Héctor Pastor

If you’ve ever asked yourself what’s the line that separates low risk alcohol use and an alcohol addiction, this article is for you.

Problematic alcohol use presents itself in different forms in our society. It can be defined by a combination of different criteria leading to people with very diverse consumption habits, but all with one common problem: difficulties controlling their consumption leading to negative consequences in their lives. Additionally, there are varying degrees of severity amongst alcohol problems, but all share the loss of personal liberty in favor of alcohol.

It is estimated that around 5% of Spain’s population could have an alcohol problem. Therefore, it is crucial to increase awareness of this disorder, so it is easier to detect and intervene early.

Any diagnosis should be conducted by a mental health professional. If you identify with the following points, seek help from a professional specialized in addictions.

You could have problems with alcohol if you meet 2 or more of the following criteria during a period of 12 consecutive months:

This criterion refers to the inability to control the conduct of drinking or the amount you drink during a year. If you find yourself drinking on more occasions or in larger amounts than you planned, this may indicate that you have an alcohol problem. Some people with this issue try to minimize the importance of the consequences of their consumption, hide their drinking from others, or use a variety of masking techniques such as only acknowledging some of their drinking. It is also common to lie to yourself about the reality of your drinking and subsequent consequences as a defense mechanism.

Attempts to reduce or stop drinking can stem from promises to family and friends or even promises with oneself to stop drinking after experiencing a bad hangover. After multiple failed attempts to gain control over drinking, it’s typical for an alcoholic to normalize and adapt their life around their drinking.

Difficulty with stopping alcohol consumption is caused by withdrawal symptoms and craving. Withdrawal symptoms can be physical in extreme cases (tremors, sweating, etc.) or psychological (irritability, cravings, apathy, etc.). When the brain adapts to habitual drinking, it becomes accustomed to high levels of pleasure in the form of dopamine (the pleasure hormone), so the brain sends signals of needing to drink in the form of withdrawal symptoms when it feels the need for dopamine. Additionally, alcohol use can become an established coping method when facing difficult situations or emotions.

For these reasons, the brain triggers the appearance of withdrawal symptoms such as irritability, sadness, and apathy when a person isn’t drinking as well as the appearance of consumption thoughts associated with these emotions resulting in relapse. Withdrawal has an important neurobiological basis; the more emotional and primitive part of the brain (called the reptilian brain) hijacks the more rational side (called the neocortex) to keep drinking.

This criterion accounts for both the amount of time spent drinking alcohol as well as the amount of time spent recovering from the subsequent effects such as sleeping, resting, or feeling unproductive due to a hangover (preventing one from doing house chores or self-care, for example). The experience of unpleasant emotions due to a lack of control in your alcohol consumption can typically lead to a desire to quit drinking, but a person can have difficulty maintaining that motivation once the withdrawal symptoms appear.

When one’s drinking is very recurrent, it could lead the person to begin isolating themselves from their environment and start spending more time drinking at home, at bars, with drinking buddies, etc, but they could also use socializing to camouflage their drinking as just a social act.

This becomes a habit in their life, although it’s not necessary to drink every day, blackout, or drink until you vomit to have a problem with alcohol. In fact, many people present problematic drinking patterns that aren’t daily, such as weekend drinkers.

They are characterized by brief periods of time in which someone experiences anxiety accompanied by a desire to drink. This can last anywhere from seconds to hours and appears alongside other emotions. For example, a person can feel a craving accompanied by anger due to not being able to drink or feel pleasure. Or a craving could be accompanied by feelings of sadness or guilt due to being unable to successfully control their drinking. It is common that the development of an alcohol problem includes drinking associated with cravings. Craving can still happen even months after stopping drinking.

These problems can range anywhere from extreme negligence to small errors. Some examples could include going to work late, missing classes, arriving late, not following through on commitments, or avoiding phone calls. Additionally, habits like neglecting family or personal hygiene and diet.

