Signs of Alcoholism: A Guide to Easy Recognition

The signs of alcoholism include lying about drinking, a higher tolerance for alcohol, continuing to drink despite negative effects in various areas of life, drinking in situations where it is unsafe to do so, and withdrawal symptoms when alcohol begins to process out of the body.

A Culture of Drinking

Alcohol consumption has long been quite common in the U.S. Many social events involve drinking — whether it’s a wedding, cookout, or meeting friends at a bar. People from all different age groups consider drinking part of their lifestyle. This might include having a few beers after work, sharing a bottle of wine with a friend, or indulging in a craft cocktail at home.

For some, however, these drinking habits can evolve into a serious and even life-threatening problem: alcoholism. Alcoholism is a severe but treatable disease also known as alcohol use disorder.

It can sometimes be difficult to differentiate between regular alcohol consumption and alcoholism, especially in a culture that normalizes — and even glamorizes —- drinking. Alcoholism is a progressive disease, so its effects only get worse with time. Recognizing signs of alcoholism and seeking treatment as early as possible may be the difference between life and death.

When It Comes to Drinking, What’s Normal?

Because each person’s relationship with alcohol is unique, it’s difficult to define “normal” drinking versus problematic drinking. For example, one individual may be able to have a drink or two every day and never feel the urge to have more. Another may have a drink or two every day for a while and then begin to feel the need to have three; they even might start drinking more and more.

There are many factors that can cause someone to be more prone to alcohol addiction. These include genetics, past trauma, mental health problems, and stressful life conditions.

Guidelines on Drinking 

While “normal” and problematic drinking habits will vary depending on the individual, government agencies and professionals have released some guidelines that are helpful in identifying what kinds of drinking may relate to a more severe problem, like alcoholism.

• According to the 2015 to 2018 Dietary Guidelines for Americans, released by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, “moderate” drinking is up to one drink per day for women and up to two drinks a day for men.
• The National Institute on Alcohol Abuse and Addiction (NIAAA) defines low-risk drinking as no more than three drinks in a single day and/or no more than seven drinks per week for women. For men, low-risk drinking is defined as no more than four drinks on any single day and no more than 14 drinks in a week
• NIAAA claims that based on their research, only two out of 100 individuals whose drinking habits meet their low-risk drinking guidelines have alcohol use disorder (AUD).
• Per the Centers for Disease Control and Prevention, binge drinking is when a man drinks at least five drinks, or a woman drinks at least four drinks within a few hours.

Heavy alcohol use is binge drinking five or more days within the past month.

Because individuals may face different factors that make them more susceptible to alcohol addiction and many people may not be completely honest with loved ones or even themselves about how much they are actually drinking, only looking at the amount or frequency of drinking may not be the best way to detect a problem with alcohol. 

Alcohol Use Disorder or Alcoholism?

When researching alcoholism, you will encounter the term alcohol use disorder (AUD). This is a clinical term used by the medical community to diagnose drinking problems.

To be diagnosed with AUD, an individual must match the criteria outlined in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). If they meet the criteria, the severity of their AUD is based on how many criteria they match. A mild AUD diagnosis would be matching two to three criteria points; a moderate diagnosis would be matching four to five criteria points, and a severe diagnosis would exhibit six or more of the symptoms outlined in the DSM. 
Alcoholism is a more general term, often used in the nonmedical community and Alcoholics Anonymous and other treatment groups.

The Current Criteria for Alcohol Use Disorder 

A doctor or medical professional will diagnose AUD on two or more of the following 11 criteria, from the latest version of the DSM. They will ask the following questions:

• Have you ever drank more than you wanted to?
• Have you tried to stop and couldn’t?
• Do you spend a good portion of your time drinking or hungover?
• Do you get cravings for alcohol?
• Does drinking or the aftermath of drinking interfere with your work, family, or other aspects of life?
• Do you keep drinking despite it causing issues in your life?
• Have you stopped doing some things you love in order to drink instead?
• Have you been in unsafe situations because of drinking, such as drinking and driving or engaging in unsafe sex?
• Do you drink even though it makes you feel depressed or anxious? Do you ever black out from drinking?
• Do you have to drink more now than you did in the past to get drunk?
• Do you experience trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating when you attempt to stop drinking?

