Almost every day someone will enter my office and ask, “Am I an alcoholic?” or, “Do you think I have a problem with alcohol?” and sometimes, “My partner says I drink too much.”
Alcohol is a drug that has its claws deep in Australian life. If you’re happy, sad, bored, have won a promotion, lost a family member, bought a house or graduated from university, these can all be seen as reasons to drink. Drinking is so common that if a person says they don’t, this lends itself to usually negative and intrusive comments.
The lines become blurred when it comes to deciding if a person has a problem with alcohol and whether they have developed an alcohol use disorder (formerly known as alcohol dependence). This is colloquially known as being an alcoholic – a term we avoid in addiction psychiatry. It’s not surprising to hear that people with AUD are told their drinking is a problem by family, partners or work colleagues. Depending on your upbringing, cultural background and exposure to alcohol, you may believe that drinking a six-pack of beer most days is “normal” and that problem drinking is when you start drinking litres of cask wine daily.
AUD is a term from the Diagnostic and Statistical Manual of Mental Disorder. It’s defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of 11 criteria within a 12-month period. Some of the criteria are: alcohol taken in larger amounts than intended; having a strong desire to use alcohol; increased time spent obtaining alcohol; tolerance – increasing amounts of alcohol are used to achieve intoxication; and experiencing withdrawal symptoms when alcohol is ceased.
Most people are best served by arranging an appointment with their general practitioner for a formal assessment.
For example, Sarah* is a 35-year-old woman who presented to my office because her fiance, Ibrahim, believes she drinks too much and this is affecting their relationship. Sarah is a lawyer and noticed that she increased her drinking amid work stress and wedding planning. Her drinking increased from one glass of wine to a bottle of wine every night. A critical event was becoming intoxicated at dinner with her friends while out celebrating her engagement, which resulting in her getting into a verbal altercation with a stranger and having to be escorted out of the restaurant. Sarah only sought help when her fiance threatened to call off the engagement. She had tried to quit “cold turkey” but went into acute withdrawals, experiencing insomnia, increased tremors, poor concentration, low mood, nausea and intense cravings for alcohol which led to a relapse.
Sarah is quick to tell me that she does not believe she has a problem with alcohol but is willing to attend sessions if it gets Ibrahim off her back. Furthermore, she claims to only have been drinking heavily for less than 12 months. Unfortunately, her liver ultrasound shows she has a fatty liver (early sign of liver damage) and has probably been drinking heavily for a longer period of time. Sarah tells me she is surprised by this, but does mention moderate …….