How Much is Too Much Alcohol?
Many people have a drink after work. Sometimes they meet with co-workers at a local bar near work and sometimes they have a cocktail at home. Sometimes they have a glass of wine before dinner which they believe is good for their health as is discussed in the media, particularly if it's red wine. Does this make them alcoholics? Better yet is the question, What is an alcoholic or alcoholism? People argue this term all the time. One definition of alcoholism is that it's "A physical compulsion, coupled with a mental obsession to drink. There is a distinct desire to consume alcohol beyond one's capacity to control it, and in defiance of all rules of common sense."*
*(Taken from an AA approved pamphlet, "This is AA, an introduction").
Terms such as alcoholism or alcoholic and addict are no longer used because they are based on a disease model of addiction and many no longer believe it's a disease. In addition, there is a lot of concern that terms like alcoholic and addict are stigmatizing. Yet, there are still many people who continue to define themselves as alcoholics and addicts.
For those who are concerned that they may have a problem with alcohol, here are a few criteria that may help:
* Am I harming myself, physically or psychologically, by drinking as much as I do?
* Am I hurting my family because of my drinking?
* Is drinking getting in the way of forming good relationships (beyond “drinking buddies”)?
* Is drinking affecting my work? Could my career be doing better if I drank less?
* Could I be putting others at risk through my drinking?
* Could I cope with the stress of life without alcohol?
And of course, the key addiction question:
* Could I cut down or stop drinking if I wanted to?
Basic to all of this is the concept of "dependence." Basic to the term dependence is the term "tolerance." Tolerance is the fact that a person needs larger doses of a drug such as alcohol in order to reach the desired goal of feeling "high" or drunk. As the body becomes accustomed to the substance, less pleasure is achieved so that more is needed. There are seven criteria for substance dependence, which includes tolerance, and they are*:
(1) Tolerance, as defined by either of the following:
(a) A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
(b) Markedly diminished effect with continued use of the same amount of the substance.
(2) Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance (refer to Criteria A or B of the criteria sets for Withdrawal from specific substances). (b) The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.
(3) The substance is often taken in larger amounts or over a longer period than was intended.
(4) There is a persistent desire or unsuccessful efforts to cut down or control substance use.
(5) A great deal of time is spent in activities necessary to obtain the substance (such as visiting multiple doctors or driving long distances), use the substance (such as chain smoking) or recover from its effects.
(6) Important social, occupational, or recreational activities are given up or reduced because of substance use.
(7) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
*(These seven criteria are taken from the DSM IV).
Does this make the person who has that drink after work an alcoholic? Probably, the best answer is not unless any of the above are at work. If there is any doubt that you may have a problem it is best to seek medical help. The very nature of alcoholism or dependence is that it is the inability to stop drinking.
Your comments and questions are encouraged.
Allan N. Schwartz, PhD