Alcohol Abuse, Alcohol Addiction and Alcoholism
A Simple Test: Signs of Alcoholism and Alcohol Abuse
If you answer yes to three of these four questions, you are probably addicted to alcohol.
- Do you have six or more drinks at least once a month?
- Do you have trouble saying no to alcohol sometimes? Do you drink more than you would like to drink sometimes?
- Do you sometimes feel guilt about how much you drank or what you did?
- Do you sometimes hide or minimize your drinking to others?
Are you concerned about your drinking? Have you ever wondered if you are an alcoholic? You probably suspect the answer. But maybe you’re afraid to admit it. This is your chance to do something about it. Click here for a more detailed alcohol dependence test.
Is there a difference between alcoholism, alcohol dependence, and alcohol abuse? All these terms mean the same thing in the DSM 5 (The Diagnostic Manual of the American Psychiatric Association) and ICD-10 (International Classification of the World Health Organization). These names have fallen in and out of favor over the years, in an effort to avoid negative associations, but they are equivalent.
Table of Contents
Stages of Alcoholism: The Functioning Alcoholic
In the early stage of alcoholism you regularly drink too much, but you haven’t suffered many consequences. This is when it’s easiest to make a change.
The middle stage of alcoholism is the classic functioning alcoholic. You still have a job and your relationships are intact, but your life is beginning to suffer. This is the most common scenario. You don't have to suffer major losses to have an addiction. Late stage alcoholism is the non-functioning alcoholic. By then you have lost your job and probably have to drink every day. It's what people think alcoholism is like, but this stereotype is rare.
Alcoholism is progressive. The consequences get worse over time. It's never easy to quit. But if you have already suffered some consequences and don't want them to get worse, there's never a better time to quit than now.
What is Moderate Alcohol Use?
- Moderate drinking is no more than 1 drink per day for women and no more than 2 drinks per day for men according to the US Department of Health and Human Services
- The World Health Organization suggests no more than 2 drinks per day, and no more than 5 drinking days per week. They also suggest at least 2 non-drinking days per week.
- A standard drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of spirits.
How Much Drinking is Too Much?
Maximum limits for alcohol use set by the National Institute of Alcohol Abuse and Alcoholism.
- For men, more than 4 drinks in a day, or more than 14 drinks per week.
- For women, more than 3 drinks in a day, or more than 7 drinks per week.
People who drink more than the maximum limits are at high risk of becoming alcoholics. 
How Common is Alcoholism or Alcohol Abuse?
- Approximately 60 percent of drinkers, drink less than 4 drinks on the days they drink.
- Only 10 percent of drinkers, have 5 or more drinks more than half the days they drink.
Alcohol withdrawal occurs because your brain works much like a spring. Alcohol is a brain depressant that pushes down on the spring. When you suddenly stop drinking it is like taking the weight off the spring. Your brain is out of balance. The spring rebounds and your brain produces excess adrenaline which causes the withdrawal symptoms.
What goes on at the level of brain neurotransmitters? GABA is the calming neurotransmitter of the brain. GABA and adrenaline are supposed to be in balance in the brain. Drinking regularly causes the brain to produce less GABA, because the brain begins to rely on alcohol for part of the calming effect. When you suddenly stop drinking, your brain chemistry is out of balance. You don’t have enough GABA neurotransmitter, and you have a relative excess of adrenaline, which causes all the withdrawal symptoms.
Alcohol Withdrawal Symptoms
These are some of the symptoms of alcohol withdrawal:
- Shaky hands
- Muscle tension/ Tightness in the chest
- Nausea/ Vomiting
Suddenly stopping alcohol can lead to seizures, strokes, or heart attacks in high risk patients. A medically supervised detox can minimize your withdrawal symptoms and reduce the risk of dangerous complications. Some of the dangerous symptoms of alcohol withdrawal are:
- Grand mal seizures
- Heart attacks
- Delirium tremens (DTs)
Alcohol Detox (detoxification) to Prevent Withdrawal
Detoxification, or detox, involves taking a short course of medication to help reduce or prevent withdrawal symptoms. Medications such as Valium (diazepam), Librium (chlordiazepoxide), or Ativan (lorazepam), the benzodiazepine family, are usually used for detox.
