Alcohol: When Does Use Become Abuse?

Alcoholism may have faded from public view in recent years due to the rise of the opioid crisis, but it remains a public health concern. As we’ll see, problematic alcohol consumption changes brain function, just like many so-called hard drugs do. This can leave susceptible individuals at risk of developing dependence. Once that happens, these folks may find it difficult to maintain relationships, hold a job or handle their finances.

In this post, you’ll learn what alcoholism is, why alcohol is addictive in the first place, and how to identify alcoholism in yourself or in others.

Ready? Let’s go.

What is Alcoholism?

Alcoholism is the most several stage, or level, of alcohol abuse. While many think of alcohol as a normal, natural substance to consume in social settings, it’s important to keep in mind that alcohol is indeed a drug. Of course, Alcoholism, also known as alcohol use disorder, is not simple social drinking. It is characterized by compulsive use of alcohol by an individual despite negative consequences. It comes in three categories: mild, moderate and severe.

What Drives Alcoholism?

We’ll cover how alcohol affects the brain in a bit, but for now, it’s important to understand that a primary driver of alcoholic behavior is the alcoholic’s belief that they cannot function normally without a drink. This need to consume alcohol on a regular basis, in turn, causes negative consequences. Alcoholics may experience setbacks in their:

• Personal life
• Professional life
• Interpersonal relationships
• Search for self-actualization, empowerment or fulfillment
• Health

Fortunately, with treatment, an alcoholic can learn to manage their addiction.

How is it Diagnosed?

There is no simple, one-and-done way to diagnose alcohol use disorder. Many doctors use questionnaires as a first step in determining whether their patient may be struggling to control their alcohol use. We provide a few of these in the last section of this post.

These questionnaires help medical professionals gauge the degree to which the client is dependent on alcohol.

In addition, part of the process may involve family members and friends filling out questionnaires. This may appear intrusive at first glance, but the additional information provides the health care professional with an important vantage point from which to determine the subject’s dependence on alcohol.

How Alcohol Affects the Brain

Alcohol is an addictive substance. Consuming alcohol causes the brain’s reward center to release feel-good chemicals known as endorphins. Endorphins are endogenous opioids—the brain produces them itself. Under normal circumstances, the brain releases endorphins during exercise and certain other activities to lessen the perception of pain. But some substances, like alcohol, force the brain to release these neurochemicals.

With today’s sophisticated brain imaging technology, researchers can see how alcohol interacts with the brain’s reward center to accomplish this.

What’s more, brain scientists can see differences between heavy drinkers and light drivers. As someone drinks more and more, the brain adapts. In the heavy drinkers, the researchers observed more endorphin release. One theory is that the brain releases more and more endorphins when the person drinks, but less endorphins during all other activities. This is problematic because if the brain begins to rely on an outside substance to tell it when to release a given neurochemical, it becomes dependent on that substance.

Chemical dependence is required for addiction to take root.

Furthermore, according to the brain scans, some people naturally respond to alcohol more than others. These people may be at higher risk of developing alcohol use disorder or displaying alcoholic behavior.

For these folks, they get quite a bit of enjoyment from drinking to drunkenness, even if being drunk isn’t always pleasant or convenient.

The good news is this research could lead to better versions of drugs like Naltrexone.  Naltrexone is an opioid inhibitor. So if an alcoholic takes the drug before drinking, they won’t get the buzz they’re expecting. This removes the reward from the equation, which may help the brain become less dependent on alcohol over time.

However, while further refinements in drugs like these may make it easier to manage alcoholism in the future, the first line of defense remains detox in an accredited rehabilitation facility followed by intensive therapy. Cognitive behavioral therapy, in particular, is often reported to be effective.

Identifying Alcoholic Behavior

It’s easy to tell when someone’s been drinking. They may exhibit any of the following:

• Slurred speech
• Lowered inhibitions
• Confusion
• Impaired coordination
• Memory problems or inability to concentrate

But the occasional drinking session does not mean that someone is an alcoholic. Indeed, determining whether someone has a drinking problem can be quite difficult. People with alcohol use disorder tend to hide, or minimize, their alcoholic behavior. Some people, known as high-functioning alcoholics, are especially good at this.

For a long time, it may be possible to ignore the addiction because it doesn’t cause major problems in the person’s home or work life. For many, however, there comes a time when that is no longer the case.

Warning Signs

If you suspect that a loved one—or indeed, you yourself—are struggling with alcohol use disorder, watch for these warning signs.

• Being unable to control consumption. They promise to curb their alcohol use, but invariably, they seem unable to keep that promise.
• Being unable to control when they drink. They know they shouldn’t drink at 9am, but they say they need a drink just to ‘calm their nerves.’
• Having uncontrollable cravings. They frequently justify their consumption by saying they have annoying cravings.
• Drinking alone. They’ll often enjoy a drink or two, or five, alone or in secret. Drinking may have started out as a social activity, but that is no longer the case.
• They maintain secret stashes of whiskey, beer or other forms of alcohol. If they know their alcohol use is not problematic, then why do they feel the need to create secret stashes?
• Exhibiting tolerance. Having to drink more than they used to in order to get a ‘buzz on’ is always a warning sign.
• If they can’t drink for any reason, they become unreasonably upset.
• Prioritizing drinking despite negative consequences. They’ll keep drinking even though their habit causes problems.
• A preference to drink instead of perusing other hobbies. This is especially relevant if they’ve dropped existing pastimes in order to drink more often.
• Experiencing blackouts. Drinking to the point of memory failure or blackout is always a warning sign.
• If they’re unable to drink for 12 hours or more, they may exhibit physical symptoms of withdrawal. This is always a warning sign of addiction.

