Am I an Alcoholic? Alcohol Addiction Assessment

We’re always talking about alcohol abuse and dependence, and the difference between the two. They both suffer consequences because of their drinking, but individuals struggling with alcohol addiction are physically dependent on the substance, and they experience withdrawal symptoms if they stop drinking. The American Psychiatric Association is considering categorizing alcohol abuse within a spectrum of disorders, which would classify some drinkers as at risk of developing addiction.

The grey areas of drinking

The lines are blurry between those addicted to alcohol, abusing alcohol, and people on the brink of having these problems. An individual with alcohol addiction may not show the same symptoms as other drinkers, or a “normal” social drinker may share in characteristics of an individual who abuses alcohol — that’s why some people want diagnosis on a spectrum — to account for all the gray areas we see in real life people.

Staff at Harvard Medical School have been developing a book series that talks about those on the brink of developing alcohol addiction. “There is a tremendous number of people who have alcohol problems and almost all have gone through the gray area of the scale,” said Dr. Robert Doyle, a co-author and clinical instructor of psychiatry at Harvard Medical School. “So almost everyone who’s at the far end had some experience in the ‘almost’ range, and if we can bring some awareness to that, we might be able to help them make some health lifestyle changes.”1

Seeing the signs

Some physicians agree that being able to define someone as being at risk of developing alcoholism, or being “almost addicted”,would be beneficial for early intervention. “It’s about describing symptoms that aren’t normal, that are well documented, and explaining those symptoms to people so they can better deal with them and have better health now and in the future,” Dr. Julie Silver, an assistant professor at Harvard Medical School said.1 “It is good for people and their friends/relatives to recognize the signs and symptoms of alcohol abuse and addiction, so that they may be able to influence someone before they get into trouble,” said Dr. Robert Gwyther, professor in the department of family medicine at the University of North Carolina at Chapel Hill School of Medicine.1

Too many terms

Other physicians are concerned there’s already too much confusion, and adding “almost  addicted” to the mix would just lead to more problems with diagnosing. “We run the risk of having too many terms — alcohol abuse, alcohol misuse, risky drinking, unhealthy use, almost addiction,” said Dr. James Garbutt, a professor of psychiatry at the University of North Carolina at Chapel Hill School of Medicine.1

At least this opens up the topic more, regardless of whether or not the “almost addicted” will stick.

“Alcohol addiction is a progressive disease and it is always precluded by problematic drinking behavior,” said Dr. Jason Hershberger, chief of psychiatry at SUNY Downstate Medical Center. “Problematic drinking is common, more common than full-blown alcoholism, and once identified, it can be helped.”1

Am I An Alcoholic: Alcohol Addiction Assessment 

Getting the appropriate type of treatment for any kind of substance use disorder (SUD), including all forms of alcohol abuse and addiction, begins by determining the correct diagnosis. Alcohol use disorder (AUD) is diagnosed through several steps and thorough evaluations by different specialists. It commonly starts by suspecting that you or someone you care for might be using alcohol in a way that doesn’t correspond to moderate consumption guidelines. When such doubts emerge, the safest thing to do is seek professional guidance and help.3

Many people go through a period of contemplation before turning to others for help. Some may be unsure what moderate alcohol use is and whether their drinking pattern qualifies as unhealthy. Resolving these doubts can provide the required motivation to take the crucial step toward finding specialist, evidence-based treatment options. One of the ways to start you along the way to recovery is self-assessment.4, 5

You can take several standard tests to get a general idea about the nature of your drinking habits. By doing this, you can finally get that initial push you need and decide to change unhealthy drinking habits and the detrimental behavior that usually accompanies them. Since alcohol abuse and numerous mental health issues frequently go hand in hand, committing to recovery from alcohol addiction generally involves addressing behavioral and mental health too.6

What Are the Signs That Show You Are an Alcoholic?

Since alcohol is legal, easily accessible, and present in most people’s lives, drawing a line between moderate and problematic use can present a challenge. As opposed to illicit drug use, alcohol is socially acceptable, and occasional use doesn’t present a problem for some people. However, people are very different, and what makes no significant impact on one person’s life can cause severe problems for others. There are different types of alcohol-dependent individuals, and all of them cope with their issues in their own characteristic ways.5

Even though alcohol addiction and alcohol dependence are not the same, both can present a significant danger to one’s physical and mental health. Alcohol can affect and change the way one’s body and mind function, even irreversibly in some cases, so recognizing and treating any level of alcohol abuse is crucial. If you’re trying to determine whether you or a loved one are struggling with problematic alcohol use, you can pay attention to some of the common signs as determined by the National Council on Alcoholism and Drug Dependence (NCADD):4, 7

