When it’s more than just a drink with dinner

Use the CAGE acronym to figure out if you or a loved one might have a drinking problem. Credit: Colourbox
Use the CAGE acronym to figure out if you or a loved one might have a drinking problem.
Credit: Colourbox

My boyfriend drinks way too much around the holidays. Sometimes, he blacks out. He comes from a family of heavy drinkers and often gets drunk with his friends on the weekends throughout the year. How do I know if he’s an alcoholic and what can I do?

After graduating with a master’s degree, I spent the first three years of my social work career performing intake evaluations at an outpatient addictions counseling center in Maryland. My job was to screen adults who had been referred from the courts — for drunk driving or other substance-related offenses — to determine whether they needed extensive alcohol and drug treatment, the 11-week substance education course, or both.

Unless they’re in recovery, alcoholics typically deny having a drinking problem. Even though we administered urine tests and sprang breathalyzers on people who reeked of booze, that wouldn’t deter craftier folk from scheming to evade detection. But the test that usually gave them away didn’t require any lab work or electronics. It was a four-part questionnaire, commonly referred to as the CAGE.

CAGE is an acronym used to recall the telltale signs of alcoholism.
1. C – Cutting Down: Have you ever felt you should cut down on your drinking?
2. A – Annoyed: Have people annoyed you by criticizing your drinking?
3. G – Guilty: Have you felt bad or guilty about your drinking?
4. E – Eye-opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?

One “yes” to any of the questions, other than question #4, is considered a sign of alcohol abuse. Two or more “yeses,” or a “yes” to question #4, is considered a sign of alcohol dependence. Why is #4 enough to diagnose alcoholism? People who are addicted to alcohol — or alcoholics — have developed a physiological dependence. Not only is there a constant craving and high tolerance, but they also experience withdrawal symptoms when they unsuccessfully try to cut back or stop. If you need to drink to function, you obviously have a problem.

While alcoholics are usually the last to admit they drink too much, loved ones are usually the first. That’s why being annoyed by someone about your drinking, combined with trying to cut back and/or feeling guilty, is often an indicator of problematic drinking, which could be either a sign of abuse or dependence. What’s the difference? According to the Diagnostic Statistic Manual of Mental Health (DSM), people who abuse alcohol develop problems — blacking out, getting into fights, driving drunk — as a result of their impaired judgment from alcohol consumption, even though they are not physiologically dependent. They may engage in binge drinking, which causes or exacerbates an ongoing relationship, work, financial or legal problem. Or, they might drink under circumstances that are physically dangerous, such as driving while intoxicated.

People who abuse alcohol have a greater chance of becoming physically dependent than those who don’t drink or do so moderately. Chances are even greater if someone in your family was or is an alcoholic, as studies suggest that genetically predisposition contributes to dependence. That doesn’t mean that those who occasionally hit the bottle too hard, who have alcoholism in their families, will become full-blown alcoholics. But given the higher probability, the earlier the problem is addressed, before dependence sets in, the better.

If you’re concerned about your boyfriend’s drinking, the best thing to do for yourself is to be honest with him about it. You can also try to CAGE questionnaire. If he continues to binge, and it affects your relationship, you can encourage him to seek help, but don’t try to control his drinking by hiding the liquor bottles. Instead, I suggest you attend an Al-Anon meeting to learn about alcoholism and get support in making the best decisions for yourself. Good luck.


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