Alcohol use is part of the American culture and its recreational landscape.
Recreational use does not require a secret contact member, or a drive to the vendor in the inner city. It is the universally acceptable way “we enjoy ourselves” at the backyard barbeque, the neighborhood party, and the family celebration. Non-drinkers must courageously exclude themselves, or embarrassingly, and sometimes conspicuously, excuse themselves. It’s not exactly a cradle-to-grave occurrence, but it’s close, and, historically, drink is associated with happy memories of “good times.”
But not all have memories of good times.
Unfortunately, for many the celebratory intent of the drinking scene becomes repetitively associated with a declining life trajectory. For those vulnerable to addiction, casual drinking may become excessive, harmful consumption as social use transitions to alcohol use disorder.
What is an alcoholic?
An alcoholic is a person who suffers from an alcohol use disorder. Alcoholism is the illness of alcohol addiction or dependence. Alcohol addiction, now known as alcohol use disorder, is a chronic disease.
The pathway to substance use disorder is sometimes obvious and blatant, but sometimes insidious, disguised, and hidden. The transition from drinking to feel good to drinking to feel normal to drinking to avoid being sick takes months to years. It depends on the social, emotional, and psychological triggers that are driving it.
What are the triggers that drive alcohol use disorder?
Sometimes, it’s genetic predisposition to mental health problems or to alcohol dependence or both. It can be environmentally-influenced or the result of traumatic life experiences. Sometimes, it’s a combination or one or all of these factors which can be present even in relatively successful lives. One or all of these factors “lubricates one’s passage from drinking to feel good and have fun to drinking to survive.”
What are the signs of alcohol use disorder?
The obvious indicators are:
- Continuous drinking throughout the day
- Bad behavior
- Blackout forgetfulness and unaccountability
- DUI or other legal consequences
- Hidden empty bottles or cans
- Weight loss or gain
- Other signs of neglect
More subtle signs are:
- Patterns of tardiness and absenteeism
- Disappearance or unexplained departures
- Declining performance and reliability
- Secret or solitary drinking
- Loss of interest or hobbies
- Escalating consumption
- Increased levels of anxiety
- Irritability and sometimes depression
- Job losses
- Family neglect or abuse
- Relationship estrangement or failure
- Household neglect
- Financial problems
- Deteriorating health
What is a “high functioning alcoholic”?
High functioning alcoholics are convinced that they have achieved equilibrium with drinking. Nonetheless, families and children suffer the consequences and are co-opted into enabling roles.
Who is at risk?
Adult children raised in alcoholic families or with extended family members who are alcohol-dependent are at risk. Anyone who suffers with undiagnosed or untreated anxiety or depression is at risk to begin self-medicating with alcohol or other substances to cope. People with undiagnosed post-traumatic conditions or attention deficit disorder are liable to consume more alcohol to work or treat their condition. When genetic predisposition to mental health disorders is coupled with genetic predisposition to alcohol use disorders, the risk of harmful drinking rises exponentially.
Take the online Alcohol Screening. Answering these questions will take only a few minutes, and will give you personalized results based on your age, gender and drinking patterns.
Joseph Messina, MD, psychiatrist, is the Medical Director of DayOne, the substance disorder program for the department of psychiatry at the UVM Medical Center.