“A lot of alcoholics talk about how they look back and can see that they never knew, never really could predict, when they’d get too drunk, when they’d cross the line from what felt like normal heavy drinking into raging, out-of-control drinking.”
~ Caroline Knapp, Drinking: A Love Story
Are you a “social drinker”?
Are you a “problem drinker”?
Are you an “alcoholic”?
How do you tell the difference?
Alcohol is the most-used intoxicant in the world. In fact, 86% of American adults have tried alcohol at some point in their lives. Right now, 56% are current drinkers, reporting past-month use.
And on the face of it, there’s nothing wrong with that. Alcohol is legal, and when enjoyed responsibly and in moderation, it is a social lubricant that can be used to commemorate special occasions. We drink at weddings, on our anniversaries, during sporting events, when we get promoted at work, and when we are just getting together with friends.
Alcohol: The Most Dangerous Drug in the World
“It’s killing people before they should be dying. These deaths are all 100 percent preventable.”
~ Dr. Maristela Monteiro, M.D., Ph.D., Senior Advisor on Alcohol and Substance Abuse, Pan American University
But alcohol is also the most-abused intoxicant. According to the National Institute on Alcohol Abuse and Alcoholism:
- 6.2% of the adult population in the U.S. meets the criteria for a medical diagnosis of Alcohol Use Disorder.
- That equates to 15.1 million Americans age 18 or older.
- There are close to twice as many men with AUD as women, 9.8 million versus 5.3 million.
- In addition, 2.5% of adolescents and teenagers between the ages of 12 and 17 have AUD.
- That works out to 623,000 young people.
- Of special relevance, girls with drinking problems outnumber boys in the age group, 325,000 to 298,000.
- 1 in 5 college students has AUD.
- Every year, over 88,000 Americans die from alcohol-related causes.
- That means there is an estimated 2.6 million years of life lost.
- Globally, the problem is even worse. Almost 6% of ALL deaths are attributable to alcohol.
- Among people between the ages of 15 and 49, alcohol abuse is the leading cause of premature disability and death.
- There are more than 200 diseases and health conditions tied to excessive drinking.
Different Types of Drinkers
“That’s the problem with drinking…If something bad happens, you drink in an attempt to forget; if something good happens, you drink in order to celebrate; and if nothing happens, you drink to make something happen.”
~ Charles Bukowski, Women
In very broad terms, there are four main types of drinkers.
The “social drinker” is someone who consumes alcohol in moderation, typically in social settings. Overall, their pattern of drinking is “low-risk”, as defined by the NIAAA.
A “binge drinker” is someone who engages in the risky drinking practice of consuming large amounts of alcohol within a short span of time, usually within one sitting.
A “problem drinker” is someone who frequently binge drinks or drinks heavily, especially those individuals who have experienced negative consequences as a result. At this stage, problem drinkers are still able to quit if they so decide.
An “alcoholic” is someone who has lost all control over when, how much, of even IF they are going to drink. As a result, their lives are usually unmanageable, but they still cannot stop drinking. Today, alcoholism is recognized as a disease, and is properly called “Alcohol Use Disorder”.
These lines aren’t “hard”, meaning it’s far too easy for a person to move from one type to the next. This is especially true for the transition from problem drinker to an alcoholic. Because alcohol has a profound effect on the brain, chronic heavy drinking can result in a severe physical dependency on alcohol. This is the first sign of developing an addiction.
The types aren’t totally defined by quantity, either. It is entirely possible for a problem drinker to regularly consume more alcohol than some alcoholics. The difference is the ability to control their drinking—a problem drinker CAN quit voluntarily, while an alcoholic CAN’T.
What Are Some of the Negative Consequences Associated with Problem Drinking?
“It’s not harmless. I’ve lost many friends to that way of life. Some have died. Some have simply fried their hard drives for the rest of time or live in a perpetual chemical fog. I’m betting not one of them would say, ‘It was worth it.’”
