Screening for a Drinking Problem
Screening for a drinking problem boils down to one simple question, “Do their behaviors change when they drink?” If you’re reading this post, you have likely been hurt, frustrated, concerned, angered, and/or scared by a loved one’s drinking. You’ve likely tried talking, yelling, cajoling, negotiating, looking the other way, believing their promise(s) to stop or cut down, but so far, nothing’s worked. I receive numerous emails and phone calls every week from people in this situation, and I know what they’re feeling. I’ve been there myself.
This is my latest book (Nov. 2019), and it answers so many of the questions that readers of this post may have. It’s available in libraries, local bookstores and online book retailers – click here for the Amazon link.
Screening for a Drinking Problem – It’s a Simple Question
One of the most common questions people have (and I had) is, “How much is too much?,” because no matter how calmly or angrily or sadly I tried to talk with a loved one about their drinking, they always had a comeback. And their ability to slice and dice and mince words or segue into a counter attack could leave me speechless and defeated.
Based on my years of studying current brain research and working in this field, I can now answer my caller’s or an email query’s question, “How much is too much?” with this simple question, “Do their behaviors change when they drink?”
And why do I start with drinking behaviors?
Because it’s the behaviors they exhibit while under the influence of alcohol that are the issue – not the numbers of drinks, not whether they’re an alcoholic or “just” an alcohol abuser, not if they’re mostly a good parent and don’t miss work, not because they’re so very sorry for what they did.
If a person’s answer is “Yes” to the question, “Do their behaviors change when they drink?,” then I invite them to better understand the following information before they take next steps – including another conversation about the drinking.
Confirm for Yourself Whether Their Drinking “Really” is a Problem
This is often what keeps a person from talking to someone about their drinking – they’re not really sure whether it is a “problem” and don’t want to get sideways with that person by suggesting it is. One of my favorite resources for answering this question is the National Institute on Alcohol Abuse and Alcoholism (NIAAA)’s website, “Rethinking Drinking,” and specifically this page on the site, “How Much is Too Much?”
To give you a sneak preview, here is what is considered “normal” or “low-risk” drinking:
For women: no more than 7 standard drinks per week, with no more than 3 of the 7 on any one day.
For men: no more than 14 standard drinks per week, with no more than 4 of the 17 on any one day.
A standard drink is defined as: 5 ounces of table wine, 12 ounces of regular beer, 1.5 ounces of 80-proof hard liquor.
The World Health Organization also offers an anonymous assessment. It’s called the Alcohol Use Disorders Test (AUDIT). Click here for the PDF download. The assessment is on page 17, and in America, Question 3 should be 4 or more drinks on one occasion for women and 5 or more for men (because drink sizes in America are larger than the world average standard drink size). Interpreting and scoring the AUDIT is found on pages 19-21. Please note – the AUDIT is designed and intended as a screening tool to be used by a medical practitioner, so for the layperson – it should be considered information only.
If after doing one or both of these assessments you find your loved one’s drinking exceeds “low-risk” limits, you are right to be concerned. Not only that, but understanding that alcohol abuse is not alcoholism is an important because they BOTH cause drinking behaviors, but they are treated differently. And not only this, but binge drinking causes drinking behaviors, too. So the label doesn’t matter — the only thing that matters is the answer to the question, “Do their behaviors change when they drink?”
Why Screening for a Drinking Problem Is So Important for Your Health
In two words — Secondhand Drinking.
If you answered, “Yes,” to the simple question screen, “Do their behaviors change when they drink,” then you are one of the nearly 80 million Americans affected by secondhand drinking.
Secondhand Drinking refers to the negative impacts of a person’s drinking behaviors on others. Drinking behaviors, include:
- Doing poorly at work because of the drinking or recovering from the effects of drinking.
- Fighting with friends or family about the drinking; saying or doing things you don’t remember or regret.
- Binge drinking (defined as drinking 4 or more standard drinks for women; 5 or more for men).
- Verbally, physically or emotionally abusing someone – often a spouse, significant other, co-worker or child.
- Experiencing blackouts.
- Being loving while drinking and then distant and indifferent the next day.
- Driving while under the influence; getting a DUI; riding in a car driven by someone who has been drinking.
- Having unplanned, unwanted or unprotected sex; date rape.
- Being admitted to the emergency room with a high BAC, in addition to the “other” reason.
The impacts of secondhand drinking are generally related to toxic stress.
About Toxic Stress and Its Connection to Secondhand Drinking
Toxic stress is what happens when a person’s fight-or-flight stress response is repeatedly triggered – like that which occurs when repeatedly coping with drinking behaviors. This fight-or-fight stress response is one of the survival instincts built into humans to keeps us safe when threatened with danger.
When it is triggered, a cascade of stress hormones causes a series of changes in the body to prepare it to fight or run – changes like the tensing of the muscles, increasing the heart rate, and shutting down of the digestive system. These changes enable us to jump out of the path of an oncoming car or experience superhuman strength to lift a fallen beam pinning our child to the ground. The physical act of jumping out of the way or lifting the beam – averting the danger – allows the body to return to normal functioning. This triggering and resolution is known as positive stress.
But when our fight-or-flight stress response is repeatedly triggered, and we never physically fight or run, the cascade of stress hormones and physical changes “marinate.” They “sit” in body organs and tissues – like the brain, heart, muscles, and stomach. This is when stress becomes toxic.
Which is Why Screening for a Drinking Problem is so Important For Your Health
The physical and emotional health consequences of toxic stress include migraines, stomach problems, muscle aches, sleep difficulties, tension headaches, anxiety, depression, difficulty concentrating, racing heartbeat, and skin problems, to name a few. When children experience toxic stress, it “weakens the architecture of the developing brain, with long-term consequences for learning, behavior, and both physical and mental health,” according to the Center on the Developing Child Harvard University. (2)
Beyond the physical and emotional health toxic stress consequences are the mapped “fight-flight-freeze-appease” stress reactions and coping behaviors a person develops in order to deal with and protect themselves from the drinking behaviors. These, in turn, affect a person’s personal, work, school, social, family, and community interactions in ways that are little understood and too complex to explain in this post.
But it’s the coping with drinking behaviors that causes problems for your health. Why? Trying to stay on top of or safe from or prevent a loved one’s drinking behaviors from happening triggers a person’s fight-or-flight stress response. This is a critically important function because it’s what it’s what causes us to jump out of the causes ongoing activation of the fight-or-flight stress response. When stress is ongoing, it becomes toxic, and toxic stress changes a person’s physical and emotional health and the very quality of their life. The impacts of toxic stress include: sleep disorders, migraines, headaches, stomach ailments, changes in eating habits, dizziness, distracted “thinking,” depression, anxiety, memory impairment, heart disease, and digestive problems.
This is why screening for a drinking problem is so important for your own health’s sake. It can help you avoid the consequence of secondhand drinking.
And as always…
know that I’m available to answer your questions personally. Send me an email to lisaf@breakingthecycles.com to arrange a phone call (no charge).
Lisa Frederiksen
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Lisa, whether it be one drink or several, a change in behavior towards loved ones IS a problem to be dealt with. The behavior can be changed, once an alcohol abuser is aware of it. Dealing with the behavior change is one way to lessen, or abstain, from alcohol consumption.
Excellent points, Shelley. Thanks so much for your comment.
I love this article and your approach!
We are a free addiction treatment center in Chicago that focuses on MCT (Meaning Centered Therapy). I’d love to meet you sometime if you are ever in Chicago and give you a quick tour.
You are a rockstar to us! Please keep it up!
Thank you, Daniel!