The drinking dilemma: What are the signs someone is addicted to alcohol?
Asking “what are the signs someone is addicted to alcohol” may seem like a ludicrous question on the surface.
However, while America is a culture awash in booze, not everyone who drinks has a problem. There are even a large number of heavy drinkers who never develop a problem, because the signs someone is addicted to alcohol isn’t necessarily evident by the amount they consume.
Consider: Last month, The Associated Press reported that after a two decade increase in alcohol consumption, Americans are drinking more now than they did when Prohibition was enacted as a reactionary measure against it in 1920 : “In the late 1910s, just before Congress banned the sale and manufacture of alcoholic beverages, each American teen and adult was downing just under 2 gallons of alcohol a year on average. These days it’s about 2.3 gallons, according to federal calculations. That works out to nearly 500 drinks, or about nine per week.”
So does that meet the standards of alcohol use disorder, the scientific term for alcoholism? According to the Substance Abuse and Mental Health Services Administration (SAMSHA), it might : “SAMHSA defines heavy alcohol use as binge drinking on five or more days in the past month.”
But what is binge drinking? What is heavy drinking? What constitutes alcohol use disorder? And most importantly, what are the signs someone is addicted to alcohol? Let’s dive in and unravel that booze-soaked ball of yarn.
Alcohol: A Brief History
Entire libraries can be and have been written about alcohol’s role in the development of civilization. Perhaps no other substance, outside of food and water, has played a greater role in the rise and fall of empires, the advancement of art and medicine or the social norms of dozens of cultures than alcohol. Rather than rehash all of them, it’s important to provide some context for just how integral alcohol is in human history.
Writing for the School of Nursing at the University of Jordan, Dr. Ayman M. Hamdan-Mansour points out  that the Code of Hammurabi, which governed Babylonian law in ancient Mesopotamia and dates back to 1700 BC, governed wine use and sale. According to the Foundation for a Drug-Free World , “Fermented beverages existed in early Egyptian civilization, and there is evidence of an early alcoholic drink in China around 7000 B.C. In India, an alcoholic beverage called sura, distilled from rice, was in use between 3000 and 2000 B.C.”
Other historical alcohol highlights, according to the Foundation:
- “The Babylonians worshiped a wine goddess as early as 2700 B.C.”
- “In Greece, one of the first alcoholic beverages to gain popularity was mead, a fermented drink made from honey and water. Greek literature is full of warnings against excessive drinking.”
- “Several Native American civilizations developed alcoholic beverages in pre-Columbian times. A variety of fermented beverages from the Andes region of South America were created from corn, grapes or apples, called ‘chicha.’”
While America has a complicated history with alcohol consumption — it was frowned upon during its Puritanical beginnings, flowed freely during the 19th century and was the subject of two Constitutional amendments that first banned it and later repealed the ban in the 20th century — that information is likely well known by anyone with a cursory knowledge of U.S. history.
But how did humans first make the connection between alcohol as a substance and its intoxicating effects? According to a 2014 article on the website Live Science , “The ability to break down alcohol likely helped human ancestors make the most out of rotting, fermented fruit that fell onto the forest floor.”
That fermentation, aided by sunlight and naturally occurring yeasts, produces ethanol — the chemical in alcohol that’s most desirable and causes the most problems.
Signs Someone Is Addicted to Alcohol: It’s About the Ethanol
So how does ethanol affect the body, and when did mankind first acquire the ability to process it in the body? There are no definitive answers, but according to the Live Science piece, “To learn more about how human ancestors evolved the ability to break down alcohol, scientists focused on the genes that code for a group of digestive enzymes called the ADH4 family. ADH4 enzymes are found in the stomach, throat and tongue of primates, and are the first alcohol-metabolizing enzymes to encounter ethanol after it is imbibed.”
After examining the family trees of 28 species that represented an accumulated 70 million years of primate evolution, their findings: “Results suggested there was a single genetic mutation 10 million years ago that endowed human ancestors with an enhanced ability to break down ethanol.” And human ingenuity being what it is, Mark Keller writes in a 1979 paper for the Rutgers University’s Center for Alcohol Studies , “It is likely that they advanced rapidly from depending on accident to deliberate manufacture of this magical drink-food that relieved fatigue, assuaged pain, evoked gaiety, enhanced bravery, promoted friendship, and even facilitated communion with the invisible spirits that seemed to control mankind's fate.”
But how does alcohol interact in the brain? In breaking it down in laymen’s terms for the website How Stuff Works , Stephanie Watson points to three neurotransmitters affected when ethanol is carried to the brain via the bloodstream:
- “Alcohol increases the effects of the inhibitory neurotransmitter GABA in the brain. GABA causes the sluggish movements and slurred speech that often occur in alcoholics.
- “At the same time, alcohol inhibits the excitatory neurotransmitter glutamate. Suppressing this stimulant results in a similar type of physiological slowdown.
- “In addition to increasing the GABA and decreasing the glutamate in the brain, alcohol increases the amount of the chemical dopamine in the brain's reward center, which creates the feeling of pleasure that occurs when someone takes a drink.”
