How can you tell if you or a loved one has a drinking problem?

Some years ago, Dr. John Ewing, founding Director of the Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, developed the CAGE questionnaire for alcoholism (the name comes from four key words in the questions).

Dr. Ewing’s questionnaire is deceptively simple, a quick list of only four questions. Yet many doctors use the CAGE questionnaire because tests have shown that it can correctly diagnose alcohol dependency 76 percent of the time. The CAGE test has even been found to be more accurate than certain liver function tests, which detect only 33 percent of patients who have more than 16 "drinks" per day.

If you or someone you care about can answer “yes” to two or more of the following four questions, that is clinically significant and means that the answerer probably has a drinking problem:

1. Have you ever felt you should CUT down on your drinking?
2. Have people ANNOYED you by criticizing your drinking?
3. Have you ever felt bad or GUILTY about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (EYE OPENER)?

In general, men who drink more than 14 drinks a week or four drinks at one occasion often have a drinking problem. For women, the standard is more than seven drinks a week or three drinks at one sitting.

If you have determined that you have a drinking problem, the next step is to figure out if you are abusing alcohol or if you have become physically dependent on it.

Alcohol Abuse or Alcohol Dependence?

Abusing alcohol is different than being physically dependent upon it.

Doctors say that you are abusing alcohol if you meet one or more of these criteria:

1. Drinking is causing you to fail to meet your obligations at work, school or home. Examples are as too many absences from your job, neglecting your children, or being suspended by school authorities.



2. You drink even though you are put yourself in physical danger by doing so (such as drinking while driving).



3. Your drinking is getting you into trouble with the law.



4. Your drinking is causing you to have problems in relationships.

Doctors say that you are dependent upon alcohol if you meet three or more of the following criteria:

1. You have built up a tolerance for alcohol and you need to drink greater amounts to achieve the effects you want, such as a “buzz” or intoxication.



2. You experience withdrawal symptoms when you stop drinking.



3. You drink larger amounts than you intend to.



4. You want to stop drinking but you cannot.



5. Drinking and recovering from binges is taking up too much of your time.



6. You give up social, occupational or recreational activities in order to drink.



7. You drink even though you know you are developing health problems because of it.

What is Alcoholism?

Alcoholism is sometimes called “alcohol dependency syndrome.” An alcoholic is a person who has lost control over her drinking, developed a tolerance for and physical dependency on alcohol, and experiences strong cravings to drink.

Doctors consider alcoholism to be a chronic, progressive disease. When doctors say that alcoholism is a progressive disease, they mean that it will not get better on its own. Instead, it will progress from Early Stage Alcoholism to Intermediate Stage to Late Stage to Death.

If used excessively, alcohol attacks every vital organ of the human body. If the disease is left unchecked, the alcoholic will eventually die from liver failure, “beer drinker’s heart,” or cancer of the liver, pancreas, mouth, or esophagus. Alcoholics also die prematurely from other diseases because they usually suffer from nutritional deficiencies and because drinking impairs their immune systems.

Only a minority of people become alcoholics, because alcohol is “selectively addictive.” This means it affects people in different ways, and only certain people will become alcoholics. Some people carry a gene that causes them to be nauseated if they take even one drink. However, alcoholics react in the opposite way – with intense pleasure. Many alcoholics can remember the joy of their first drink. Writer Jack London could recall his first taste of liquor at age seven. An alcoholic all his life, London died when he was only 40 years old.

Even children can become alcoholics – and if they do develop this condition, it is vital that they receive treatment. Research shows that children, teenagers, and young adults are more likely to become long-term alcoholics if their disease is not treated early.

Some people have a genetic tendency for alcoholism, and are more likely to become addicted. They become alcoholics because of the chemical and psychological effects that liquor has on their bodies and minds. For these people, moderate drinking will never be possible. This is what is meant when alcoholism is described as a “chronic” disease.

Treatment & Recovery

Alcoholics can pursue long-term recovery through a variety of modern treatment methods.

By entering residential treatment centers, they first undergo chemical withdrawal from alcohol dependency under safe, medically supervised circumstances. Then they have to acquire the skills they will need to live a sober life.

Components of an effective treatment program include individual and group counseling, good nutrition, physical exercise, learning better communication and social skills, learning how to deal with uncomfortable emotions without drinking, setting new goals, and choosing activities to fill up the time previously spent drinking.

Follow-up care is important after the person returns to his home environment. The family of a recovering alcoholic usually enters counseling in order to best support the recovering alcoholic’s efforts, who will likely remain in counseling for months or even years after completing the initial treatment phases.

Most recovering alcoholics (and many family members of recovering alcoholics) also benefit by attending group support meetings on a regular basis.