Alcoholism Warning Signs

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Alcoholism Warning Signs. The warning signs of alcoholism include out-of-control drinking, physical dependence, tolerance, and a strong need to drink.

There are several "self-assessment" tools for diagnosing "alcoholism" (also known as alcohol dependency and alcohol addiction) that supposedly identify "alcoholism warning signs." With the exception of a few "relevant" questions in thee tools, however, most of the questions that are supposed to help a person figure out whether he or she is alcohol dependent apply more to alcohol abuse than to alcoholism.

In order to understand this more clearly, and before we get into specific alcoholism-related questions, let us first give a definition for alcohol abuse and then for alcoholism.

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A Definition of Alcohol Abuse

The following is a definition of Alcohol Abuse.

Alcohol abuse is defined as a pattern of drinking that results in one or more of the following circumstances in a twelve-month period of time:

  • Drinking in situations that can result in health problems (such as alcohol related liver problems) or physical injury (such as an alcohol related injury in the workplace).

  • Continued drinking despite ongoing alcohol-related relationship problems, especially when drinking was not an issue earlier in the relationship.

  • Failure to attend to important responsibilities at home, school, or in the workplace, especially when the person was responsible before he or she started drinking abusively.

  • Experiencing recurring alcohol-related legal problems (such as getting a DUI or a DWI for the first time).

A Definition of Alcoholism

The following is a definition of alcoholism.

Alcoholism, also known as alcohol addiction or alcohol dependence, is a progressive, debilitating disease that includes the following four components:

  • Loss of control over one's drinking (such as the inability to limit one's drinking on any given occasion or over time).

  • Craving: A strong and continuing compulsion or need to drink (such as an overwhelming desire to drink).

  • Tolerance: The need to drink increasingly more amounts of alcohol in order to get intoxicated (or a "buzz" or a "high").

  • Physical dependence: the experience of alcohol withdrawal symptoms when an alcoholic stops drinking after a long period of abusive and excessive drinking. Examples of alcohol withdrawal symptoms include the following: throbbing headaches, sleep disturbances, anxiety, confusion, nausea, and excessive sweating.

The CAGE Questionnaire

Now that we have defined alcohol abuse and alcoholism, let us look at a popular diagnostic instrument entitled the "CAGE Questionnaire." (1) According to John A. Ewing, MD, the person who developed this questionnaire, the CAGE Questionnaire has " proved useful in helping to make a diagnosis of alcoholism."

The CAGE Questionnaire consists of the following four questions.

  1. Have you ever felt you should cut down on your drinking?

  2. Have people annoyed you by criticizing your drinking?

  3. Have you ever felt bad or guilty about your drinking?

  4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

We assert that all four of these questions pertain more to alcohol abuse rather than to alcoholism. Why? Simply because they don't focus on the four "components of alcoholism, that is, on what differentiates alcoholism from alcohol abuse.

Questions That Point to Alcoholism and Not to Alcohol Abuse

What is needed, we assert, is an instrument that has questions that point explicitly to alcoholism and not to alcohol abuse.

In order to accomplish this, the questions need to be strongly associated with the four key "components" of alcoholism, namely, out-of-control drinking, tolerance, craving, and physical dependence.

With this in mind, we have constructed the following four questions so that they relate specifically to alcoholism and not to alcohol abuse.

  1. "Between 6 and 24 hours after your last drink, do you experience excessive sweating, throbbing headaches, anxiety, oral or visual hallucinates, uncharacteristic rapid emotional changes, insomnia, muscle tremors, seizures, or depression?"Note: this question relates to the alcohol withdrawal symptoms that alcoholics (and not alcohol abusers) experience when they abruptly stop drinking due to the fact that they are physically dependent on alcohol.

  2. "Virtually every time you have a drink, do you continue drinking until you are intoxicated?"Note: this question relates to the out-of-control drinking manifested by alcoholics.

  3. "Do you need to drink increasingly more alcohol in order to get drunk?"Note: this question relates to the component of tolerance in the definition of alcoholism.

  4. "On a daily basis or multiple times throughout the day, do you have a strong compulsion or urge to drink?"Note: this question relates to the component of craving in the definition of alcoholism.

Discussion

Perhaps to some people, the above discussion is an exercise in semantics. We disagree. To substantiate this, we assert that taken as a group, if a person answers "yes" to ALL four questions in the CAGE Questionnaire, it can be determined that this person probably has a drinking problem, engages in abusive drinking, but is NOT necessarily alcohol dependent.

On the other hand, when "our" four questions that are tied into the definition of alcoholism are taken collectively and a person answers ALL of them with a "yes," there is very little doubt that the person has a drinking problem AND is alcohol dependent.

How can we make such a strong claim. First of all, answering "yes" to the first question (about alcohol withdrawal symptoms) applies only to alcoholics. Why? Because alcohol withdrawal symptoms are experienced by alcoholics and not by alcohol abusers who are not alcohol dependent.

In a similar manner, answering "yes" to the second question (about out-of-control drinking) applies significantly more to alcoholics than to alcohol abusers. Indeed, while alcohol abusers at times exhibit out-of-control drinking, alcoholics, on the other hand manifest out-of-control drinking behavior EVERY DAY.

Additionally, answering "yes" to the third question (about tolerance) applies substantially more to alcoholics than to alcohol abusers. Why? Because the concept of "tolerance" is a key component in the definition "alcohol addiction" and not in the definition of "alcohol abuse." 

Finally, answering "yes" to the fourth question (about craving) also points more strongly to alcoholism than to alcohol abuse. Indeed, while alcohol abusers can exhibit a desire to drink, alcoholics, on the other hand, are essentially obsessed with drinking.

One of the main reasons for this is that alcoholics, and not alcohol abusers, are alcohol dependent and will experience alcohol withdrawal symptoms if they stop drinking. In short, alcoholics "crave" alcohol mainly because they are alcohol dependent and fear experiencing alcohol withdrawal symptoms if they fail to get their next "fix" (that is, the next series of drinks).

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Conclusion: Alcoholism Warning Signs

As a result of the above, we assert that the "best" and most relevant questions that point to alcoholism and therefore help a person figure out whether he or she is alcohol dependent are the following "alcoholism warning signs."

  1. Between 6 and 24 hours after your last drink, do you experience excessive sweating, throbbing headaches, anxiety, oral or visual hallucinates, uncharacteristic rapid emotional changes, insomnia, muscle tremors, seizures, or depression?

  2. Virtually every time you have a drink, do you continue drinking until you are intoxicated?

  3. Do you need to drink increasingly more alcohol in order to get drunk?

  4. On a daily basis or multiple times throughout the day, do you have a strong compulsion or urge to drink?

Reference

1.  Counselling Resource

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