Typical alcohol withdrawal symptoms include, but are not limited to:

• Nausea
• Sweating
• Hallucinations
• Shaking or trembling
• Vomiting
• Convulsions

Behavioral Signs of Alcoholism

As you might expect, the items on the above list tend to manifest as a series of predictable behaviors. As alcoholism progresses from mild to severe, these behaviors become more common. In this section, we’ll elaborate on the above points. Let’s take a look.

#1 High Tolerance

In most folks, tolerance for alcohol builds slowly over time. When you have your first drinking session, you’ll likely notice that you’re quite sensitive to the effects of alcohol. But if you make drinking a regular event, your brain will adapt by becoming less sensitive to the drug’s effects. At this point, you might notice that when you go out with friends and drink socially, you’re able to drink much more than they can.

#2 Inappropriate Use

If you notice yourself using alcohol where it’s prohibited, you should consider this a warning sign. Examples include work or certain social situations. There is little reason to consume alcohol in these situations unless, of course, you’re experiencing intense cravings. If you’re experiencing cravings for alcohol, you may be well on your way to addiction.

Moreover, using alcohol in these places may indicate that you can’t drink at home. But if your use is not problematic, why can’t you drink around your loved ones?

#3 Isolation

The budding alcoholic may begin isolating themselves from others. Interestingly, this can manifest as workaholism or absence from work. In the former, diving headfirst into a project may be an excuse to be alone and drink. In the latter, absence from work, or dodging obligations, could indicate loss of control over consumption.

In addition, showing up for work, school or to other obligations late is often an early warning sign.

#4 Irrational Mood Swings

As alcoholism takes root, it begins to affect the brain in more profound ways. As the brain’s reward center comes to rely on alcohol for activation, you may feel stressed out more often. This will be most notable during any periods in which you can’t drink your usual amount of alcohol. This can lead to mood swings or irrational outbursts. Pining for a simpler time when alcohol was a way to escape stress and didn’t cause stress can also bring on intense emotions.

#5 Avoiding Social Functions or Other Events That Don’t Include Alcohol

If you’re feeling intense cravings or withdrawal, you’ll be more likely to avoid events or social functions that don’t offer a chance to drink. Instead, you’ll be more likely to stay home.

#6 Risky or Dangerous Behavior

As casual drinking becomes alcoholism, you may notice that you take risks you would have found unacceptable before. The changes in brain function we covered earlier drives this behavior. You may find yourself drinking too long or too much. Where before, you knew how many drinks you could take before blackout, you now go right over that threshold without much thought.

You’re able to mentally minimize the negative consequences while focusing on the more immediate upsides. The bottom line, however, is that self-control and judgment become impaired.

#7 You Often Joke About Your Alcohol Use

Or you get defensive about it. If you find yourself minimizing your drinking or joking about it, you may have a problem. This can actually be a way for you to admit to your buddies or loved ones that you have a problem, but that you’re not sure how to handle it.

What Does High-Functioning Mean?

In short, a high-functioning alcoholic is someone who defies the stereotypical image of a typical alcoholic. They can maintain their job, relationship and finances. They have little or no trouble managing their day-to-day life or maintaining a routine.

However, a high-functioning alcoholic is still dependent on alcohol, and they’re likely consuming an unsafe amount.  Additionally, they’re likely to be in denial about their dependence on alcohol, and they’ll point to their relatively well-managed life as evidence of this despite their high rate of alcohol consumption.

Because they exhibit less alcoholic behavior, and because they’re in denial about their dependence, they’re less likely to seek help. Unfortunately, for many, the precarious balancing act that has allowed them to maintain relatively stable lives while drinking more and more does not last forever. It can all come crashing down very quickly.

High-functioning alcoholics often use alcohol as a way to relax or to build confidence. Note, however, that this is often just dependence in disguise.

How Much Is Too Much?

If you’re concerned about your own consumption after reading the above, consider the following. According to many experts, a person is considered at high risk of developing dependence on alcohol if they have more than four drinks in a given day or 14 drinks within one week.

If you’re drinking more than this, we strongly urge you to see the self-assessments provided in the next section. It may be time to seek the help of an accredited rehabilitation facility.

A ‘drink’ can be any of the following:

• A 12 oz. beer that’s five percent alcohol
• A 5 oz. glass of wine, around 12 percent alcohol
• 8 ounces of malt liquor, seven percent alcohol
• 5 oz. of 80 proof, which is 40 percent alcohol

When to Seek Help

Consider the following simple self-assessment. If you answer ‘yes’ to two or more of these, it may be time to seek help. Do you:

• Ever feel guilty or ashamed about your alcohol use?
• Lie to others to hide or minimize your use?
• Need to drink in order to feel relaxed, more confident or in control?
• Ever experiences blackouts?
• Need to be taken home by someone else because you were so drunk you couldn’t walk or drive?
• Often drink more than you meant to?

Because alcohol affects everyone differently, alcoholism can sneak up on you. So if you are concerned about your use, consider revisiting this self-assessment every now and then.

Additionally, other questionnaires, like AUDIT and MAST are longer and are more in depth.

Isn’t Rehab Unpleasant?

While it’s certainly true that detox is uncomfortable because of withdrawal, detox is just the start of the recovery journey. In an accredited rehabilitation facility, you’ll learn powerful therapy modalities like cognitive behavioral therapy. With these tools, you’ll be equipped to handle cravings going forward. This can give you the power to manage your addiction over the long term.

For instance, cognitive behavioral therapy can make you more aware of triggers that would otherwise drive you to drink. By simply being aware of these triggers—and by being present in the moment as a consequence—you’ll find your cravings to be more tolerable. As many recovering alcoholics will point out, CBT allows you to ‘ride the wave.’ The craving comes, it crests, and then it goes.

Once you learn to ride the wave, you no longer need be a slave to alcohol. Recovery is possible, but it starts with that first step.

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