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Useful Notes: Alcoholism And Alcohol Abuse
Alcohol abuse and alcoholism have existed probably as long as alcohol itself has. In fiction, The Alcoholic is an often-used angst trope, as are other depictions of alcohol abuse and alcoholism. But what is alcohol abuse and alcoholism? What is the difference between the two, and how do you know if you are at risk for or are an alcoholic?

This article exists to give a short overview of alcohol abuse and alcoholism, and include ways you can find help for yourself and/or someone else if you or someone you know is an alcohol abuser or alcoholic.

Alcohol abuse is simply the regular use of alcohol to a dangerous or unhealthy degree, the regular overuse of alcohol, and/or the use of alcohol to a degree that it creates dangerous or problematic behavior on a regular basis. Almost all alcoholics are alcohol abusers, but not everyone who abuses alcohol is or will become a true alcoholic.
  • Moderate and responsible drinking behavior is two or fewer alcoholic beverages over 24 hours (depending on height, weight, medications, and other factors, one or "half of one" per 24 hours may be more correct as moderate - more than two over 24 hours generally qualifies as overuse for anyone). Exceeding two drinks a day on a regular basis (as in, more than once within a six-month span) is a warning sign of alcohol abuse.
  • Binge drinking is the consumption of five or more alcoholic beverages within a span of 24 hours, generally within the same drinking session (e.g. not four drinks over 10 hours, but four drinks in two hours). If one has binged more than once in a six-month period, this is generally a sign of ongoing alcohol abuse. If you find that you cannot stop drinking once you've started, that you consistently lose track of how much alcohol you've consumed after several drinks, or that your drinking sessions almost always end with you passing out (and occasionally stop short of that solely because you've consumed all the alcohol you could find), you have almost certainly passed into alcoholism. When excessive drinking goes from being a desire to a compulsion, you have passed beyond the threshold.
  • Relational problems from the use of alcohol is a sign of alcohol abuse. If your use of alcohol causes you to get in fights, engage in violence, or be criticized for your drinking (and the people criticizing you are not The Fundamentalist), this is likely a warning sign that you need to monitor your alcohol usage. This goes double for people with unpleasant personality shifts after they imbibe: if people begin to empty out of a room when you start drinking or you are outright told that you are mean, vicious, and abusive when drunk, you should not drink. Period. If you doubt that the person telling you this is being truthful, ask around. If the general consensus is that you're an asshole when you're drunk, it's a safe bet that you are a mean drunk. Failure to moderate your drinking in this case can cost you friendships and relationships, strain family relations, give you a reputation that makes you a pariah, and possibly even cost you a job if you get verbally abusive at an office party. This goes quadruple for people who become aggressive or violent when drunk: if you gain a Hair-Trigger Temper when you get loaded and fly off the handle at everything, you should consider not even being near alcohol, as the stakes are far higher here. Not only are the above possibilities magnified, but getting arrested is now a very real possibility, as is getting severely injured or even killed if you fuck with the wrong person. Quite a few alcohol-related murder and manslaughter cases have boiled down to "one guy was drunk, attacked the other guy, and got beaten to death/stabbed/shot in return". Don't be one of them.
  • Legal problems are another warning sign of alcohol abuse. Not legal problems so much as in "I carried my beer outside the bar and got a ticket" or "someone opened a container in my car" as those aren't necessarily related to your personal usage, but if you get a DUI or drunk and disorderly conduct arrest, that is a major warning sign. Also, while not necessarily a legal problem (though it can easily turn into this if your behavior is bad enough to get the police called or result in charges being filed), if you find yourself getting 86'dnote  from establishments, chances are good that you have a problem, and if you receive a ban from one, you definitely have a problem. (The only possible exception is an ejection or ban that is entirely unrelated to drinking - e.g. over a dispute over not tipping/leaving a bad review in the case of spectacularly bad service, someone else in your band/party group/etc started problems, you violated a dress code)
