For people who are questioning whether they, or their loved ones, are dealing with an alcohol use disorder or alcoholism, it can sometimes be difficult to determine with certainty the existence of a problem. The lines between casual drinking, binge drinking, heavy alcohol use, and alcoholism can sometimes be tough to decipher.
There are some signs and symptoms that can help these people recognize alcoholism in themselves or loved ones. Knowing the details of these signs can help people determine whether alcohol use has crossed the line into addiction and when help is needed. While there isn’t a finite test for alcoholism, such as a blood test, there are physical, psychological, and psychosocial signs that can help make the determination that alcoholism is present.
Alcohol abuse creates changes in the body that can affect many aspects of a person’s physical being, from outward appearance to organ health. Based on information from WebMD, some signs to look for include:
- Redness of the face after drinking, which may become permanent over time
- Skin sores
- Severe digestive problems
- Heart problems, such as arrhythmia or high blood pressure
- Shakiness or loss of balance
- Diminished motor skills and clumsiness
More specifically, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has a pamphlet called Beyond Hangovers that discusses some of the more severe physical consequences of long-term alcohol abuse. Occurrence of these issues in various organs can be an indicator of a long-term alcohol use disorder or alcoholism:
- Is the person having heart problems?
Heavy drinking can result in damage to heart tissue that results in a weakened heart muscle; this, in turn, can cause breathlessness and swollen legs and feet. The damage can also cause heartbeat disturbances like atrial fibrillation or ventricular tachycardia, which can lead to stroke or heart attack. High blood pressure can also result.
- Is the person exhibiting jaundice (yellow skin or eyes)?
The liver helps to remove toxins from the body. When a person drinks a lot of alcohol, the liver can become overtaxed, resulting in the buildup of fat and scar tissue that can ultimately lead to alcoholic hepatitis or cirrhosis, which decreases liver function and can cause issues with other illnesses like diabetes or liver cancer.
- Does the person have severe abdominal pain radiating up the back, with fever, nausea or vomiting, and diarrhea?
Heavy alcohol use can disrupt the digestive actions of the pancreas, causing it to become toxic and increasing the chances of a disease called pancreatitis. This is not a common result; it occurs in only about 5 percent of people with alcohol addiction issues.
- Is the person exhibiting problems with cognition, focus, memory, learning, and other brain functions?
Alcohol causes damage to brain tissue and the nervous system. This can also result in psychological issues that can be further signs of alcoholism.
A psychological test for alcoholism can be more challenging because these symptoms can be harder to see or may occur before the alcoholism issue is in place. However, if individuals or their loved ones feel that alcohol use may be severe enough to contribute to these factors, it’s worth paying attention to these signs:
- Sleep problems
- Antisocial behavior
- Extreme mood swings
A study on Alcoholism and Psychiatric Disorders published by NIAAA indicates that antisocial personality disorder is more prevalent for those with alcohol use disorders than for the general population. This is evidenced by the fact that 15-20 percent of men with alcoholism and up to 10 percent of women with alcoholism demonstrate this psychiatric disorder as compared to 4 percent of men and 0.8 percent of women in the general population.
Based on indicators of Alcohol Abuse Disorder from NIAAA, people concerned that they, or loved ones, have an alcohol use disorder or alcoholism can ask the following additional questions:
- Does the person exhibit guilt or shame about drinking?
- Is the person hiding drinking habits?
- Does the person feel withdrawal symptoms if drinking is stopped, such as shakiness, nausea, headache, and restlessness, or even hallucinations?
- Does the person exhibit an inability to stop drinking, drink more than intended on a regular basis, or drink longer than planned?
- Has the person experienced relationship problems with family or friends and continued to drink anyway?
- Does the person regularly engage in risky behavior while intoxicated?
- Has the person had problems with work or school responsibilities based on drinking?
- Does the person’s drinking result in regularly missing activities that would normally be enjoyed?
Is there an “alcoholism gene,” and is there a test for it?
