If you’re reading this post, likely you’ve been hurt, frustrated, concerned, angered, and/or scared by a loved one’s drinking. You’ve likely tried talking, yelling, cajoling, negotiating, looking the other way, believing their promise(s) to stop or cut down, but so far, nothing’s worked. I receive numerous emails and phone calls every week from people in this situation, and I know what they’re feeling. I’ve been there myself.
One of the most common questions people have (and I had) is, “How much is too much?,” because no matter how calmly or angrily or sadly I tried to talk with them about it, there was always a comeback. And their ability to slice and dice and mince words or segue into a counter attack could leave me speechless and defeated.
Based on my years of studying current brain research and working in this field, I can now answer my caller or email querier’s question, “How much is too much?,” with this answer, “Do their behaviors change when they drink?” If their answer is “Yes,” then I proceed with some variation of the following information.
And why do I start with drinking behaviors? Because it’s the behaviors they exhibit while under the influence of alcohol that are the issue – not the numbers of drinks, not whether they’re an alcoholic or “just” an alcohol abuser, not if they’re mostly a good parent and don’t miss work, not because they’re so very sorry for what they did. Understanding the cause of the drinking behaviors is what helps a person better understand…
What to Say to Someone Who Drinks Too Much
The following information can provide readers with important information to help them effectively talk with their loved one about their drinking.
What does it mean to lose control of your drinking?
- Doing poorly at work because of the drinking or recovering from the effects of drinking.
- Fighting with friends or family about the drinking; saying or doing things you don’t remember or regret.
- Binge drinking (defined as drinking 4 or more standard drinks for women; 5 or more for men).
- Verbally, physically or emotionally abusing someone – often a spouse, significant other, co-worker or child.
- Experiencing blackouts.
- Driving while under the influence; getting a DUI; riding in a car driven by someone who has been drinking.
- Having unplanned, unwanted or unprotected sex; date rape.
- Being admitted to the emergency room with a high BAC, in addition to the “other” reason.
The above are known as drinking behaviors. These behaviors occur with alcohol misuse which is when a person drinks more alcohol (ethyl alcohol chemicals) than their liver, body and brain can process. These behaviors cause secondhand drinking impacts for others, including family, co-workers, and friends. Alcohol misuse refers to a variety of drinking patterns, including binge drinking, heavy social drinking, alcohol abuse, and alcoholism (explained below).
- New brain imaging technologiesof the recent 10-15 years allow neuroscientists and medical professionals to study the live human brain like never before. The resulting discoveries are shedding new light on brain functioning and development and providing visual evidence of the chemical and structural changes that occur in the brain as a result of alcohol misuse (aka binge drinking, heavy social drinking, alcohol abuse and alcoholism). These changes affect areas of the brain that are necessary for a person’s ability to “think straight” and act responsibly.
- There are stages of drinking: use, abuse and alcoholism (see note at end of post). One does not have to be an alcoholic (see note at end of post) to have significant problems related to their drinking. The earlier a person addresses their alcohol misuse, the better it is for brain health and those within their sphere of influence. Alcohol use is defined as moderate or “low-risk” drinking.
- Alcoholism is a brain disease– one of the diseases of addiction, a chronic, often relapsing brain disease. Disease by its simplest definition is something that changes cells in a negative way. When cells are changed in a body organ, those cell changes, in turn, change the health and functioning of that organ. Alcoholism (addiction) changes cells in the brain, which is what changes the health and functioning of the brain, making it a brain disease. The American Medical Association (AMA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Drug Abuse (NIDA) and the U.S. Surgeon General are a few of the prominent organizations that define alcoholism as a brain disease.
9 Reasons a Person Can Lose Control of Their Drinking
- Not understanding the brain’s electro-chemical signaling process and formation of brain maps. The brain is the organ that controls everything a person thinks, feels, says and does. It does this through an electro-chemical signaling process and the mapping of frequently used neural networks. These can be influenced and changed (and thereby change a person’s thoughts and behaviors) by genetics, trauma, mental disorder, pain, alcohol misuse, and stress, to name a few examples.
- Not staying within moderate, “low risk” drinking limits:
For women: no more than 7 standard drinks in a week nor 3 of the 7 in a day.
For men: no more than 14 standard drinks in a week nor 4 of the 14 in a day.