It’s common that people who have alcohol problems have had it brought to their attention by their family, partner, or friends. After which can unfold a series of conversations or promises to control their drinking that continue for months or years until the people close to them pull away. It is very difficult for friends and family to put themselves between the drinker and their habit. The motivation to stop drinking must come from the person with the drinking problem in order for them to successfully make a change, which can be very frustrating to family or friends.

When the habit of drinking starts to expand in a person’s life, they begin to substitute other activities for drinking. It’s common to change plans on the weekend to instead spend most of their time on alcohol related activities or change after work habits to favor drinking. When someone manages to quit drinking, finding other recreational activities to occupy the time previously spent drinking can be quite a challenge. On a neurobiological level, it is complicated to adjust to new activities due to a lower stimulation in the brain’s reward center compared to the one produced by drinking.

Alcohol consumption commonly can produce disinhibition of conduct thanks to a lowered perception of risk. Due to this people take more risks than usual under the influence of alcohol. When a drinking habit is very established, many risky behaviors become normalized such as driving home while under the influence of alcohol, operating machinery, or going to work hungover.

Due to the negative reinforcement that is produced by addiction, it is common to turn to drinking to stop feeling unpleasant emotions such as guilt, sadness, doubts, fear, or anxiety amongst others. This reinforces drinking behaviors which in turn worsens the behaviors. Emotional difficulties in people’s lives that alcohol provokes can be minimized since alcohol can also help the drinker manage their emotions since it takes away the craving, thus perpetuating the problem.

• A need for markedly increased amounts of alcohol to achieve intoxication or desired effect
• A markedly diminished effect with continued use of the same amount of alcohol.

Tolerance acquired from alcohol can cause an amount that once seemed like a lot to change over time to seem like very little. Tolerance is due to the increased regulation of dopamine receptors in the brain’s reward system among many other adaptive factors of the metabolization of alcohol that occurs in the body.

Alcohol abuse can cause physical or psychological withdrawal symptoms such as trouble sleeping, tremors, restlessness, nausea, sweats, accelerated heart rate, convulsions, or seeing things that aren’t there. The presence of these symptoms usually indicates a person’s alcohol problem is considerably severe.

A consumption equivalent to 4 beers per day for men or 2-2.5 beers for women indicated risky alcohol consumption.

You can calculate the sum by taking the average number of drinks consumed over the course of the week or month. Some days you may drink more than others, especially since it is common to binge drink when dealing with an alcohol problem. The term binge drinking defines a form of consumption in which someone drinks at a high velocity to obtain a greater effect, for example drinking quickly before doing any activity such as coming home after work, before going to work, before going into a night club, etc.

Additionally, people who meet the criteria for alcohol abuse usually present symptoms for other mental conditions such as anxiety or mood disorders. As far as personality traits, impulsivity and pleasure seeking are more prevalent in people in treatment for alcoholism.

The Ministry of Health, Consumption, and Wellness employs the Standard Drink Units to inform the population of the levels of risk associated with alcohol: “A Standard Drink Unit of alcohol, in Spain is the equivalent of 10 grams of alcohol which is, approximately, the amount of half a glass of wine at 100 ml at 13 percent, 1 300ml glass of beer at 4 percent, or 30 ml of liquor at 40 percent.” Nowadays, the following criteria are used to determine risky drinking levels:

1. Through the AUDIT questionnaire: > 7 points in men, > 5 in women
2. Consumptions of 40 percent per day (4 SDUs/day) in men and > 20-25 percent per day (2-2,5 SDUs/day) in women.

According to DSM-5, any person that meets 2 or more of the 11 criteria during the same period of 12 months would receive a diagnosis of disordered use of alcohol. The intensity- light, moderate, or intense- is based in the number of criteria which are present:

Héctor Pastor Pardo is a General Health Psychologist with experience in addictions, individual therapy, and couples therapy. Trained in Third Generation Therapies with a focus in cognitive behavioral and integrative therapies. His main focus is the treatment of adults and couples.