Is Your Drinking a Problem?
Binge and excessive drinking have lately become a much bigger problem in my area in the past five years, and not necessarily with youth. It is probably in your community too.
Surprisingly, the number of people in their 40’s and 50’s say they cannot stop drinking once they start is increasing. Cannot stop at all regardless of the consequences to their careers and relationships. Yet they don’t want to stop drinking.
It is time to get real about the consequences and what is dangerous drinking.
No part of your body is unaffected by drinking alcohol. Most of us know the liver is greatly affected, which can lead to cirrhosis as it can only metabolize a small amount of alcohol at one time, so the rest circulates through the body. The central nervous system is depressed right away because alcohol is quickly absorbed by the small intestine and stomach and right into your blood.
In my experience, nearly all who say they are having problems admit they drink more than the average “pour” and they forget how much they actually drink in one sitting. Virtually all have to estimate how much they consumed during their last drinking event. Older persons and those with little food in their stomachs are affected faster and more profoundly than the average 25-year-old. People with parents or grandparents who have drinking problems are generally much more affected and endangered as well. Back to what is a true pour or serving in the U.S.
A standard drink is equal to 14.0 grams (0.6 ounces) of pure alcohol. All the drinks are about the same and beer is not “safer” than any other of these substances.
Therefore a standard amount of pure alcohol is:
· 12 ounces of beer (5% alcohol content).
· 8 ounces of malt liquor (7% alcohol content).
· 5 ounces of wine (12% alcohol content).
· 1.5 ounces or a “shot” of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).
What is moderate, controlled drinking?
According to the Dietary Guidelines for Americansexternal icon, moderate alcohol consumption is defined as having up to 1 drink per day for women and up to 2 drinks per day for men. This definition refers to the amount consumed on any single day and is not intended as an average over several days. However, the Dietary Guidelines do not recommend that people who do not drink alcohol, start drinking for any reason. (1.)
How do I know if I have a drinking problem?
Drinking is a problem if it causes trouble in your relationships, in school, in social activities, or in how you think and feel.
Drinking is a problem anytime you can’t stop and won’t stop at 1 or 2 drinks per day.
Drinking is a problem when you drink every day.
Drinking is a problem when you drink more than 1 drink per day for women and 2 drinks per day for men.
What is Dangerous Binge Drinking?
NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours. (2.) And the Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the annual National Survey on Drug Use and Health (NSDUH), defines binge drinking as 5 or more alcoholic drinks for males or 4 or more alcoholic drinks for females on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past month. (3.) Many in the treatment community feel these definitions are out of date and the number of drinks should be defined as much lower.
Heavy Alcohol Use
SAMHSA defines heavy alcohol use as binge drinking on 5 or more days in the past month.
What is Alcohol Use Disorder?
So how do clinicians diagnose Alcohol Use Disorder? We (psychiatrists, doctors, psychologists, clinicians of all licensing, treatment centers, etc.) are all required to use the DSM 5, which is the Diagnostic and Statistical Manual of Mental Disorders” published by the American Psychiatric Association. Insurance nearly always requires a DSM 5 Dx (diagnosis).
To Dx with the DSM-5, if a person exhibits two or more symptoms from a list of 11 criteria, they are diagnosed as having an alcohol use disorder, with classifications of mild, moderate, and severe.
What are the types of Alcohol Use Disorder Severity
When a person is diagnosed with alcohol use disorder, the severity of the condition is determined by the number of symptoms they have.
Mild: 2-3 symptoms present
Moderate: 4-5 symptoms present
Severe: 6 or more symptoms present
What are the symptoms used to Dx severity?
The DSM-5 lists 11 symptoms that can be used to determine if someone has an alcohol use disorder.
1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. 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.
10. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or b) A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
Impact on your health, well-being, and appearance
Drinking too much alcohol on a single occasion or over time can cause health problems, per the Mayo Clinic (4.) and many other sources:
· Hair Loss. Alcohol depletes your hair follicles of essential minerals, including zinc. Zinc deficiency leads to hair fallout. The effects of alcohol on your hair does not take years to show up as you’ll begin to notice strands of your hair falling out more frequently. If you don’t stop drinking, you’ll eventually have thinner hair, with noticeable scalp showing in your part line. You might think that your hair loss is genetic, but it could be due to alcohol use.
· Lines and Wrinkles. Alcohol dehydrates your body – every organ. As your body’s largest organ, your skin shows the effects of dehydration since wrinkles will first start to appear where the skin is thinnest, around the eyes. The longer you drink, your skin will develop even more lines and wrinkles, causing you to look like a much older person than your numerical age. While both sexes are affected, women seem to experience this somewhat more dramatically than men initially.
· Eye problems. Excessive drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamin). A thiamin deficiency can also be associated with other brain changes, such as irreversible dementia, if not promptly treated.
· Sagging Skin. Alcohol depletes vitamins and nutrients, so your skin won’t be able to produce as much collagen as it needs. Collagen is the substance that is responsible for keeping your skin supple and firm. This makes the skin on your face sag, causing that jowly look that is usually only seen on the elderly.
· Heart problems. Excessive drinking can lead to high blood pressure and it increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause a serious heart arrhythmia called atrial fibrillation.
· Weight Gain. Alcohol is full of empty calories. One glass of red wine is about 125 calories. Many beers have at least 100 calories in each bottle. If you order mixed, flavored drinks and cocktails, expect your weight to soar. Alcohol is also full of sugars, which the body turns to stored fat. Some people gain weight in their stomach, giving them “booze belly”. Others gain weight all over.
· Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss. Having memory problems? Is it taking longer than usual to remember a fact or a name?
· Broken Capillaries. Drinking alcohol often leads to flushing, which is when excess blood rushes to the face, a temporary overall temporary redness. Often it results in broken capillaries, particularly around the nose and cheeks which are often permanent.
· Kidney Problems. Simply put, alcohol contains toxins that your body is not designed to handle. Your kidneys have a hard time processing the alcohol that you drink so fluids build up in your body and face, causing a bloated look. This can happen even to relatively slim people. The eyelids look swollen and the whole face takes on the appearance of being bloated. This condition may continue and worsen as alcohol use continues.
· Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It can also interfere with the absorption of B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis).
· Increased risk of cancer. Long-term, excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, esophagus, colon and breast cancers. Even moderate drinking can increase the risk of breast cancer.
· Liver disease. Heavy drinking often causes increased fat in the liver (hepatic steatosis), inflammation of the liver (alcoholic hepatitis), and over time, irreversible damage and scarring of liver tissue (cirrhosis).
· Birth defects, Weakened immune system, Medication and alcohol interactions, Diabetes complications, Bone damage and many more too numerous to list here.
Do you need help?
Stopping drinking excessively is tough for most people. Talk to your medical doctor right away and also check what resources are available through your insurance. Medications can help many.
Some people can resume drinking sensibly after a period of “drying out” and getting healthy – but, honestly, most cannot if they’ve allowed their drinking to become habitual or are unable to stop once they had a drink or two.
Seek the support of qualified addiction clinicians who actually have certifications in this field. Unfortunately, almost anyone can claim they treat addiction.
AA and other support organizations have helped many. Check out all the resources available to you because your life, your health, your looks and your quality of life depends on it.
Seek the support of your family and loved ones. You don’t have to drink and people supporting you don’t have to drink in front of you, so please don’t tell them it won’t bother you. It will sooner or later.
1. US Department of Health and Human Services and US Department of Agriculture. 2015–2020 Dietary Guidelines for Americansexternal icon. 8th ed. Washington, DC: US Dept of Health and Human Services and US Dept of Agriculture; 2015.
2. National Institute of Alcohol Abuse and Alcoholism, https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
3. Substance Abuse and Mental Health Services Administration, https://www.samhsa.gov
4. Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243
Sharon Valentino, LMFT, Psychotherapist, Behavioral Health
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Your life does not get better by chance, it gets better by change.