In other words, a foreign substance — in this case, ethanol — interferes with naturally occurring “feel good” chemicals in the brain, stimulating their production in a way that produces euphoria (along with the other physical and psychological side effects of drinking). Because the introduction of alcohol results in pleasure, it leads many individuals to repeat the experience, according to Dr. Fernando Valenzuela, in the paper “Alcohol and Neurotransmitter Interactions” : “This effect may lead to positive reinforcement and persistent alcohol-seeking behavior. The brain’s adaptive changes to the continued presence of alcohol result in feelings of discomfort and craving when alcohol consumption is abruptly reduced or discontinued. These feelings reinforce alcohol-seeking behavior during abstinence.”
Because of the complexities of the brain, the science is exact, but Valenzuela points out that “reinforcement appears to be regulated by the interaction of multiple neurotransmitter and neuromodulatory systems,” among them systems that produce dopamine, endogenous (naturally occurring) opiates, GABA, serotonin and glutamate. Over time and with repetition, some of those systems become conditioned to release when alcohol is present and less so when it’s not. Eventually, alcohol interferes with the normal production of those neurotransmitters, and the brain becomes dependent on ethanol as the “gatekeeper” of when and how much those neurotransmitters are released.
In other words, the brain is “dependent” on alcohol to release chemicals that make us feel good, and the absence of alcohol has the opposite effect: We feel lousy. Ergo, brain and body tell us that repeating the pattern of alcohol consumption will make us “better.”
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Signs Someone Is Addicted to Alcohol: Who Is ‘Someone?’
So if Americans consume that much alcohol, and alcohol does those things to your brain, why isn’t everyone who drinks showing signs someone is addicted to alcohol? Good question. Obviously, not everyone who drinks is an alcoholic. The simple answer is that some brains are biologically and genetically more predisposed to addiction than others. According to the National Institute on Drug Abuse , the spikes in those feel-good chemicals result in reinforcement to repeat the consumption of drugs and alcohol that produce those spikes, and “as a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug — an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, sex, or social activities.”
Why do some people become addicted and some don’t? A number of reasons, the NIDA continues:
- Biology: “The genes that people are born with account for about half of a person's risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction.”
- Environment: “Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person’s likelihood of drug use and addiction.”
- Development: “Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.”
So where’s the line? How much is considered an acceptable amount of alcohol to consume? Well, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) , “The 2015-2020 Dietary Guidelines for Americans defines moderate drinking as up to 1 drink per day for women of legal drinking age and up to 2 drinks per day for men of legal drinking age.” But even those recommendations come with some cautions: Don’t drink if you take medications that alcohol might interfere with, don’t drink if you have a medical condition that can worsen because of alcohol, don’t drink if you’re planning to drive or operate machinery, don’t drink while pregnant.
Any consumption above moderate drinking may be considered problematic. What are those?
- “Binge drinking is a pattern of drinking that brings blood alcohol concentration (BAC) to 0.08 percent or higher. This typically occurs after 4 drinks for women and 5 drinks for men — in about 2 hours.”
- “Heavy alcohol use is defined as more than 4 drinks on any day for men or more than 3 drinks for women.”
- “Drinking excessively, which includes binge drinking and heavy alcohol use, increases your risk of harmful consequences, including (alcohol use disorder). The more drinks on any day and the more heavy drinking over time, the greater the risk.”
What Sort of Problems Can Develop?
The negative consequences associated with alcohol consumption depend on a number of factors, as the NIAAA points out , including:
- “How much and how often a person drinks;
- “The age at which he or she first began drinking, and how long he or she has been drinking;
- “The person’s age, level of education, gender, genetic background, and family history of alcoholism;
- “Whether he or she is at risk as a result of prenatal alcohol exposure; and
- “His or her general health status.”
Not everyone is affected the same, but the generally accepted consequences of excessive alcohol include, according to the NIAAA:
- Blackouts and memory lapses: “Alcohol can produce detectable impairments in memory after only a few drinks and, as the amount of alcohol increases, so does the degree of impairment. Large quantities of alcohol, especially when consumed quickly and on an empty stomach, can produce a blackout, or an interval of time for which the intoxicated person cannot recall key details of events, or even entire events.”
- Brain damage: “People who have been drinking large amounts of alcohol for long periods of time run the risk of developing serious and persistent changes in the brain. Damage may be a result of the direct effects of alcohol on the brain or may result indirectly, from a poor general health status or from severe liver disease.”
- Liver disease: “Heavy, long–term drinking can damage the liver, the organ chiefly responsible for breaking down alcohol into harmless byproducts and clearing it from the body.”
- Heart issues : Cardiomyopathy, arrhythmia, stroke and high blood pressure can all result from excessive alcohol use.
