How to Know If You Are an Alcoholic—And What to Do About It

I don’t have a problem, or do I?

Do I really have everything under control?

I’m not an alcoholic, am I?

Something has you questioning your relationship with alcohol. It might be because of the recent night out that you don’t remember or the friend who recently voiced concern. Maybe your weekly bar bill or liquor store tab is starting to strain your finances. Whether there is a nagging voice in your ear or a glaring reality that must be confronted, it’s clear that something isn’t right. Let’s look at how to know if you are an alcoholic, and what you can do about it.

The Risk Factors for Developing Alcohol Addiction

There are several risk factors that may increase your chances of developing alcohol use disorder:

Genetic predisposition and family history are strong risk factors for alcoholism. Through research, scientists have determined that alcoholism may be inherited through our genes, known as multigenerational alcoholism. But it is not as simple as you have the gene or you don’t. Multiple genes interact in a complex way to influence your susceptibility for substance addictions. Even so, genetics determine only about 50% of alcohol abuse risk, and environmental factors may affect the outcome as well.

Peer or social pressures are another risk factor. Drinking, especially heavy drinking, among young teens is a special concern since the brain is not yet fully developed. Alcohol use may impair brain development in young people, especially those under the legal drinking age, and lead to an increased risk of alcohol use disorder.

A history of trauma is strongly correlated with the development of alcohol addiction. This applies to both childhood trauma and post-traumatic stress disorder (PTSD) in adults. The Department of Veterans Affairs (VA) estimates that up to three-quarters of those who survive abuse or violent traumatic events—and up to one-third of people who survive a traumatic accident, illness, or disaster—report having an excessive drinking problem. This association between PTSD and alcohol abuse is more common in women than in men.

Adverse childhood experiences (ACEs) may also make someone more vulnerable to mental health disorders and addiction in adulthood. These experiences can include abuse, neglect, domestic violence, divorce, drug or alcohol abuse in the home, and incarceration of a parent. Having one or more of these experiences during childhood correlates with an increased risk of heavy drinking and binge drinking in adulthood.

Mental health issues, such as anxiety, major depression or clinical depression, antisocial personality disorder, bipolar disorder, and other similar psychiatric disorders are risk factors and frequent co-occurring conditions with alcohol abuse. When these mental health disorders are undiagnosed and untreated, some people find temporary relief by self-medicating with alcohol. Unfortunately, the relief is not long-lasting since the underlying cause still remains. Alcohol abuse may add another layer to the problem.

Personal and professional stress exists in everyone’s life, and sometimes people use alcohol to “take the edge off.” However, if this becomes a frequently used solution, it may lead to a dangerous relationship with alcohol and it is possible to become alcohol dependent. Stressors will always be present, and getting into a cycle of excessive alcohol use is not a sustainable solution.

How to Know If You Are an Alcoholic

The NIH’s National Institute on Alcohol Abuse and Alcoholism defines alcohol use disorder as “a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.” But because alcoholism is a brain disease, it cannot be diagnosed simply by a physical exam or a blood test. A set of detailed criteria has been developed to help diagnose an addiction to alcohol.

The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) of the American Psychiatric Association further divides alcohol use disorder into mild, moderate, and severe categories according to how many of the following criteria apply. Consider whether or not you:

• spend a lot of time engaging in activities related to alcohol use
• have drank greater levels of alcohol or for a longer period of time than intended
• have had such bad cravings for alcohol or experienced physical compulsions, you can’t think of anything else
• have found that your drinking habits or being sick from drinking interferes with family, work, or school
• continued  with a pattern of drinking even though it was causing trouble with your family or friends
• have more than once found yourself in a dangerous situation while drinking
• have developed a tolerance or lost your sensitivity to alcohol that makes you have to drink more to feel the same effect
• have made more than one unsuccessful attempt to cut down on alcohol intake
• continued use despite physical health complications and health conditions, emotional problems, or any other issues requiring medical care associated with alcohol use
• have reduced or eliminated participation in other activities because of heavy alcohol consumption
• have experienced withdrawal symptoms when cutting back or practicing abstinence from alcohol

If you recognize any of these key diagnostic criteria in your own life, your relationship with alcohol may have crossed the line between use and substance abuse. Before you suffer more dangerous consequences, it may be time to get some help.

How You Can Reach Out for Help in Recovery

Getting treatment for alcohol use and substance use disorder is easier than you think; you just have to take the first step. Asking a trusted friend or family member to help you navigate what comes next will give you moral support as you seek guidance from an addiction specialist who can help evaluate your situation.

If you need help finding an alcohol addiction specialist near you, consult your family physician, or contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP(4357). This free federal service provides information on substance abuse and can refer you to treatment resources in your area.

Once you have contacted an addiction medicine specialist, they can walk you through your options. They will likely ask some questions based on the diagnostic criteria above to help determine the scope of your problem with alcohol. The specialist can give you medical advice on what further steps they recommend. If a more thorough assessment for alcohol use disorder is necessary, it will likely include a review of your medical records and family history, a physical examination with diagnostic testing, and possibly consultations with other providers.

Since each of us is highly unique, finding an appropriate treatment for your alcohol dependency should involve a personalized treatment plan that addresses underlying risk factors and co-occurring conditions. The most effective alcohol addiction treatment programs will apply evidence-based therapies based on sound neuroscience and addiction medicine, and they will get your family and friends involved in supporting the process. Finding the best treatment option for your personal set of circumstances will also help you to build a toolbox designed to weather the challenges as you recover and find your way to a healthier lifestyle.