How Do You Know if Someone is an Alcoholic

How Do You Know if Someone is an Alcoholic

I often get this question, “How do you know if someone is an alcoholic?” Generally, the person asking continues with something like, “I mean, my husband (or wife or sister or…) drinks about a six pack a night – more on the week-ends, but he still goes to work and hasn’t lost his job, yet. Does that make him an alcoholic?” Or that last information may go something like, “He’s OK during the week, but when the week-end comes, he starts cracking open the beers on Friday night and drinks steadily all the way through till Sunday evening. He’s not mean or anything, but we don’t do ANYthing because he just wants to drink his beers and watch TV. He says he deserves to relax after working hard all week.”

Believe it or not, in spite of how much these individuals are drinking, they may not be alcoholics.

So how can you tell if someone’s an alcoholic?

First, I’d like to share with you the definition of “low-risk” or “normal” drinking. This is provided by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) on their website, Rethinking Drinking:

  • For women: no more than 7 standard drinks in a week with no more than 3 of the 7 in any one day.
  • For men: no more than 14 standard drinks in a week with no more than 4 of the 14 in any one day.
How can you tell if someone's an alcoholic? Does always drinking enough to pass out a sign?

How can you tell if someone’s an alcoholic? Does drinking enough to pass out every week-end meet the definition?

A “Standard Drink” is defined as 5 ounces of wine, 3.3 ounces of champagne, 12 ounces of regular beer, 1.5 ounces of 80 proof hard liquor (vodka, for example) and 8-9 ounces of lager (dark ales).

So now that you know what “normal” drinking is, does that make everything else alcoholic? And the answer to this question is, “No.”

Depending on how frequently and in what pattern a person exceeds these “low-risk” limits, they may be engaging in “at-risk drinking” – a drinking pattern that’s considered alcohol abuse when followed repeatedly.

“At-risk drinking” is defined as:

  • For women: drinking more than one standard drink per day every day of the week (called “heavy social drinking”) or drinking 4 or more standard drinks in any one day (called “binge drinking”).
  • For men: drinking more than two standard drinks per day every day of the week (called “heavy social drinking) or drinking 5 or more standard drinks in any one day (called “binge drinking”).

“At-risk” drinking is where it all starts. When a person repeatedly engages in the above “at-risk” drinking patterns, they start the chemical and structural changes to their brain that are the result of alcohol abuse. Alcohol abuse, in turn, makes a person’s brain more susceptible to his/her key risk factors for developing addiction (in this case, an addiction to alcohol) – explained here. Risk factors explain why one person who may drink as much or more than another does not cross the line from alcohol abuse to alcoholism. In fact, alcohol abuse is a bigger problem in terms of numbers of people engaging in it, than is alcoholism in terms of the number of people estimated to be alcoholics.

But regardless of whether it’s alcohol abuse or alcoholism, these sorts of drinking patterns causes secondhand drinking for others. Secondhand drinking is a term to describe what happens to those who are on the receiving end of a person’s drinking behaviors – the crazy, convoluted circular arguments, the verbal and emotional abuse, driving while impaired, sexual assault — the behaviors a person exhibits when they drink more than their live and brain can process. Click here to learn more about secondhand drinking.

But, I know… this still does not answer the question, “How can you tell if someone is an alcoholic?”

One suggestion is to use the World Health Organization’s Alcohol Use Disorders Test (AUDIT) to get a general idea of what you are dealing with.

Using AUDIT to Assess Your Loved One’s Drinking

The following assessment was developed and evaluated over a period of two decades by the World Health Organization’s (WHO) Department of Mental Health and Substance Dependence. It is called AUDIT (the Alcohol Use Disorders Identification Test).(1) It was created primarily for health care practitioners around the world as a simple method of screening for excessive drinking. Other professionals who work with people who seem to have alcohol-related problems also find it useful.(2)

To complete the assessment, mark the answer that best applies to your perception of your loved one’s drinking. In other words, the “you” is your loved one. [Don’t forget, the “size” of a drink matters. A drink is defined as 5 ounces of wine OR 12 ounces of beer OR 1.5 ounces of 80-proof spirits (vodka, scotch).]

1. How often do you have a drink containing alcohol?
(0) Never
(1) Monthly or less
(2) 2 to 4 times a month
(3) 2 to 3 times a week
(4) 4 or more times a week

2.  How many drinks containing alcohol do you have on a typical day when you are drinking?
(0) 1 or 2
(1) 3 or 4
(2) 5 or 6
(3) 7, 8, or 9
(4) 10 or more

3.  How often do you have six or more drinks on one occasion [note: this is known as binge drinking, and in the U.S., binge drinking is five or more drinks on one occasion for men and four or more drinks on one occasion for women]?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

4.  How often during the last year have you found that you were not able to stop drinking once you had started?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

5.  How often during the last year have you failed to do what was normally expected from you because of drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

7.  How often during the last year have you had a feeling of guilt or remorse after drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

8.  How often during the last year have you been unable to remember what happened the night before because you had been drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

9. Have you or someone else been injured as a result of your drinking?
(0) No
(2) Yes, but not in the last year
(4) Yes, during the last year

10.  Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?
(0) No
(2) Yes, but not in the last year
(4) Yes, during the last year

Now, look at the numbers in the ( ) for each answer you’ve circled and total those numbers. According to AUDIT, total scores between 8 and 19 indicate alcohol abuse (excessive drinking). Total scores 20 and above indicate alcohol dependence (alcoholism).(3) A score of 0-7 indicates drinking at moderate levels. This is also known as “normal” drinking or “alcohol use.”


