hat is the difference between the person who likes to have a few drinks and the alcoholic? Patients who arrive in my office, either of their own volition, or at the insistence of family and friends, are usually on the defensive when I first ask them about their drinking habits and behaviors. I am an addiction psychiatrist, and after seeing thousands of men and women dependent on alcohol, the markers of alcoholism are quite clear to me. Yet, as with all diagnoses in psychiatry, it is more useful to consider an individual's overall functioning from a variety of perspectives than to rely on some rigid guidelines as to what defines alcoholism.
The simplest and most useful way to know if you are an alcoholic is to seriously and carefully ask yourself if it adversely affects the way you function.
Questions to ask yourself
First, think about your performance on the job. How often are you showing up for the day with a hangover? Do you note a significant difference in how you perform at your job after a night without drinking, as compared to when you "had a few drinks" the night before? Are you returning to your desk useless after lunch because you had a couple of drinks and are ready to coast through the rest of the day until you can get out? Are you known by your colleagues and superiors as the guy who's always up for a good time, the woman who looks foolish at the office party, the one who's late or absent more than a little too often? Have you been falling off your career track, taking work one day at a time until you get home to relax with a drink? It's often difficult to answer honestly.
Relationships
How is your relationship with your significant other? Is your sex life suffering because after a night of drinking you just want to go to sleep, or because you are too drunk for your partner to have any interest in you? Do you find yourself arguing more frequently, or saying the wrong thing after a few drinks? Do you run to get a drink after a fight? Do you find yourself saying "I'll show him" by getting another drink? Or are you without a companion, and in order to avoid those feelings of loneliness, you look toward alcohol instead? Try asking your partner how he or she would answer these questions about you.
Drinking frequency
The frequency and amount you drink is an important part of the self-assessment process. Tolerance, an essential feature of heavy alcohol use, is defined by the need for more and more alcohol to elicit the same effect, and it is directly related to the frequency of drinking and the amount of alcohol consumed. Daily drinking is surely a danger sign. Would you find it very difficult to come home at the end of the day and not have a drink? Is it difficult to sit down to dinner without a beer or a glass of wine? If you look back over the past several months, are you consistently drinking more each day than you used to? Are you still sober after three or four drinks?
Withdrawal
Withdrawal is another key element of excessive alcohol use. Alcohol is metabolized within a few hours, and the body's reaction to a precipitous drop in alcohol level is characterized by the sometimes severe physical symptoms of withdrawal. Do you ever feel shaky the morning after a night of drinking? Do you have a drink when you wake up to calm your nerves? Are you tense, irritable or easily agitated after you stop drinking for day or two? Do you need a tranquilizer to relax when a drink is not available or acceptable? Do you feel antsy at the end of the day, knowing you must have a drink to be calm? Do you ever have trouble remembering the details of what you did the night before while you were drinking?
Health
Often patients insist they can handle their alcohol and it doesn't affect them adversely in any way. High-powered professionals, who drink heavily on a regular basis-often with clients-assure me their drinking is under control. A college student promises me that a few beers a night, with an occasional weekend blow-out, is just their way to let off steam and have fun. Or a mother tells me she always needs a few glasses of wine to unwind after she finally gets the kids to bed. It's important to remember that everyone's definition of functioning poorly is different, but keeping up appearances is not a satisfactory substitute for moving ahead with your life. Often people come to see me for depression, and in the course of taking their histories, I discover significant, regular alcohol use. Instead of turning to antidepressants, I will ask them to stop drinking for thirty days.
The sobriety test
You can imagine the hundreds of excuses I have received for why a month of sobriety is "just not possible." They range from "I have a party Saturday night and everyone will be drinking" and "How will it look if my clients are drinking and I say no?" to "I'm too shy in social settings, and I need a couple of drinks to get started," and "If I don't have a drink, everyone will know something is wrong." Well, it's probably because something is wrong.
It's rare that I have a patient who drinks heavily who does not see tremendous improvement in the way he or she feels and functions after thirty days of sobriety. They think more clearly, and feel less depressed, healthier, more energetic, and interested in a wider variety of activities. It is true that some people drink to mask underlying problems, and that without alcohol those problems can come to the surface, leading to the conclusion that life is better with drinking. Yet it doesn't take long for problem drinking to develop a life of its own, regardless of what the original precipitating problems were. Often ongoing difficulties will seem far more manageable without the cognitive and emotional distortion of heavy drinking. Whatever problems do remain, however, can only be worked on constructively in a state of sobriety.
Because alcohol makes your thinking hazy, and allows you to ignore unpleasant feelings, the only true way to know if alcohol is adversely affecting the way you function is to have some sober time for comparison. If you won't try, then you are not yet willing to seriously face the question, "Am I an alcoholic?" If you try the sobriety test, and find you just can't do it, you're already in trouble and will need some help. One of the sure signs of alcoholism is knowing you want to stop drinking, and despite your most sincere efforts, being unable to refrain from alcohol. If you can stay sober for a month, then you're in a position to realistically assess the negative impact of drinking in your life. If you find that it is seriously getting in the way of your job, your relationships and your personal goals, then you are an alcoholic.
An important warning
It is essential to note that if you're drinking several drinks a day, every day, it is dangerous to suddenly stop drinking all together. You may hear stories from friends that it's no problem, that you may just feel a little jittery or uncomfortable, or that you'll feel nothing at all. It's true that some heavy drinkers have no withdrawal symptoms. However, the consequences of lowering or stopping your alcohol use suddenly can be deadly serious, including shaking, sweating, racing heartbeat and elevated blood pressure, culminating in seizures and hallucinations after a few days. Any test of your sobriety should be done under a doctor's supervision. It can be a family doctor as well as a psychiatrist, and for most people it can be done outside of the hospital.
The label of alcoholism
The first step in treating a problem is recognizing and naming it. Unfortunately, the term "alcoholism" has a terrible connotation. We hear tales of alcoholics with careers destroyed and marriages ruined, friends lost, and self-respect gone. There is the implication that alcoholism is a moral weakness or a character flaw. None of this is true. Alcoholism is an illness, which is successfully treatable with a wide variety of interventions. It stems from a genetically mediated biological predisposition, and for those who are hardwired with the potential for alcoholism, drinking can prove to be a chronic, debilitating enemy. It is true, at least for now, that the single most important factor determining whether or not a person can overcome alcoholism is their motivation to improve the quality of their lives. That is why asking the questions-while you're sober-about the adverse effects of your drinking is so important. Recognizing what you're losing, and looking down the road to see what further losses lie ahead, is therefore not only the way to determine if you are an alcoholic, but it is also the first step in the treatment of alcoholism.
Conclusion
If you find that you are an alcoholic, don't get hung up on the label. Your situation is far from hopeless. Acknowledgement is the first part of the process. Now it's time to take action.
