Alcohol is woven into the fabric of American culture. It's the only substance mentioned in the U.S. Constitution.
Twice.
Prohibition was so unpopular, that it lasted just 15 years. We turned the taps back on in 1933 and haven't stopped drinking since.
Drinking habits are even more ingrained into Iowans than other Americans. Alcohol is the most frequently used substance by both adults and kids. A 2016 Iowa Department of Public Health study found that 56 percent of Iowa residents over 12 years old had used alcohol in the last month, and a quarter of them reported binge drinking.
With that long-standing tradition of alcohol in the United States and our own state, drinking is considered normal. And it's hard to tell when normal crosses the line into alcoholism.
So where do you draw the line between moderation and alcoholism?
The short answer: if alcohol is affecting your life or health, it's a problem.
Absent that, it's a little squishy. Starting with the fact that “alcoholism” is not even a clinical term with a clear definition.
The National Institute on Alcohol Abuse and Alcoholism picks up the tab on the most alcohol research in the world — and do much of it themselves. Based on all that research, NIAAA defined drinking levels and outlined the risk for alcohol use disorder, which the rest of us call alcoholism.
| Alcohol Consumption | Men | Women |
|---|---|---|
| Moderate Drinking | 2 drinks a day | 1 drink a day |
| Low-Risk Drinking | 4 drinks in one day or 14 in a week | 3 drinks in one day or 7 in a week |
| Binge Drinking | 5 drinks in a day | 4 drinks in a day |
| Heavy Drinking | Binge drinking 5 days a month | Binge drinking 5 days a month |
The health consequences certainly increase as you move up the ladder from low-risk drinking to binge drinking and heavy alcohol use. But based on consumption alone, none of them qualify as alcohol use disorder. NIAAA research shows that low-risk drinkers of either sex have just a two percent chance of becoming alcoholics.
If you do the math, women can enjoy up to 31 drinks in a month — and men 62 drinks — and be safely drinking in moderation. But five weekend binges are considered heavy drinking even though that may mean “only” 20 drinks for a woman or 25 for a man.
That doesn't add up. Who's considered an alcoholic then?
As you go up the scale or beyond it — you're drinking to get drunk. That's alcohol abuse and that's when problems arise. Alcohol abuse can affect your home, work and school life. You can put yourself into risky situations, like driving while drunk. You may get into fights or run into legal problems from your excessive drinking. And after all that, you may continue drinking even though it's ruining your life.
You should curb your drinking and get help, if needed.
But that's still not alcoholism.
As it's clinically defined, alcohol use disorder is a chronic disease characterized by a particular set of symptoms:
- Compulsive alcohol use despite any related problems
- The inability to limit your drinking
- Strong cravings for alcohol
- A negative emotional state and other withdrawal symptoms when you're not drinking
Questions to Diagnose Alcohol Use Disorder
If you're concerned that you or someone you know may be an alcoholic, think about the last 12 months and answer these questions outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
In the past year, have you:
- Had times when you ended up drinking more, or longer than you intended?
- More than once wanted to cut down or stop drinking, or tried to, but couldn't?
- Spent a lot of time drinking? Or being sick or getting over the aftereffects?
- Experienced craving — a strong need, or urge, to drink?
- Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
- Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?
How many times did you nod your head or mutter “yes” under your breath? Zero? Just once? That's great. You (or your friend) do not have AUD, but the problem drinking is still cause for concern.
Any more than one and you or your loved one would be diagnosed with alcohol use disorder. The degree of the disease — mild, moderate or severe — depends on how many “yes” answers you just gave. The more symptoms, the more need for immediate changes.
Help for Alcoholics
There's help. Lots of it. You can start by talking to a health professional you know and trust. Whether you're seeking help for yourself or someone else, they can get you the support you need.
For a more anonymous support system, visit Des Moines area chapters of Alcoholics Anonymous to enter a 12-step program for recovery or Al-Anon if you've been affected by someone else's alcoholism. The Substance Abuse and Mental Health Services Administration has a Behavioral Health Treatment Services Locator, a confidential tool for finding the help you need wherever you live.
Not quite ready for that step? NIAAA created the Alcohol Treatment Navigator, an in-depth guide for finding and getting help for alcohol problems. The Navigator uses NIAAA's decades of research to give you knowledge about alcoholism and guide you to evidence-based treatment options.