Let’s face it, having a few adult beverages is as American as apple pie and fireworks. We drink to celebrate newlyweds or to ring in the new year. We drink mimosas at Sunday brunch with our girlfriends and we crack open a cold beer after a tough day at work. We drink when we are happy, sad, anxious, frustrated and bored. Sometimes we drink for no reason at all.

Thomas Rhett reminds us in his popular country song that “There Ain’t Nothing a Beer Can’t Fix” and Margaritaville famously assures us that a cocktail will fix our problems. You know the tune, “… There's booze in the blender, And soon it will render, That frozen concoction that helps me hang on…”. And, who could forget all the good times the ladies of Bad Moms had while drinking away their sorrows? As the saying goes, ‘it’s all fun and games until someone gets hurt’.
So, what happens when a casual celebratory drink becomes more than just that? What happens when it becomes a daily ritual or a necessity? Where is the line between a drinking socially, binge drinking or alcohol dependence? How does this happen and what can we do? Let’s find out as we explore the dark-side of drinking.

AM I AN ALCOHOLIC?

The National Institutes of Health defines Alcohol Use Disorder (AUD) as “a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences.” Annually, about 17 million Americans are diagnosed with an AUD. Additionally, many more adults are struggling to find a balanced, healthy relationship with this widely popular vice.
For the sake of clarity, we should define a few things first. Moderate drinking or “healthy drinking” is defined by the NIH as no more than one drink per day for women, and no more than two drinks per day for men. Binge drinking, on the other hand, is defined as consuming 5 or more alcoholic drinks for males or 4 or more alcoholic drinks for females on the same occasion or on at least 1 day in the past month. A “drink” is defined as either a 12 oz of regular beer, 5 fluid oz of wine, or 1.5 fluid oz of 80-proof distilled spirits.

ASSESSING FOR ALCOHOL ABUSE

To answer the original question, “Am I an alcoholic?” you can use a simple tool like the CAGE questionnaire as a starting point. This does not give you a definitive answer, it’s just an assessment but it’s a launching pad for your exploration. If you answer “yes” to two or more of these four questions, you should seek professional help from a doctor, therapist or treatment center. Or, if just reading these questions, stirs up some unpleasant thoughts, seek help. We address more self-reflection questions later in this blog, too.
The CAGE questions are below for reference:

1. Have you ever felt you should cut down on your drinking?
   2 Have people annoyed you by criticizing your drinking?
   3 Have you ever felt bad or guilty about your drinking?
2. Have you ever had a drink first thing in the morning to steady your nerves or get over a hangover?

PANDEMIC + OVERALL HEALTH
The data that is emerging from the pandemic is quite alarming. If things were rough before March 2020, the pandemic made them worse. Research is suggesting that people increased their use of alcohol to escape reality, numb pain and reduce stress.
In the winter of 2020, life was uncertain and changing by the minute. Information about the coronavirus was overwhelming, evolving and scary. Businesses and schools closed with little warning and the term ‘social distancing’ entered our vernacular. We lost our sense of normalcy and at that time, 18 months ago, we had no idea about the devastation that laid ahead.

Let us not forget, we were either stuck at home alone in solitary confinement, or perhaps (worse yet for some) we were confined to our home and forced to confront our troubled marriages.
Given the situation, it makes sense that many adults turned to alcohol for comfort. Afterall, alcohol is easily accessible, legal and socially acceptable in our society. Why not stock-up on a few of your favorite craft beers, vintage wines and organic seltzers if you fear the world is coming to an end?

NUMBERS SPEAK LOUDER THAN WORDS

One thing was certain, if we were going to stuck in our homes alone while a virus ravished the world and killed millions of people, we were not facing this monster without a few drinks. It is clear that alcohol abuse is trending upwards thanks to the pandemic. And, I am certain that we will not know the full effect of this situation for years to come. But, here are facts as now know them:

• Online sales of alcohol increased by a staggering 262% compared to the previous year in early 2020 (NIH)
• Between March 1- April 18th 2020 sales of alcohol from liquor stores increased by over 50% compared to sales at the same time in 2019 ( NIH)
• From March – May 2020, 13% of Americans started or increased substance use as a way of coping with COVID-19 anxiety and stress (CDC)
• 60% of people surveyed by the CDC reported that their drinking had increased compared to before COVID-19 (Table 3) due to increased stress, increased availability of alcohol, and boredom
• "harmful or hazardous style” drinking (otherwise known as ‘binging’) increased 20% between April 2020 and September 2020 (University of Arizona Health Services study )
  -Alcohol dependence rose from 7.9% to 29.1% from April 2020 to September 2020 (University of Arizona study of 6,000 Americans)

