data-gallery Sobering Questions
Alcoholic? Me? How to tell if your drinking is becoming a problem
Written By: Sarah Jo Nixon, Ph.D.
We’re just emerging from the most wonderful time of the year, when holiday parties collide with collegiate and professional athletics events.
What do they all have in common? Booze, lots of it, and often free.
Of course, drinking isn’t limited to a single season, but it holds a prominent place during the holidays. Across a few short weeks, consumption of spiked cider, wine, beer, cocktails and variations thereof may be higher than at any other point in the year. During this party time, we see up close the drinking habits of our partners, co-workers, relatives and, of course, ourselves.
As a new year gets underway, now is a good time to consider just how much you’re drinking. Maybe you can take an honest assessment of why you drink. Or think about the long-term effects. While it may be tempting to dismiss these unsettling reflections, as director of the University of Florida Center for Addiction Research and Education, I encourage you not to.
How many is too many?
About 1 in 8 U.S. adults met criteria for an alcohol use disorder in 2013 — the most recent year for which we have data. Compare that to just over 1 in 12 in 2002.
That’s a nearly 50% increase. Alcohol misuse can lead to interpersonal violence and physical injury and worsen medical and psychiatric conditions. Besides its impact on health and well-being, alcohol misuse costs the U.S. an estimated $224 billion a year in lost productivity, health care costs, criminal justice costs and others. More than 75% of those costs are associated with binge drinking.
But these statistics don’t answer the question I get most often from friends, family, casual acquaintances and even strangers at parties or on cross-country flights. What everyone wants to know is, “How much can I drink without being an alcoholic?” The answer is, “It depends.”
For starters, stop calling names
To effectively address the question, we must rethink our use of the term “alcoholic.” People have disorders; they are not themselves these disorders. The distinction is not merely a matter of semantics. It is fundamental to eliminating the stigma of substance use disorders and other psychiatric conditions.
Still, the more appropriate question, “How much can I drink without developing an alcohol use disorder?” gets the same answer: It depends. The amount that a person drinks doesn’t directly determine an alcohol use disorder diagnosis. But how can a “drinking problem” not have a definitive cutoff?
That’s because two people could drink the same amount and experience completely different consequences. So, the diagnostic criteria for alcohol use disorder focus on those consequences, rather than number of drinks imbibed.
For example, inability to control your drinking, no matter how much you drink, is a red flag. Having cravings for alcohol is another one. Does drinking interfere with your work, school or home responsibilities? Do you drink in situations in which you know it’s risky to do so?
Of course, the more you drink, the more likely it is that you will experience negative consequences.
Most drinkers do not develop a disorder. But that doesn’t mean you’re off the hook. Research shows that Americans are drinking more and for longer each time they drink than ever before. And, adults are continuing to drink into older ages than ever before.
Women, in particular, seem to drink more as they age. A significant percentage of drinkers over age 55 often exceed the National Institute of Alcohol Abuse and Alcoholism’s suggested guidelines for moderate drinking without necessarily meeting criteria for an alcohol use disorder. Whether you have a diagnosable disorder or not, all this drinking can cause problems.
One of those problems is driving. People mistakenly think of this as a young person’s problem. But about 1 in 4 adults 45 to 64 and another 1 in 12 over age 65 report driving after drinking in the previous month.
At blood alcohol concentrations equivalent to one or two drinks, older adults show notable shifts in cognitive performance, neural activity and driving strategies compared with younger ones.
Putting all this in the context of social events, it’s not just the pervasive presence of booze that makes us drink. It’s the party culture. If you’re seen without a drink, you are often encouraged to take one. If you lose track of your drink, you get another (full) one.
This excess may meet criteria for a binge drinking episode. For women, that’s four or more standard drinks in a single occasion. For men, it’s five or more. And, as for “standard” drinks, we all know that many of us are typically pouring ourselves two to three times the standard in every glass.
Binge drinking, too, is increasing in older adults. And that matters because it has an immediate impact on driving abilities, fall risk and prescription medications.
Should I take action?
If your alcohol use is gnawing at your conscience, you have options. Talk candidly with a trained professional about your drinking. Access the National Institute of Alcohol Abuse and Alcoholism website, where you can assess your drinking and seek help. If you believe a friend or relative has a problem, talk with someone who can help you identify next steps.
Here are some ways to be a safer drinker:
• Before a party, eat something, even if you have to eat it in the car.
• Make your first drink nonalcoholic. It keeps you from gulping down the first “real” drink and allows your “car snack” time to settle.
• Alternate alcoholic and nonalcoholic drinks.
• Eat (actually, graze) throughout the evening. Assuage guilt about calories by prioritizing fitness.
• Disregard peer pressure. Susceptibility to it may lessen with age, but seldom vanishes. When you reach your limit, don’t be swayed.
• To escape from an awkward conversation, don’t make a beeline to the bar. Take an indirect route through the room, mingling with the guests.
• Take a ride-share home or to and from a party.
If you think your seasonal drinking could be a sign of a year-round issue, discuss it with a medical or behavioral health provider. There are a variety of options, including the support and help of Alcoholics Anonymous, which is free. Online AA meetings are also available. For more information, visit: https://www.aa.org.
A version of this column was published in the online magazine The Conversation.