- Not knowing standard drink sizes. A standard drink equals 5 ounces of table wine or 12 ounces of regular beer or 1.5 ounces of spirits (ex., vodka)
- Lack of awareness that not all ‘drinks’ are the same. A margarita, for example, may contain 2-3 standard drinks; a bottle of table wine contains 5. It takes the liver about 1 hour to metabolize (get rid of) the ethyl alcohol chemicals in 1 standard drink. Therefore, it would take approximately 2-3 hours to get rid of the ethyl alcohol chemicals contained in the margarita drink cited in this example. While the ethyl alcohol “waits” its turn out the liver, it “sits” in body organs, like the brain, and interrupts the electro-chemical signaling process, which is what causes the drinking behaviors described in the opening section.
- Not understanding the difference between alcohol abuse and alcoholism. Alcohol abuse is drinking more than moderate limits (#1). It includes binge drinking (defined as 4 or more standard drinks on an occasion for women and 5 or more for men) and heavy social drinking (defined as regularly drinking 2 or more standard drinks a day for women and 3 or more for men). Alcoholism is a developmental, chronic, often relapsing brain disease. Visit the National Institute on Drug Abuse (NIDA)’s website, “Drugs, Brains and Behavior: the Science of Addiction,” for more information.
- Not understanding the impact of early use of alcohol on a person’s brain development. This recent brain research shows the brain goes through a critical developmental stage from ages 12 – 25. The portions of the brain that deal with emotion, memory, learning, motivation and judgment are the last to develop. As such, they are the areas most deeply affected by alcohol (or other drug) misuse. Additionally, this research shows the teen brain handles alcohol differently than a fully developed, adult brain, which explains, in part, why underage drinking can be especially problematic.
- Not understanding the risk factors that contribute to a person developing the brain disease of alcoholism. Alcoholism is ‘caused by’ the chemical and structural changes caused by alcohol abuse in combination with the key risk factors: genetics, mental illness, early use, social environment and childhood trauma. These same risk factors also contribute to a person engaging in alcohol abuse.
- Not understanding that treatments of alcohol abuse and alcoholism differ.People who abuse alcohol but are not alcohol dependent (alcoholics) may be able to return to moderate drinking limits (#1) and thereby stop their drinking behaviors. Visit NIAAA’s website, “Re-Thinking Drinking,” for tips on cutting down. People who are alcoholics cannot drink any amount of alcohol if they want to stop their drinking behaviors long-term because alcoholism is a chronic, often relapsing brain disease. Alcoholism can successfully be treated, however, and the brain can recover. Check out NIDA’s “Principles of Effective Treatment” for more information.
- Not understanding Secondhand Drinking – defined as the negative impacts of a person’s drinking behaviors on others. Living with and/or working with a person’s drinking behaviors when a person does not understand the foregoing can cause that person to develop unhealthy coping skills and/or experience serious physical or psychological problems that interfere with school, work, family and relationships, as a result of stress and the physiological impacts of toxic stress. We call these impacts secondhand drinking (SHD). SHD can also contribute to a person developing some of the risk factors for engaging in alcohol abuse or developing alcoholism.
Why It’s So Important That You Talk to Your Loved One – Coping With Their Drinking Behaviors Has a Direct Effect On You – Your Physical and Emotional Health and Quality of Life
To answer why it’s so important to talk with your loved one is to understand Secondhand Drinking (SHD).
Secondhand drinking refers to the negative impacts of a person’s drinking behaviors on others. Drinking behaviors occur with a variety of drinking patterns: binge drinking, heavy social drinking, alcohol abuse and alcoholism.
Generally, drinking behaviors (see side bar) are not “intentional,” unless that’s how the person behaves when sober. Rather they are the result of brain changes caused by the ethyl alcohol chemical in alcoholic beverages interrupting the brain’s electro-chemical signaling process and thereby changing how the brain works.
- how the body processes alcohol via specific enzymes in the liver which metabolize [rid the body of] the ethyl alcohol chemicals in alcoholic beverages at an average rate of 1 standard drink per hour;
- standard drink sizes;
- staying within normal or moderate drinking limits; and
- the other variables listed in the side bar
can help a person avoid exhibiting drinking behaviors. It can also help a person protect themselves from secondhand drinking.