- Increased cancer risk: “Based on extensive reviews of research studies, there is a strong scientific consensus of an association between alcohol drinking and several types of cancer,” including head and neck cancer (two to three times more likely in individuals who drink 3 ½ or more drinks daily), esophageal cancer, liver cancer, breast cancer (women who drink three or more drinks daily have a 1.5 times greater chance of developing it) and colorectal cancer (3 ½ drinks per day or more puts consumers at 1.5 times the risk of developing it as non-drinkers.
- Immune system issues: “Chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much.”
- Pancreas problems: Alcohol promote the production of toxins in the pancreas that can lead to the development of pancreatitis.
- Other problems : “Alcohol consumption is associated with a wide range of adverse health and social consequences, both acute (e.g., traffic deaths, other injuries) and chronic (e.g., alcohol dependence, liver damage, stroke, cancers of the mouth and esophagus).”
And while those issues are all potential problems that heavy drinkers may experience, other studies show that even moderate drinkers may face some health risks: According to Harvard Health Publishing, an arm of Harvard Medical School : A 30-year British study of more than 500 individuals found that “those who had the equivalent of four or more drinks a day had almost six times the risk of hippocampal shrinkage as did nondrinkers, while moderate drinkers had three times the risk.”
That doesn’t mean you should pour every alcoholic beverage in your house down the drain, but it should serve as a warning sign: Alcohol can be problematic, even for those who drink heavily but don’t consider themselves addicted to it.
So, What ARE the Signs Someone Is Addicted to Alcohol?
It can’t be stressed enough: Not everyone who drinks is addicted to alcohol, but everyone addicted to alcohol drinks. To separate the two, it’s important to keep an eye out for signs that someone you care about may be trudging down a path where their lives will be upended, if not destroyed, by booze.
- Alcohol is everything. If their idea of a social life is spending every night in a bar, they might have a problem. For these individuals, alcohol is part and parcel of every activity, and the go-to solution for all things. Broken heart? They drink to forget. Got a promotion? They drink to celebrate. It’s New Year’s Eve? Gotta drink! It’s a Wednesday in mid-June? Let’s knock off early and go have a few. Alcohol is the center of their universe, and without it, they feel out of place or awkward.
- They can outdrink everyone. In college, it may be a point of pride to drink your fraternity brothers or sorority sisters under the table. A strong constitution when it comes to liquor is an enviable trait … but not so much when you’re 50 and getting hammered at the company Christmas party, or worse, drinking the well dry at that party and still seeming fairly coherent.
- They get defensive. If you or others suggest that slowing down, or quitting altogether, might be a good idea because you’re concerned, and the object of your concern gets angry and/or refuses to even entertain the idea, they may be secretly scared of facing the truth.
- They change. Maybe they’re painfully shy, but alcohol gets them dancing on the bar. Maybe they’re the sweetest, gentlest souls you know, but booze turns them into raging maniacs. Radical, sometimes frightening personality shifts can be a sign someone is addicted to alcohol.
- They never seem to be without one. If they come to class smelling like booze, or they keep a pint in a desk drawer at work, and they never fail to order a couple of drinks at lunch, take note: That’s not normal.
- They’re suffering financial consequences. Buying booze may not lead to the same financial ruination of drug addiction, but an expensive bar tab nightly can take a toll. If someone you care about always seems to have money to drink but is constantly borrowing it to buy food or pay rent, something is amiss.
- They’re suffering physical consequences. All of those health risks associated with drinking? They come with obvious physical signs — jaundice, for example, is a sign of liver problems. Perhaps it’s the sunken eyes and the sallow skin and the sweat that smells like gin — all a sign that someone is addicted to alcohol.
- They’re suffering legal consequences. “Normal” drinkers don’t get arrested for driving under the influence, or assault, or any number of other charges that can result from being impaired. In the event a single bad decision leads to a DUI charge, those who don’t have a problem usually hit the reset button and immediately change their drinking habits. Individuals who have a problem often continue to drink even in the face of some pretty stiff consequences.
- They make poor decisions. Perhaps she decides to leave the bar with a guy she just met. Perhaps he insists that he’s OK to drive when clearly he’s not. Perhaps they try to talk your social circle into going skinny-dipping in mid-January. Alcohol impairs judgment, and if someone you care about is consistently bemoaning the decisions they’ve made while under the influence, that’s a sign someone is addicted to alcohol.
- They ask for help. This one is clearly the most obvious sign, and should they reach this point, you should avail yourself of the information necessary to offer it. A list of Alcoholics Anonymous meetings in your area, or the phone number to a reputable drug and alcohol treatment center, is a good place to start.
But it’s important to know this: You don’t have to let it get to the point where they’re asking for help. If there are signs someone is addicted to alcohol, and you care about their health and well-being, approaching them in a non-confrontational, supportive and empathetic manner might keep them from additional harm.
While addicts and alcoholics may take part in shameful actions while under the influence, being an addict or an alcoholic is nothing to be ashamed of. They are, after all, legitimate medical diseases, recognized as such by both medicine and science, and it’s important to understand that when looking at the scope of the problem: They’re not “bad” people who need to be “good,” they’re sick people who need to get better. And that’s where alcoholism treatment can save lives.