It’s not always easy to recognize when drinking has crossed the line from moderate or social use to problem drinking. But, if you consume alcohol to cope with life or to avoid feelings, you’re in potentially dangerous territory. Alcoholism and alcohol abuse can sneak up on you, so it’s important to be aware of the warning signs and take steps to cut back once you recognize them. Understanding the problem is the first step to overcoming it.

Understanding alcoholism and alcohol abuse

Alcoholism and alcohol abuse may result in the presence of many interconnected factors: genetics, a family history of alcoholism, associating closely with heavy drinkers, your social environment, and emotional health. Certain cultures are naturally more at risk, such as American Indians and Native Alaskans. Finally, those who suffer from a mental health problem such as anxiety, depression, or bipolar disorder are also particularly at risk, because alcohol may be used to self-medicate.

Sometimes alcoholism develops suddenly in response to a stressful change, such as a breakup, retirement, or other loss. Other times, it gradually creeps up as tolerance to alcohol increases. The risks of developing alcoholism are greater if you binge drink or drink every day.

Substance abuse experts make a distinction between alcohol abuse and alcoholism (also called alcohol dependence). Unlike alcoholics, alcohol abusers have some ability to set limits on their drinking. However, their alcohol use is still self-destructive and dangerous to themselves or others.

Since drinking is common in many cultures and the effects vary widely from person to person, it’s not always easy to recognize the boundary between social drinking and problem drinking. The key is how alcohol affects you. Quite simply, if your drinking is causing problems in your life, you have a drinking problem.

You may have a drinking problem if you:

• Feel guilty or ashamed about your drinking.
• Lie to others or hide your drinking habits.
• Have friends or family members who are worried about your drinking.
• Need to drink in order to relax or feel better.
• “Black out” or forget what you did while you were drinking.
• Regularly drink more than you intended to.

Common signs and symptoms of alcohol abuse include:

• Repeatedly neglecting your responsibilities at home, work, or school because of your drinking. For example, performing poorly at work, flunking classes, neglecting your kids, or skipping out on commitments because you’re hung over.
• Using alcohol in situations where it’s physically dangerous, such as drinking and driving, operating machinery while intoxicated, or mixing alcohol with prescription medication against doctor’s orders.
• Experiencing repeated legal problems as a result of your drinking. For example, getting arrested for driving under the influence or for drunk and disorderly conduct.
• Continuing to drink even though your alcohol use is causing problems in your relationships. Getting drunk with your buddies, for example, even though you know your wife will be very upset, or fighting with your family because they dislike how you act when you drink.
• Drinking as a way to relax or de-stress. Many drinking problems start when people use alcohol to self-soothe and relieve stress. Getting drunk after every stressful day, for example, or reaching for a bottle every time you have an argument with your spouse or boss.

Signs and symptoms of alcoholism (alcohol dependence)

Alcoholism is the most severe form of problem drinking. Alcoholism involves all the symptoms of alcohol abuse, and an additional element: physical dependence on alcohol. If you rely on alcohol to function or feel physically compelled to drink, you’re an alcoholic.

Tolerance: The 1st major warning sign of alcoholism

Do you need to drink a lot more than you used to in order to get buzzed or to feel relaxed? Can you drink more than other people without getting drunk? These are signs of tolerance, which can be an early warning sign of alcoholism. Tolerance means that, over time, you need more and more alcohol to feel the same effects.

Withdrawal: The 2nd major warning sign of alcoholism

Do you need a drink to steady the shakes in the morning? Drinking to relieve or avoid withdrawal symptoms is a sign of alcoholism. When you drink heavily, your body gets used to the alcohol and experiences withdrawal symptoms if it’s taken away. These include:

• Anxiety or jumpiness
• Shakiness or trembling
• Sweating
• Nausea and vomiting
• Insomnia
• Depression
• Irritability
• Fatigue
• Loss of appetite
• Headache

In severe cases, withdrawal from alcohol can also involve hallucinations, confusion, seizures, fever, and agitation. These symptoms can be dangerous, so talk to your doctor if you are a heavy drinker and want to quit.

