DEAR DOCTOR K:
I started drinking more during the holidays. It seemed natural, as there were so many parties and happy hours. But the holidays are long over, and I haven’t cut back. Could I have a problem?
You ask a difficult question. What constitutes “healthy” versus “harmful” drinking can vary quite a bit from person to person. So where is the line between social drinking and problem drinking? Does drinking every day or drinking a certain amount indicate a problem?
Here’s the bottom line: If your pattern of drinking creates difficulty for you personally, socially or at work, then your drinking is likely harmful to your health.
Having said that, I’ve known people who drink throughout the day and have liver and other problems because of it. Yet they would tell me that drinking wasn’t interfering with their family or work life at all. Maybe that’s the way it seemed to them, but their drinking was on its way to making them sufficiently sick that it later seriously interfered with their lives.
If you’re not sure if you might have a drinking problem, answer a few questions about your drinking habits. Several screening tests can help determine whether you might have a drinking problem. I’ve posted two of the tests, the CAGE questionnaire and the AUDIT, at the end of this article.
Alcohol use occurs along a spectrum. Alcohol dependence is the most severe type of alcohol misuse. It is marked by complete loss of control over drinking behavior. You’re preoccupied with drinking and have a strong desire to drink. You start to tolerate alcohol; you don’t get tipsy as easily. You start to feel a little nervous and shaky several hours after your last drink, and you learn that another drink can quiet the shakes.
Alcohol abuse is a milder problem. You don’t have the same compulsion or physical need to drink as those who are dependent on alcohol. But you do drink excessively — and if you keep drinking excessively, you are very likely to go on to alcohol dependence.
Even if you aren’t suffering from alcohol dependence or abuse, your drinking still could be cause for concern. I’ve known people who just “loosen up” enough that they start to say things they may not mean, and surely should not say — to their spouses, friends, co-workers or bosses. Their drinking still is hazardous to their home and work life, and to family and friends. It also puts them at risk for developing more serious problems with alcohol down the road.
The fact that you were concerned enough about your drinking to ask me about it is a red flag. Talk to your doctor about your alcohol use. If you do have a problem, you can work with your doctor to determine the best treatment options for you.
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 letters of a key word in each question spell “cage.”
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.
The World Health Organization developed the following screening tool, called AUDIT (Alcohol Use Disorders Identification Test), to help physicians identify harmful or hazardous drinking patterns in their patients.
Add up the numbers for each response to get your total score. A score of 8 or more suggests that you may have a drinking problem and indicates the need for more in-depth assessment.