• Tolerance to alcohol builds over time, generally after prolonged and frequent alcohol use. This is because the body adapts to the presence of alcohol in the system and keeps needing more significant amounts to produce the same effects or avoid withdrawal symptoms.
• No control over one’s drinking. For example, a person might want to stop drinking but is unable to.
• High-risk behaviors include situations like driving under the influence of alcohol, abusing other illicit or prescription drugs, getting into violent arguments or fights, and engaging in unprotected sex.
• Secrecy. Being vague about the amount of alcohol one consumes, hiding alcohol, or having unexplained accidents or injuries. Drinking alone, in secret, is also common.
• Personality changes and mood swings are connected to mental health issues that often co-occur with alcohol abuse problems. For example, anxiety, depression, and irritability may lead to frequent arguments with family members and friends and sometimes even verbal and physical violence.
• Blackouts and temporary memory loss are common signs of alcohol abuse. The affected individual may have trouble remembering the thing that happened even when they are conscious.
• Withdrawal symptoms start appearing as the effects of alcohol begin to wear off. They usually manifest themselves as anxiety, trembling, nausea, vomiting, trouble sleeping, fatigue, irritability, anger, depression, headaches, and loss of appetite.
• Avoiding or neglecting activities you once enjoyed or considered important, like spending time with friends and family or engaging in hobbies or other interests. This can also manifest as poor performance at work or school.
• Interpersonal issues or relationship problems with close friends and family members, particularly if they’re trying to address their drinking habits. Relationship problems can also emerge at work or with classmates or teachers in school.

Take Our Online Alcohol Assessment Tests

You can use several standard tests to get a general idea about the severity of your alcohol use pattern. These tests consist of a certain number of questions designed to point to potential alcohol use disorder (AUD). They examine your alcohol consumption habits and the symptoms you experience as a result of your alcohol use. The most used alcohol assessment tests are CAGE, AUDIT, and MAST alcohol assessment quiz.8

You can find each of them online and take the test yourself. Still, they can also be part of the initial evaluation performed by your primary care physician to determine the level of your drinking issues before they can refer you to a specialist if necessary. An accurate diagnosis requires a thorough evaluation by substance abuse and mental health specialists. These tests are diagnostic tools, but they do not provide a complete picture and are not to be taken as a final diagnosis on their own.9

CAGE Alcohol Assessment

The CAGE Assessment Quiz is a questionnaire composed of four questions that serve as a personal or self-assessment tool for determining substance abuse in general, but it is often used for alcohol addiction. CAGE is an acronym that stands for:10

• Cut
• Annoyed
• Guilty
• Eye-opener.

Each of these words represents one of the questions that the assessment test covers:10

1. Have you ever felt you need to cut down on your drinking?
2. Do people annoy you by criticizing your alcohol use?
3. Do you or have you ever felt guilty about your drinking?
4. Have you ever used alcohol first thing in the morning as an “eye-opener” or to get rid of a hangover?

Answering “yes” to at least one or two of these questions might mean you’ve become dependent on alcohol.10

AUDIT Alcohol Assessment

AUDIT self-assessment quiz is also an acronym meaning Alcohol Use Disorders Identification Test. This simple test can effectively point to unhealthy alcohol use patterns. The AUDIT alcohol assessment was developed by the world health organization (WHO) and consists of 10 questions. It is one of the most widely used screening tools for alcohol use disorder worldwide, and health professionals use it too as an initial evaluation tool before referring the patient to substance abuse specialists.11

It takes only a few minutes to complete and quickly identifies potential alcohol dependence and its harmful consequences. The audit test is scored on a scale of 0-40, where 8-14 points suggest harmful alcohol use, while 15 or more points indicate severe dependence or addiction. The questions this test consists of are:11

1. How often do you consume drinks containing alcohol?
2. When drinking, how many standard alcoholic drinks do you have per day?
3. How frequently do you consume six or more drinks on one occasion?
4. How often were you unable to stop drinking once you’ve started during the past year?
5. How often has drinking prevented you from doing what was typically expected during the past year?
6. How often do you need a drink to get up in the morning?
7. How often have you felt guilt or remorse after drinking during the past year?
8. How often were you unable to remember what happened the night before because you were drinking?
9. Was your drinking ever the cause of injury to yourself or anyone else?
10. Have your friends, family members, your doctor, or anyone else expressed concern about your drinking and suggested you cut it down?

What Makes Me an Alcoholic?