  • Regret over one's actions while under the influence is another major warning sign of alcohol abuse. If your drinking causes you to lose control of your actions or emotions, it may definitely be alcohol abuse. If you regularly find yourself apologizing to people when sober for the things you said and did while you were drunk, you need to take a look at your drinking.
    • Alternatively loss of memory or blackouts are always a major warning sign of alcohol abuse, and a warning sign that alcohol abuse may be becoming alcoholism.
  • Drinking regularly for Drowning My Sorrows is another warning sign of alcohol abuse, and one that should be taken with far more seriousness than even the others. There is a very important saying in the recovery community regarding this: "sorrow knows how to swim."
    • Additionally, if you have anxiety problems and regularly find yourself using alcohol to loosen up, you should use that as a wake-up call to address the underlying issues that make you feel like you need to drink to function socially. While this itself isn't outright destructive, it is unhealthy (if you are not doing so in full awareness that you are using alcohol as medication, if you do have an anxiety disorder, and treating it with the same respect that you would a prescription anxiety medication) and can lead to worse patterns.
    • If you have Bipolar 1 (especially rapid cycling or with severe mood swings such as psychotic mania and suicidal depression), drinking is a horrible idea regardless of whether you're medicated or not. If you are medicated, know that alcohol interacts horrifically with most meds for Bipolar 1 - the meds and alcohol often amplify each others' effects, so one glass of wine can equal five or your med dose can feel quadrupled - and sometimes alcohol makes the meds less effective. Unmedicated, heavy drinking can make cycling happen faster, or potentiate a cycle into something far worse (e.g. your mania that was equivalent to a constant cocaine buzz becomes a psychotic breakdown, your depression that was "just" paralyzing and miserable becomes cause for a suicide attempt) If you have Bipolar 2, you should not drink during depressive episodes or if you are on medication. Cyclothymia is probably the only mood swing disorder where moderate drinking is okay regardless of where you're at - and even there you have to be very careful.
    • If you have epilepsy, drinking is one of the worst things you can do. While alcohol does have some anticonvulsant action (it works on GABA), this is heavily outweighed by its pro-convulsant properties and its tendency to play very badly with most anti-convulsant meds. Drinking even moderately (much less heavily) if you are epileptic is risking seizure events and further brain damage.
    • If you are on certain medications that you are advised to not mix alcohol with, don't. This is because the interactions between those medications and alcohol can kill you, or can make the medications not work, or can cause other issues. When your doctor or pharmacist tells you that you cannot drink while taking a medication, they are not saying it to legally cover their ass in most instances - they are saying it because that med has a dangerous interaction with alcohol. If you are uncertain as to whether a medication can interact with even moderate drinking safely or you think the doctor or pharmacist is just making a big deal out of nothing, look it up yourself before you take a drink.
  • Dangerous behavior while under the influence is another warning sign that should be taken with the utmost seriousness, as it means that your irresponsible use of alcohol is immediately life-threatening, as opposed to liver damage or cancer or other long-term effects. If you find yourself getting into even one car accident drunk, walking on a freeway, fighting people twice your size and stronger than you (or even just randomly going up to people and starting shit with them - you never know when someone might be a trained martial artist or have weapons on them), engaging in unwanted or unsafe sex, jumping from windows or other heights, using firearms, attempting or even contemplating suicide, breaking bones or sustaining other injuries requiring hospital treatment, or anything similar while drunk, you need to either immediately stop drinking or seek treatment for alcoholism. This is also a major warning sign that you may be self-medicating or triggering another underlying mental illness with alcohol.

