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There are many assessment tools available to help determine if someone has a problem with alcohol. The diagnostic statistical manual (DSM-5) classifies an alcohol use disorder as mild, moderate, or severe. Regardless of any assessment tool, the only person who truly knows whether they are an alcoholic is the alcoholic.
If the alcoholic is honest with themselves and others, then any one of the well-known assessment tools will confirm that. Honesty and a sincere desire to address the problem are essential for these assessment tools as they only work with the information you put in them. Many people criticize Alcoholics Anonymous because they disagree with the practice of members introducing themselves as alcoholics.
At the end of the day, it is the person’s choice as to whether or not they call themselves an alcoholic. If the person using alcohol or their family has to question it, then chances are high the answer is yes – the person is an alcoholic.
The most significant difference between an alcoholic and someone who may have a problem with drinking is the level one will go to continue consuming alcohol despite the consequences.
The book Alcoholics Anonymous considers an alcoholic to have an allergic reaction to alcohol. Unlike allergies to other things, why does the alcoholic not have common sense or willpower not to use a substance that they know will cause an adverse reaction? Someone with an allergy to peanut butter does not need “peanut butter anonymous” to stop themselves from eating it.
So, what is it that causes the alcoholic to consume alcohol despite the consequences? Nobody has a definitive answer, and no assessment tool will explain why. We have seen work as a complete change in behaviors and perception, along with letting go of the notion that alcoholics can solve their problems with willpower and just saying no.
For most alcoholics, external changes do not solve the drinking problem either. Gym memberships, new job opportunities, changes in location, new relationships, etc., rarely solve the alcoholic’s problem. These solutions may work for some who are not alcoholics, such as heavy drinkers. Nonalcoholics or heavy drinkers typically stop drinking when the issues or consequences have piled up, and they can realize continued drinking is not worth the risk.
But a true alcoholic does not have this luxury.
Unfortunately, most families of alcoholic loved ones can’t see the difference, believing their loved one is a heavy drinker who will one day be able to stop by willpower, self-knowledge, fear, or consequences alone.
In this blog, we will be looking at the following:
- How to know when someone has an alcohol problem
- What qualifies someone as an alcoholic?
- Alcoholic assessment tools
- Signs of alcoholism in others
- How to talk to someone who is abusing alcohol
- How to help an alcoholic
How to Know When Someone has an Alcohol Problem
Many people have a drinking problem. It is quite common for people to get drunk or consume alcohol and have issues piling up in their life. Plenty of people go out and celebrate, and at the end of the night or the following day, the only thing they’re left celebrating is the consequences of drinking the night before.
The difference between a drinking problem and an alcoholic is whether or not the person has the ability to stop when they see that there is a problem.
On college campuses, there are plenty of people with drinking problems. Many college students go home after graduating and control their drinking without a problem. The real alcoholics continue after college, progressively getting worse. How to tell if someone is an alcoholic or becoming one is whether or not they continue to drink despite continued consequences.
One could argue that alcohol consumption often causes problems. Problems can range from a hangover to a DUI to divorce, along with plenty of legal, financial, and medical issues. When the problem drinker does not learn their lesson and continues when a heavy drinker has become an alcoholic. The sooner the problem drinker addresses the problem, the better the chance they stop the issues associated with drinking – if they can do so.
If the problem drinker continues drinking despite consequences and destruction to themselves and others, they will most likely need intervention and professional help.
What Qualifies Someone as an Alcoholic?
When the alcoholic cannot stop drinking on willpower alone, they are most likely an alcoholic. There are a few cases of alcoholics who manage several years, even decades, of remaining abstinent. If you ask them or their family members how they are doing, they will tell you that they are getting by.
The only thing we have seen worse than an alcoholic is a dry drunk. A problem drinker who can stop on willpower will seldom be as miserable as an alcoholic who managed to pull off the near-impossible – stopping drinking on their own.
There is a big difference between the words sober and abstinent. Sober means a person who is happy and comfortable in their skin and a person that has addressed their past, made things right, and continues to do so moving forward in life.
A sober person has changed perception and behavior and lives an unselfish life while recognizing how their shortcomings and character defects negatively affect themselves and others. Sober alcoholics seek to positively impact others they encounter and acknowledge and own it when they are wrong.
An abstinent and dry alcoholic, on the other hand, is someone miserable and often unpleasant to be around. A dry abstinent alcoholic has little to no consideration of how their negative attitude and behaviors can still harm others even in the absence of alcohol. You can almost always tell a dry drunk from an ex-problem drinker, and you can also tell when a sober person is slipping back into miserable and dry abstinence.
What qualifies someone as an alcoholic is not always determined by how much or how often they drink. Sometimes alcoholism is not identified by problems or lack thereof. Assessment tools do little to address the behaviors associated with an alcoholic that lead to drinking. An alcoholic can qualify themselves better than any assessment tool regarding how they feel when not drinking.
