How Much is Too Much? Binge Drinking, Alcohol Abuse, and Alcohol Dependence in the United States

alcoholism itriageThe United States is a country that embraces excess. Americans have the biggest cars, the biggest houses, and, according to the latest report from the Organisation for Economic Co-operation and Development (OECD), the biggest bodies. We also express our work-hard-play-hard attitude in the way we imbibe; according to the National Council on Alcoholism and Drug Dependence  (NCADD), approximately 17.6 million people, or one in every 12 adults, suffer from alcohol abuse or independence. During Alcohol Awareness Month, activists, organizations and government institutions are looking to spread awareness about the unhealthy relationships many Americans have with alcohol.

To clarify: alcoholism, otherwise known as alcohol dependence, is not the same as alcohol abuse. According to the U.S. National Library of Medicine, alcoholism is defined as having signs of physical addiction to alcohol and continuing to drink, despite problems with physical health. Alcohol abuse is “when your drinking leads to problems, but not physical addiction.”

1 in 6 adults binge drink. CDC Vital Signs. http://www.cdc.gov/VitalSigns/BingeDrinking/In addition to the high number of American alcoholics, another cause for worry is the number of American adults who binge drink, a public health concern that many see as exclusive to rowdy college students. Not so, according to the CDC: around 38 million American adults, many of them well out of college, binge drink around four times a month, increasing their chances of crashing their cars, engaging in violent behavior, and committing suicide. Those who are dependent on alcohol, or abuse alcohol, are also at higher risk of developing a slew of chronic diseases, neurological impairments, and social problems, including dementia, stroke, myocardial infarction, cardiomyopathy, depression, cancer, liver diseases, and gastrointestinal problems.

How much is too much?

Turns out that “too much” is a lot less than most people would assume. A woman consuming four drinks over two hours would be binge drinking, according to The National Institute on Alcohol Abuse and Alcoholism (NIAAA). For a man the limit is six drinks over the same time period. So, if you polish off a six-pack by yourself while watching a football game, you could well be binge drinking. So how are you supposed to know whether your relationship to alcohol is unhealthy or not?

Signs of alcohol abuse and alcoholism

Though it may sometimes be hard for people to distinguish whether or not their imbibing habits are healthy, Daniel Bober, DO, a psychiatrist and addiction specialist in Hollywood, FL, says to look out for these signs of alcohol abuse:

  • Memory lapses after heavy drinking
  • Needing more and more alcohol to feel “drunk”
  • Feeling sick after not having a drink for a while (nausea, vomiting, tremors)
  • Alcohol-related illnesses such as alcoholic liver disease.

According to the U.S. National Library of Medicine, symptoms of alcoholism include:

  • Continuing to drink, even when health, work, or family are being harmed
  • Drinking alone
  • Becoming violent when drinking
  • Hostile behavior when asked about drinking
  • Inability to control the amount of alcohol intake
  • Making excuses to drink
  • Missing work or school
  • Needing alcohol to get through the day
  • Neglecting to eat or eating poorly
  • Attempts to hide alcohol use

But knowing the signs doesn’t necessarily mean an alcoholic or someone who abuses alcohol is on the road to recovery.  According to Dr. Bober, “Alcoholics lack the ability to see their personal drinking patterns as a destructive force. In many cases, their judgment and insight are skewed.”

Hope on the horizon

Barbara, whose name has been changed at her request, says that it took her a long time to realize that she had a problem. “My mom went to rehab for her drinking when I was fourteen. I knew I drank a lot, but my mantra was ‘I’ll stop when I’m older. I’m too young to be a drunk.’” Her story is echoed in the words of Gary Goldstein, a former in recovery who is now a motivational speaker: “It took a prison sentence to finally get me to admit that I had a disease, and needed help with my addiction.”

John, who is in recovery and whose name has also been changed, said that for him, there was no external wake-up call. “Most people believe you need to hit ‘rock bottom’ in order to stop. I don’t. I hit rock bottom and went out and got a chisel; I ended up homeless and still couldn’t stop drinking.”

