Frequently Asked Questions about Alcoholism

By Mark S. Gold, MD

Here are some of the most frequently asked questions about alcoholism, and their answers.

How can I have a drinking problem if I can hold my liquor?

Anyone who drinks too much liquor in too short a time, with too little in their stomach, or with too little body mass gets drunk. Some people can drink more than others because of genetic factors or because they have built up their tolerance, just like any other drug user. Ironically, “holding your liquor” is actually a sign that you may have a drinking problem.

I’m no different when I drink than when I’m sober. Is it possible that it doesn’t affect me at all?

Most people who are moderate drinkers report that low doses of alcohol have a pleasant effect on their ability to communicate, a stimulant effect on appetite, and an overall relaxation effect.

A regular low-dose “user” of alcohol can experience a number of mental effects, ranging from sadness to anxiety, hyperactivity, and irritability, and a wide range of interpersonal problems. At higher, chronic doses—continued drinking on a regular basis—almost any psychiatric symptom can result, from paranoia to auditory hallucinations to intense prolonged insomnia. The effects on mental processes are as severe or as limited as the dose and length of use.

Do alcoholics have “addictive personalities”?

No one kind of addictive personality appears to predict alcoholism. The addictive personality does not seem to be inherited or to be present before the onset of alcoholism.

However, antisocial behavior in childhood frequently leads to alcohol drinking and eventual alcoholism. It is estimated that somewhere between 50 percent and 90 percent of prisoners are alcoholic, and many of these are antisocial personalities.

I like to drink. You could even say I’m a heavy drinker. Does that mean I’m an alcoholic?

Because someone is a “problem drinker” or “heavy drinker” does not mean that he or she is automatically an alcoholic. You can say that these people abuse alcohol, but alcoholism is an addiction with several definitions, and there is some controversy about how the diagnosis should be made.

We say alcoholism is an addiction primarily because it contains these crucial elements: preoccupation with acquisition, compulsive use, narrowing of interests, denial, and relapse. These factors are seen in addiction to all other drugs.

There is no single “correct” definition of alcoholism because the disease is so subtle in its progression. The point where heavy drinking becomes alcoholism is often unclear, but applying an overall definition of addiction—compulsive use and continued abuse in spite of adverse consequences—is a good place to begin.

Any person whose alcohol use has proceeded to the point of addiction as defined above, including serious interference with functional ability, is an alcoholic and needs immediate professional help.

It’s important to remember that many people who are only moderate drinkers experience some of the early symptoms of alcoholism, such as hangovers that cause absenteeism from work, interpersonal difficulties, and medical problems.

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