Detox can be done as either an inpatient or outpatient depending on the person’s health, their volume of drinking, and their past history of withdrawal. Detox is always done under close supervision. A common plan for outpatient detox is to prescribe a high dose of medication on the first day, and then gradually reduce the dose over the next 5-7 days. People with serious alcohol abuse may be admitted to hospital.
This is general medical information, and not tailored to the needs of a specific individual.
Alcoholic Hepatitis/ Alcoholic Liver Disease
The liver filters toxins from the blood, including alcohol. If you drink excessively, the liver cannot keep up, and becomes damaged. This is called alcoholic hepatitis. In the United States, alcoholic liver disease affects more than 2 million people (approximately 1% of the population).
There are three stages of liver damage: 1) elevated liver enzymes, 2) alcoholic hepatitis or fatty liver, 3) cirrhosis.
The most common form of liver damage is elevated liver enzymes. Your doctor can do a blood test to check if you have elevated liver enzymes. The three enzymes tested are AST, ALT, and GGT. Your liver is able to repair itself, and at this stage liver damage is potentially reversible. If you stop drinking the liver enzymes may go back to normal.
How do liver enzyme tests work? The enzymes AST, ALT, and GGT normally occur inside liver cells. If your liver is damaged, the enzymes escape into your blood stream and show up in your blood test. Therefore the higher the enzyme count, the greater the liver damage. The most accurate of these tests for alcoholic liver damage is GGT.
The second most common form of liver damage is ‘fatty’ liver.
Some fat in the liver is normal. The liver is the main organ of fat metabolism in the body. But when your liver is damaged by alcohol abuse fat begins to deposit in your liver. If fat makes up more than 5% - 10% of the liver, it is considered a fatty liver.
Fatty liver can be identified by blood tests and a liver ultrasound. This stage of liver damage is also reversible with abstinence. However, fatty liver damage has a greater risk of turning into cirrhosis with continued alcohol abuse.
Significant liver damage can cause jaundice. Jaundice means that your skin and/or the whites of your eyes have turned yellow. This occurs when your liver can't remove a toxin called bilirubin from your blood. Bilirubin is yellow, therefore when it builds up your skin and the whites of your eyes turn yellow. Jaundice can be reversible if you stop drinking.
Repeated liver damage can cause cirrhosis. Your liver is a remarkable organ, but it can only repair itself so many times. After a while your liver won't be able to repair itself and it will turn into scar tissue. Cirrhosis is just the medical term that means part of your liver has turned into scar tissue.
Signs of Cirrhosis or Severe Hepatitis
- Reduced appetite
- Weight loss
- Nausea and vomiting
- Pain especially in the left side of the abdomen
- Yellowing skin and whites of the eyes (jaundice)
- Swelling abdomen due to fluid accumulation (Your liver produces many of the proteins in your blood. When it is damaged, fluid in your blood vessels gradually seeps out and accumulates in your abdomen.)
- Hepatic encephalopathy. A damaged liver has trouble removing toxins from your body. The buildup of toxins can damage your brain, leading to changes in your mental state, behavior, personality, and in severe cases, coma.
There is good news. Your liver is a big organ and you have more liver than you need. People can lose 30 percent of their liver in a car accident and still lead normal lives. So if you have less than 30 percent cirrhosis and you stop drinking, you can still lead a normal life. Your doctor can do an ultrasound to see if you have cirrhosis, and estimate what percent of cirrhosis you may have.
Nerve damage due to alcohol abuse is called alcoholic neuropathy. Alcohol is toxic to nerves cells, which can cause brain damage and peripheral nerve damage. A significant part of alcoholic neuropathy is also caused by the poor nutrition associated with alcoholism.
Alcoholic neuropathy usually has a reversible and irreversible component. The reversible components is caused by the poor nutrition, and can be treated by thiamine (vitamin B1), folic acid, and vitamin B12. The irreversible component is caused by the direct poisoning of nerve cells, and there is no known cure. Up to half of long-term, heavy alcohol abusers develop alcoholic neuropathy.
Symptoms of Alcoholic Neuropathy
- Numbness or pins and needles (paresthesia) in the arms and legs. This usually occurs in the hands and feet in what is called a “stocking-glove distribution.”