The exact causes of alcoholism aren’t easy to pinpoint, even after comprehensive evaluations and counseling. It’s almost impossible to drill down to only one specific factor. When it comes to substance use, alcohol use included, many different elements play a role in developing problematic use that turns into an addiction. Some of these underlying causes of alcoholism can be identified and addressed during counseling sessions or various approaches to behavioral therapy. Group therapies and support groups have also shown great potential for uncovering reasons behind alcohol abuse, encouraged by other people’s examples.12

Causes of alcoholism are numerous and diverse and can include various factors:3, 13, 14

• Social. This can include the culture one belongs to, family dynamics and drinking habits, and even the workplace environment. Family history and drinking at an early age significantly increase the chances of developing AUD later in life.
• Phycological. Many people use alcohol as a coping mechanism that helps suppress unpleasant emotions and use it as an attempt to self-medicate, particularly if they’re battling stress, anxiety, depression, trauma, or any other co-occurring mental health issue. This is particularly dangerous as alcohol can further aggravate mental health issues creating a vicious cycle.
• Environmental factors can also influence one’s chances of developing unhealthy drinking patterns. For example, they can involve a person’s proximity and alcohol exposure. Environmental factors also include socio-economic background and general lifestyle.
• Biological. A close connection between alcoholism and a family history of alcohol abuse was noted long ago, and many studies have confirmed this genetic link. The genes connected to greater susceptibility to alcohol abuse can be passed down through generations.

Am I Drinking Too Much?

Determining whether your drinking habits are dangerous and pose a significant risk to your physical and mental health is a process that needs to be conducted by a team of experts. Alcohol doesn’t have the same effect on everyone, so a careful examination of your overall physical health, mental health, and professional alcohol assessment needs to be conducted to reach the most accurate conclusion. So naturally, not everybody who drinks alcohol develops an addiction. Many people can drink in moderation and never develop physical dependence or addiction.3

The difference between various stages of alcohol abuse can seem confusing. Still, some guidelines are determined by national agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). According to these authorities:15

• Binge drinking is defined as a pattern of alcohol use that raises blood alcohol concentration (BAC) to 0.08% or higher. That’s the amount of alcohol that corresponds to 0.08 grams of alcohol per one deciliter of blood. This is at least 5 standard drinks for men and 4 drinks for women within a couple of hours on at least one day during the past month.
• Heavy drinking is defined as more than 4 drinks daily for men on any day (or more than 14 per week) and more than 3 drinks for women (or more than 7 a week). SAMHSA offers another definition of heavy alcohol use and describes it as binge drinking on five or more days during the past month.
• Alcohol Use Disorder (AUD) or alcohol addiction is considered a mental health disorder that can be mild, moderate, or severe. It’s characterized by one’s inability to stop consuming alcohol despite severely adverse health and social consequences.3

What Is a Safe Level of Drinking?

The line between “safe” and “dangerous” levels of alcohol consumption is not universal and clear. Many factors must be taken into consideration when determining the nature of one’s alcohol drinking habits and their severity. Each person has different physical, psychological, and emotional characteristics. Combined with their background and lifestyle, they form a complex picture that needs to be evaluated on a case-to-case basis. There are, however, some universal guidelines.16

For example, the 2020-2025 Dietary Guidelines for Americans define moderate drinking levels as 2 drinks or less for men and 1 drink or less for women (per day). One standard drink in the U.S. contains about 0.6 ounces or 14 grams of pure alcohol. That amount of alcohol corresponds to:15

• 12 ounces of beer (5% alcohol content).
• 5 ounces of wine (12% alcohol).
• 8 ounces of malt liquor (7% alcohol).
• 1.5 ounces of hard liquor (40% alcohol) like whiskey, vodka, gin, rum, etc.

How to Get Help for My Alcohol Addiction?

If you need professional help for yourself or a loved one, start by obtaining the most accurate information about your options. You can rely on guidance and referrals from nationwide government entities like SAMHSA or NIAAA. They operate entirely free and confidential alcohol addiction helplines that are available 24/7 to direct you to reliable, evidence-based programs and rehab centers. National Council on Alcoholism and Drug Dependence (NCADD) can also connect you with appropriate local resources.17

You can use SAMHSA’s National Helpline: 1-800-662-HELP (4357). You can also use their online locator tool, Findtreatment.gov, to find an appropriate facility near you.16 Another reliable way to explore your option is to reach out to American Addiction Centers (AAC), a nationwide network of substance abuse facilities that offer a full continuum of care at multiple locations across the U.S.

You can call the AAC’s helpline and speak to one of the highly trained admission navigators that can answer any questions you might have about alcohol addiction in general, insurance coverage, and the cost of treatment. They can guide you through the process of admission, evaluation, initial steps of detoxification, and subsequent treatment options and different types of alcohol addiction recovery programs. AAC uses evidence-based therapy approaches personally tailored to each patient’s needs.

Medication might also be used during and after the detoxification phase. Naltrexone, acamprosate, and disulfiram are approved by the FDA to reduce cravings and help prevent relapse, used alone or in combination with therapy and support groups.3

Frequently Asked Questions

Take Our Online Assessment

Take this Alcohol Addiction Assessment. The Michigan Alcohol Screening test (MAST), is a self-scoring test that helps determine whether an individual has a problem with drinking. (This is the current revised version of the MAST; the original MAST is composed of 25 questions and uses a more complex scoring method.)
Selzer ML: “The Michigan Alcoholism Screening Test: the quest for a new diagnostic instrument” Am J Psychiatry 127(12):1653-1658, 1971.