~ Rainn Wilson, The Bassoon King: My Life in Art, Faith, and Idiocy
Alcohol use can become alcohol abuse faster than you ever thought possible, and this progressive disease can infect every part of your life.
- Divorce—50% greater likelihood
- Estrangement—A third of all alcoholics and other addicts are separated from their families
- Domestic Violence—Drinking/drugs are involved in 80% of cases
- Homelessness—Substance abuse is the #1 cause
- Sexual Assault—Alcohol and/or drugs are involved in half of all cases. Especially relevant, over 70% of college women who have been raped report being too drunk to either refuse or consent.
- Child Neglect—4X more likely
- Abuse—3X more likely
- Intervention by Child Welfare—Substance abuse is a factor in 81% of cases
- Generation Alcoholism—Children with an alcoholic parent are 4X more likely to abuse alcohol as adults
They are also at tripled risk of marrying an alcoholic.
- Fetal Alcohol Syndrome
- Poor Growth—1 out of every 8 children born to a mother who abuses alcohol has impaired growth.
- According to the World Health Organization, there are over 200 health problems tied to alcohol misuse.
- Liver disease
- Cancer—1 out of every 30 cancer deaths are due to alcohol
- Cardiovascular disease
- Brain Damage
- Depression—3X higher in males and 4X higher in females
- Anxiety—1 out of 3 substance abusers
- Eating Disorders—Affecting 40% of female alcoholics
- PTSD—90% of people in alcohol rehab have a history of trauma.
- Suicide—The risk is 2.5X higher in men and 6X higher in women.
- Unemployment—3X more likely to be unemployed
- Under-Employed—1 out of 8 substance abusers have held 3 or more jobs within the past year.
- Higher Absenteeism
- DUI anhasiminal Charges
- Attorney’s Fees
- Ignition Interlock Devices
Drinking Levels Defined
“There is pain and suffering going on that is undiagnosed—and untreated—simply because it hasn’t really been described or defined.”
~ Drs. Joseph Nowinski, PhD, and Robert Doyle, M.D., Almost Alcoholic: Is My (Or My Loved One’s) Drinking a Problem?
The federal government’s Dietary Guidelines Advisory Committee has set recommended limits that clearly define “moderate”, “binge”, and “high-risk” drinking levels for both men and women. Regularly exceeding these limits is a red flag that someone may have progressed from a social drinking habit to problem drinking or even AUD.
- Low-Risk Drinking: No more than 1 drink per day for women or 2 drinks per day for men.
- Binge Drinking: Within a two-hour period, consuming 4 or more drinks if you are a woman, or 5 or more drinks if you are a man. In a related manner, the Substance Abuse and Mental Health Services Administration defines “heavy drinking” as binge drinking on 5 or more occasions within the past month.
- High-Risk Drinking: For women, the threshold is 4 or more drinks in one day or 8 or more drinks in a single week. For men, high-risk drinking occurs after 5 or more daily drinks or 15 or more weekly drinks.
1 out of 10 of high-risk drinkers will consume an average of 74 weekly drinks, or over 10 per day.
These guidelines are important, because only 2% of people who are low-risk drinkers develop AUD.
Does the Type of Alcohol Matter?
“‘Well, it’s only beer. I mean, it could be REAL alcohol!’ Learn this lesson from someone who knows: addiction is addiction and alcoholism is alcoholism.”
~ Carolyn S. Hennecy, Orange Blossom Wishes
Some people think they can’t possibly have a problem, because of WHAT they drink. But a “standard” drink is ANY beverage that contains 14 grams of alcohol, which is only a little more than a tablespoon.
Beer or Wine Cooler (5% alcohol)
- 12 oz = 1 serving
- 16 oz = 1.3
- 22 oz = 2
- 40 oz = 3
A man who only has “a few beers” when he gets off work has ALREADY exceeded the limits of moderate drinking. In fact, his weekly total puts him in the high-risk category.
