Alcoholism and Alcohol Abuse

Understanding drinking problems

Many people drink regularly without experiencing any harmful effects, other than perhaps a slight hangover on rare occasions. Yet millions of others suffer from alcoholism and alcohol abuse, making even an occasional drink dangerous.

How can some people drink responsibly, while others drink to the point of losing their health, their family, or their job? There are no simple answers. Drinking problems are due to many interconnected factors, including genetics, how you were raised, your social environment, and your emotional health. People who have a family history of alcoholism or who themselves suffer from a mental health problem such as anxiety, depression, or bipolar disorder are particularly at risk, because alcohol may be used to self-medicate.

Since drinking is so common in our culture and the effects vary so widely from person to person, it’s not always easy to figure out where the line is between social drinking and problem drinking. Taking an honest look at why you drink may help you figure out which side of the line you fall on. Remember, though, the bottom line is how alcohol affects you. If your drinking is causing problems in your life, you have a drinking problem.

Signs and symptoms of alcohol abuse

Substance abuse experts make a distinction between alcohol abuse and alcoholism (also called alcohol dependence). Unlike alcoholics, alcohol abusers still have at least some ability to set limits on their drinking. However, their alcohol use is still self-destructive and dangerous to themselves or others. 

Common signs and symptoms of alcohol abuse include:

• Repeatedly neglecting your responsibilities at home, work, or school because of your drinking. For example, performing poorly at work, flunking classes, neglecting your kids, or skipping out on commitments because you’re hung over.
• Using alcohol in situations where it’s physically dangerous, such as drinking and driving, operating machinery while intoxicated, or mixing alcohol with prescription medication against doctor’s orders.
• Experiencing repeated legal problems on account of your drinking. For example, getting arrested for driving under the influence or drunk and disorderly conduct.
• Continuing to drink even though your alcohol use is causing problems in your relationships. Getting drunk with your buddies, for example, even though you know your wife will be very upset, or fighting with your family because they dislike how you act when you drink.

Signs and symptoms of alcoholism (alcohol dependence)

Alcoholism is the most severe form of problem drinking. Alcoholism involves all the symptoms of alcohol abuse, but it also involves another element: physical dependence on alcohol. There’s a fine line between alcohol abuse and alcoholism, but if you rely on alcohol to function or feel physically compelled to drink, you’ve crossed it.

Tolerance: The 1st major warning sign of alcoholism

Do you have to drink a lot more than you used to in order to get buzzed? Can you drink more than other people without getting drunk? These are signs of tolerance, the first warning sign of alcoholism. Tolerance means that, over time, you need more and more alcohol to feel the same effects you used to with smaller amounts.

Withdrawal: The 2nd major warning sign of alcoholism

Do you need a drink to steady the shakes in the morning? Drinking to relieve or avoid withdrawal symptoms is a sign of alcoholism and a huge red flag. When you drink heavily, your body gets used to the alcohol and experiences withdrawal symptoms if it’s taken away. Alcohol withdrawal symptoms include:

In severe cases, withdrawal from alcohol can also involve hallucinations, confusion, seizures, fever, and agitation. These symptoms can be dangerous, so talk to your doctor if you are a heavy drinker and want to quit.

Other signs and symptoms of alcoholism (alcohol dependence)

• You’ve lost control over your drinking. You often drink more alcohol than you wanted to, for longer than you intended, or despite telling yourself you wouldn’t.
• You want to quit drinking, but you can’t. You have a persistent desire to cut down or stop your alcohol use, but your efforts to quit have been unsuccessful.
• You have given up other activities because of alcohol. You’re spending less time on activities that used to be important to you (hanging out with family and friends, going to the gym, pursuing your hobbies) because of your alcohol abuse.
• Alcohol takes up a great deal of your energy and focus. You spend a lot of time drinking, thinking about it, or recovering from its effects. Often, drinking is the center of your social life.
• You drink even though you know it’s causing problems. For example, you recognize that your alcohol abuse is damaging your marriage, making your depression worse, or causing health problems, but you continue to drink anyway.