- Pain in the arms and legs
- Muscle cramps and muscle weakness
- Impotence (in men)
- In severe cases, nerves that regulate internal body functions (autonomic nerves) may be affected.
Alcohol and Hypertension: High Blood Pressure
More than two drinks a day has been proven to cause high blood pressure. Studies have also shown that reducing or eliminating alcohol use can reduce blood pressure.
Alcohol Abuse and Cancer Risk
Alcohol abuse significantly increases the risk of most forms of cancer, including mouth, esophagus, breast, stomach, liver, prostate, and colon cancer.
How does alcohol increase cancer risk? It is likely that there are several ways this happens. Acetaldehyde, a byproduct of alcohol metabolism is thought to be one of the main causes of alcohol related cancers.
In the case of mouth, esophagus, and stomach cancer, alcohol appears to also act as a direct irritant that damages tissues. Alcohol may also allow harmful chemicals, such as tobacco smoke, to enter the digestive tract more easily. This explains why smoking and drinking combined are more deadly than either one alone.
Alcohol Abuse and Breast Cancer
Breast cancer, the leading cause of death in women, is strongly correlated with alcohol abuse. Drinking more than two drinks a day increases the risk of breast cancer by 50%!  This result has been confirmed in studies of over one hundred thousand women.
Depression and Alcohol Abuse
Depression is one of the most common, serious consequences of alcohol abuse. You may wonder if alcohol abuse leads to depression or if it’s the other way around? Do people drink to deal with depression, which then leads to alcohol abuse and addiction? Research has shown that alcoholism and alcohol abuse usually lead to depression. 
Alcohol abuse doubles the risk of depression. One study looked at 2,945 alcoholics. 15% were depressed before they began abusing alcohol. 26% were depressed while they were using alcohol, and 15% remained depressed once they had stopped drinking for an extended period.
Alcohol and Pregnancy: Fetal Alcohol Syndrome
All studies show that there is no safe amount of alcohol during pregnancy. Alcohol is toxic to the fetus and especially to the developing brain of the fetus. Drinking during pregnancy has a number of effects including low birth weight and increased risk of premature birth. The main serious side effect of drinking during pregnancy is fetal alcohol syndrome.
Fetal alcohol syndrome (FAS) and alcohol-related developmental disorders combined occur in approximately one in 100 live births in the US and Great Britain. 
Some of the consequences of fetal alcohol syndrome include:
- learning disabilities
- obsessive-compulsive disorder
- physical disabilities such as kidney and internal organ diseases
- skeletal abnormalities including facial deformities
- Binge drinking is defined as five or more drinks per occasion for a man, or four or more drinks for a woman, at least one day a month.
- Heavy binge drinking is defined as that much alcohol at least 5 days a month.
Why is binge drinking so risky? Drinking four or five drinks over a few hours will raise your blood alcohol concentration (BAC) quickly which makes you drunk quickly. Drinking the same amount over several hours, and accompanied by food, will not have the same effect on your blood alcohol concentration, and therefore will have less effect on your brain.
Approximately 12 percent of woman report having been sexually assaulted when either they or their assailant had been drinking. Binge drinking increases the risk of unprotected sex, sexual assault, and sexually transmitted diseases.
Approximately one third of accidental deaths and one third of motor vehicle deaths are related to alcohol abuse.
Binge drinking increases the risk of academic problems, fights, motor vehicle accidents, physical and sexual assault, and changes in brain development that may have long-term effects.
Binge drinking dramatically increases the risk of developing an addiction. College students who drink more than 5 drinks, more than twice in two weeks are 19 times more likely to develop alcoholism than non-binge drinkers.
Resources for Binge Drinking
- National Institute of Alcohol Abuse: Underage Drinking
- National Institute of Alcohol Abuse: College Drinking
- College Drinking Fact Sheet
- College Drinking Prevention
How Big is a Drink? The Definition of a Standard Alcoholic Drink.
A standard drink is defined as 14 grams of pure alcohol according to the US Department of Health and Human Services. However in Europe the most commonly used standard is 10g of pure alcohol.
