I often get this question, “How do you know if someone is an alcoholic?” [aka “How do you know if someone has a severe alcohol use disorder?“]

Generally, the person asking continues with something like, “I mean, my husband (or wife or sister or…) drinks about a six pack a night – more on the week-ends, but he still goes to work and hasn’t lost his job, yet. Does that make him an alcoholic?” Or that last information may go something like, “He’s OK during the week, but when the week-end comes, he starts cracking open the beers on Friday night and drinks steadily all the way through till Sunday evening. He’s not mean or anything, but we don’t do ANYthing because he just wants to drink his beers and watch TV. He says he deserves to relax after working hard all week.”

Believe it or not, in spite of how much these individuals are drinking, they may not be alcoholics.

So how can you tell if someone’s an alcoholic?

First, I’d like to share with you the definition of “low-risk” or “normal” drinking. This is provided by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) on their website, Rethinking Drinking:

• For women: no more than 7 standard drinks in a week with no more than 3 of the 7 in any one day.
• For men: no more than 14 standard drinks in a week with no more than 4 of the 14 in any one day.

How can you tell if someone’s an alcoholic? Does drinking enough to pass out every week-end meet the definition?

A “Standard Drink” is defined as 5 ounces of wine, 3.3 ounces of champagne, 12 ounces of regular beer, 1.5 ounces of 80 proof hard liquor (vodka, for example) and 8-9 ounces of lager (dark ales).

So now that you know what “normal” drinking is, does that make everything else alcoholic? And the answer to this question is, “No.”

When a person exceeds “low-risk” limits, their “excessive drinking” put themselves at risk for developing alcohol abuse.

Alcohol abuse is an outcome of excessive drinking and includes repeated binge drinking and/or routine heavy drinking.

• Binge drinking is defined as 4 or more standard drinks on an occasion for women and 5 or more for men.
• Heavy drinking is defined as consuming 8 or more standard drinks a week for women and 15 or more a week for men.

Alcohol abuse causes chemical and structural changes in the brain. These changes make a person’s brain more susceptible to his/her key risk factors for developing addiction (in this case, an addiction to alcohol) – explained here. Risk factors explain why one person who may drink as much or more than another does not cross the line from alcohol abuse to alcoholism even though the other person does. In fact, alcohol abuse is a bigger problem in terms of numbers of people engaging in it than is alcoholism in terms of the number of people estimated to be alcoholics.

But regardless of whether it’s alcohol abuse or alcoholism, these sorts of drinking patterns causes secondhand drinking for others. Secondhand drinking is a term to describe what happens to those who are on the receiving end of a person’s drinking behaviors – the crazy, convoluted circular arguments, the verbal and emotional abuse, driving while impaired, sexual assault — the behaviors a person exhibits when they drink more than their live and brain can process. Click here to learn more about secondhand drinking.

But, I know… this still does not answer the question, “How can you tell if someone is an alcoholic?”

One suggestion is to use the World Health Organization’s Alcohol Use Disorders Test (AUDIT) to get a general idea of what you are dealing with.

Using AUDIT to Assess Your Loved One’s Drinking

The following assessment was developed and evaluated over a period of two decades by the World Health Organization’s (WHO) Department of Mental Health and Substance Dependence. It is called AUDIT (the Alcohol Use Disorders Identification Test).(1) It was created primarily for health care practitioners around the world as a simple method of screening for excessive drinking. Other professionals who work with people who seem to have alcohol-related problems also find it useful.(2)

To complete the assessment, mark the answer that best applies to your perception of your loved one’s drinking. In other words, the “you” is your loved one. [Don’t forget, the “size” of a drink matters. A drink is defined as 5 ounces of wine OR 12 ounces of beer OR 1.5 ounces of 80-proof spirits (vodka, scotch).]