Alcoholism is understood to have at least some degree of basis in family history. If an individual’s close family member has struggles with alcoholism or other drug abuse, it is more likely for that individual to develop a substance use disorder as well. However, as described by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), it’s not as simple as finding just one gene and determining that the individual who has it will develop alcoholism. Multiple genetic markers may contribute, and other factors, such as environment, co-occurring mental health conditions, and social relationships, contribute to whether or not the condition will actually develop.
That said, researchers are continually seeking new ways to prevent alcoholism, and various strategies have already been discovered that can help to identify genes implicated in alcoholism, providing the potential for tests that may be able to tell whether or not a person has a higher likelihood of developing alcoholism based on genetic makeup, as described in a report from NIAAA. In the meantime, noting the family relationship can help individuals determine whether alcoholism may be a risk.
Are there different levels of alcoholism?
All substance use disorders have various levels of manifestation, and alcoholism is no different. Alcohol abuse can take multiple forms, and it can also progress from milder versions to more severe problems. As described by Healthline, these levels of alcohol abuse and alcoholism cover the following range of stages:
- Occasional abuse and binge drinking: In this case, the individual may have regular, if occasional, periods of drinking more than 3-5 drinks in a two-hour period. This is known as to as binge drinking, and while it is not usually referred to strictly as alcoholism, it is a type of alcohol abuse that can start the spiral into more severe abuse and eventually addiction. Mild alcohol abuse may also manifest as self-treatment for symptoms of other mental health conditions; a person who drinks to “take the edge off” or to offset anxiety or depression may be engaging in this type of alcohol abuse.
- Regular to heavy alcohol use: Sometimes, individuals begin to move into more frequent alcohol use; perhaps they drink every night or begin to binge drink more often. This can lead to the person developing tolerance for alcohol, meaning that it takes more drinking to have the same effect that a single drink might have had before. The individual begins to drink more for emotional reasons rather than as an occasional treat or accompaniment for food.
- Dependence or alcoholism: A person may be dependent on alcohol without being addicted, but in either case, the person’s drinking begins to affect the rest of the individual’s life. It may be more difficult to keep up with responsibilities, or social relationships may suffer. The person becomes unable to control alcohol use, perhaps drinking more than intended on a regular basis and being unable to quit drinking altogether. Another hallmark of this level of alcohol abuse is the occurrence of withdrawal symptoms when trying to stop. With heavy alcohol abuse, withdrawal can also present with a set of dangerous symptoms known as delirium tremens (DTs) that can put the individual’s life at risk.
What should you do with the results of a positive self-test for alcoholism?
Based on the levels of alcohol abuse above, and on the idea that alcohol abuse is interfering with the individual’s daily activities, relationships, and ability to function normally, the person may determine that alcohol use disorder is present. If this is the case, it is important to get a medical diagnosis and support before attempting to stop drinking.
The reason for this is the potential for health risk described above. When a person who has been engaging in heavy alcohol use for a long period of time tries to quit, severe withdrawal symptoms can occur, and these require medical management to prevent further health risk to the individual. Symptoms described by WebMD, which include DTs and seizures, can result in death if medical support is not provided.
Thankfully, medical support can minimize or even prevent withdrawal symptoms. This not only helps to protect the individual’s life, but it also gets the person on the right foot to start a helpful addiction treatment program so they can move forward into recovery.
How would a professional diagnose alcoholism?
It can often be difficult to determine whether a person is dealing with an alcohol use disorder; most diagnosis relies on the individual providing honest information to the treatment or medical professional, and that is dependent on the individual not feeling ashamed or stigmatized, as is often the case. Nevertheless, people who regularly work to recognize, diagnose, and treat alcoholism can often see signs that a layperson might not relate to alcoholism. For example, as described on MedicineNet, if the person has a co-occurring mental condition, a professional may relate the person’s drinking patterns to the condition, recognizing the potential for the use of alcohol as self-treatment, which is a form of alcohol abuse.
Professionals use a combination of diagnostic questions and this experience to determine whether or not alcohol use is interfering with the individual’s ability to function. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as described by VeryWell, provides guidelines for a professional to diagnose substance use disorders like alcoholism, creating a framework through which the doctor or treatment professional can ask appropriate questions. By pulling together the answers and following the DSM-5 guidelines, the professional can then make a reasonable diagnosis and provide recommendations for treatment.