- 1 can of beer (12 oz or 330 ml) at 5% alcohol is one drink
- 1 glass of wine (5 oz or 140 ml) at 12% alcohol is one drink
- 1 shot of liquor (1.5 oz or 40 ml) at 40% alcohol is one drink
Note that a 750ml bottle of wine contains 5 drinks. Therefore 2 drinks a day is less than half a bottle of wine a day.
The basic formula for calculating a drink is that each milliliter of pure alcohol weighs 0.79 grams. Therefore, for example, 12 oz of beer or 330 ml of beer x 5% alcohol x 0.79 = 13 grams of pure alcohol.
Blood Alcohol Concentration (BAC) Calculator
This information is provided as guideline only and should not be relied upon to determine if you can safely operate a vehicle. Many factors can affect BAC, including the amount of alcohol consumed, rate of consumption, food consumption, and factors such as gender, age, weight, height and metabolism. However these numbers apply over a broad range of body weights.
It can take up to 30 minutes after the last drink to reach the maximum BAC level.
To Keep BAC Less than 0.05 (g/dL or 50 mg/dL)
- For men, 2 drinks or less in the first hour, and 3 drinks or less over three hours.
- For women, 1 drink or less in the first hour, 2 drinks or less over three hours.
BAC Greater than 0.05 (g/dL or 50 mg/dL)
- For men, more than 3 drinks over 4 hours.
- For women, more than 3 drinks over 4 hours.
Alcohol poisoning is a serious and potentially deadly consequence of drinking large amounts of alcohol over a short period of time. If you suspect someone has alcohol poisoning, call for emergency medical help right away.
There are many kinds of alcohol:
- Ethyl alcohol is drinking alcohol. It can also be found in mouthwash, cooking extracts, and medications in liquid form.
- Isopropyl alcohol is found in rubbing alcohol, lotions, and some cleaning products. It is more toxic than drinking alcohol.
- Methanol (methyl alcohol) is used as an industrial solvent. It is very toxic and as little as 10 mL of pure methanol can cause permanent blindness.
- Ethylene glycol is a common ingredient in antifreeze, air conditioning, paints, and solvents. It is toxic to the central nervous system, heart, and kidneys. Because it has a sweet taste, children are more inclined to consume large quantities of it.
Alcohol Poisoning Symptoms
These symptoms can occur from poisoning by all forms of alcohol. Alcohol poisoning symptoms begin to occur when the blood alcohol concentration (BAC) is approximately 0.25. (Intoxication occurs at 0.05. Poisoning occurs at 5 times the blood alcohol level of intoxication.)
- Vomiting. This is the only symptom that can occur at lower blood alcohol levels. Alcohol depresses the gag reflex and increases the risk of the person choking on their own vomit (aspiration). Many famous and not-so-famous people have died this way.
- Breathing, slow or irregular. In severe cases this can progress to stopping breathing.
- Skin, pale, bluish, cold or clammy due to insufficient oxygen.
- Body temperature, low.
- Heartbeat, slow or irregular, which may progress to cardiac arrest.
- Confusion. Unconsciousness. Coma.
- Death can occur at BAC 0.37 or higher.
Alcohol Poisoning What to Do (Treatment)
- Seek immediate medical care if you suspect the person has alcohol poisoning, even if you don't see the classic symptoms.
- Try to keep the person awake and sitting up.
- Keep them warm.
- If the person is unconscious, make sure they stay on their side, not their back, and turn their head to the side to help prevent choking.
What Not To Do
- Don't give the person food, drink, or medication of any kind.
- Don't try to make the person vomit. Their gag reflex won’t be working properly which means they could choke on their vomit.
- Don't leave an unconscious person alone to sleep it off. Again they may choke on their own vomit.
BAC and Growing Impairment
BAC (0.05 – 0.08)
Relaxation, euphoria, sociable, and talkative.
Impaired judgment, attention, and fine motor control.
BAC (0.08 – 0.1)
Poor muscle coordination.
BAC (0.1 – 0.2)
Impaired balance. Staggering.
Impaired vision, including ability to see detail and peripheral vision.
BAC (0.2 – 0.3)
Impaired perception of color, form, motion, and dimensions.
Increased pain threshold and lack of muscular coordination.
Near total loss of motor functions, inertia, little response to stimuli, inability to stand or walk, vomiting, and incontinence.