Drinking problems and denial

Denial is one of the biggest obstacles to getting help for alcohol abuse and alcoholism. The desire to drink is so strong that the mind finds many ways to rationalize drinking, even when the consequences are obvious. Unfortunately, denial often increases as drinking gets worse. And by keeping you from looking honestly at your behavior and its negative effects, denial also exacerbates alcohol-related problems with work, finances, and relationships. It’s a vicious cycle.

For example, you may blame an ‘unfair boss’ for trouble at work or a ‘nagging wife’ for your marital issues, rather than look at how your drinking is contributing to the problem. While work, relationship, and financial stresses happen to everyone, an overall pattern of deterioration and blaming others may be a sign of trouble.

If, once again, you find yourself rationalizing your drinking habits, lying about them, or refusing to discuss the subject, take a moment to consider why you’re so defensive. If you truly believe you don’t have a problem, why do you feel the need to cover up your drinking or make excuses? Is it possible that your drinking means more to you than you’re ready to admit?

Five myths about alcoholism

Getting to the truth behind the myths that you may be using to justify your drinking is crucial to breaking down the wall of denial.

Myth #1: I can stop drinking anytime I want to.

Maybe you can; more likely, you can’t. Either way, it’s just an excuse to keep drinking. The truth is, you don’t want to stop. Telling yourself you can quit makes you feel in control, despite all evidence to the contrary and no matter the damage it’s doing. 

Myth #2: My drinking is my problem. I’m the one it hurts, so no one has the right to tell me to stop.

It’s true that the decision to quit drinking is ultimately up to you. But you are deceiving yourself if you think that your drinking hurts no one else but you. Alcoholism affects everyone around you—especially the people closest to you. Your problem is their problem.

Myth #3: I don’t drink every day, so I can’t be an alcoholic OR I only drink wine or beer, so I can’t be an alcoholic.

Alcoholism isn’t defined by what you drink, when you drink it, or even, to some extent, how much you drink. If your drinking is causing problems in your life, you may be an alcoholic and you definitely have a drinking problem—whether you drink daily or only on the weekends, down shots of tequila or stick to wine, have three drinks a day or three bottles.

Myth #4: I’m not an alcoholic because I have a job and I’m doing okay.

You don’t have to be homeless and drinking out of a brown paper bag to be an alcoholic. Many alcoholics are able to hold down jobs, get through school, and provide for their families. Some are even able to excel. But just because you’re a high-functioning alcoholic doesn’t mean you’re not putting yourself or others in danger. Over time, the effects will catch up with you.

Myth #5: Drinking is not a “real” addiction like drug abuse.  

Alcohol is a drug, and alcoholism is every bit as damaging as drug addiction. Alcohol addiction causes changes in the body and brain, and long-term alcohol abuse can have devastating effects on your health, your career, and your relationships. Alcoholics go through physical withdrawal when they stop drinking, just like drug users do when they quit.

Effects of alcoholism and alcohol abuse

Alcoholism and alcohol abuse affect all aspects of your life. To start, long-term alcohol use can cause serious health complications, affecting virtually every organ in your body, including your brain. What’s more, problem drinking can also damage your emotional stability, your finances, your career, and your ability to build and sustain satisfying relationships. But it doesn’t stop there. Alcoholism and alcohol abuse have an impact on your family, your friends, the people you work with, and even the greater community you live in.

The effects of alcoholism and alcohol abuse on the people you love

Despite the potentially lethal damage that heavy drinking does to the body—including cancer, heart problems, and liver disease—the social consequences can be just as devastating. Alcoholics and alcohol abusers are much more likely to get divorced, have problems with domestic violence, struggle with unemployment, and live in poverty.

But even if you’re able to succeed at work or hold your marriage together, you can’t escape the effects that alcoholism and alcohol abuse has on your personal relationships. Drinking problems put an enormous strain on the people closest to you.

Often, family members and close friends feel obligated to cover for the person with the drinking problem. So they take on the burden of cleaning up your messes, lying for you, or working more to make ends meet. Pretending that nothing is wrong and stuffing all of their fears and resentments inside takes an enormous toll. Children are especially sensitive and can suffer long-lasting emotional trauma.

