Are You At Risk?
by Lisa Frederiksen
You may have nagging thoughts about your drinking or that of 
a loved one. You may have running discussions with yourself about whether drinking a couple of glasses of wine every evening or having 6 or 7 on Friday or Saturday nights is a problem or whether a DUI is a sign of alcoholism. While there are no definitive answers when it comes to “diagnosing” a person’s drinking, here are some guidelines.
The Moderate (Social) Drinker. This is someone who drinks within “safe” limits – limits defined by the National Institutes on Alcohol Abuse and Addiction’ Clinician’s Guide as not likely to cause alcohol-related problems. You’ve read these limits before on this website: no more than 3 in a day NOR 7 in a week for woman and no more than 4 in a day NOR 14 in a week for men. Part of this definition includes the understanding that a standard drink is 5 ounces of wine OR 12 ounces of beer or 1.5 ounces of 80-proof spirits. Click here for additional standard drink definitions.
The Alcohol Abuser. This is someone who is not addicted to alcohol (not an alcoholic) but whose drinking is causing problems. These might include a DUI, blackouts (doesn’t remember anything or parts of a drinking episode), getting into fights with a spouse, parent or siblings about their drinking, missing work or not being as effective at work due to a hangover, engaging in unprotected sex, getting involved in unwanted sex or sexual assault or doing or saying “things” while drinking that you would not normally do. The alcohol abuser has not crossed the invisible line to addiction, so that person is able to change their drinking habits (which may include stopping all together).
The Alcoholic (a person with an addiction to alcohol). The alcoholic engages in the same drinking behaviors as the alcohol abuser (DUIs, relationship problems, unwanted sex), but they also have the disease of addiction; a chronic, relapsing brain disease as a result of the chemical and structural changes in the brain caused by alcohol abuse. All alcoholics go through a period of alcohol abuse, but not all alcohol abusers become alcoholics. The disease includes the following four symptoms:
- Craving–A strong need, or urge, to drink.
- Loss of control–Not being able to stop drinking once drinking has begun.
- Physical dependence–Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking.
- Tolerance–The need to drink greater amounts of alcohol to get “high.”
If you are an alcoholic, the only way to treat your disease is to abstain entirely from drinking alcohol. There is no amount of alcohol that can safely be consumed at anytime in the future if one is an alcoholic. But this concept is the subject of a whole other post.
Are You At Risk For Becoming an Alcoholic? Because alcoholism is a disease, it is like all other diseases in that there are risk factors that contribute to the development of the disease. Here are a few:
- Genes. Just as woman with a mother who has breast cancer or a man with a father who has prostate cancer have a genetic predisposition to those cancers, so it is true of alcoholism. People born into families with alcoholism run a genetic risk for developing alcoholism.
- Environment. Growing up in a family with alcoholism (or alcohol abuse) causes a young person to develop coping skills and perceptions of drinking that increase their own chances of developing an addiction to alcohol.
- Mental Health Illness. Having an untreated mental health illness (depression, ADHD, PTSD, bipolar) can cause a person to turn to alcohol to self-medicate without any understanding that that is what they are doing — it just feels better. It is important to treat the mental health illness in order to stop the alcohol abuse or treat an addiction.
- Psychological Factors. People who are highly impulsive or sensation seekers are also at higher risk for addiction. The need for high-risk “adventure” or the inability to think something through to assess potential negative consequences can cause a person to embrace binge drinking, which can in turn, can lead to alcohol abuse and perhaps addiction.
- Age of First Use. Age of first use, independent of other factors (e.g., genetics, environment, mental health issues [ADHD, depression, bi-polar, PTSD]), strongly predicts the development of a lifelong addiction to alcohol.(1) Children who begin drinking before the age of 15 are five times more likely to develop problems with alcohol than those who start after 21.(2) For each year a teen delays alcohol use, their chances of becoming dependent (addicted to alcohol) drops by 14%.(3) The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that one-half of alcoholics were addicted by age 21, and 2/3 were addicted by age 25.(4)
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(1) NIAAA Statistical Snapshot Underage Drinking, <http://www.niaaa.nih.gov/AboutNIAAA/NIAAASponsoredPrograms/StatisticalSnapshotUnderageDrinking.htm>
(2) The National Survey on Drug Use and Health Report, 10/22/04
(3) Spear, L.P., The Adolescent Brain and Age-Related Behavioral Manifestations, Neuroscience and Biobehavioral Reiews 24 (2000) 417-463
(4) NIAAA Statistical Snapshot Underage Drinking, <http://www.niaaa.nih.gov/AboutNIAAA/NIAAASponsoredPrograms/StatisticalSnapshotUnderageDrinking.htm>
