Jul 4, 2022 | By Tim Stoddart

Is my dad an alcoholic or hard drinker?

Miscellaneous

For many families, this question has had to be addressed regarding one family member or another. Trying to determine the condition of someone else’s relationship to alcohol is a tricky prospect. The line between heavy drinking and alcoholism can be blurry to say the least, and more often confusing and misinterpreted at best. At the end of the day, both types of drinking are disordered but there are definite distinctions regarding what constitutes actual alcoholism apart from just heavy drinking. Understanding this as well as the DSM’s levels of alcohol use disorder can allow us the opportunity to better shape our approach to our loved one as well as how to adjust our expectations for them.

The following is the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders) criteria pertaining to alcoholism, or as it is now referred to, Alcohol Use Disorder:

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 or more of the following, occurring at any time in the same 12-month period:

–    Alcohol is often taken in larger amounts or over a longer period than was intended.

–    There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.

–    A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.

–    Craving, or a strong desire or urge to use alcohol.

–    Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.

–    Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.

–    Important social, occupational, or recreational activities are given up or reduced because of alcohol use.

–    Recurrent alcohol use in situations in which it is physically hazardous.

–    Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.

–    Tolerance, as defined by either of the following:

1. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.

2. A markedly diminished effect with continued use of the same amount of alcohol.

–    Withdrawal, as manifested by either of the following:

1. The characteristic withdrawal syndrome for alcohol 

2. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Specify if the Alcohol Use Disorder is:

–    Mild – Presence of 2–3 symptoms

–    Moderate – Presence of 4–5 symptoms

–    Severe – Presence of 6 or more symptoms

While on the surface heavy drinking can mimic full-blown alcoholism, some distinctions between the two are worth noting. A heavy drinker may experience many of the same unwanted outcomes that their alcoholic counterparts do apart from withdrawal symptoms when they try to stop drinking, and general symptoms of physical dependency. Heavy drinkers tend to be able to stop for stretches where those suffering from a more severe alcohol use disorder cannot. Tolerance and the need for larger amounts of alcohol also lean toward the side of alcoholism as opposed to emotional dependency which is more in step with heavy drinking. The greater the tolerance, the greater the need for more alcohol to create the same euphoric buzz one may be used to experiencing. Increased tolerance is very often a sign of a damaged liver as it can develop scar tissue (cirrhosis) inhibiting its ability to filter out toxins from the body.

The CDC (Center for Disease Control) and Alcoholic Determinations:

–    About one third of Americans are excessive drinkers but only 10% meet the criteria for alcoholism.

–    Binge drinking for men is defined as five drinks or more on one occasion, and for women, four drinks or more on one occasion.

–    The CDC considers heavy drinking for men to be fifteen drinks or more per week and for women, eight drinks per week.

–    Half the number of men seek help in recovery compared to women.

What Is a “Drink”?

Many times, determining exactly how much alcohol is being consumed is a necessary exercise. It is worth noting that a “drink” would be anything with approximately fourteen grams of alcohol. This would roughly translate into:

–    One 12oz beer.

–    One 5oz glass of wine.-    A 1.5oz shot of liquor.

With wine and liquor, it is very easy to drink more than one might realize given that a “pour” of wine or liquor at home is rarely measured. Often there is a more generous amount of alcohol in drinks consumed at home simply because they don’t come premeasured or in one fixed amount such as beer by the bottle. Therefore, the perception of how much one drinks can be skewed simply because the actual amount of alcohol being consumed goes unspecified. For this reason, many addiction counselors don’t rely on self-reporting for their clients and patients regarding how many drinks they consume simply because the data can be so compromised by the absence of any real way to accurately assess it.

Avoid Labeling an Alcoholic:

Very often loved ones get caught up in whether their family member is willing to admit they are an alcoholic and feel that if they don’t make that admission, their sobriety is a lost cause. A helpful approach might be to simply ask them if they would agree that their drinking is disordered and that they are often experiencing unwanted outcomes. If they can agree to that, then it is a great segue at that point to extend opportunities for them to experience getting help. Treatment is not reserved only for those who will admit their alcoholism but rather anyone who is ready to address whatever disordered relationship they have with a substance and embrace the opportunity to heal and reset.