Of special relevance, some craft beers contain up to 20% alcohol.
Malt Liquor (7% alcohol)
- 12 oz = 1.5
- 16 oz = 2
- 22 oz = 2.5
- 40 oz = 4.5
Just one 40 oz bottle of malt liquor puts the person in the high-risk category.
Wine (12% alcohol)
- 5 oz glass =1
- 1 25 oz bottle = 5
A woman who “only” has a couple of glasses of wine with dinner has ALREADY exceeded the limits of moderate drinking, and her weekly consumption puts her in the high-risk category.
Hard Liquor (40% alcohol, or 80 proof)
- 1.5 oz = 1
- Pint = 11
- A fifth = 17
- 1.75 L = 39
It’s important to remember that different spirits and cocktails have varying amounts of alcohol. Depending on the recipe, a mixed drink can contain 3 or more standard drinks.
For example, the most popular cocktail in the United States is the margarita. When made according to the official recipe, a margarita contains enough alcohol for 1.7 standard drinks. Another popular drink, the pina colada, is the equivalent of 2 standard drinks, while a 16-ounce Long Island Iced Tea, has enough alcohol for 3 drinks.
Binge and Heavy Drinking is a More Common Than You Think
“Take a drink because you pity yourself, and then the drink pities you and has a drink, and then two good drinks get together, and that calls for drinks all around.”
~ H. Beam Piper, Little Fuzzy
Most people who drink have drunk to excess at some point. In fact, according to the NIAAA, over 70% of people have an extended period in their life where they drink heavily. For most, the peak drinking period lasts 3 to 4 years and occurs between the ages of 18 and 24—the “college-age” years.
Eventually, most people grow out of this heavy drinking phase. Not coincidentally, the mid-20s is also when the human brain finishes maturing.
But heavy and binge drinking does still occur quite often.
Within the past month, 7% of American adults drank heavily and approximately 27% binge drank. Among youth, the patterns are similar—3.3% of people between the ages of 12 and 20 drank heavily, while 13.4% engaged in binge drinking within the past 30 days.
But among college students between the ages of 18 and 22, alcohol misuse is a real problem. 12.5% self-report drinking heavily, while 38% binge drank. This is much higher than their non-collegiate peers of the same age, who had a heavy drinking rate of 8.5% and a binge drinking rate of 32.6%.
The Risks of Binge Drinking
“When people think about alcohol, they tend to think of two problems each: addiction and drinking and driving. This (report) shows there is another big problem—you can die from alcohol itself.”
~ Dr. David Jernigan, Ph.D., Director, Center on Alcohol Marketing and Youth, Johns Hopkins University
There are several inherent dangers associated with binge or heavy drinking.
First, there is the loss of control over one’s actions. Alcohol impairs judgment and decision-making, while at the same time lowering inhibitions. This can lead to:
- Drunken driving
- Car crashes
- Unsafe sex
- HIV and other STDs
- Unplanned pregnancies
In fact, the Centers for Disease Control and Prevention estimates that because of crime, healthcare costs, and lost productivity, binge drinking imparts a financial toll of $746 on every citizen of the United States.
Next, there is an increased risk of alcohol addiction. Drinking affects the areas of the brain associated with reward, pleasure, memory, learning, and motivation. Significantly, new research from Brown University found that even a few drinks change the way memories are formed, paving the way for the cravings associated with addiction.
Finally, consuming large quantities of alcohol creates a serious risk of alcohol poisoning. A rapid increase in Blood Alcohol Content (BAC) severely impairs the brain, to the point that it cannot support basic functions. Literally, the body shuts down.
Symptoms of alcohol poisoning include:
- Severe confusion
- Loss of consciousness
- Problems breathing
- Extremely slowed heartbeat
- Cool, clammy skin
- Lowered body temperatures
While some of the symptoms may resemble extreme drunkenness, there is one telltale difference. A person who is overdosing on alcohol will have an impaired response to stimuli. For example, they will be unresponsive to pain or have no gag reflex. This can lead to the person choking to death on their own vomit.
