How can I tell if someone is an alcoholic?
This question begs further questions - Why are you asking? And what will you do with the information?
Why are you asking?
If you are a professional, then you will want to be clear about whether alcohol is playing a major part in the problems your client is presenting with, so you can be as effective as possible in however you are going to intervene.
If you are a family member concerned about a loved one’s drinking, then it is also helpful be clear about whether alcohol is playing a major part in the problems you and/or your loved one are having, especially so you are not drawn into their defense mechanisms (denial, minimization, rationalisation, projection etc.) because that can impact greatly on your own mental health and well-being.
There are various ways to assess the extent of someone's drinking, how they might be using this drug and what harmful consequences are occurring because of their alcohol use.
The World Health Organisation notes that, while there is no safe level of alcohol use, a maximum of 1 to 2 drinks per day, no more than 4 in any one setting, and nor more than 14 per week are suggested as levels that are considered low risk. Body size and gender can affect this too.
Note: No more than 4 drinks in any one setting because high BALs are more likely affect behaviour and damage brain and other cells. i.e. Binge drinking carries more risks than spreading out drinks over time.
If a person has this knowledge and continues to drinking at higher doses, the question then arises as to why?
A conversation about self-care, and addiction, becomes very relevant.Social drinking means drinking in the company of other people. A person, who is drinking alone, is not social drinking.
Likewise a person slipping alcohol into their coffee unbeknown to others, and theoretically drinking in company whilst everyone else is not drinking alcohol, is not “social” drinking. Hiding alcohol use can be a sign that the person knows they are “needing” more alcohol to function than would be seen as socially acceptable.
High Tolerance/ High BALs. Someone who is walking, talking and appearing to function ‘normally”, whilst having a high Blood Alcohol Level that would have a novice drinker asleep or “legless”, indicates that the person has been drinking high levels to avoid withdrawal symptoms, although this may not be so obvious to the person. Someone drinking late into the night, may be having the “hair of the dog” at lunch-time.
Morning drinking for someone, who is not a shift-worker, is an important indication of ‘addiction”.
Some one caught on a random breath test, in the morning has either had something to drink that morning, or has been drinking heavily the day before. The body only processes about 1 standard drink per hour, so the person must have a high number of drinks the day before to take that long to be eliminated, if in fact they had not drunk that morning.
Alcohol related withdrawal symptoms. Alcohol, as a depressant, slows the nervous system down as blood alcohol levels raise, and conversely as the drug withdraws the nervous system is speeded up. Hangovers themselves are withdrawal symptoms - the worse the hangover the more likely non-safe levels of alcohol use. Other symptoms are anxiety, tremors, and in more extreme withdrawal, fits/ seizures, hallucinations (both visual and tactile) known as Delirium Tremens. If the person is sneaking drinks, it is likely to be to avoid withdrawal symptoms.
A common question, used in AA , can be very helpful in discussing the impact of someone’s drinking in their lives. “Is alcohol costing you more than you?” Here the focus is taken away from “how much” to “what are the consequences” of the drinking. It takes the focus away from comparisons with other people’s drinking to justify one’s drinking to focus on this person and their behaviour.
What will you do with the information?
As noted earlier, the helping professions have moved away from using the terminology “alcoholic” and “alcoholism” because of the negativity around those terms. Essentially many people including problem drinkers, have little detailed knowledge about alcohol as a drug and ‘alcoholism”,
So if you are a professional, part of your role will be educative. Educating someone about alcohol addiction, alcohol use disorder or alcoholism with whatever terminology you feel comfortable using*, usually takes time.
Also referring someone to Alcoholics Anonymous, will require some education and follow-up. Making a good referral is no different, whatever the medical complaint. Problem drinkers require the same attention and respect.Explaining the word “alcoholic” to allow self-diagnosis is part of a strategy to assist the person work through their defense mechanisms which can be used by professionals and family members alike, although for the family there are many more risks and complications.
If you are a family member, the dynamics are much more complicated. Finding a way to be supportive, but not enabling, likewise takes a lot of time. You have the right and responsibility to seek help for yourself, if you have problems because of someone else’s drinking, whether they admit it or not. Many family members, in addition to being well educated about alcoholism, need support, and find the Al-Anon Family Groups are abl
