How Can I Tell If Someone I Love Is an Alcoholic?

If you worry about someone's drinking, you're not alone

Even though he was a practicing physician, Bob got drunk nearly every night for 17 years. Somehow believing he could hide his alcoholism from Anne, his wife, he constantly looked for new places to stash his liquor.

"When my wife was planning to go out in the afternoon, I would get a large supply of liquor and smuggle it home and hide it in the coal bin, the clothes chute, over door jambs, over beams in the cellar and in cracks in the cellar tile," Bob recalled years later in the Big Book of Alcoholics Anonymous.

Bob did not fool Anne forever. Eventually she took her husband to meet Bill, a man who called himself a recovering alcoholic.

One month after that meeting, on June 10, 1935, Bob took his last drink. He and Bill began seeing other alcoholics, and soon they formed a mutual-support group called Alcoholics Anonymous (AA).

Members of AA often tell the story of Bill's first meeting with Dr. Bob. But any full account of AA history must note that someone worried enough about Bob's drinking to arrange that meeting.

If you worry about someone's drinking, you're not alone. According to the most recent figures from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 13.7 million U.S. adults meet the criteria for alcohol abuse or alcohol dependence.

Still, people might struggle for years with the question: How can I tell if the person I love is truly alcoholic?

Fortunately you don't have to be a medical professional to answer that question and take appropriate action.

One simple option is to use a four-item questionnaire developed by Dr. John Ewing. The first letter of a key word in each question forms the acronym CAGE:

  • Have you ever felt you should cut down on your drinking?
  • Have people annoyed you by criticizing your drinking?
  • Have you ever felt bad or guilty about your drinking?
  • Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover ("eye-opener," "hair of the dog")?

You can pose these questions directly to your loved one, or come up with your own answers for that person. According to NIAAA, one "yes" answer signals a possible problem, and more than one means that it's time for your loved one to get help.

Another way to help determine if your loved one is alcoholic is to learn about the way alcoholism is diagnosed. In the United States, professionals commonly use the criteria listed in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

According to DSM-IV criteria, people who are alcohol dependent (alcoholic) will:

  • Show tolerance (find that they have to drink more to get their desired effect from alcohol).
  • Experience withdrawal symptoms when the effects of alcohol wear off.
  • Drink larger amounts over a longer period of time than intended.
  • Consistently fail to cut down or control their drinking.
  • Give up important work or personal activities in favor of drinking.
  • Spend a great deal of time getting alcohol, drinking it, and recovering from its effects.
  • Continue to drink despite knowledge of a persistent physical or psychological problem caused or exacerbated by drinking.
  • To satisfy a diagnosis of alcohol dependence, a person must experience at least three of these criteria during a 12-month period.

People who are not alcohol dependent may still meet the criteria for alcohol abuse, a condition listed separately in DSM-IV. Alcohol abusers can limit the amount they drink when the consequences become severe enough. People who are truly dependent on alcohol cannot do this.
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