Alcohol poisoning is always a medical emergency and requires immediate medical treatment. Every year, there are over 50,000 alcohol overdoses in the United States, claiming more than 2200 lives.
Several celebrities have died due to alcohol poisoning, including:
- Amy Winehouse, singer
- Vern Troyer, actor, most famous for his role as “Mini-Me”
- Keith Whitley, singer
- Jani Lane, lead singer of Warrant
- Bon Scott, lead singer of AC/DC
- Kristoff St. John, actor, star of “The Young and the Restless”
Training the Brain
“Because their bodies have become sensitized to alcohol, once they have taken that first drink the tissues of the body cry out for more and more, until sufferers find that they cannot control the amount of alcohol consumed. One drink is too many, a hundred, not enough.”
~ John G. Cooney, Under the Weather—Coping with Alcohol Abuse and Alcoholism
It is a common lament among people with AUD—” I didn’t mean for it to get this bad. I just like to have a few drinks every now and again.”
So how does this kind of social drinking turn into alcohol addiction?
Like other addictive disorders, alcoholism is a disease of the brain. Chronic alcohol abuse changes the brain and “teaches” the person that drinking is not only a pleasurable activity, but it is also necessary.
Recent research suggests that even one drink induces changes in the brain that promote future drinking. Of special relevance, these changes occur after the very first exposure to alcohol. After the person drinks for the first time, the pleasurable effects are immediately stored in their memory. This reinforces the behavior and motivates them to do it again.
This effect is magnified greatly in those individuals who are genetically predisposed to addiction.
Forgetting the Negatives
“The effects of alcohol on mood are known contributors to its use and abuse. It is less known how its effects on memory and inhibitory control add to alcohol being an addictive drug. Material acquired in an intoxicated state is less effectively retrieved in a sober state. Thus, people who abuse alcohol forget the consequences of intoxication during periods of abstinence.”
~ Dr. Theodora Duka, M.D., Ph.D., University of Sussex
When a person drinks alcohol, the initial sensations are positive—euphoria, a sense of well-being, and the relaxation. But at a certain fine point, too much alcohol leads to decidedly unpleasant side effects:
- Loss of coordination
- Slurred words
- Greater risk of accidents and injuries
- Painful hangovers
For a long time, it was a confounding conundrum. If getting drunk comes with so much pain and discomfort, why does anyone ever do with more than once?
Recent research from the University of Sussex determined that alcohol affects memory in a very selective manner. In other words, it is easier for someone to remember the good things about drinking than it is to remember the negatives associated with drinking too much.
This inability to remember the consequences of excessive alcohol consumption is one of the main causes of risky behaviors such as binge drinking.
“There were plenty of nights I’d promise myself I wouldn’t imbibe but end up indulging, or have four drinks instead of the planned one…These behaviors are red flags for problem drinking, and they’re alarmingly common.”
~ Joy Manning, Women’s Health
In the beginning, a person CHOOSES to drink because they like the way it makes them feel.
Like other substances of abuse, alcohol triggers a surge in the production of dopamine, the neurotransmitter associated with pleasure and reward. This is why a drinker experiences a pleasurable buzz.
But over time, this artificial overstimulation fatigues the brain’s dopamine receptors, making them less responsive to alcohol. This diminished response, known as tolerance, means that the person has to continually increase the amount of alcohol they consume in order to feel the same pleasurable effects.
When the reward system is impaired enough, however, the person loses their ability to feel pleasure or motivation from any source except alcohol. This is why they lose interest in other activities such as hobbies or socializing. This is known as alcohol dependence.
Even worse, whenever alcohol isn’t available or they try to stop drinking, they suffer the painfully-unpleasant symptoms of alcohol withdrawal. This is so physically and emotionally distressing that they are compelled to drink again.