Two-thirds of the people whose drinking patterns cause drinking behaviors are not alcoholics. They are the binge drinker, heavy social drinker or alcohol abuser. Persons who are not alcoholics – don’t have the brain disease of addiction, aka a dependence on alcohol – have the potential to change their drinking patterns to fall within low-risk, normal or moderate limits.
A person with alcoholism, however, cannot drink any amount – ever – due to brain mapping around the characteristics of this brain disease, which include: cravings, tolerance, physical dependence and loss of control, as well as any untreated, underlying risk factors, such as mental illness or childhood trauma. Alcoholism is a fully treatable disease, however.
Why is Secondhand Drinking a Serious Concern?
Two reasons: the sheer numbers of people affected (approximately 90 million Americans) and its connection to stress.
The primary consequence of SHD’s impacts on a family member or close friend is stress. Coping with drinking behaviors triggers the fight-or-flight stress response system (FFSRS) centered in the limbic system, the reactionary part of the brain.
The FFSRS was “designed” in the human species to prepare a person to fight or run when faced with physical danger, and it causes a number of physiological changes to occur. For example, blood vessels to the skin constrict to lessen blood loss in the event of injury; the digestive system shuts down to conserve glucose needed for energy to run or fight; and heart rate increases to push blood flow to large muscles to allow a person to run more quickly.
The FFSRS also leads to dysregulation of the cerebral cortex (the thinking part of the brain) so that a person reacts immediately without considering the options when confronted with danger. As a result of another brain design feature – “neurons that fire together, wire together” – the brain “maps” the reaction (fight or flight) that kept the person safe. This map becomes a person’s default reaction the next time a similar triggering event occurs. This was especially important back in the day when early man’s only immediate threat was physical danger.
Today, however, and especially in families with untreated alcohol misuse, the FFSRS is more often than not triggered by things other than physical danger – emotional cues, for example, such as simmering fear, anxiousness or anger, memories and constant worry.
What Happens to the Person Affected by Secondhand Drinking?
Coping with drinking behaviors causes ongoing activation of the FFSRS. When a person doesn’t fight or run, all of those physiological changes described above sit – “marinate” – in body organs, like the brain, heart and muscles, resulting in physical and emotional ailments, such as: sleep disorders, migraines, headaches, stomach ailments, changes in eating habits, dizziness, distracted “thinking,” depression, anxiety, memory impairment, heart disease and digestive problems.
In addition to these physical and emotional impacts, the chronic activation of the FFSRS causes a person to wire unhealthy coping skills, because their brain maps the behaviors that kept them “safe” when confronted with the drinking behaviors. These can include:
- shutting down emotionally, retreating inside one’s mind when confronted with abusive or scary behaviors
- being hyperaware of others’ feelings or actions and adjusting one’s own accordingly
- yelling, crying, blaming, shaming or verbally lashing out
- carrying pent up, explosive rage that spills out in other situations because it cannot be expressed to the person exhibiting the drinking behaviors
- attempts to be especially good to make up for or fix the problem
- withdrawing from family, friends or activities out of embarrassment over the drinking behaviors.
These reactionary coping skills and the physical and emotional consequences change the family member and interfere with their work, school, relationships and ability to see, let alone enjoy, the pleasures in everyday life. All of which explains why family members need help – not a one-size-fits-all kind of help – rather the kind of help that addresses their bio-psycho-social issues in order for them to reclaim their lives in long-term secondhand drinking recovery.
What to Say to Someone With a Drinking Problem
Sometimes knowing what to say to someone with a drinking problem is as much about knowing what NOT to say.
Here’s where it’s helpful to start with WHAT NOT TO SAY:
- You’re a drunk!
- Do you know how stupid you sounded last night!
- Once again, you broke your promise. You broke YOUR PROMISE!!
- If you loved me you’d stop!
Although these kinds of statements are totally normal, they generally stem from not understanding that when a person drinks more than their liver can process (rid the body of), the alcohol continues to change brain function, which is why the person behaves the way they do. It’s not “them,” it’s alcohol changing brain function. Check out “Why BAC Can Keep Rising After a Person Stops Drinking” and “Understand Brain Maps | Change a Habit | Change Your Life.”
