When does a wine after work become a drinking problem?
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It's early evening, you're just home from work and out of habit you immediately pour yourself a drink, then another, and sometimes another ... do you have a drinking problem?
In a society that normalises heavy drinking and in particular binge drinking, it's becoming increasingly hard to tell whether our own alcohol consumption is under control or if we're moving into dangerous drinking territory.
The problem is most of us tend to underestimate the amount we drink. We like to tell ourselves we are moderate drinkers yet so many of us are guilty of consistently pouring glasses of wine that are double the "standard drink" measurement.
Do that a couple of times a night and technically that's binge drinking!
Those 375ml bottles of full strength beer in the fridge aren't standard drinks either so down a few of those in one sitting and you guessed it, you're binge drinking.
The thing is no self-respecting 30-plus year-old will admit to binge drinking on a regular basis yet inadvertently, that's what many of us are doing, and often. We may not be falling flat on our faces, slurring our words or getting into fights but we are risking our health even if it's not obvious ... yet.
Definition of binge drinking
Binge drinking is defined by the National Health and Medical Research Council as having four standard drinks in one night: a standard drink being 100ml of wine, a 220 ml midi of beer or a 30ml nip of spirits.
It may not sound like much but if we exceed this limit regularly, does that mean we have an alcohol problem?
Associate professor Tim Slade from the National Drug and Alcohol Research Centre suggests that anyone still binge drinking beyond their mid 30s may need to take stock of the situation.
"Binge drinking is certainly the normative drinking pattern among people in their late teens and up to their 30s but normally that behaviour decreases over time and if it doesn't it's an indication there could be problems," he says.
Does binge drinking lead to alcoholism?
"Alcoholism is a bit of an outdated term," Slade says. "The phrase we use these days is alcohol dependence and it's defined as a mental disorder according to the DSM-IV, the standard criteria for the classification of mental disorders.
"Typically, we think of the traditional alcoholic as someone who can't get by without a drink first thing in the morning and also has family and work problems because of their drinking habit but that's the severe end of the alcohol dependence spectrum.
"There are milder versions and you only need three out of the seven [criteria] to occur in any one year to be diagnosed as alcohol dependent."
DSM-IV Criteria for alcohol dependence:
- Tolerance – need to drink more for the same effect
- Withdrawal symptoms or clinically defined Alcohol Withdrawal Syndrome
- Use in larger amounts or for longer periods than intended
- Persistent desire or unsuccessful efforts to cut down on alcohol use
- Time is spent obtaining alcohol or recovering from effects
- Social, occupational and recreational pursuits are given up or reduced because of alcohol use
- Use is continued despite knowledge of alcohol-related harm (physical or psychological)
- If you can relate to any three of the above, it may mean you need professional help but as Slade points out it's a subjective judgement which makes diagnosis difficult.
"Only a third of people who meet the diagnostic criteria will go and get help which comes down to our culture. It's an accepted thing; we drink and deal with the effects later and don't complain about it. However, when it reaches a level where it's impairing relationships and making it difficult to work then we sometimes do something about it."
And that's where rehab hospitals often come into the picture. On Sydney's northern beaches is South Pacific Private for people with addictions including alcohol dependency. Cofounder Lorraine Wood who formed SPP with her late husband Bill, who was alcohol dependent, says behaviours like obsession and compulsion tend to differentiate someone with alcohol dependency from a heavy drinker.
"A heavy drinker doesn't obsess about drinking but an alcoholic does," she explains. "We often say when you're alcohol dependent, one drink is too many and a thousand is not enough."
On her centre's website, the definition of alcohol dependency includes excess drinking, alcohol abuse, alcohol addiction, drinking problems and binge drinking.
Two types of alcohol dependency
"Binge drinking can be part of alcoholism," Wood says. "Basically there's two types: regular or habitual drinkers and binge or heavy episodic drinkers who often go for long periods with no alcohol.
"I knew a guy who would go to Japan and binge on whisky in his hotel room for a month and after that he would come back to run his business and wouldn't touch alcohol for quite a while."
But alcohol dependency can manifest in so many other ways besides binge drinking. It's a disease that can affect all ages, genders and social demographics and usually by the time they seek help significant mental and physical damage has already occurred.
However, most experts would agree it's almost impossible to convince somebody with emerging alcohol dependency that they have a problem, especially if their life is running relatively smoothly.
South Pacific Private's head psychiatrist, Dr Ben Teoh explains the delay in seeking help is commonly up to ten years from the onset of the drinking problem.
"Denial, lacking awareness, physical dependency, lifestyle, psychiatric illness like depression and anxiety disorders are some of the reasons for the delay," he says, adding that a general acceptance of drinking excessively and accompanying peer pressure also don't help.
Wood adds: "Our typical client is often female, in her mid-30s, on her third relationship and in a lot of pain. They come in for things like eating disorders or depression and anxiety before it dawns on them they are alcohol dependent. 'Oh my God', they say, 'I'm an alcoholic and I didn't even realise it'."
Getting the boss onboard
Wood believes employers can play a greater role in helping those who may be alcohol dependent.
She reckons about 90% of those pulled aside by their boss and told they are not performing because of their drinking habit will seek help. Those same people often won't listen to a spouse or friend, she says.
Even so, diagnosing alcohol dependency is notoriously tricky, even for GPs. Ask someone how many drinks they have each night and they'll tell you want they want you to hear, Wood says. "Very few GPs ever ask the right questions."
But that's all about to change, according to Slade who says further education for GPs to enable better diagnosis is afoot.
Better diagnosis but more cases expected
"GPs need to have a few core questions in their repertoire that they can ask during regular consultations to try to determine whether their patient has alcohol dependence," he says.
"They need to be able to tease out exactly the amounts their patients are drinking and be aware it's [alcohol consumption] is often underreported and underestimated."
Meanwhile, Slade says the latest revision of the DSM will be released later this year, which is expected to lower the threshold for diagnosis of alcohol dependence.
"This will mean that the prevalence of alcohol dependency will go up so somebody who was considered fine one day could be diagnosed as alcohol dependent the next."
Clearly, challenging times are ahead both for the healthcare system and us as alcohol loving individuals. All the more reason to cut back, eh?
Cumulative effects of excessive alcohol use*
- Cardiovascular disease
- Overweight and obesity
- Foetal alcohol disorder
- Liver diseases
- Depression and anxiety
- * Source: NHMRC
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