Possible loss of consciousness, stupor.
BAC (0.3 – 0.5)
Depressed or absent reflexes.
Reduced body temperature.
Impaired circulation and respiration.
If you have decided you have an alcohol problem, you’ve taken an important step. The key to making change is to use the supports available. Self-help groups, online groups, your physician, therapist, rehab, websites like this are all potential supports.
Using supports helps you feel like you’re not alone. It gives you confidence that you can make changes. It helps you see techniques that have worked for others. It dramatically increases your chances of success.
To learn more about recovery skills and relapse prevention methods please follow these links. You can change your life. Your continued recovery depends on learning healthier coping skills and making better decisions.
Getting Help: Online Resources for Alcohol Problems
There are many online resources for dealing with alcohol problems. Here are a few select links:
- Alcoholics Anonymous (AA) (aa.org)
- Adult Children of Alcoholics (ACA) (adultchild.org)
- Women for Sobriety (WFS) (womenforsobriety.org)
- AA Intergroup (aa-intergroup.org)
- 12 Step Forums (12stepforums.net)
- Reddit.com/Alcoholism (reddit.com/r/alcoholism)
- Reddit.com/AlcoholicsAnonymous/ (reddit.com/r/alcoholicsanonymous)
- Find an addiction specialist in your area: ASAM Addiction Medicine Treatment Finder
- Find a substance abuse treatment facility: Substance Abuse Treatment Facility Locator
Please click here for a more detailed list of addiction and recovery resources.
If someone you love has a drinking problem, you may be struggling between how to help the person and how to avoid being overwhelmed. You are probably feeling a combination of anger, fear, shame, and sometimes even guilt. I hope some of these suggestions will help you.
- Educate yourself on addiction and recovery.
- Say that it is hard for you to raise the topic of their drinking, but you are concerned. You care about them, and what their drinking is also doing to your family.
- Try not to accuse or judge. Avoid name calling. This is a difficult time for both of you.
- Provide a sober environment that reduces triggers for using.
- Allow the alcoholic time to go to meetings. Don’t expect them stop drinking and stay sober without help.
- Understand that your lives will change. Do not wish for your old life back. You both need to create a new life where it is easier to not use alcohol or drugs.
- Make sure that you both have time for fun. People use alcohol to escape, relax, and reward themselves. The alcoholic needs to find alternative ways to escape, relax, and reward themselves otherwise they will turn back to their addiction.
- Set boundaries that you all agree on. The goal of boundaries is to improve the health of the whole family. Do not use boundaries to punish or shame.
- If you want to provide financial support, buy the goods and services the person needs instead of giving them money that they might use to buy alcohol.
- Recognize and acknowledge the potential the person has within them.
What Not To Do
- Don’t be surprised if the person is defensive.
- Don't punish, threaten, bribe, or preach to the person. It will only make them more defensive.
- Do not enable. Do not provide excuses or cover up for them.
- Do not shield them from the consequences of their drinking. People are more likely to change if they have suffered enough negative consequences.
- Do not argue or try to discuss things with the person when they are under the influence. It won’t get you anywhere.
- Don't try to drink along with them.
Things You Can Do For Yourself
- Practice loving detachment. What are your needs beyond the needs of the alcoholic? How can you take care of yourself even when the other person does not take care of themselves? How can you do that without feeling guilty and without being punitive?
- You also need time to recover. Living with an alcoholic is exhausting.
- Avoid self-blame. You can’t control another person’s decisions, and you can’t force them to change.
- Do not work harder than the person you’re trying to help. The best approach is to not do things for the alcoholic, but instead to be an example of balance and self-care.
- Being a caretaker is not good for you or for them. Understand that there is only so much you can do.
- Ask for help. Talk to a professional. Go to a support group such as Al-Anon. (More support groups are listed below.)
- If at all possible, try not to be negative when dealing with them. That may only increase their feelings of guilt and push them further into drinking.
Helpful Links for Family and Friends of Alcoholics
- Al-Anon.org (al-anon.org) For family members of alcoholics.
- Coda.org (coda.org) For co-dependent individuals.
- Adultchildren.org (adultchildren.org) For adult children of alcoholics and addicts.
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