Alcoholism is far more serious than even the alcohol abuse that can become it and that is always a part of it. The difference between alcoholism and alcohol abuse is that alcoholism is a literal physical and emotional addiction to alcohol itself. Someone who is abusing alcohol but who is not addicted (yet) can, even if they drink problematically, manage their drinking. The Alcoholic cannot, at least not without outside help and therapy in almost all cases.
  • The alcohol abuser may binge drink at every party and may even get busted for DUI leaving one - but he/she can go days without drinking with no ill effect, can drink moderately, and/or can just go "you know, I don't want to get plastered at this party." It is a want for alcohol, even at the expense of one's health or other consequences.
  • The Alcoholic, on the other hand, needs to use alcohol or will go into a possibly fatal withdrawal syndrome called delirium tremens, cannot stop drinking once he or she begins to drink, even if the circumstances would demand moderation or sobriety. Alcoholic drinking is a need or compulsive behavior - an alcoholic may drink even when they do not want to do so.

Whether someone can ever drink responsibly again after having been an alcoholic is an issue of fierce debate: one side (that of most therapeutic opinion and of Alcoholics Anonymous) says that complete abstinence is required for anyone who ever reached the point of physical addiction (or, in some cases, even short of that threshold) and insists that any consumption of alcohol after beginning rehabilitation is a relapse. The other side (championed by Moderation Management, Rational Recovery, and some other therapists) postulates that it is possible for someone who was once an alcoholic to drink responsibly/on a limited basis - given the variables of personal willpower to do so, and structured settings to reduce temptation to overconsume or revert to addictive use.

It's also possible that Both Sides Have a Point, what with how the legal system and people seeking help for relatives/friends can conflate true alcoholism (where the latter side may or may not be correct, depending on what side of the Flame War you're on) with non-addictive alcohol abuse/misuse (where the latter side is the correct first approach)

Immediate help (protecting someone who is very drunk)

