For Lauren, the realization happened slowly, over time. “I started drinking more wine at night when my kids were little, because I was so tired and needed an escape at the end of the day,” she said. “I would pour a glass of wine, and that would feel great, so you pour another as you’re making dinner, and that feels great. Then somehow you pour a third, and suddenly you’re like, Wow, I’m a little drunk as you’re washing the dishes.”
It wasn’t like she was going out to clubs and doing tequila shots, or even waking up with a hangover. Still, the “habit,” as she calls it, stuck. Now it’s 10 years later, and at 48, Lauren isn’t drinking every night. But she’s noticed lately that she’s drinking more than she used to. When she goes to the grocery store, she buys a few bottles of wine, just so there’s always some in the house. When she’s home alone in the evening, she’ll sometimes finish an entire bottle by herself.
“It’s almost a little gift for myself at the end of the day,” she said. “Having said that, there are times when I wake up and I say, I’ve got to take a look at this and figure out if this is a problem.”
“You don’t have to be addicted to have problems with alcohol,” said Dr. John Kelly, a psychiatry professor specializing in addiction medicine at Harvard Medical School. “Although we may have a stereotype of what an ‘alcoholic’ looks like, there is a broad range of alcohol involvement and impairment which can affect people in different ways.”
Kelly says that only about 15 percent of people who have had a drink actually become addicted — i.e., develop a compulsive and physiological need for alcohol. But a person can still be at risk of becoming dependent, meaning they have difficulty quitting, as well as developing a host of health problems that accompany even not-so-heavy drinking.
Alcohol consumption has been linked to a heightened risk of several cancers in both men and women, according to a report by the World Cancer Research Fund. For women, one and a half drinks a day can increase breast cancer risk by 20 percent. (A note on the “alcohol is good for you” science: A large-scale federal study on the benefits of moderate drinking was recently revealed to be funded by the alcohol industry. The study has, for now, been suspended.)
Not quite addicted
Kelly says drinking becomes a medical problem when it starts to interfere with functioning and well-being, when a person centers their life around alcohol and making sure it’s around, or when they begin prioritizing it, such as by only going to parties where the drinks are free-flowing.
“What typically happens is the person has a sense they are drinking too much and they try to cut down,” he said. “But they can’t fully do it, and so they feel like they’re losing their grip. That’s a function of the changes in the brain. The brain tries to adapt to these higher and higher levels of alcohol exposure, and it creates more of a propensity for continued use.”
About 17 million people in the United States meet criteria for alcohol use disorder, a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake and a negative emotional state when not using, according to the Substance Abuse and Mental Health Services Administration. The National Institute on Alcohol Abuse and Alcoholism defines “moderate drinking” as one drink a day for women and two for men, and “binge drinking” as about four daily drinks for women and five for men. “Heavy alcohol use” means five or more days of binge-drinking in the past month. It’s worth noting that these general guidelines don’t take into account genetic factors that might increase someone’s propensity toward alcohol addiction, such as differences in the way people metabolize alcohol.
You might have a problem. Now What?
There are hundreds of self-screening tools and “Am I an Alcoholic?” quizzes online. The AUDIT, developed by the World Health Organization, is the industry standard recommended by addiction medical professionals. It consists of 10 questions about drinking quantity and frequency, and the ways in which drinking might be affecting someone’s life. The AUDIT is a good starting point for people who think they might have a problem, or who have a friend or family member they’re concerned about. Drinker’s Checkup is another online resource for getting feedback about drinking.
Getting treatment is trickier. Once a person decides to seek help, navigating treatment options — and the growing number of people who call themselves “addiction experts” — can be overwhelming.
Rehab centers can be a minefield; regulations vary from state to state. Some states require facilities to have at least a certificate of need, or CON, aimed at curbing costs for patients. California is not a CON state, which may help explain why so many luxury rehabs flourish there. The dearth of regulations also allows rehab facilities to operate independently of rigorous state oversight and offer treatments that are in no way rooted in science. The luxury rehab facility Passages Malibu, for example, lists “sound therapy” as one of its treatment methods, saying the practice “results in healing at the cellular level.” There is no scientific data on addiction treatment to support this claim.
“Not everybody has to go to rehab,” Kelly said. “In fact, very few people who have an alcohol problem will actually need to go away.” If someone is experiencing severe withdrawal, it’s appropriate to go to the emergency room.
For those wondering if they have a problem, Kelly recommends seeing a doctor for proper assessment. Licensed addiction psychiatrists, as well as licensed board-certified addiction medicine physicians, have a higher level of training specific to addiction. NIAAA offers a treatment navigator on its site, with recommended questions to ask a provider to make sure they are operating on evidence-based practice guidelines.
“Some people can have one or two sessions with an addiction specialist and that can be sufficient,” Kelly said. He thinks people are often scared away by the idea of getting treatment, assuming they’ll immediately have to go to rehab for 30 days. That misconception, in his view, prevents many people who are on the cusp of being at-risk from seeking help.
Alcoholics Anonymous is free and easily accessible, but it’s not the only game in town. While it has been found to be effective, many people need medical stabilization, which AA doesn’t offer. “A lot of people don’t think of alcohol as being a psychoactive drug in the same way cocaine or heroin is, and yet it is,” Kelly said. “It affects the central nervous system in a very profound way.”
There are currently three FDA-approved drugs for treating alcohol addiction, but they are underused, according to a recent government report. This could be due in part to the ubiquity of the 12-step model. But there are many different levels of care: a few months of weekly outpatient treatment, medication in concert with outpatient treatment and AA, as well as treatment for depression and other psychiatric disorders that accompany alcohol abuse. Only 20 percent of people who abuse alcohol ever get treatment.
“There’s a broad range of services that people can plug into,” Kelly said, depending on the severity of their drinking. If it’s safe, a person can also work with a specialist to curb their drinking without eliminating it entirely. “A lot of people think, I’m not bad enough to go to rehab. But the thing is, don’t wait until you’re that bad. Do something now.”