Alcohol is such a big part of our culture that it can be tough to determine whether your drinking has become a problem. After all, alcohol is legal, and it’s everywhere. The coronavirus pandemic may have shut down bars, but it certainly hasn’t shut down drinking, what with Zoom happy hours and memes like “Cocktail hour can be any hour!”
For many people, what used to be a way to “unwind” or “take the edge off” has become a clinical case of alcohol use disorder (AUD).
“A lot of people are dealing with isolation and using alcohol more to cope,” says Larry Nye, PA-C, one of Ideal Option’s addiction medicine providers. “I get calls from people who don’t have a job, and they’re at home, bored. They’ll say, ‘I know if I don’t get help, something bad’s going to happen. I’m just out of control.’”
Others seek help because something bad already has happened — they’ve been arrested for DUI, for example, or their spouse has called the police because of their violent or belligerent behavior.
For others still, coming to terms with their disorder is a gradual process.
“A lot of patients know deep down there’s an issue, but they have a hard time coming forward and admitting it,” says Andrea Roberts, ARNP, an Ideal Option addiction medicine provider.
This is true even among folks who acknowledge their addiction to opioids or other illegal substances. “When people come in for opioid or meth use, they are very honest about it,” says Andrea. “But the same people are embarrassed to talk about their alcohol use and really downplay it. Maybe it’s because alcohol is more socially acceptable.”
How can you tell whether your alcohol use has crossed the line into alcohol use disorder?
The diagnosis of AUD is not based on the number of drinks you consume per day or per week. Rather, AUD is defined by the effect of alcohol on your life — in other words, the extent to which drinking is causing damage to your relationships, your job, and/or your physical or mental health.
The questions below are based on the criteria medical providers use to diagnose AUD. As you read through them, consider whether you recognize yourself in the scenarios described.
If you answer “yes” to two or more of the questions, you may have AUD and be a candidate for treatment. That’s not as scary as it sounds! You don’t need to drop your life and check into an inpatient rehab center. Thanks to recent changes in treatment guidelines, you can now undergo medication-assisted withdrawal management (formerly known as “detox”) at home, with daily check-ins at one of our clinics. From there, you will transition to longer term outpatient treatment, combining medication with group support or individual counseling to prevent relapse.
AUD is generally classified as mild, moderate, or severe, based on the number of criteria you meet. If you answer “yes” to two or three of the questions, you likely have mild AUD. Your case would be considered moderate if you meet four or five of the criteria and severe if you meet six or more.
These questions can give you a rough idea of where you fall in the continuum. When you start treatment with Ideal Option, an addiction medicine specialist will conduct a formal assessment of your drinking behavior and withdrawal symptoms and provide a clinical diagnosis and treatment plan.
As you answer the questions, consider whether any of these situations have applied to you in the past six months.
1. Have you had times when you ended up drinking more, or longer than you intended?
“People will tell themselves, ‘I’m only going to have two drinks,’ but the next thing they know, it turns into a fifth or sixth and they’re blacking out,” says Chad Perry, PA-C, an Ideal Option addiction medicine provider.
They may justify the excess by comparing themselves to others — “Hey, everyone’s drinking” — not realizing that they are still going long after their friends stopped.
2. More than once, have you tried to cut down or stop drinking but found that you couldn’t?
Many people promise themselves or family members they’ll stop drinking during certain hours of the day, or days of the week, or even quit altogether. “But then they have a hard time sticking with their promise, so they start hiding their drinking,” says Andrea.
Andrea notes that AUD takes different forms. Whereas some people drink to excess every day, others periodically binge drink. “The person doesn’t have to drink every day,” she says, “but when they do drink, they can’t stop.”
3. Have you spent a lot of time drinking, being sick from drinking, and/or getting over the after-effects?
A telltale sign for many people with AUD is when drinking starts to dominate their lives. “People are drinking just to feel normal and get on with their day,” says Chad. “But then they need a couple shots before they go to bed, too.” If they’re not drinking, then they’re riding out a hangover or recovering from a blackout.
