Should I be concerned about my drinking?

DEAR DOCTOR K:

During my daughter’s wedding, and all the events surrounding it, I started drinking more than usual. But that was six months ago, and I haven’t cut back to where I was before. When do I get concerned that I might have a drinking problem?

DEAR READER:

It’s not easy to answer your 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.

Now, that sounds reasonable, but it raises some important questions. Most important, are you the best judge of whether your drinking is creating difficulties for you? Would your family, friends and co-workers share your judgment?

Another important question: Could your drinking be affecting your health without you knowing it? I’ve known people who drank throughout the day and were damaging their liver. But in the earliest stages of liver damage from excessive drinking, there often are no symptoms. And some of the damage that is silently done is irreversible.

Several screening tests can help determine whether you might have a drinking problem. (I’ve put two of the tests, the CAGE questionnaire and the AUDIT, below.)

Screening tests to identify problem drinkers

Health care professionals have developed several screening tests that can help assess whether you, or someone close to you, might have a drinking problem. Among these are the CAGE and AUDIT tests.

If either of these test results suggests that you have an alcohol problem, contact your doctor, a psychotherapist, a substance abuse rehabilitation program, or a self-help group (see “Resources”).

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.”

  1. Have you ever felt you should Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt Guilty or bad about your drinking?
  4. 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.

AUDIT

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.

  1. How often do you have a drink containing alcohol?
    0 = never
    1 = monthly or less
    2 = 2–4 times a month
    3 = 2–3 times a week
    4 = 4 or more times a week
  2. How many drinks containing alcohol do you have on a typical day when you are drinking?
    0 = none
    1 = 1–2
    2 = 3–4
    3 = 5–6
    4 = 7–9
    5 = 10 or more
  3. How often do you have six or more drinks on one occasion?
    0 = never
    1 = less than monthly
    2 = monthly
    3 = weekly
    4 = daily or almost daily
  4. How often during the past year have you found that you were unable to stop drinking once you had started?
    0 = never
    1 = less than monthly
    2 = monthly
    3 = weekly
    4 = daily or almost daily
  5. How often during the past year have you failed to do what was normally expected of you because of drinking?
    0 = never
    1 = less than monthly
    2 = monthly
    3 = weekly
    4 = daily or almost daily
  6. How often during the past year have you needed a first drink in the morning to get going after a heavy drinking session?
    0 = never
    1 = less than monthly
    2 = monthly
    3 = weekly
    4 = daily or almost daily
  7. How often during the past year have you had a feeling of guilt or remorse after drinking?
    0 = never
    1 = less than monthly
    2 = monthly
    3 = weekly
    4 = daily or almost daily
  8. How often during the past year have you been unable to remember the night before because you had been drinking?
    0 = never
    1 = less than monthly
    2 = monthly
    3 = weekly
    4 = daily or almost daily
  9. Have you or someone else been injured as the result of your drinking?
    0 = never
    2 = yes, but not in the past year
    4 = yes, in the past year
  10. Has a relative, doctor, friend, or health professional been concerned about your drinking or suggested you cut down?
    0 = never
    2 = yes, but not in the past year
    4 = yes, in the past year

Scoring

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.

 

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 don’t drink excessively, but even a couple of drinks cause them to say things they may not mean, and surely should not say — to their spouses, friends, co-workers or bosses. That makes their drinking hazardous to their home and work life, and to relationships with family and friends. It also puts them at risk for developing more serious problems with alcohol down the road.

So while I don’t know enough about you to answer your question, the fact that you were concerned enough about your drinking to ask me about it indicates that it may be a problem. 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.

(This column is an update of one that ran originally in February 2013.)