An abstinent alcoholic will most likely continue to be resentful, blame others, speak ill will of and be critical of others, and be angry, miserable, restless, irritable, and discontent. A sober person will not have these alcohol use symptoms; if they do, they will be far less severe.
The alcoholic knows within themselves whether or not they are an alcoholic, and some well-known assessment tools can help identify an alcoholic. As stated above, these assessment tools have two design flaws. They do not entirely address the underlying behaviors, shortcomings, and character defects that drive the alcoholic’s drinking problem, and they require accurate and honest data.
As with all assessments, please seek the guidance of a professional to perform the assessment. Some assessments are self-administered, and those are still encouraged to perform by a professional.
Read More: The 12 Core Functions of a Drug and Alcohol Counselor
Alcoholic Assessment Tools
Audit – AUDIT is a 10-question test developed by the World Health Organization (WHO) to help identify unhealthy alcohol use, alcohol dependence, and any consequences associated with alcohol consumption. The questions focus on alcohol consumption, alcoholism symptoms, and problems caused by alcohol. The scoring is as follows:
- 1 – 7: Low-Risk Consumption
- 8 – 14: Hazardous or Harmful Alcohol Consumption
- 15 or more: Moderate or Severe Alcohol Use Consumption
Cage – Is a straightforward 4-question test:
C – Have you ever felt the need to CUT back on your drinking?
A – Have you ever felt ANNOYED about someone criticizing your drinking?
G – Have you ever felt bad or GUILTY about your drinking?
E – Have you ever had a drink first thing in the morning (EYE OPENER) to steady your nerves or get rid of a hangover?
MAST – The Michigan Alcohol Screening Test. The MAST is 25 questions and is a simple test that can be completed in a short amount of time. The scores are 0 for a non-drinking response and a range of 1-5 for a drinking response.
The total possible score is 53, and the results indicate the following:
- 0 – 4: Nonalcoholic
- 5 – 6: Suggests an alcohol problem
- 7 – 9: Alcoholism detected
- 10 – 20: Moderate alcoholism
- 20 or more: Severe alcoholism
DSM 5 – Is a diagnostic and statistical manual for mental disorders authored by the American Psychiatric Association (APA). The manual includes 11 questions to determine the criteria for substance use disorders and ranks the disorder by severity:
- 2 – 3: Mild
- 4 – 5: Moderate
- Six or more: Severe
ASAM – Is the American Society of Addiction Medicine. ASAM criteria is used to assess the client’s needs across six dimensions and for all levels of care. Each dimension has a severity/intensity rating of zero for no problem or stability; one is mild, two is moderate, three is substantial, and four is severe.
The six dimensions are:
- Acute Intoxication and/or Withdrawal Potential
- Biomedical Conditions and Complications
- Emotional, Behavioral, or Cognitive Conditions and Complications
- Readiness to Change
- Relapse, Continued Use, or Continued Problem Potential
- Recovery/Living Environment
Signs of Alcoholism in Others
Above, we talked about what qualifies someone as an alcoholic. Today, professionals no longer refer to an alcohol problem as abuse or a person with an alcohol problem as an alcoholic. Today’s clinical terminology is an alcohol use disorder diagnosed as mild, moderate, or severe.
It’s soundest to recognize signs someone has a drinking problem through an assessment with a professional. By performing an assessment, the client and the clinician can determine the problems and consequences and formulate a treatment plan to meet the client’s needs.
Aside from any assessment, the first sign of alcohol abuse is when the person consuming the alcohol asks themselves or feels things may get out of hand. They probably do if the person has to ask themselves if they have a problem. The number one sign that someone has an alcohol problem is when they continue to consume alcohol despite problems or consequences.
Here are some good indicators that the person drinking alcohol may need to address their situation with an assessment:
- Cannot stop picking up a drink even when they know they shouldn’t
- Cannot stop themselves from stopping drinking once they start
- Continues to use despite the consequences
- Continues to use even when drinking, and their subsequent behaviors affect others (family, children, etc.)
- Alcohol use affects their job, finances, health, legal, etc.
- The person drinks at others; In other words, they are filled with resentment and blame others for their problems.
- Exhibits behaviors including anger, manipulation, flipping the script, passing blame, restlessness, irritability, discontentment, selfishness, dishonesty, and resentment.
Until the alcohol user sees the need to do something different, they will not change.
Interventions are always necessary; They are initiated by the family on the family’s terms or by the alcoholic on society’s terms. Every substance user will have an intervention if they continue drinking despite the consequences and early signs of alcoholism.
For families reading this, if your loved one has a problem and will not address it, it is most likely that they are an alcoholic and do not feel the need to address it. Families often enable and keep the alcoholic comfortable enough to accept their situation and carry on.