Physical Signs of a Drinking Problem 

Because alcoholism is a progressive disease, its physical signs and effects will get worse over time. Short-term physical signs and effects of alcoholism and alcohol abuse include:

• The continuous and frequent smell of alcohol coming from an individual. The smell of alcohol can linger on the breath for hours after drinking heavily and may also come out in sweat
• Weight loss or change in body shape. An individual may forgo eating and instead choose to drink. They may also develop strange eating habits and lose any sense of a regular eating schedule as alcohol becomes the focus of their life and starts to interfere with regular daily activities.
• Dry and brittle nails and hair caused in part by the dehydrating effects of alcohol.
• Wrinkles and a rapidly aging appearance. These are also caused by dehydration and general poor health due to alcohol use
• Broken capillaries on the face and nose. Alcohol use temporarily dilates blood vessels, allowing more blood to flood close to the surface of the skin, causing redness and increasing the risk of broken capillaries
• Yellowing of the skin and eyes due to liver toxicity and damage.

Poor hygiene, as an individual becomes unable to keep up with daily hygiene routines due to continuous alcohol use.

Behavioral Signs of a Drinking Problem

In addition to the symptoms identified in the DSM, an individual with a drinking problem or alcoholism may exhibit other symptoms that include:

• Organizing social life around drinking. This may include spending time with friends who drink rather than friends who don’t or staying home rather than going out  to avoid the need to drink and drive
• “Pre-gaming,” or drinking before going out, to save money or loosen up before a social event
• “Changing the math” on the number of drinks consumed to make it okay to have more. This might mean not counting drinks consumed earlier in the day or not counting certain types of alcohol, like wine or beer
• Lying to friends and family about drinking habits
• Worrying about the number of bottles in the recycling bin or trash
• Feeling jealous of people who are in alcohol addiction treatment or recovery or feeling instinctual that recovery or treatment is needed
• Getting defensive about drinking when approached about it by friends or family.

Is Alcoholism Different From Binge Drinking?

Alcoholism is used in some circles to describe any drinking problem, including binge drinking. When used in more specific or clinical terms, it is usually meant to describe a severe alcohol use disorder.

Binge drinking, while dangerous, does not necessarily indicate that someone has a severe AUD or is dependent on alcohol. Someone may binge drink on a few occasions over a few months, for example, without having an AUD that would be diagnosed as severe or in the “dependency” stages.

Although not all binge drinking would be diagnosed as a severe AUD, someone who has a severe AUD is likely to binge drink.

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Any degree of binge drinking is certainly a warning sign that someone may have a problem with alcohol that could get worse if left untreated. 

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Treating Alcoholism

For those with alcoholism or any form of an AUD, social drinking can quickly spiral out of control into a dangerous and serious disease that will have a negative impact on their health, well-being, and relationships. As a progressive disease, the effects will only get worse with time, and the addiction will only grow stronger.

Alcoholism and all forms of drinking problems are treatable. Identify warning signs and proactively seek treatment to mitigate long-term damage in all areas of life.

Sources

(August 2018) Alcohol Facts and Statistics. National Institute on Alcohol Abuse and Alcoholism. from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics

(June 2018) Understanding the Basics of Alcoholism. Buddy T. Verywell Mind. from https://www.verywellmind.com/what-is-alcoholism-66518

(April 2014) Why Do Some People Become Alcoholics But Not Others? Blame the Brain. from https://www.healthline.com/health-news/lateral-habenula-responsible-for-alcholism-040814#1

Drinking Levels Defined. National Institute on Alcohol Abuse and Alcoholism. from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

(December 2015) Dietary Guidelines for Americans: 2015-2020 Eighth Edition. U.S. Department of Health and Human Services and the U.S. Department of Agriculture. from https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf

Centers for Disease Control and Prevention. Alcohol and Public Health. Binge Drinking. Retrieved from (https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

Alcohol Use Disorder. National Institute on Alcohol Abuse and Alcoholism. from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders

(April 2018) What Causes Broken Blood Vessels on the Face? Jon Johnson. Medical News Today. from https://www.medicalnewstoday.com/articles/321387.php

(February 2017) 10 Major Signs of an Alcohol Problem. Psychology Today. from https://www.psychologytoday.com/us/blog/philosophy-stirred-not-shaken/201702/10-major-signs-alcohol-problem

(November 2014) Most Binge Drinkers are Not Actually Alcoholics. CBS News. from https://www.cbsnews.com/news/most-binge-drinkers-are-not-actually-alcoholics/

(May 2018) What is Alcohol Abuse Disorder, and What is the Treatment? Medical News Today. from https://www.medicalnewstoday.com/articles/157163.php

(June 2014) People Severely Underestimate – Or Lie About – How Much They Drink. Keith Humphreys. The Cut, New York Magazine. from https://www.thecut.com/2014/06/people-underestimate-how-much-they-drink.html

(July 2016) Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5. National Institute on Alcohol Abuse and Alcoholism (NIAAA). from https://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.htm

(January 2019) Physical Signs and Symptoms of Alcoholism. Verywell Mind. from https://www.verywellmind.com/signs-and-symptoms-of-alcoholism-66520