NEGATIVE COPING SKILLS
Take my friend, Lucy, for example. Like many Americans, she is a hard-working single mother. When not managing the day-to-day operations of a very large non-profit, she’s moving her kids from soccer to art classes to scouts and so on. Then, of course, she is cooking, cleaning, paying bills, planning vacations, and walking the dog. Some time in her week, she might even get a few minutes for exercise. Exercise is a lifeline for my friend. A must. It is not optional anymore.
Before Lucy had exercise, she had tequila. Cocktails quickly morphed from a special occasion drink with friends to a daily happy hour ritual alone to a meal replacement for breakfast, lunch and dinner. The problem skyrocketed and took over her life for several months before friends intervened. Thankfully, my friend recognized when she hit her ‘rock bottom’ and she allowed her friends to help her.

Things were rocky for a while, but she considers herself lucky to have escaped this nightmare without legal issues or chronic health concerns. Like many people during the pandemic, she was scared, bored and looking for answers to life’s problems at the bottom of the bottle rather than tackling the nagging issues head-on.
Today she is sober with the help of skilled substance abuse counselors, countless hours of group therapy, friends, and exercise. Every day of sobriety is a blessing for someone in recovery and we must also understand that relapse is often part of recovery. Today, however, is a good day.

WHO IS AT RISK?

If Lucy’s story resonates with you, maybe there is comfort in knowing that you are not alone. Your friends, colleagues, and neighbors are also potentially struggling to establish the line between healthy drinking, binge drinking, alcohol abuse or alcohol dependence. My experience in working with so many people reminds me that it is almost impossible to guess who is suffering. There is no rhyme nor reason when it comes to addictions.

However, the statistics behind Alcohol Use Disorders (AUD) are simple and somewhat predictable. According to research published in the DSM-V, in the USA, about 8.5% of adults aged 18 or order are diagnosed with an alcohol use disorder. It is more prevalent in men than women and it is most often a problem for men aged 18- 29 years old. Native Americans and Alaskan Native populations are more likely to be diagnosed with an AUD than any other group.

Of course, genetics and environmental factors work together to express (or repress) the emergence of addictive behaviors. Evidence suggests that alcohol use disorders run in families, with 40- 60% risk being attributed to genetics alone. If you began drinking at an early age or suffered trauma in your childhood, your risk also increases. The truth is, some people are at greater risk than others based on these factors.

WHAT ABOUT WOMEN?

Women drink too. A new study, published in the journal Alcoholism: Clinical and Experimental Research, found that alcohol-related deaths in the United States doubled between 1999 and 2007 — with the largest increase among non-Hispanic white women.
Read that again… the largest increase in alcohol-related deaths was noted within the category of white women. Whether you are single working woman, a stay-at-home mom, a recent college graduate, a widow, married or a recent divorcee, the risk is rising amongst non-Hispanic white women.

The CDC reports that approximately 13% of adult women report binge drinking almost every week. The CDC published research indicating that ‘problem-drinking’ (defined as drinking to the point where it interferes with your life or you are unable to stop) jumped by more than 80% among American women between 2002 and 2013. So, yes, men are more likely to be diagnosed with an AUD than women, but women are at risk, too.

Just check the internet if you don’t believe me. The ‘mommy juice’ memes are rife on the internet. I got 5 million hits in less than one second when I searched this phrase on Google. Memes are so powerful because they (often) do express those deep, dark, ugly thoughts in our heads. Memes also lighten the mood on serious subjects and bring attention to otherwise stigmatized topics and that can be beneficial. However, memes normalize behaviors and experiences. Humor is an excellent medicine but it can also minimize the impact that problematic drinking can have on our family, our health and our self-esteem.

WHAT’S THE DAMAGE?

Prolonged use of alcohol and drugs can significantly change the chemistry and wiring of the brain. Because of this, the person abusing substances may experience severe cognitive, behavioral and physiological symptoms. They can also suffer with brain shrinkage (and this is worse for women than men according to research). And, it goes without saying that the health problems associated with frequent intoxication are numerous- liver disease, cancer of the mouth, throat, esophagus, and damage to the muscles around the heart…. to name a few. Lastly, about 95,000 Americans die from excessive use of alcohol each year.
Even if you do not develop chronic medical problems from alcohol abuse, you will likely develop myriad of social problems and this is, perhaps, the worst part. Simply put, alcohol clouds judgement. Many people continue to use substances despite negative consequences such as a job loss, financial instability, related health problems, separation from spouse, loss of custody of kids and legal issues. When the pressure of these natural consequences start to emerge, the client or their loved one calls someone like me to start psychotherapy.