Consequences may not keep you sober, and they are the only thing that moves the substance user out of the contemplation stage of change and closer to a treatment plan. Consequences do not keep an alcoholic sober because of how quickly they forget the devastation after things get better.
An alcoholic often sobers up to regain their footing and repair the damages caused rather than address the cause of the damage. The reason is the behaviors and the perception that lead to the alcohol use that causes the damage.
How to Talk to Someone Who is Abusing Alcohol
It would be best to allow the professionals to start the conversation with a non-confrontational approach. Using motivational interviewing skills and allowing the person to speak will help the alcoholic verbalize and become aware of any discrepancies they have. Discussions would include desire, ability, reasons, need, and commitment.
The professional should always listen for change talk and reflect back with summaries. Change talk is when the person verbalizes their consideration, motivation, or commitment to change. The goal is to try to transfer any external motivations to internal ones.
The interventionist should express empathy and start a therapeutic relationship with the person. The majority of alcoholics are in the contemplation stage. If the person were in pre-contemplation, you would have to try and lead them to become ambivalent about their situation. If in contemplation, the focus would be to help resolve their ambivalence.
Remember that very few people with a substance use disorder are in the pre-contemplation stage. The majority of people with a problem are aware there is a problem. I know many people throw around the phrase “complete denial,” but very few are in complete denial.
Confrontational approaches rarely work well in the first two stages of change. These first two stages are pre-contemplation and contemplation. Using confrontational approaches causes the client to speak more on the other side of the argument, which is not changing.
If the alcoholic is forced to defend themself, they may dig their heels in and most likely plead their case not to change or stay the same.
There are times that confrontation, when used effectively and therapeutically by a professional, can benefit the addict or alcoholic. It is not so much the confrontation as it is the engagement to allow the person to gain insight.
Motivational interviewing and an empathetic approach allow for the greatest chance for a counselor-client relationship to develop.
Unlike the confrontational approach, the client verbalizes responses to open-ended questions and starts talking. The more they disclose, the more they allow themselves to recognize and verbalize the discrepancies. Motivational Interviewing enables the client to focus on the side of their ambivalence that promotes change.
From a cognitive-behavioral approach, it is best to use strategies of engagement and persuasion in the hope the person begins to move through the remaining three stages of change. These stages are preparation, action, and maintenance (relapse prevention).
During the engagement phase between a professional and an alcohol user, the focus would be on a working relationship and opening the door for continued conversations.
If the addict or alcoholic is comfortable talking, they will most likely trust their professional. In this stage, the person would not be judged or lead to feeling uncomfortable. It is to engage them and focus on what they are saying to increase communication about their substance use and/or mental illness.
In the persuasion phase between professional and alcoholic, the focus would be on the addict or alcoholics’ views of the situation and their willingness to change and do something different. The goal is to continue and increase the motivation and change talk.
You can learn more about the stages of change and evidenced-based strategies here: https://family-intervention.com/addiction-recovery/
How to Help an Alcoholic
To help an alcoholic, you must stop enabling the alcoholic to avoid needing to change. One of the biggest reasons an alcoholic chooses not to address their problem is not because they do not want to; it is because they do not have to. Thousands of families have tried telling us their loved one does not wish to help, and within an hour after arriving for the intervention, the alcoholic is packing their bags and headed to treatment.
Why is this?
It is almost always because the family was scared to let us try and ask the alcoholic if they wanted help. Most of the time, the alcoholic sees us as a life preserver in an otherwise drowning situation. When the alcoholic sees their family come together to offer love, support, and help, it is uncommon that they refuse.
For the alcoholic to want help, they must see the need for help.
Most want help; they cannot see the need for change. Until the alcoholic can look at their situation and realize that continued drinking is a more significant challenge and fear than addressing the problem, they won’t do anything about it. Families and the alcoholic’s environment are the two most significant factors that help the alcoholic see the need to do something about their drinking problem.
For the family to help the alcoholic, they must stop making excuses and determine if they should do an intervention based on what will happen to them instead of what will happen to the alcoholic. Families selfishly forgo intervening because they worry more about themselves than their loved one’s addiction. To help the alcoholic, the family has to simultaneously step outside of their comfort zone and move the alcoholic out of theirs.
If nothing changes, then nothing changes, and there’s a big difference between wanting help and having to seek help. Every alcoholic and drug addict wants help; it is up to the family how they will make the substance user see the need for it.
An intervention is not about how to control the substance user; it is about how to let go of believing you can.
“The most formidable challenge we professionals face is families not accepting our suggested solutions. Rather, they only hear us challenging theirs. Interventions are as much about families letting go of old ideas as they are about being open to new ones. Before a family can do something about the problem, they must stop allowing the problem to persist. These same thoughts and principles apply to your loved one in need of help.”Mike Loverde, MHS, CIP