  • DO NOT overserve, if you are hosting a party or bartending yourself - realize there is a point at which people should not consume more alcohol. Don't be afraid to cut them off and supply them with nonalcoholic beverages at least until they've had time to process some of what they've had. If you are a bartender and decide that a customer is too drunk to continue serving but is also too profitable to cut off and lose out on tips, you can at least severely water down their drinks and substitute alcoholic components for non-alcoholic substitutes, as the body loses the ability to perceive alcohol after a certain point anyways. While morally dubious, it IS a win-win situation for you nonetheless - if they don't notice or protest, they'll keep throwing money at you, and if they do, they'll look like any other drunken asshole bitching about how weak the drinks are and will get hauled out by the bouncers.
    • As a secondary tip for bartenders/servers: alcohol and caffeine are an okay combination but only to a point. After that point, it leads to everything from people being "awake drunk," (e.g. drunk but not aware how drunk they are) to actual heart attacks and poisonings (because both intensify the other's cardiotoxicity). Over two drinks with an energy drink or strong coffee as mixer is generally a very bad idea - if someone is repeatedly ordering such, try to steer them toward something with a non-caffeinated mixer even before you cut off the alcohol. Also, try to avoid doing Jagertrains for large groups who order lots of Jagerbombs - while they look impressive and can net handsome tips, it's impossible to keep track of that many people. If one of them decides to drink multiple Jagerbombs and has a bad reaction, your ass will be on the line.
  • DO NOT let someone drunk get behind the wheel of a vehicle. Ever. If someone is visibly drunk (or even if they don't seem so but you suspect they have had more than one drink in the last two hours) drive yourself if you're sober, find a sober driver in the group, call a cab or ride service, get on public transit (and keep an eye on the worst-off drunks), let the drunk people stay over at your place until sober... Drunk driving kills and injures many people every year around the world - and even when no one is injured or killed and no property is damaged, people (especially poorer people who can't fight the charges with a lawyer/don't know how to act when arrested) will face life-altering criminal charges and legal trouble. It's entirely stupid and entirely preventable.
    • Furthermore, negligence on your part that leads to drunk driving also can have major legal consequences for you. Taking keys at gatherings where people are likely to get piss drunk is customary not just because it's a very easy way to keep people from being able to drive drunk, but also because if you fail to take someone's keys and they subsequently go off and drive drunk (or worse, get into an accident) and they implicate you when asked where they got the alcohol by an arresting officer, you can get in serious trouble for negligence in the form of arrests or lawsuits. If you could have prevented it and failed to, your ass will be on the line.
  • DO NOT allow someone drunk to use a firearm, fireworks, or pyrotechnics or be in too-close proximity to them. Yes, people do drink alcohol at occasions like holiday parties with fireworks, hunting trips and target shoots, and as performers and audience at shows involving pyro. But if someone is visibly drunk or acting recklessly, that person should be kept away from guns, fireworks, and stage pyro. Many fatal and injurious accidents have occurred as the result of combining drunk people with things that are dangerous even with the utmost care and skill applied.
  • If a drunk person or people (or one using any substance for that matter) is in a place where they could fall/jump from a height that could be fatal (e.g. high-rise apartment party, roof...) either keep them in sight at all times and make the hazard harder to access (close the balcony door or the window) or, better yet, walk with them somewhere safer.
  • This also applies to other things that are dangerous, or even to things that might not seem dangerous at first glance. Drunk people (especially those who are also high on a stimulant at the same time, anything from too many Jagerbombs to cocaine or meth) can be highly inventive in regard to ways to get accidentally injured or killed. If someone could fall on it or fall off of or out of it, get stabbed or cut on it, choke themselves on it or with it, consume it when it shouldn't be consumed, shove it into a bodily orifice, etc, etc - make sure that it's not easily accessible to someone drunk.
    • Something a lot of people don't even realize could be dangerous here is food, specifically hard candies, nuts in shell, sections of soft pretzels, grapes, or food that contains inedible garnishes or bones. If you're putting out food for a party where you're expecting lots of people to be drunk, ask yourself if someone could choke on it - and if the answer is "yes," either don't serve it or remove the choking hazard, or serve it early on before people have the chance to be very drunk. Furthermore, think long and hard before you put out anything that contains common allergy triggers. Sober people are usually very good about remembering what their triggers are and are generally quite capable of administering an epinephrine shot if they carry an EpiPen on their person. Drunk people are forgetful and easily confused when things go awry and will not react to sudden changes in the way that they would if they were sober. In short, alcohol-induced forgetfulness and serious food allergies are a lethal combination. If a drunk person goes into anaphylaxis, their diminished ability to know just what the hell is going on means that death is a very real possibility.
