Drinking to Excess: Recognize and Treat Alcohol Problems

9/7/2014, midnight
Some people enjoy an occasional glass of wine with dinner. Others might grab a beer while watching a football game.

Some people enjoy an occasional glass of wine with dinner. Others might grab a beer while watching a football game. Most people drink alcohol moderately, within their limits. Others overdo it occasionally. But some people find they can’t control their drinking. How do you know when drinking is becoming a problem? And what can you do if it is?

About 18 million Americans have an alcohol use disorder. Drinking too much alcohol raises your risk of injury and accidents, disease, and other health problems. Heavy drinking is one of the leading causes of preventable deaths in this country, contributing to nearly 88,000 deaths each year.

How much is too much? Men shouldn’t have more than 14 drinks per week and 4 drinks on any single day. Women shouldn’t have more than 7 drinks per week and no more than 3 drinks on any day. But you might be surprised at what counts as a drink. A 5-ounce glass of table wine, a 12-ounce glass of regular beer, and 1½ ounces of hard liquor each contain the same amount of alcohol, and each counts as 1 drink. You may need to adjust the amount you drink depending on how alcohol affects you. Some people—such as pregnant women or people taking certain medications—shouldn’t drink alcohol at all.

Alcohol problems come from drinking too much, too fast, or too often. People with alcohol dependence are addicted to alcohol, and they can’t control their drinking. When alcohol-dependent people try to stop drinking, they may feel anxious and irritable—so they may drink some more, and it becomes a vicious cycle.

“Addiction has 3 major problems: You lose your ability to feel good, you get more stressed, and you have a hard time making proper decisions,” says Dr. George Koob, director of NIH’s National Institute on Alcohol Abuse and Alcoholism. “That’s a recipe for disaster.”

Signs of an alcohol problem include drinking more, or more often, than you intended, or making unsuccessful attempts to cut back or quit. People with alcohol problems often have trouble functioning at work, home, or school.

“A good indicator is that something is out of whack. Is your personal life deteriorating because of your drinking? Are people starting to shun you? If you’re feeling generally miserable, that’s a warning sign,” Koob says. “You don’t have to hit bottom. You’ll save yourself a lot of damage socially, professionally, and probably in your own body if you attend to an alcohol problem a lot earlier.”

“People shouldn’t wait for a physical problem like liver disease,” says Dr. Lorenzo Leggio, an NIH researcher studying new alcoholism treatments. “People develop an alcohol disorder before liver problems get bad. The goal is to identify an alcohol disorder sooner. The sooner you act can help prevent medical consequences.”

Studies show that most people with an alcohol use disorder can benefit from some form of treatment. If you or someone you care about may have an alcohol problem, help is available. The first step is to talk to a primary care doctor. In some cases, a brief intervention, or an honest conversation about drinking habits and risks, is all the person needs. If the problem is more serious, the doctor can help create a treatment plan, prescribe medications, or refer the person to a specialist. In more severe cases, the doctor might recommend a treatment clinic or in-patient addiction center.