but identify unhealthy habits, seeking help from a mental health professional can help you get back on track to building a healthy relationship with alcohol.
A diagnosis is simply a guideline for treatment and not having an official diagnosis does not mean a person’s relationship with alcohol could not benefit from change, particularly if their drinking behavior is having any sort of negative impact in their life. The precursor to alcohol use disorder is often a pattern of smaller, unhealthy habits that on their own may not be a cause for concern but when combined together, create significant long-term problems or clinical diagnosis.
Where can I go to get help?
The first step is acknowledging there may be a problem and recognizing the need for extra support. If you or someone you know would like to get started on healing their relationship with alcohol with me or another judgment-free, trauma-focused therapist at H&S, reach out to us at 407-308-0345.
We are also offering “Healthy Minds, Healthy Habits”, a virtual support and educational group to support women who have a desire to change their relationship with alcohol. Contact us at H&S for more information.
You are not alone. Support is here for you.
Additional Resources:
Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline, 1-800-662-HELP (4357)
National Institute on Alcohol Abuse and Alcoholism (NIAAA) - Rethinking Drinking: https://www.rethinkingdrinking.niaaa.nih.gov/Default.aspx
AUDIT (Alcohol Use Disorder ID Test) Self-Test: https://auditscreen.org/
References
[1] Takashi, T. et al. (2017). Comparison of DSM-IV and DSM-5 criteria for alcohol use disorders in VA primary care patients with frequent heavy drinking enrolled in a trial. Addiction Science & Clinical Practice. https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-017-0082-0
[2] Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5
[3] National Institute on Alcohol Abuse and Alcoholism. (2022, March). https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
[4] Centers for Disease Control and Prevention. (2022, April). Alcohol and Public Health. https://www.cdc.gov/alcohol/data-stats.htm
[5] National Institute on Alcohol Abuse and Alcoholism. (2021, April). Understanding Alcohol Use Disorder. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder