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Problem Drinking: What It Is and When to Cut Back

April 3, 2018 (Updated: August 16, 2018)

Do you every worry about how much your spouse is drinking? Do you have a friend who is always drunk at the end of the evening? Are you always drinking more than everyone around you? According to a vast new study, alcohol use has jumped dramatically in the United States, especially among women and older adults. With April being Alcohol Awareness Month, I’d like to focus your attention on some behavior that has entered the alcohol discussion – problem drinking – and share some practical advice to help you or someone you love cut back.

“Problem drinking” isn’t a medical term, but it’s something that I’ve become more concerned about as I talk with my patients.

Drinking is engrained in our culture, and it’s been that way for thousands of years. Weddings, birthdays, promotions, stressful days, sporting events and more – all popular events where you might have a drink. Sometimes a few drinks. Sometimes a few too many drinks.

In most cases for most people, this is generally OK. Most people don’t drink excessively in these situations. Most people know when they’ve reached their limit.

But drinking is on the rise. The previously mentioned alcohol study showed that high-risk drinking (5 drinks/day for men, 4 or more drinks/day for women) increased by 65% among older adults. Older adults are especially vulnerable to the effects of alcohol– direct toxic effects to your body, complications with other medications, and injuries resulting from intoxication.

The study confirms something that I’ve seen in the decades I’ve been in practice: Our society is collectively losing its sense of self-control, especially when it comes to drinking.

Simply put, alcohol is a toxin. A poison. A drug. It harms your body. Regular alcohol consumption has serious (I wish I could emphasize that word more) long-term effects on your entire body. Frankly, there are too many to fully list in one article but here’s a quick list:

  • Impaired brain function
  • Anemia
  • Cirrhosis of your liver
  • Hepatitis
  • Gastritis
  • Pancreatitis
  • Type 2 diabetes
  • Cardiomyopathy
  • Cancer of the mouth, trachea, and esophagus.

All of these are serious illnesses, some potentially fatal. All of them. On top of that, alcohol has a variety of potent psychological effects such as cravings, irritability, depression, anxiety, sleep disorders, antisocial behavior, and more.

Now, a drink or two every month only increases your risk of the above by a tiny amount. But there is a vast gray area that separates casual drinking and alcohol abuse. Problem drinking takes root in this gray area and can eventually lead to health risks and addiction. Further, it’s difficult for doctors to treat this level of drinking because patients may not be adding up how much and how frequently they drink.

Problem Drinking vs. Alcoholism

You may be wondering what’s the difference between problem drinking and alcoholism. There are major differences between these similar sounding concepts.

Problem drinking is alcohol abuse, drinking to the point where it hurts you. Alcoholism is a physical dependence on alcohol. A problem drinker’s alcohol use negatively impacts their lives, but they aren’t physically and psychologically dependent on alcohol. That dependency is the trademark of alcoholism. The effects of problem drinking are more focused on how drinking affects daily life and relationships, such as:

  • Frequently missing work or appointments
  • Isolating from family and friends
  • Experiencing financial problems
  • Making poor and unsafe decisions
  • Having blackouts
  • Experiencing depression
  • Behaving violently

Make no mistake, problem drinking can turn into alcoholism over time. Even if it doesn’t, a person’s problem drinking will more likely put them in a dangerous situation or damage personal relationships. That’s why it’s critical to recognize problem drinking early and address it now.

Practical Ways to Cut Back on Drinking

When I talk with patients about cutting back on drinking, I discuss pragmatic ways that focus on the amount they drink and the context of their drinking. For example, do you tend to drink more when watching TV? On weekends? On vacations? During periods of stress? As a celebration? Are there certain people who cause you to drink, whether it’s because they are heavy drinkers or because they are difficult to be around? Do you use alcohol as a coping mechanism for personal problems?

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On the occasions that you do drink, do you have more than 4 drinks? Make poor decisions? Behave erratically? Function at a lower level the next day?

The answers to these questions help determine if you have a pattern of problem drinking. How and when you drink have a strong bearing on how much you drink. By identifying patterns in your drinking, you can find a way to cut back on drinking to the point where the amount and frequency is not problematic.

For example, if you find that most of your drinks are a response to stress, then I suggest that you try to find other coping methods such as exercise, meditation, counseling, or a fun hobby. Or if you still want alcohol after a stressful day, have one drink and then ask yourself, “Was that enough to make me feel better?”

Or if you find that you tend to drink when going out to dinner, then I suggest that you try being the designated driver or replacing those cocktails with non-alcoholic versions of them. Or, again, have one cocktail and then stop to ask yourself, “Was that enough for me?”

You don’t have to stop drinking but rather learn to control it.

Talking to Somebody Else About Their Drinking

Dialing down your own drinking is one thing. Talking to somebody else about their drinking is another. By nature, most people don’t like to be confronted with negative feedback. How you approach is this conversation is critical to how somebody will react. I suggest you try to remove yourself from the conversation so it doesn’t come off as finger pointing. Here are questions that you can ask that are less focused on blame and more focused on introspection:

  • Why do you think people are concerned about your drinking?
  • How do you think drinking is affecting you?
  • How do you think your drinking is affecting other people?
  • How do you feel the day after drinking?
  • If you could cut back on drinking, how would you do it?
  • If someone could help you cut back on drinking, how could they help?
  • If you couldn’t drink anymore, what would that be like?

Notice that the word “I” is not in any of the questions above. That’s intentional because this conversation isn’t about you. It’s about someone you care about. These questions are designed to tone down your opinions, which are implied but not said outright. They bypass the sharp edges of negative feedback and force a problem drinker to take inventory of their drinking and its effects on others.

But ultimately, you can’t control someone else’s behavior. People change when the reasons to change outnumber the reasons to keep the status quo. However, it’s important for them to know that you care and that you will listen when they are ready to talk.

Having a Healthy Relationship with Alcohol

Finally, I’d be remiss if I didn’t offer some resources to help you or a loved one get started in cutting back drinking…

Hello Sunday Morning has great advice about how to talk to yourself and others about alcohol. It also has an app called Daybreak where people can share their experiences of cutting back their drinking or quitting without having to go to an AA meeting, which can be intimidating to a lot of people.

The National Institute on Alcohol Abuse and Alcoholism has a lot of research, events, and links to online and physical support groups across the country.

The Alcohol Treatment Navigator is exactly what its name says it is – a personalized map for alcohol treatment. It’s a great resource for all age groups too, whether they are looking for help themselves or help for a loved one.

Big picture, a healthy relationship with alcohol isn’t about what you drink but the context around your drinking. And when you better understand what’s causing your (or somebody else’s) urges to drink, you are better able to make real changes with better results.

References

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