  • Make sure drunk people are not vulnerable to rapists. This means, again, watching out for them until they are either sober or with someone they previously have known and trust. It means not being a rapist yourself - recognize that drunk people past a certain point of drunkenness are not capable of consent to sexual activity - even if they are outright verbally requesting it. Furthermore, if you're with someone who is drunk while a known predator is also in their vicinity, keep a close eye on both parties and be prepared to step in the minute that that predator tries to make their move. You could very easily prevent a rape that way.
    • Added to this, BDSM play while drunk at any point beyond "slightly buzzed" is generally considered not Safe, Sane and Consensual. This is because, as noted above, alcohol lowers inhibitions and boundaries beyond what someone sober might draw a line at doing, while, as noted below, being highly drunk makes people nearly insensible to pain - meaning they may well not realize they need to stop and use their Safe Word (or forget it entirely) and get badly injured for real as a result - and passing out in some bondage positions or while doing anything related to asphyxiation has killed people. There is a reason why most professional BDSM events will either ban alcohol and drug use entirely, or will demand people actually participating be not visibly drunk or high. Whether you're a partner or a professional "worker," it's a good idea to never play with someone beyond "slightly tipsy," and to keep an eye on them to protect them from less ethical people and/or themselves. If someone insists anyway (e.g. they've hired you as a dominant and don't want to "waste their money,") at least try to placate them with activities that don't require them to know their body's condition or how much pain/pressure they are actually feeling to be safe.
  • If someone drunk is being aggressive or overemotional, do your very best to distract them with something that doesn't involve starting a physical fight or harassing/insulting other people. Treat them like you would an unruly, tantrum-prone child: don't attempt to argue with them or convince them that their behavior is unacceptable, because they a). aren't functioning at a level where they can process it and b). don't really give a fuck anyways and very well may just take it as a reason to escalate things. Make simple, direct statements that don't come off as antagonistic, don't argue with them or take the bait if they try to start one, and if they're being aggressive or acting in a threatening manner, make sure that your distraction doesn't piss them off further and can hold for long enough to make them forget why they were angry. Drunks have short attention spans and tend to be forgetful - use this to your advantage.
    • Additionally, if you wind up getting attacked, do not physically take your frustration out on them or fight them any more than you have to to get away from them. You will probably be understandably furious at having to deal with a violent drunk, but once again, drunks do not process pain on the same level that sober people do. They may continually get up again and again, but the injuries are still the same. Beat the shit out of them, and there's a good possibility that they won't realize that they've broken or dislocated a bone, received a major laceration, or even that they're bleeding internally (which is normally immensely painful). Again, lots of beating deaths where alcohol was a factor have boiled down to "the victim attacked the offender, got pounded into jelly, and was too drunk to know just how badly injured they were", and if someone winds up dying by your hands under similar circumstances, you will almost always be facing a manslaughter conviction.
  • If you have a friend who is a mean, abusive, belligerent, or violent drunk and who insists on drinking anyways even after having been made aware of their repellent behavior while they were sober and able to process it, you should probably not let them wander out of your sight if they're drunk. Be ready to defuse bad situations and/or break up fights and talk people out of continuing them, as you never know if the person they're threatening or loudly insulting has a bad temper, is a skilled fighter, or carries guns or knives on them. Even if your friend is steadily wearing away at your patience and desperately needs to accept that they have a problem and need treatment, the last thing you want is for them to wind up getting beaten to a pulp, stabbed, or shot; beating-related deaths or permanently-crippling injuries are particularly common among drunks due to the body's greatly dulled ability to perceive pain while inebriated, which leads to people getting up from injuries or attempting to struggle out of holds that would have a sober person howling in pain.
  • Generally, it's best to do your best to keep drunk people from encountering law enforcement. Being drunk is temporary, but a criminal record - or being shot or even sometimes "just" beaten up and tased - is permanent. This ties into several of the above - keeping them away from driving, fights, or dangerous activities - but it also means if someone really, really drunk can be kept out of public view or any situation where they are likely to encounter police, it's a good idea to do so.
  • Most importantly, NEVER, EVER, EVER, EVER LEAVE A SEVERELY DRUNK PERSON ALONE. This encompasses all of the above and the points below - always make sure an adult who is at least somewhat sober is keeping an eye on anyone who is overwhelmingly drunk until they sober up. (In an absolute pinch "buzzed" people are okay for supervising - in that someone who's only had a couple beers or smoked a little bit of a joint watching someone who is in a far more worse state is better than nobody watching them)