Other signs and symptoms of alcoholism (alcohol dependence)

• You’ve lost control over your drinking. You often drink more alcohol than you wanted to, for longer than you intended, despite telling yourself you wouldn’t.
• You want to quit drinking, but you can’t. You have a persistent desire to cut down or stop your alcohol use, but your efforts to quit have been unsuccessful.
• You have given up other activities because of alcohol. You’re spending less time on activities that used to be important to you (hanging out with family and friends, going to the gym, pursuing your hobbies, etc.) because of your alcohol use.
• Alcohol takes up a great deal of your energy and focus. You spend a lot of time drinking, thinking about it, or recovering from its effects. You have few if any interests or social involvements that don’t revolve around drinking.
• You drink even though you know it’s causing problems. For example, you recognize that your alcohol use is damaging your marriage, making your depression worse, or causing health problems, but you continue to drink anyway.

Drinking problems and denial

Denial is one of the biggest obstacles to getting help for alcohol abuse and alcoholism. The desire to drink is so strong that the mind rationalizes drinking, even when the consequences are obvious. Denial also exacerbates alcohol-related problems with work, finances, and relationships by stopping you from looking honestly at your behavior and its negative effects,.

If you have a drinking problem, you may deny it by:

• Drastically underestimating how much you drink
• Downplaying the negative consequences of your drinking
• Complaining that family and friends are exaggerating the problem
• Blaming your drinking or drinking-related problems on others

If you find yourself rationalizing your drinking habits, lying about them, or refusing to discuss the subject, take a moment to consider why. If you truly believe you don’t have a problem, there should be no reason for you to cover up your drinking or make excuses.

Helping a loved one with alcoholism or alcohol abuse

If someone you love has a drinking problem, you may be struggling with a number of painful emotions, including shame, fear, anger, and self-blame. The problem may be so overwhelming that it seems easier to ignore it and pretend nothing is wrong. But in the long run denying it will be more damaging to you, other family members, and the person with the drinking problem.

• Don’t attempt to punish, threaten, bribe, or preach.
• Don’t try to be a martyr. Avoid emotional appeals that may only increase feelings of guilt and the compulsion to drink or use other drugs.
• Don’t cover up or make excuses for the alcoholic or problem drinker or shield them from the realistic consequences of their behavior.
• Don’t take over their responsibilities, leaving them with no sense of importance or dignity.
• Don’t hide or dump bottles, throw out drugs, or shelter them from situations where alcohol is present.
• Don’t argue with the person when they are impaired.
• Don’t try to drink along with them.
• Above all, don’t feel guilty or responsible for their behavior.

Dealing with a loved one’s alcohol problem can be emotionally challenging. It’s vital that you take care of yourself and get the support you need. It’s also important to have people you can talk honestly and openly with about what you’re going through. A good place to start is by joining a group such as Al-Anon, a free peer support group for families coping with alcoholism. Listening to others with the same challenges can be a tremendous source of comfort and support. You can also turn to trusted friends, a therapist, or people in your faith community. Remember:

• You cannot force someone you love to stop abusing alcohol. As much as you may want to, and as hard as it is to watch, you cannot make someone stop drinking. The choice is up to them.
• Don’t expect the person to stop drinking and stay sober without help. Your loved one will need treatment, support, and new coping skills to overcome a serious drinking problem.
• Recovery is an ongoing process. Recovery is a bumpy road, requiring time and patience. An alcoholic will not magically become a different person once sober. And the problems that led to the alcohol abuse in the first place will have to be faced.

Admitting that there’s a serious problem can be painful for the whole family, not just the alcohol abuser. But don’t be ashamed. You’re not alone. Alcoholism and alcohol abuse affects millions of families, from every social class, race, and culture. But there is help and support available for both you and your loved one.