How to know if you have a drinking problem

by Lori Wiviott Tishler M.D. Harvard Medical School
May 15, 2008 02:24 PM EDT views: 53 | rating: 10/10 (5 votes) | comments: 6

After I put my daughter to bed at night, I sometimes enjoy a glass of wine with my husband. For me, having an occasional drink or two is a way to relax and have fun, especially at a party or when I'm out to dinner. But, as you probably know, many people can't drink alcohol in moderation.

For many people, it can be hard to tell where the line is between social drinking and problem drinking. Can someone who never misses a day of work be dependent on alcohol? Does drinking every day or drinking a certain amount indicate a problem? I try to ask all my patients, at least annually, about their drinking. I use the CAGE questions below, but I also ask them – and you can ask yourself – is your drinking a problem for you or for anyone else in your life?

Here's an article excerpted from Alcohol Use and Abuse, a Special Health Report published by Harvard Medical School, that can help people tell the difference between responsible drinking and problem drinking:

Women and men of all ages and from every walk of life are vulnerable to alcohol problems, and their lives are affected in many different ways. Alcohol problems don't develop along one typical course, which is why it can be difficult to recognize them in yourself or in others, even close friends and family members. One way to find out is to take the CAGE test, below. Talking to your doctor about alcohol is also a good idea. He or she can help you determine what is safe for you and help you think about whether or not you might have a drinking problem. The resources below are excellent ones for information and treatment.

Are you a problem drinker?
Health care professionals have developed several screening tests that can help assess whether you, or someone close to you, might have a drinking problem. The AUDIT and the CAGE tests are often used.

If either of these tests indicates that you have an alcohol problem, contact your doctor, a psychotherapist, a substance abuse rehabilitation program, or a self-help group.

The CAGE test

Physicians and therapists frequently use the following four-question test, which is most useful in identifying more severe alcohol problems. Despite its apparent simplicity, this test can provide valuable information. It's called the CAGE test because the first letter of a key word in each question spells "cage."

Have you ever felt you should Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty or bad about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves, get rid of a hangover, or as an Eye opener?
If you responded "yes" to any one of these questions, you may have a drinking problem. If you responded "yes" to more than one question, it's highly likely that a problem exists.

Are there safe drinking guidelines?
Government health agencies and the American Medical Association define moderate drinking as no more than 2 standard drinks per day (or no more than 14 per week) for men under age 65 and 1 drink per day (no more than 7 per week) for women. Women have lower limits because they absorb more alcohol into the bloodstream, resulting in higher blood alcohol levels and more rapid intoxication. Women also have less of the liver enzymes that help to break down alcohol. Also, the National Institute on Alcohol Abuse and Alcoholism recommends that men age 65 and older have no more than one drink per day because metabolism slows with age. Older people are more at risk, as well, for alcohol related falls and injuries, which can be particularly devastating to their independence.

However, people who have a personal or family history of alcohol problems or have problems with a mental illness such as a mood or anxiety disorder should be more cautious. Also, certain medical conditions, such as hepatitis (liver inflammation), may rule out drinking.

Drinking more than moderate amounts of alcohol can increase the risk of dying from a deadly form of liver damage called cirrhosis, other types of heart disease, some types of cancer, and injury. Even moderate drinking can have harmful consequences in the wrong setting. Certainly, no one should drink and drive, and drinking any alcohol during a pregnancy can hurt a developing baby.

I hate to admit it but I drink alot when I drink. I keep getting tested for liver diease every year or 2 and so far it's pretty healthy. I've battled with eds for over half of my life now and that can also damage a persons liver. Saddly we lost my mom's uncle cause he had a drinking problem. Everyone really liked him. Even some of my friends, an ex bf of mine and Chad.