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Are You a Risky Drinker?

alcoholic man

April 30, 2018 -- Every morning, Josh starts his day by making the same pledge: Today is the day he’s not going to drink. By lunchtime, though, he’s already thinking about what bottle of wine to pick up at the liquor store on the way home from work.

“I buy a bottle of wine with the intention of just having a glass with dinner,” says Josh, who is 33 and lives in Washington, D.C. He asked that has last name not be used to protect his privacy.

“I don’t think I can open a bottle without having the entire thing,” he says.

When it’s not a wine night, he’ll pour himself a bourbon that he keeps topping off.

From about 7 to 10 p.m., he’ll sit on the couch, watch TV, and drink. He says he doesn’t get drunk. He says the antidepressant he takes blocks most of the alcohol’s buzz. He doesn’t drive, and he’s rarely hung over the next morning.

“It allows me to just kind of zone out,” he says.

He says he doesn’t see any real impacts to his health, except he’s noticed the waistband of his pants has gotten tighter.

But it bothers him that he��s drinking alone and that he can’t seem to stop.

“It’s just funny to have this mild habit that you just can’t say no to,” Josh says. “I’ve never had that with chocolate cake or with cookies.”

Psychologists and addiction experts agree that our drinking habits put us on a spectrum of risk for having mental and physical problems.

The website “Rethinking Drinking,” which was created by the National Institute on Alcohol Abuse and Alcoholism, helps measure this risk. At the mild end of the spectrum are light or “low-risk” drinkers -- men who knock back fewer than 14 drinks a week, and no more than four drinks in a day; or women who stay under seven drinks a week, and three in one day.

Your level of risk rises with the amount you drink over those levels, either on a daily or weekly basis.

According to the website, Josh’s pattern of drinking -- having more than four standard drinks a night, every night -- makes him a high-risk drinker. It means that he drinks more heavily than about 9 out of 10 adults in the U.S.

At this level of drinking, about 50% of people have an alcohol use disorder, along with bigger chances for other problems with their liver and other organs over time. An alcohol use disorder is a chronic brain disease defined by compulsive alcohol use, the loss of control over drinking, and a negative state of mind when not drinking.

Recent government studies have found a troubling rise in risky drinking across the U.S. for nearly all age groups.

The rate of one type of risky drinking -- binge drinking -- for example, has increased for all adults aged 30 and up over the last 10 years, according to Rick Grucza, PhD, an associate professor of psychiatry at Washington University School of Medicine in St. Louis, who analyzed data from five government surveys. The biggest increases -- nearly 24% -- were seen for adults ages 50 to 74.

Teens Drink Less as Others Drink More

One bright spot seems to be teenagers.

“The good news is that underage drinking has declined about three-fold in the last 10 years,” says George Koob, PhD, director of the National Institute on Alcohol Abuse and Alcoholism. “Among teenagers right now, it’s not really that cool to drink.”

The bad news is that everybody else seem to be indulging more, and sometimes a lot more.

“We’re seeing, in the 20- to 30-year [age] range, extreme binge drinking,” Koob says.

Binge drinking, as defined by the government, is reaching a blood alcohol level of .08 in 2 hours. It takes about five drinks for a man, and four drinks for a woman, to reach that level. A standard drink is 12 ounces of regular beer; 5 ounces of wine; or 1.5 ounces of distilled liquor like gin, rum, tequila, vodka, or whiskey.

Our alcohol-soaked culture is taking a toll on health. A study published in February found that the number of alcohol-related emergency department visits increased 62% between 2006 and 2014. Alcohol-related emergencies include everything from overdoses to accidents where alcohol played a part.

“It’s a staggering number of visits per day,” says study author Aaron White, PhD, a biological psychologist at the National Institute on Alcohol Abuse and Alcoholism. “About 10 times a minute, somebody shows up in an emergency department in the U.S. for a reason related to their drinking.”

White says it’s not clear what’s driving the increase, but one possibility is the rise in risky drinking.

“Right now, the best explanation seems to be a shift toward higher-level drinking -- a small percentage of drinkers is drinking more,” White says.

