Here's how to tell if you may have a drinking problem.

Alcoholic beverages are a "social lubricant." At holiday and other parties, bouts of excessive drinking can seem like part of the celebration. But here's something to think about as you raise your glass: drinking too much alcohol at a party -- or at any time -- can be a sign of alcohol use disorder (AUD).


What is AUD?

AUD is the umbrella term for problem drinking that stems from alcohol abuse or alcohol dependence. While both are marked by problems stopping or controlling alcohol use, they're not the same.

"Alcohol abuse causes significant problems in your life at home or at work, but it doesn't involve physical addiction. So maybe you show up late for work once a week because of your drinking, and people around you are upset. Or maybe you're having trouble sleeping because of your drinking. Alcohol dependence is different. It's a physical addiction to alcohol. You have withdrawal symptoms if you stop drinking," explains Dr. Robert Doyle, a psychiatrist with Harvard-affiliated Massachusetts General Hospital and co-author of the book Almost Alcoholic.

Types of AUD

There's no specific amount of alcohol or frequency of drinking that determines the nature of AUD. That's unique to everyone, Dr. Doyle notes. For example, even if you drink only on weekends, you may still have AUD if your drinking is causing trouble.

Instead, AUD is classified as mild, moderate, or severe, depending on the number of symptoms a person exhibits (for a list of the symptoms, see "Alcohol use disorder criteria").

Mild AUD is diagnosed when a person has two to three symptoms. This may indicate alcohol abuse. Moderate AUD is diagnosed when a person has four to five symptoms. This may be caused by alcohol abuse or dependence. Severe AUD is diagnosed when a person has six or more symptoms. This is caused by alcohol dependence.

Alcohol use disorder criteria from the American Psychiatric Association

Having two to three of the following in the past year indicates mild alcohol use disorder (AUD); having four to five indicates moderate AUD; having six or more indicates severe AUD.



Were there times when you ended up drinking more, or longer, than you intended?

More than once, have you wanted to cut down or stop drinking, but couldn't?

Have you spent a lot of time drinking or getting over other aftereffects of drinking?

Have you wanted a drink so badly you couldn't think of anything else?

Have you found that drinking -- or being sick from drinking -- often interfered with taking care of your home or family, or caused job tor school troubles?

Have you continued to drink even though it was causing trouble with your family or friends?

Have you given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?

Have you more than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, using machinery, or having unsafe sex)?

Have you continued to drink even though it was making you feel depressed or adding to another health problem (or after having had a memory blackout)?

Have you had to drink much more than you once did to get the effect you want?

Have you found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure?

The health risks of AUD

Drinking too much alcohol can lead to problems in your relationships, job, and other aspects of your life, especially your health.

Excessive drinking (defined as more than one drink per day for women and more than one or two drinks per day for men) is associated with an increased risk for many health issues, such as liver disease (hepatitis and cirrhosis), irregular heart rhythms and heart failure, stomach ulcers, brain damage, stroke, cancer (especially of the breast, colon, liver, esophagus, or throat), sleep difficulty, osteoporosis, malnutrition, depression, high blood pressure, dementia, difficulty concentrating, depression, weight gain, and anxiety. In pregnant women who drink alcohol, there is also a danger that the baby will develop physical and psychological problems.

The National Institutes of Health estimates 88,000 men and women die from alcohol-related causes each year.

Do you have a problem?

If you're not sure if you have AUD, Dr. Doyle has two suggestions. "Don't drink for a month. If that's hard for you, then maybe it's a problem. Or ask the people around you what they think. If it's causing them distress, then it's a significant problem," he says.

He also notes that some people don't realize they have a problem because they haven't changed their alcohol intake. However, the ability to metabolize alcohol declines with age, so as you get older, alcohol can more easily impair your functioning.

Seeking help

Start by talking to your primary care physician. "Ask your doctor to check for signs that alcohol is affecting your health, such as higher blood pressure or higher liver enzymes," suggests Dr. Doyle. If you have alcohol dependence, you'll need medical guidance to stop drinking, including help coping with withdrawal symptoms (such as anxiety, sweating, trembling, nausea, and, in severe cases, physical seizures and hallucinations) and maybe a medication to curb your urge to drink.

And for any level of AUD, Dr. Doyle says talk therapy -- such as a 12-step program (like Alcoholics Anonymous) or cognitive behavioral therapy -- can help you change your behavior.

Asking a friend or family member to help you stay on track can make a difference. So can a change in environment and social activities. "It might be enough to just remove alcohol from your house or stop going to the club where you have cocktails. But if you go back to your old ways it could trigger an abuse problem again," Dr. Doyle says. "Figure out some way to make things different to change your pattern."

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