Recognizing alcohol poisoning

  • Often, the line between "overwhelmingly drunk" and "alcohol poisoning" is hard to tell at first, especially with milder cases of alcohol poisoning (e.g. those that are likely survivable with minimal intervention aside from observation and protecting the person from suffocation due to vomit or positioning), and sometimes even with moderate and severe cases that do need hospital intervention to keep the person alive. If someone appears overwhelmingly drunk, you should make sure they have no more access to alcohol, and possibly use a personal breath alcohol testing device if you have one to make sure they are in safe territory, and observe them for any of the following signs- which mean they need to be in a hospital at once.

    • Seizures
    • Irregular or slow breathing (less than eight breaths a minute)
    • Blue-tinged or pale skin
    • Low body temperature (hypothermia)
    • Stupor – when someone’s conscious but unresponsive
    • Unconsciousness – passing out (without being immediately rousable - someone who passes out but is awakened by your talking to them or poking or shaking them probably just needs to be watched until sober so they don't pass out doing something dangerous to them. Someone who doesn't wake up needs a hospital immediately.)

The following signs are debatable - they could mean alcohol poisoning, but if someone is only showing these and not worsening to any of the above, they could be fine with observation and no further alcohol - that said, if someone is showing these and even slightly any of the above, or they are severe, it's also a good idea to call Emergency Services.

  • Confusion (if someone is confused to the level of being absolutely unresponsive, they likely do need a hospital, but if they are talking - even if what they are saying is silly or stupid or weird - they are likely not immediately in danger of dying, or at least capable of being taken to the hospital without a call to Emergency Services.
  • Loss of coordination - Can happen with even slightly drunk people (and it's why driving isn't a good idea) but if someone has lost control of even generally involuntary functions or if they have lost bladder or bowel control - they probably need to be in the hospital immediately.
  • Vomiting - can happen with people who are not in immediate danger, but also with people who are in severe danger. If someone is vomiting, do not let them fall asleep or go to bed until the vomiting has been over for at least a few hours, do not allow them to consume more alcohol, and watch for the far more threatening symptoms - and if they are vomiting heavily enough to become dehydrated (e.g. they've vomited more than a couple times) they also need to be hospitalized. If they are showing no other more threatening symptoms and dehydration is the only worry, it's probably a good idea to risk a bit of vomit in your car to drive them yourself, or call for a taxi to the hospital, rather than call Emergency Services if law enforcement response is a possibility.

Whether to call Emergency Services, a private ambulance, or drive someone to the hospital yourself/have a sober driver drive them/call a taxi is a very complicated decision. If you have the money or connections for a private ambulance call, it is likely the very best option - medical assistance ensured to arrive solely with no law enforcement response and the person in a safe environment if they do begin experiencing a life-threatening issue. Emergency Services is best if someone is experiencing life-threatening problems and you don't have the means for a private ambulance call - and it is sometimes possible to avoid law enforcement response if you give the person's age as being of legal age and you emphasize that there is no violence or threat of violence. Your/someone else's vehicle or a taxi, however, is the best idea IF, and only IF, the person is NOT experiencing any of the life-threatening symptoms (e.g. their breathing is fine and they are not seizing) and the concern is dehydration/sickness/vomiting or similar alone.

Getting help in the long term

  • Alcoholics Anonymous is often considered the best recovery program for those who are alcoholics or severe alcohol abusers. That said, there is major controversy as to whether Alcoholics Anonymous is anywhere near as effective as it claims, or whether it is the best approach.
  • Smart Recovery and Rational Recovery both are alternatives to AA that take a slightly different approach than AA's traditional 12-step recovery with no focus on the idea of a higher power, whatever it may be.
  • Moderation Management is a harm-reduction approach that allows for continued drinking but strictly controlled. It is at odds with much of the recovery community (which, often for very good reasons, demands total sobriety) and has somewhat less successful odds, and is probably more useful for problem drinkers/alcohol abusers than for true alcoholics.

There are also many others, including inpatient rehabs, outpatient rehab programs, one on one counseling, and more. There are programs specially for military members or ex-military (generally, you can find out about these in the US by contacting the Veterans Administration), programs for the LGBTQI community (there's generally meetings listed at community centers), for atheists or secularists who still want to do 12-step but without references to the "higher power," and alternatively, for devout religious believers who want to specify their higher power as their object of worship. And there's also harm reduction measures, listed above, whether via MM or via one's own ideas (e.g. thinking about what you can do to reduce alcohol intake or behave responsibly even if planning on getting drunk, for example, substituting a larger liquid volume drink for one with more alcohol, spacing out alcoholic drinks with nonalcoholic ones, making sure one is not driving or doing other hazardous things until sober) - which are especially valuable for alcohol abusers or overusers to prevent becoming alcoholics.
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