'Low Responders'

How do you know if you’re in trouble with alcohol?

It may be tough to tell, especially if you’re somebody who can hold your liquor, or drink a lot without feeling much of an effect.

If that sounds like you, you may be what Marc Schuckit, PhD, calls a “low responder.”

Low responders have to drink a lot more than others before they start to feel alcohol’s effects, which gives them a higher chance of having an alcohol use disorder, says Schuckit, who’s a professor of psychiatry at the University of California, San Diego.

“They don’t get the same kind of feedback that other people do that they’re getting drunk,” he says. “What happens is they pass a crucial point where enough alcohol has been absorbed to get them to feel pretty drunk, and by then, they probably have three extra drinks in their stomach that they haven’t processed yet.”

Because low responders tend to drink heavily, they like to hang out with other heavy drinkers, which reinforces their habit.

Schuckit estimates that 15% to 20% of people in the general population qualify as low responders, and that rises to about 40% to 50% for the children of alcoholics.

Know How You Deal With Alcohol

Whatever kind of drinker you may be, the first step in understanding your relationship with alcohol is to take stock of how much and how often you’re drinking. One way is to use the calculator on the Rethinking Drinking website.

The consequences of overdoing it may be subtle, at least at first.

 “When you start getting in trouble with alcohol, and you can recognize that it’s the alcohol, that’s a warning sign,” Koob says.

“It could be that you’re late for work. You’re late for exams. It could be increasing bad interactions with a family member or a significant other,” he says.

“It could be sleep. Maybe you drink to fall asleep, but you wake up in the middle of the night. You’re cranky and irritable and start snapping at people. These are the signs and they start to add up,” says Koob.

Other signs that you’re becoming physically dependent on alcohol include if you've:

  1. Had times when you ended up drinking more, or longer, than you intended
  2. More than once, wanted to cut down or stop drinking, or tried to, but couldn’t
  3. Spent a lot of time drinking or got sick from the effects
  4. Wanted a drink so badly, you couldn’t think of anything else
  5. Found that drinking -- or being sick from drinking -- often interfered with taking care of your home or family, or caused job or school troubles
  6. Kept drinking even though it was causing trouble with your family or friends
  7. Gave up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink
  8. More than once gotten into situations, while or after drinking, that raised your chances of getting hurt
  9. Continued to drink even though it made you feel depressed or anxious, added to another health problem, or caused a memory blackout
  10. Had to drink much more than you once did to get the effect you want, or you found that your usual number of drinks had a much lower effect than before
  11. Found that when the effects of alcohol were wearing off, you had withdrawal symptoms such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure, or you sensed things that were not there

If you can answer yes to two or three of the things on this list, you may have a mild alcohol use disorder. If you can say yes to four or five things on the list, that’s a moderate alcohol use disorder, while having six or more symptoms qualifies as a severe disorder, according to the DSM-5, which psychologists use to diagnose mental disorders.

However severe the problem may seem, most people with an alcohol use disorder can benefit from treatment.

Josh says he’d like to taper off. His goal would be to drink occasionally -- on the weekends out with his girlfriend or in social settings.

“The thing that annoys me the most is that it’s a silly money drain,” he says. “That inability to say no to something really bothers me.”

WebMD Article Reviewed by Neha Pathak, MD on April 30, 2018

Sources

Josh, 33, Washington, D.C.

National Institute on Alcohol Abuse and Alcoholism, “Rethinking Drinking.”

Rick Grucza, PhD, associate professor of psychiatry, Washington University School of Medicine, St. Louis.

George Koob, PhD, director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD.

Aaron White, PhD, biological psychologist, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD.

Marc Schuckit, PhD, professor of psychiatry, University of California, San Diego.

JAMA Psychiatry: "Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013, Results From the National Epidemiologic Survey on Alcohol and Related Conditions."

Alcoholism: Clinical and Experimental Research: "Trends in Alcohol-Related Emergency Department Visits in the United States: Results from the Nationwide Emergency Department Sample, 2006 to 2014."

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