Signs and Symptoms of Alcoholism
Alcohol misuse may be easily overlooked given the fact that alcohol is so widely used around the world. In fact, about 2/3 of all U.S. adults drink alcohol.1 While it’s likely true that many of these people drink responsibly, it’s not difficult for a person’s alcohol consumption to get out of control. If you think you or someone you love may be drinking excessively, keep reading to learn about the signs of alcohol abuse and alcoholism.
How to Know if You Have a Drinking Problem
The following signs and symptoms can serve as a warning that your drinking is moving out of the realm of moderate drinking into problem drinking:2
- You drink more than 4 drinks/day if you’re a woman and more than 5 drinks/day if you’re a man.
- You’ve had legal problems due to drinking.
- You’ve had blackouts (not remembering events that occurred during an episode of drinking).
- You drink in the morning to feel better after drinking at night.
- You’ve felt guilty or remorseful after drinking.
- Your friends and/or your doctors have expressed concern to you about how much you’re drinking.
- Your drinking has resulted in an injury to someone else.
What Are the Warning Signs of Alcoholism?
There are tools sometimes used by medical professionals that can help you to identify whether you have a problem with alcohol use. The CAGE questionnaire is one way to assess whether you’re beginning to lose control over your alcohol use.3
CAGE Questionnaire: Catching the Early Signs of Alcoholism
A simple 4-question test is sometimes used by physicians and treatment professionals to determine whether someone is potentially alcohol dependent. The questions are as follows:3
- C: Have you ever felt like you should cut back on your drinking?
- A: Have you felt annoyed due to criticism about your drinking from others?
- G: Have you ever felt bad or guilty because of your drinking?
- E: Have you needed an eye-opener, or a drink first thing in the morning to relieve a hangover or calm your nerves?
Answering “yes” to 2 or more of these questions may indicate that you are developing a problem with alcohol and may need further assessment by a doctor or other treatment provider.3 The CAGE questionnaire is not used to diagnose an alcohol use disorder but can potentially identify those who are at risk.
DSM-5 Criteria for Alcohol Use Disorder
When psychiatrists diagnose an alcohol use disorder, or AUD, they don’t simply look for physical or behavioral warning signs. They use a very specific set of criteria. Questions they ask include those that would indicate that you’ve lost the ability to set limits on how much you drink and that you cannot stop despite knowledge that drinking is doing you harm.4 Examples include:4
- Have you wanted to stop or cut back on drinking but found that you couldn’t?
- Do you spend a big portion of your time in getting alcohol, drinking alcohol, or recovering from a hangover?
- Do you have problems at work, at home, or at school because of your drinking?
- Have you given up hobbies or activities you enjoy in order to spend your time drinking?
There are 11 criteria for an alcohol use disorder. Meeting 2 of them indicates you have a mild AUD. The more criteria you meet, the more severe the disorder.4 View the full list of DSM-5 criteria for an AUD.
Recognizing the Signs of Alcoholism in Others
Most of the time, if your friend, coworker, or loved one is drinking too much, you won’t be sitting them down and attempting to ask them the questions outlined above in the CAGE questionnaire or DSM-5 criteria for AUD. Most often, you’re looking for behavioral changes that indicate something is off.
Alcoholic Personality and Behavior Changes
Someone who is abusing alcohol may start to act differently. Watch for changes like the following:5–7
- Showing up late (or not at all) to work or school.
- Not performing as well at work or school.
- Using sick leave excessively for work absences, especially on Mondays or Fridays.
- Acting suspicious/secretive.
- Increasingly isolating themselves from friends/coworkers.
- Having sudden mood swings.
- Acting irritable and/or having outbursts of anger.
- Seeming overly fearful or paranoid without cause.
- Suddenly spending time with new friends or engaging in new hobbies.
- Exhibiting changes in appetite and sleep.
- Neglecting personal hygiene.
- Staggering or stumbling.
- Acting/speaking inappropriately.
- Acting more jealous toward a romantic partner.
- Incurring financial trouble.
- Taking risks while drinking, such as driving or having unprotected sex.
Effects & Symptoms of Severe Alcohol Abuse
When someone has been abusing alcohol for a prolonged period of time, they can suffer very serious long-term health effects. They may damage their liver, for example, and develop fatty liver, alcoholic hepatitis, or cirrhosis.8 And of course, those who drink excessively are at risk for potentially fatal alcohol poisoning.8
Other medical and psychological issues that may indicate someone has a significant problem with alcohol abuse include:9–11
- Suppressed immune system.
- Cardiovascular problems.
- Pancreatitis (an acute swelling of the liver that can be fatal).
- Thiamine deficiency (which can lead to brain damage).
In pregnant women, alcohol abuse may result in miscarriage, stillbirth, or fetal spectrum disorders.11
Risk Factors for Alcohol Abuse
Risk factors for the development of an alcohol use disorder include:8,12–15
- Family history of alcohol or other substance abuse.
- Family history of alcohol use disorder.
- Family history of mental illness.
- Childhood abuse/neglect or other psychological trauma.
- Lack of parental involvement.
- Living in an area stricken by poverty and/or violence.
- Low commitment to and/or poor performance in school.
- Economic insecurity.
- Lack of impulse control/ability to regulate behavior.
- Comorbid mental illness such as depression.
- Early alcohol use (prior to age 15).
- Having peers who abuse alcohol.
- Being male.
- Engaging in heavy or binge drinking.
What to Do When a Loved Needs Help for Alcoholism
It is never too early to speak up about alcoholism if your loved one is at risk. Subtle signs could grow more severe with time. Even when your loved one is in denial, you can still make attempts to get them to recognize their problem and agree to seek help. It may take more than one attempt, and although it may feel hopeless, many experts agree that family support and encouragement is important for alcoholics in seeking and achieving recovery.16
Some people with alcoholism are very open to the idea of getting help. Their lives are difficult and painful, and while they may want their lives to change, they may not know where to start.2 Your loved one may know they need help—and they may want help—and they may be reassured to discover that you care enough to intervene.
Before speaking to your loved one, it can help to investigate treatment options. If you’d like support in doing so, we can help you. Call us any time day or night at to go over treatment options for alcoholism.