Getting help for alcoholism or alcohol abuse

If you’re ready to face your drinking problem, congratulations! Admitting you have a problem is a huge first step. It takes tremendous strength and courage to face your alcohol abuse or alcoholism head on. The second step is reaching out for support.

Much as you may want to, don’t try to face your drinking problem alone. Changing your drinking habits will be hard and you’ll need support. Without it, it is very easy to rationalize just one more drink, especially since alcohol is everywhere in our society, or to fall back into old patterns when things get tough.

When a loved one has a drinking problem

If someone you love has a drinking problem, you may be struggling with a number of painful emotions, including shame, fear, anger, and self-blame. The problem may be so overwhelming that it seems easier to ignore it and pretend that nothing is wrong. But you know that something is wrong, and in the long run, denying it will be more damaging to you, other family members, and the alcoholic.

Dealing with a loved one’s alcohol problem can be an emotional rollercoaster. It’s vital that you take care of yourself and get the support you need. Having people you can talk honestly and openly with about what you’re going through is important.

A good place to start is by joining a group such as Al-Anon, a free peer support group for families coping with alcoholism. Listening to others with the same challenges can be a tremendous source of comfort and support. You can also turn to trusted friends, a therapist, or people in your faith community.

• You cannot force someone you love to stop abusing alcohol. As much as you may want to, and as hard as it is to watch, you cannot make someone stop drinking. The choice is up to them.
• Don’t expect the person to stop drinking and stay sober without help. Your loved one will need treatment, support, and new coping skills to overcome a serious drinking problem.
• Recovery is an ongoing process. Recovery is a bumpy road, requiring time and patience. An alcoholic will not magically become a different person once sober. And the problems that led to the alcohol abuse in the first place will have to be faced.

Admitting that there’s a serious problem can be painful for the whole family, not just the alcoholic. But don’t be ashamed. You’re not alone. Alcoholism affects millions of families, from every social class, race, and culture. But there is help and support available for both you and your loved one.

Related articles

Related links for alcohol abuse and alcoholism

Signs and symptoms of alcohol abuse and alcoholism

Alcohol Abuse: How to Recognize Problem Drinking – List of questions that can help you identify the signs and symptoms of problem drinking, alcohol abuse, or alcoholism. (American Academy of Family Physicians)

Rethinking Drinking – Interactive website with tools to help you check your drinking pattern, identify signs and symptoms of a problem, and get tools to cut back. (National Institute on Alcohol Abuse and Alcoholism)

Is it a Problem? – Offers a number of screening tests and quizzes to help you determine the extent of a drinking problem in yourself or a loved one. (The Partnership for a Drugfree America)

Effects of alcohol abuse and alcoholism

Alcohol: What You Don't Know Can Harm You – Explains some of the consequences of drinking, including long-term effects of alcohol use on your health and relationships. (National Clearinghouse for Alcohol & Drug Information)

Alcohol's Damaging Effects on the Brain – Reviews the effects of alcohol on the brain, including blackouts, memory lapses, and other types of brain damage. (National Institute on Alcohol Abuse and Alcoholism)

Helping someone with a drinking problem

Helping Others With a Problem – Learn what to do and say to help someone with a drinking problem. Includes information about interventions, enabling, and where to go for help. (The Partnership for a Drugfree America)

How to Talk to an Older Person Who Has a Problem with Alcohol or Other Medications (PDF) – How to identify the signs and symptoms of problem drinking in older adults and express your concerns. (Hazelden)

Support for family members of alcoholics and alcohol abusers

Alcohol and Drug Addiction Happens in the Best of Families – Explains the effects of alcohol abuse and alcoholism on families and loved ones. (SAMHSA Center for Substance Abuse Treatment)

Al-Anon and Alateen – Support group for friends and families of problem drinkers. Based on the twelve-step Alcoholics Anonymous program.

Coping with an Alcoholic Parent – Article for teenagers and adolescents on dealing with the problem of an alcoholic parent and how to get support. (KidsHealth)

Melinda Smith, M.A.; Joanna Saisan, MSW; and Jeanne Segal, Ph.D. contributed to this article. Last reviewed: December 2009.