1 in 3 crash diver deaths involves a drunk driver. CDC Vital Signs. www.cdc.gov/VitalSigns/DrinkingAndDriving/This reluctance to seek treatment is exacerbated by common misconceptions surrounding alcoholism: Paul Hokemeyer, PhD, an addictions specialist and Senior Clinical Advisor at Caron Renaissance in New York City, NY says that many people believe that “alcoholism is a moral failing or personal weakness. People don’t realize that alcoholism is a disease that is chronic, meaning it persists, progresses, and, if not treated, is fatal.” These misconceptions, says Dr. Hokemeyer, create shame and stigma around substance abuse disorders, which “keeps people isolated and trapped in their disease. In order for people to get the help they need, they must admit they have a problem, and find the courage to reach out for help.”

For Barbara and John, Alcoholics Anonymous, the twelve-step program of mutual aid, helped them in their journey of recovery. “I had tried AA before,” says Barbara, “but it didn’t work for me. It didn’t work because I went in with the attitude that I was only going to do what I wanted to do, and not what was suggested.” Barbara’s second run with AA proved to be more successful, and she went on from being “unemployed, un-teachable, and unmanageable to holding not one, but two jobs, and sponsoring other AA members.”

John was met with similar success through AA. He attended his first few meetings drunk and still using drugs, but remembers one thing clearly: “People were friendly, despite my condition.” After relapsing “so many times I lost count,” John says, “Something changed in me…Perhaps it was a spiritual awakening, or perhaps something that these nice people said finally got through, I don’t know. What I do know is that I go to a twelve step meeting every day and I haven’t had a drink in four years.”

Of AA, Dr. Hokemeyer says, “The beauty of AA is that it enables human beings who were formerly isolated by their disease to connect with other human beings in recovery. There is enormous power in a group of people focusing on healing and recovery.” Dr. Boben also lauds Alcoholics Anonymous, citing its proven track record of over sixty years of success, low cost, 24-hour support, its reach, and its anonymity.

But AA is not for everyone, he says, “AA may not help people with additional issues of depression and/or anxiety. The greater the psychiatric distress a person is experiencing, the more the person is tempted to drink, particularly in negative situations.”

Some people may also be put off by the spiritual element of AA, says Dr. Boben, while others may not be comfortable in a group setting when trying to tackle an addiction. Dr. Boben also points out to alternative modes of treatment, such as medications reduce the craving for alcohol that prevent or reduce the symptoms of withdrawal. His advice to those who think they might have problems with alcohol is to seek out an evaluation by a primary care provider for any physical manifestations of alcoholism, then seek a referral to a psychiatrist or other addiction mental health professional.

These days, Barbara reflects on her journey by saying, “It hasn’t been easy. Life isn’t easy for anyone, I don’t think. I had to go back and honestly look at my moral inventory and find the root causes of why I drank the way I did. I had to stop pointing fingers at situations and other people, and take responsibility for my actions…Have I wanted a drink? Heck, yes. Have I? Not yet. I am sober today. I have to remember that tomorrow isn’t a given…I used to joke that people had begun to trust me with keys, cars, cash, and kids. It might not sound like much, but it was huge.”

Where to get help

If you struggle with alcohol abuse, consider visiting these support group’s sites, supplied by the U.S. National Library of Medicine:

SMART recovery teaches you have to change your thoughts and behaviors to help people with alcoholism recover.

LifeRing recovery and SOS are two nonreligious programs that offer support for people with alcohol abuse.

Women for Sobriety is a self-help group just for women.

Moderation Management is a program for those who want to reduce how much they drink. It recommends abstinence for people who cannot do this.

If you know someone who is struggling with alcohol abuse or dependence, consider going to an Al-Anon Meeting.

If you are struggling with thoughts of suicide, call the National Suicide Prevention Hotline at 1-800-273-TALK.

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