Not only this, but these kinds of statements are of the blaming and shaming type and while they make you feel better (believe me, I know from my own experiences), they don’t help the situation because the person with the drinking problem already feels ashamed and filled with self-loathing for why they can’t stop at one or two.
Instead, try these possible entry statements to the conversation BUT ONLY when they are sober and you’ve asked to talk with them:
- I don’t know if you’re aware how much your behaviors change when you drink, but last night, for example____________.
- I’ve been doing some googling trying to figure out if I should say anything about how you behave when you drink too much and found this great website, Rethinking Drinking. I’d really like you to do the anonymous assessment and take a look at the other information on the site.
- I’ve finally found a name for what happens to me when you behave the way you do while drinking – it’s called secondhand drinking. I’m going to be learning a great deal more about this, but I wanted you to know that your drinking behaviors – the way you act when you drink too much – are causing real problems for me. I’m not sure what to do about them, but I’m also understanding that my old ways of talking about this don’t work, either.
Know it doesn’t have to all be done at once
We tend to want to get it ALL out there and then have a solution – an action plan – by the end of the conversation. But with these kinds of conversations, rarely is this possible. The better approach is to calmly state your concern and then ask if you can talk about some of your other observations and research findings in a day or two – and then be sure to set a date/time to talk. They may want to keep going, but likely they won’t. And if they get defensive at any point, remind them you are doing this out of love and concern. You’d be doing the same thing if you were concerned about some other aspect of their health and wellbeing.
Remember – they are a person, first, and then a person with a drinking problem
It’s so easy to see them as their problem because their drinking problem is causing drinking behaviors that in turn cause you problems. You’ll want to be clear in your own mind that you are taking a stand against their drinking behaviors – against secondhand drinking (the negative impacts of their drinking behaviors on you and the quality of your life) – and not against them as a person.
Learn More About Drinking Behaviors, Secondhand Drinking, and What to Say to Someone Who Drinks Too Much
- For research-based information on drinking and its impact, visit from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) website, “Alcohol & Your Health.”
- Visit the National Institute on Alcohol Abuse and Alcoholism (NIAAA)’s website, “Rethinking Drinking.” There you will can anonymously assess a person’s drinking pattern, better understand what’s considered “low-risk” drinking, and find suggestions a person can follow to cut down on their drinking.
- Check out my short eBook, Quick Guide to Secondhand Drinking: A Phenomenon That Affects Millions.
Note About the Terms Alcoholism and Alcohol Abuse
Until May 2013, it was common to use the terms, alcohol abuse and alcoholism, because it’s how they were classified in the 4th edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This manual, updated now and then as a new edition, is for use by clinicians to give them a common language with which to understand, diagnose, and talk about a wide range of mental health conditions. Alcohol abuse and alcoholism were two of those conditions.
In May 2013, the 5th edition was released, DSM-5. This revised edition put both alcohol abuse and alcoholism into one disorder classification and called it “alcohol use disorder (AUD).” Within the AUD, there are three sub-classifications: mild, moderate, and severe.
Source: National Institute on Alcohol Abuse and Alcoholism (NIAAA). “Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5.” Reviewed July 2016, NIH Publication No. 13-7999. Accessed October 26, 2017. https://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf
When talking about both alcohol and other drugs, the term is substance use disorders (SUD).
I’ve chosen, however, to continue using society’s more commonly used terms, alcohol abuse and alcoholism, for two reasons. The first is because these are the terms most people know and use. The second is to make the distinction easier to explain and understand because the way a person stops their alcohol abuse is different than the way a person develops and treats their alcoholism. Yet, alcohol abuse or alcoholism have something hugely significant in common – drinking behaviors – the behaviors that can be so destructive to family members and friends’ physical and emotional health and quality of life, co-workers and society at large.
Note About the Terms Alcoholic and Alcohol Abuser
As part of this new brain science is the use of new language to describe a person who has the brain disease of alcoholism. The effort now is to refer to individuals with alcoholism as “a person with alcoholism.” This helps to remove the stigma, misinformation and shame that surrounds this disease and typically keeps people from seeking the help they need. It’s the idea of the individual is a person with a disease. They are not their disease.
As with the above, I continue (for now) to use the terms alcoholic and alcohol abuser because the way these drinking patterns are treated or changed varies greatly and is explained below.
©2017 Lisa Frederiksen