1. How often do you have a drink containing alcohol?
(0) Never
(1) Monthly or less
(2) 2 to 4 times a month
(3) 2 to 3 times a week
(4) 4 or more times a week

2.  How many drinks containing alcohol do you have on a typical day when you are drinking?
(0) 1 or 2
(1) 3 or 4
(2) 5 or 6
(3) 7, 8, or 9
(4) 10 or more

3.  How often do you have six or more drinks on one occasion [note: this is known as binge drinking, and in the U.S., binge drinking is five or more drinks on one occasion for men and four or more drinks on one occasion for women]?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

4.  How often during the last year have you found that you were not able to stop drinking once you had started?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

5.  How often during the last year have you failed to do what was normally expected from you because of drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

7.  How often during the last year have you had a feeling of guilt or remorse after drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

8.  How often during the last year have you been unable to remember what happened the night before because you had been drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily

9. Have you or someone else been injured as a result of your drinking?
(0) No
(2) Yes, but not in the last year
(4) Yes, during the last year

10.  Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?
(0) No
(2) Yes, but not in the last year
(4) Yes, during the last year

Now, look at the numbers in the ( ) for each answer you’ve circled and total those numbers. According to AUDIT, total scores between 8 and 19 indicate alcohol abuse (excessive drinking). Total scores 20 and above indicate alcohol dependence (alcoholism).(3) A score of 0-7 indicates drinking at moderate levels. This is also known as “normal” drinking or “alcohol use.”

CAUTION: The AUDIT goes on to say that in the absence of a trained professional conducting this questionnaire (as he or she knows how to ask the question and interpret the answer or dig more deeply for an accurate answer), these guidelines and scoring must be considered tentative — NOT definitive.  Additionally, the AUDIT notes that in an [“official”] evaluation, it matters on which questions points were scored. So it’s important to review the entire AUDIT document and not to draw any firm conclusions.

So, Why Assess?

According to the AUDIT,

• “the bulk of harm associated with alcohol occurs among people who are not dependent [but rather engage in excessive drinking (alcohol abuse)].

• “people who are not dependent on alcohol (alcoholics) may stop or reduce their alcohol consumption with appropriate assistance and effort. Once dependence [addiction/alcoholism] has developed, cessation of alcohol consumption is more difficult and often requires specialized treatment.

• “Although not all hazardous [excessive/alcohol abuse] drinkers become dependent, no one develops alcohol dependence [alcoholism] without having engaged for some time in hazardous alcohol use.”4)

And, Now What?   

If your loved one’s drinking pattern is a problem based on the AUDIT assessment, this is still not a diagnosis, but it gives you a general sense of the scope of the problem. Now, you’ll want to learn more before you talk to you loved one about all of this – you may even want to have the conversation with your loved one in the presence of a therapist who specializes in addiction (or a similar addiction professional) to “broker” the conversation. And for this, I suggest you read my latest book published in 2019 — not so I can sell books but so you can learn about the huge scientific advances that explains all of this in layman’s terms.

The first half covers alcohol use disorders (drinking problems) – how they’re developed and treated and what long-term recovery requires. In the case of alcohol abuse, for example, it’s possible to learn to “re-drink,” but in the case of alcoholism, it must be total abstinence from alcohol, yet in both cases, there are other brain healing aspects necessary in order to address “why” a person finds themselves drinking to these extents in the first place (e.g., trauma, anxiety, depression, social environment…).

The second half explains what happens to family members and friends and what they can do to help their loved ones, as well as what they can do to take back control of their physical and emotional health and the quality of their lives.

This is the link to the Amazon version. It comes in both paperback and Kindle (which can be read on an iPad or other eReader device). With the Kindle format, you’re able to get it immediately, which may be helpful for right now, and it allows you to read it without anyone knowing, which may also be helpful. It is also sold by other retailers and available in some libraries, as well.

If you have further questions, please email me at lisaf@BreakingTheCycles.com to schedule a phone call. There is no charge.

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Note: This post was originally published August 2013. It was updated January 2020.

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(1) Babor, Thomas F., et. al., World Health Organization (WHO), “The Alcohol Use Disorders Identification Test, Guidelines for Use in Primary Care, Second Edition,” <http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf>

(2) Ibid, p.2

(3) Ibid., pgs. 17, 29 and 20

(4) Ibid., pgs. 5-6

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Lisa Frederiksen

Author | Speaker | Consultant | Founder at BreakingTheCycles.com

Lisa Frederiksen is the author of hundreds of articles and 12 books, including her latest, "10th Anniversary Edition If You Loved Me, You'd Stop! What you really need to know when your loved one drinks too much,” and "Loved One In Treatment? Now What!” She is a national keynote speaker with over 30 years speaking experience, consultant and founder of BreakingTheCycles.com. Lisa has spent the last 19+ years studying and simplifying breakthrough research on the brain, substance use and other mental health disorders, secondhand drinking, toxic stress, trauma/ACEs and related topics.

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