CAUTION
: The AUDIT goes on to say that in the absence of a trained professional conducting this questionnaire (as he or she knows how to ask the question and interpret the answer or dig more deeply for an accurate answer), these guidelines and scoring must be considered tentative — NOT definitive.  Additionally, the AUDIT notes that in an [“official”] evaluation, it matters on which questions points were scored. So it’s important to review the entire AUDIT document and not to draw any firm conclusions.

So, Why Assess?

According to the AUDIT,

  • “the bulk of harm associated with alcohol occurs among people who are not dependent [but rather engage in excessive drinking (alcohol abuse)].
  • “people who are not dependent on alcohol (alcoholics) may stop or reduce their alcohol consumption with appropriate assistance and effort. Once dependence [addiction/alcoholism] has developed, cessation of alcohol consumption is more difficult and often requires specialized treatment.
  • “Although not all hazardous [excessive/alcohol abuse] drinkers become dependent, no one develops alcohol dependence [alcoholism] without having engaged for some time in hazardous alcohol use.”4)

And, Now What?   

If your loved one’s drinking pattern is a problem based on the AUDIT assessment, this is still not a diagnosis, but it gives you a general sense of the scope of the problem. Now, you’ll want to learn more before you talk to you loved one about all of this – you may even want to have the conversation with your loved one in the presence of a therapist who specializes in addiction (or a similar addiction professional) to “broker” the conversation. Here are some resources to help you gather additional information. Please know these are not to be taken as advice, nor a diagnosis, rather they are to help you get more clear on what constitutes alcoholism vs alcohol abuse and suggestions for next steps:

NIAAA’s Rethinking Drinking  You’ll find so much here – drink calculators, tips for cutting down, tools to asses one’s drinking pattern and more.

NIAAA’s Clinicians Guide for Helping Patients Who Drink Too Much  Here’s you’ll find the guide NIAAA suggests clinicians use when trying to help their patients who drink too much.

Alcoholism is a Disease and It’s Not Alcohol Abuse  This is a 10 minute video of mine to explain the difference between alcoholism and alcohol abuse.

The Addiction Project  This website is chock full of information about addiction (alcoholism is an addiction to alcohol). The site and videos were produced by HBO and the content is a production collaboration of the National Institute on Drug Abuse (NIDA), the NIAAA and The Robert Wood Johnson Foundation.

Effective Dual Diagnosis Treatment | Relapse Prevention   This post will help you better understand next steps if your loved one struggles with drinking and has a mental illness (PTSD, depression, anxiety or bipolar, as examples).

The Health Consequences of Secondhand Drinking   This post will give you more information on what happens to the physical and emotional health of someone repeatedly exposed to Secondhand Drinking – the individuals posing the questions in the opening paragraph, for example.

_________________________________

(1) Babor, Thomas F., et. al., World Health Organization (WHO), “The Alcohol Use Disorders Identification Test, Guidelines for Use in Primary Care, Second Edition,” <http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf>

(2) Ibid, p.2

(3) Ibid., pgs. 17, 29 and 20

(4) Ibid., pgs. 5-6

Lisa Frederiksen

Lisa Frederiksen

Author | Speaker | Consultant | Founder at BreakingTheCycles.com
Lisa is the author of hundreds of articles and 11 books, including "If You Loved Me, You'd Stop!," "Addiction Recovery: What Helps, What Doesn't," and "Secondhand Drinking: the Phenomenon That Affects Millions." She is a national keynote speaker with over 25 years speaking experience, consultant, and founder of BreakingTheCycles.com. She has spent more than 14 years studying 21st century brain research in order to write, speak, and consult on substance use disorders prevention, intervention and treatment; mental disorders; addiction (aka substance use disorders) as a brain disease; adolescent addiction treatment vs adult addiction treatment; effective treatment for co-occurring disorders (having both a substance use and mental disorder); secondhand drinking | drugging; help for the family; and related subjects. In 2015, she founded SHD Prevention, providing training and consulting to companies, public agencies, unions, nonprofits and other entities to address the workplace impacts of employee secondhand drinking and alcohol misuse.

7 Responses to How Do You Know if Someone is an Alcoholic

  1. Jody Lamb says:

    Thanks for this, Lisa. I get these kinds of questions often, too. There’s a lot of confusion about alcoholism. This is great resource to clarify. Thank you, as always!

  2. Austin Barry says:

    Great way to ask yourself how much alcoholic you are? Thanks Lisa to share this post with us. I am very much impressed with your ‘question section’ and the male and female weekly drink take ratio. Working as a DWI attorney, I know the bad results of access drinking. We all should avoid this thing.

  3. Sherita says:

    My boyfriend drinks about 3 times a week. He has cheated on me in the past 2 months. He drinks a six pack to a 12 pack every week or every time he drinks. He stays out till 4 am when he gets off work at 11pm . We have a 2 year old he only spends time with him when it’s convenient for him. Is he an alcoholic?

  4. Kimberly says:

    My husband doesn’t drink during the week but he does binge drink EVERY weekend. Usually a case between Friday and Saturday night. Sloppy drunk and he thinks just because he doesn’t “need” it during the week, he doesn’t have a problem. It is getting to be a real problem. Our kids are grown but grand children are usually around to see his “sloppy” behavior.

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