CHOICE is no longer a factor. Where once they made the conscious decision to drink because it felt good, now, they must compulsively drink to keep from feeling bad.
There is one important consideration—alcohol dependence can be so severe that it can be dangerous or even life-threatening to stop drinking abruptly. This is why a chronic heavy drinker should NEVER try to self-detox from alcohol on their own. Alcohol detox should ONLY be done under the close supervision of trained medical personnel.
How Alcohol Use Disorder is Diagnosed
“Alcohol is one hell of a pitchman, and perhaps his greatest lie is convincing us that we need him, even as he tears us apart.”
~ Sarah Hepola, Blackout: Remembering the Things I Drank to Forget
Once upon and less-enlightened time, alcoholism and other addictive disorders reviewed as moral failings and weaknesses on the part of the individual. Today, all forms of Substance Use Disorder are recognized as legitimate medical conditions. Although some societal stigma still exists, the tide is slowly turning.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), an AUD diagnosis may be called for when a person exhibits three or more of the following symptoms:
- Loss of control
- Inability to cut back or quit
- A disproportionate amount of time spent on thinking about, acquiring, using, and recovering from alcohol
- Disinterest in other activities/Inattention to responsibilities and obligations
- Continue drinking despite negative consequences
- Alcohol withdrawal
The good news is that now alcoholism it is a recognized illness, there are approved, evidence-based treatment strategies and medications that have proven to be quite effective. It’s
Can an Alcoholic Learn to Drink Socially?
“Alcohol ruined me financially and morally, broke my heart and the hearts of too many others. Even though it did this to me and it almost killed me and I haven’t touched a drop of it in seventeen years, sometimes I wonder if I could get away with drinking some now. I totally subscribe to the notion that alcoholism is a mental illness, because thinking like that is clearly insane.”
~ Craig Ferguson, American on Purpose: The Improbable Adventures of an Unlikely Patriot
Given the proper motivation, the person who is a social problem drinker should be able to stop or cut back. Sometimes, they quit drinking or change their habits because they have experienced some sort of negative consequence –a DUI, a health scare, or maybe just because they are tired of waking up with a hangover. Other times, they may temporarily stop drinking because they want to reevaluate their relationship with alcohol—perhaps during Dry January. Some people stop drinking for religious reasons, such as the 40 days of Lent.
The point is if they are successfully able to choose if, when, and how much they drink alcohol, then they have not progressed to the point of AUD.
After they have achieved in the period of sobriety, an alcoholic invariably starts to think that now that they have control of themselves again, they should be able to safely take a drink now and again. After all, they think, they are much wiser and stronger than they were before.
But this is another aspect of addiction—denial. In essence, this is the disease lying to the recovering alcoholic, saying that “It never was THAT bad”… “You can control it now.”…”You’re cured.”
Alcoholism is a disease that hijacks the brain and takes away the person’s ability to control any aspect of their drinking. It is extremely important to remember that addiction in any form is incurable. Once a person has developed AUD, they will always be vulnerable. It takes significant lifestyle changes, a structured plan of recovery, constant vigilance, and ongoing support to avoid a slip or a full-blown relapse.
Alcoholics Anonymous has an old saying—” It’s the first drink that causes a problem.”
The idea that an alcoholic can somehow learn to drink socially “like other people” is not realistic, and it ignores what medical science has to say about addiction.
Look at it this way—every person who has ever struggled with alcohol addiction has made numerous attempts on their own to somehow control their drinking. They have resorted to such measures as:
- Not drinking during the daytime
- Switching to beer instead of spirits
- Only drinking on the weekends
- Setting limits of only one or two
These efforts always fail, because well-wishes and willpower don’t work on addiction, any more than they would on any other chronic illness such as diabetes, high blood pressure, or asthma.