4. Have you experienced alcohol cravings?
A craving is an incredibly strong urge to drink. Cravings are often triggered by emotions, such as anger or resentment, or by certain settings, such as a favorite bar or living-room chair.
Cravings feel different to different people. Maybe you can’t sleep or feel anxious or irritable, and you feel sure those feelings will go away if you drink.
5. Has drinking — or being sick from drinking — interfered with your ability to take care of your home or family, perform on the job, and/or complete your school work?
“Often, people with AUD aren’t able to maintain their normal priorities in life, like picking up their children from school on time or being home to watch their kids,” says Andrea. “Or they’re making mistakes at work and missing deadlines, and people are starting to notice.”
As a result, Andrea notes, they may try to conceal their drinking at work, by drinking alcohol such as vodka, that is not likely to be detected on their breath.
6. Have you continued to drink even though it was causing trouble with your family or friends?
Drinking often triggers a downward spiral that encompasses work, family, and friends, says Andrea. “You wake in the morning feeling terrible because you drank too much the night before, so you call in sick to work. Eventually you lose your job and maybe your house, and your family and friends,frustrated with your behavior, say, ‘You’ve got to figure this out on your own.’ ”
Maybe you’re getting into fights over nothing, and over time, these escalate to major blow-outs. Maybe your alcohol use is making your children anxious, too. “Kids often know what’s going on with their parents,” says Andrea, “and they may have trouble concentrating in school, worrying their parent is passed out somewhere.”
7. Have you given up or cut back on activities that were important to you or fun for you in order to drink?
“Maybe at one point you were into a team sport or involved in a church group, but now you’ve pushed these activities out of your life because you don’t want to feel judged ,” says Andrea. Soon, you’re limiting yourself to people who have the same drinking habits you do, or you’re just drinking alone.
Says Andrea, “People will tell me, ‘I don’t want so-and-so riding my case. I’m sick of hearing it. I’d rather be by myself.”
8. Has drinking gotten you into situations that increased your chances of getting hurt, such as driving, swimming, using machinery, walking in a dangerous area, and/or having unsafe sex?
The most common among these risky situations is drinking and driving. Says Chad: “People tell themselves, ‘I’m okay to drive — I’m just buzzed.’”
9. Have you continued to drink even though using alcohol has made you feel depressed or anxious or has compounded another health problem? Have you continued to drink despite having one or more memory blackouts?
“A lot of people have gotten to the point where alcohol has not only affected their social life but also their health,” says Andrea. Maybe a bout with pancreatitis, a painful abdominal inflammation, sends you to the emergency room, but you still go home and drink. Maybe you drink to cope with PTSD, even though drinking exacerbates your stress. Maybe you continue to drink despite sustaining liver damage or despite nutritional deficiencies.
“For some drinkers, food isn’t a high priority,” says Andrea. “They’re mainly subsisting on a liquid diet.”
10. Have you had to drink much more than you once did to get the effect you want? Have you found that your usual number of drinks has much less effect than before?
An increased tolerance for alcohol is a telltale sign of AUD. “People find that they’re spending more on alcohol and making more trips to the store just to buy alcohol,” says Andrea.
Drinking more is not necessarily something these folks want to do; they’ve simply become tolerant to alcohol and need more of it to feel the same effect
11. Have you found that when the effects of alcohol wear off, you have withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, and/or sweating?
Often, the symptoms of withdrawal are more subtle than people realize. “You don’t necessarily have to get the shakes or start vomiting,” says Andrea. “One of the biggest symptoms is anxiety, a constant worry. A lot of people have insomnia or feel they need a drink because it relaxes their nerves.”
Symptoms like these are often dismissed and rationalized away, rather than recognized as red flags for AUD.
If you’ve answered “yes” to at least two of the questions above, come see us for a professional AUD assessment and personalized treatment plan.
“A lot of times people come to the decision that they want to quit,” says Chad, “but they just don’t know how to do it. We can help.”You can find out more information about how we treat AUD and make an appointment to see one of our providers here: https://www.idealoption.com/alcohol.