ALCOHOL AND ANXIETY
Addictions and mental health go hand and hand. That is fact. Studies show that there is a clear relationship between anxiety and AUDs. Both prolonged drinking and alcohol withdrawal are associated with an increased anxiety. One study estimated that 18.3% of people with general anxiety disorder self-medicated their condition with alcohol. Additionally, 3.3% self-medicated with alcohol because of panic disorders. Alcohol is also a known depressant. So, no matter how much great you feel while intoxicated, you are aiding depressive symptoms.
Substances are used to escape, avoid and numb pain. When we are faced with challenging or uncomfortable feelings, life circumstances or intrusive thoughts, we quickly discover some reprieve when we are high on alcohol and drugs. Of course, this feeling of relief is only temporary because when we wake-up after an episode of binging, we not only still have our original problem (whether that was a failing marriage, the death of loved on, creditors demanding payments) but we now have additional feelings of guilt, shame and embarrassment for our behaviors the night before.
And so, the cycle begins. Drink, smoke, eat, snort… do whatever it takes to avoid the reality of our feelings, thoughts and life circumstances. There is a no resolution or solution at the bottom of bottle but for some reason we keep looking there anyway. The healing comes when you reach out to professionally trained counselors and doctors to tackle your challenges holistically and realistically.

NOW WHAT?
Take some time to reflect on the role that alcohol plays in your life. You must start with self-reflection, observation and contemplation. What to do next will greatly depend on what you discover about yourself.

And, unlike many other areas of life, I would venture to say that your relationship with alcohol is one area where other people’s opinions do matter. If your spouse, mother, brother or best friend are concerned about your drinking, carefully consider what they are suggesting. Remember, addictions impair memory and cloud judgement. You need people who love you to help you see more clearly.
Listed below are some open-ended questions that you can use to start your reflection process. Spend time with this and if something feels alarming, uneasy or scary, understand that you are receiving information from your mind and body. Process it. Act on it.

Sit quietly and contemplate your life over the past 12 months. Consider if you have:

• Had times when you drank more, or for longer, than you intended?
• Wanted to stop drinking or reduce your alcohol consumption but couldn’t?
• Been sick from drinking or the next day had terrible hangovers?
• Had friends or family comment on your use or misuse of alcohol?
• Had to sneak drinks to avoid confrontation from friends or family?
• Found that drinking—or being sick from drinking—often interfered with:
o taking care of your home or family?
o caused job troubles?
o school problems?
o financial challenges?
• Given-up or cutback on activities that were important or fun in order to drink?
• Missed work or important family events due to intoxication or a hang over?
• Developed any serious medical conditions or injuries related to drinking? Or, have you have narrowly escaped injury or car accidents due to intoxication?
• Engaged in risky behaviors (unprotected sex, driving, gambling) while intoxicated?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem?
• Do you ever wonder what your life would look like if you did not drink?
• Become a different person when you drink such as a careless, angry, violent or more extroverted?
• Compromised on your morals or values while drinking?
• Experienced memory blackouts due to intoxication?
• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heartbeat?
If, after pondering these questions, you believe that your drinking habits are harmful, connect with a professional counselor or a doctor; ask a friend for help; or call a confidential national hotline such as SAMHSA’s National Helpline at 1-800-662-HELP (4357).
There is no shame in asking for help. Every big change begins with a small step. Start small- make a call, do some online research, attend a meeting. From there, let your healing begin.
If you live in Maryland, feel free to contact me directly to find out more about my psychotherapy services. I can help you find local resources to support your mental and physical wellbeing and we can work through this together. Whatever happens, you are not alone. Ask for help even though it’s scary and uncomfortable. Your future-self will thank you.

Carrie Mead, MS, LCPC is a professional counselor licensed in the state of Maryland. Carrie offers psychotherapy to adults suffering from anxiety, depression, chronic stress, and trauma. Carrie utilizes a person-centered holistic approach to healing and she honors the client as the expert of their own lives. Carrie earned her Master’s Degree in Counselor Education from McDaniel College in Westminster, MD where she resides with her family. When not working, Carrie can be found seeking the warmth of the sun in her garden or curled-up with a good book and strong coffee. For more information visit my website