The absolute answer to the question “Can an alcoholic drink socially?” is an unequivocal “NO”.
For Alcoholics, Abstinence is the ONLY Option
“…patients whose goal was total abstinence were more successful than those who had chosen to control their drinking.”
~ Dr. Kristina Berglund, Associate Professor, Department of Psychology, University of Gothenberg
Until recently, the general expert consensus was that a treatment goal shared by both the patient and the addiction care provider was the most important factor in determining successful recovery.
However, a recent Swedish study determined that the overall goal of treatment—total abstinence versus controlled drinking—was instead the biggest factor.
For example, the study found that among rehab patients who agreed with their providers:
- 90% of those whose goal was total abstinence remained sober at a 30-month follow-up.
- By contrast, only about 50% of patients who had opted for controlled drinking were successful.
Dr. Berglund concluded, “…in the end, it is more difficult to stick to controlled drinking than to give it up entirely.””
The idea of controlled drinking is very similar to the Moderation Management self-help group founded by Audrey Kishline in 1994 as an alternative to abstinence-only Alcoholics Anonymous. MM members admit that they struggle with sobriety, but they don’t want to give up alcohol entirely.
Instead, they try to manage their condition by drinking moderately, within weekly and situational limits:
- No more than 9 total drinks for women or 14 drinks for men.
- No driving after drinking.
- No drinking in situations that could be dangerous to others or to themselves.
- Partially abstaining by not drinking on 3 or 4 days out of the week.
There are two additional differences that put MM at odds with other recovery concepts. First, unlike AA, MM has no spiritual component. Additionally, MM rejects the disease concept of addiction, saying that it is and moral weakness that can be overcome with willpower.
Despite their goals, however, critics of MM say that it is just an organized attempt to bargain with alcoholism, that it is not much different than a whiskey drinker promising to switch to beer. The most serious criticism of MM is that at best, it is misguided, and at worst, it is just an excuse to continue drinking.
Does it work?
Consider the tragic story of its founder.
In 2000, six years after she founded Moderation Management, Kishline drove the wrong way down the highway while drunk with a BAC that was triple the legal limit. She crashed into another vehicle and killed a father and daughter.
She was convicted and sent to prison, and after her release, Kishline relapse to multiple times. At one point, she was sent back to prison for violating her parole. As she struggled with lingering guilt and shame, with alcoholism continued to progress.
In 2015, just a few days before Christmas, Audrey Kishline committed suicide.
What’s the Bottom Line?
“I felt empty and sad for years, and for a long, long time, alcohol worked. I’d drink, and all the sadness would go away…But at some point, the booze stopped working. That’s when drinking started sucking. Every time I drank, I could feel pieces of me leaving. I continued to drink until there was nothing left. Just emptiness.”
~ Dina Kucera, Everything I Never Wanted to Be: A Memoir of Alcoholism and Addiction, Faith and Family, Hope and Humor
Every person has their own individual relationship with alcohol. What happens next depends on the nature of that relationship. No one ever starts out drinking with a goal of becoming an alcoholic. But the insidious nature of this cunning and baffling disease only ensures that it can sneak up on you faster than you would care to admit.
If you are a true social drinker with a low-risk habit and you are not experiencing any negative consequences, then congratulations—you probably don’t need to make a whole lot of changes right now. Continue to be careful and responsible.
If you are binge or problem drinker, you might want to step back and consider making some changes before you get into serious trouble, or before your recreational habit progresses to tolerance, dependence, and even possibly, addiction.
Ideally, the best way to protect yourself is to stop drinking. But if that’s not a realistic goal for you, you should still be able to cut back voluntarily and drink more responsibly, without too much trouble.
But if you are finding it hard or even painful to change how much you drink, despite the impact it is having on your life, you may have an addiction to alcohol that requires professional help. If you are worried about what your drinking is doing to you and the people you care about, your first step should be to contact a reputable alcohol rehab program to determine what’s best for you and your situation.