When to Stop Drinking
The question of whether to quit drinking alcohol or not is a serious one. Fortunately, there’s a rule of thumb to follow if you think you need to take a break from alcohol or stop drinking altogether. It’s simple. If you’ve ever asked yourself either of these two questions: “Should I lay off alcohol for a while?” or “Should I quit drinking?” The answer is yes. That’s not direct medical advice; only your doctor can give you that. Nor is it a suggestion to stop drinking cold turkey right now without consulting a medical professional or addiction specialist; that’s dangerous and can have serious repercussions. Yes is the universally appropriate answer to these questions for two common-sense reasons. First, if you don’t have an alcohol problem – called an Alcohol Use Disorder (AUD) by mental health and substance abuse experts – and your alcohol consumption is low-to-moderate with a minor risk of developing an AUD, then a period without alcohol will do absolutely no harm. You’ll get a first-hand reminder of how much social activity in our culture revolves around alcohol and alcohol-related activities. Second, if you do have an AUD, a yes answer to these questions can be the impetus you need to get sober and live a life without the pain and suffering associated with substance abuse. This article addresses questions which necessarily follow the yes answers. It defines and discusses the different types of alcohol use, the risk factors for developing an AUD, the health complications caused by excessive drinking, and the dangers of attempting to detox from alcohol without professional guidance and monitoring.
What is an Alcohol Use Disorder?
The fifth edition of the American Psychological Association’s authoritative publication, the Diagnostic and Statistical Manual (DSM-V), is the gold-standard reference handbook used by mental health professionals to diagnose and classify mental health and substance abuse disorders. The DSM-V identifies the presence of an AUD by posing the following eleven questions to a patient: In the past year, have you…
- Had times when you ended up drinking more, or longer, than you intended?
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
- Spent a lot of time drinking, or being sick and getting over the after-effects of drinking?
- Wanted a drink so badly you couldn’t think of anything else?
- Found that drinking, or being sick from drinking, often interfered with taking care of your home or family, cause job-related troubles, or problems with school?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
- More than once gotten into situations while or after drinking that increased your chances of getting hurt?
- Continued to drink even after a memory blackout, and even though it was making you feel depressed or anxious or adding to another health problem?
- 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 heart, sensing things that were not there, or seizures?
Positive answers (yes) to two or more of these questions indicates the presence of an AUD. The DSM-V further clarifies the scope of the AUD by identifying three categories, or levels of severity:
- Mild: positive answers to two or three of the diagnostic questions.
- Moderate: positive answers to four or five of the diagnostic questions.
- Severe: positive answers to six or more of the diagnostic questions.
The DSM-V, published in 2013, alters the diagnostic criteria from those presented in the DSM-IV, published in 1994 and revised in 2000. The DSM-V eliminates two distinct diagnoses – alcohol abuse and alcohol dependence – and replaces them with the single diagnosis, Alcohol Use Disorder, which is then divided into mild, moderate, and severe sub-classifications.
Common Levels of Alcohol Use
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) offer easy-to-understand definitions of alcohol consumption and how different levels of consumption affect general health and wellness. If you’re unsure where you fall on the continuum, use these guidelines to help understand your level of use:
- Moderate Alcohol Consumption is defined as drinking up to one drink a day for women and two drinks a day for men.
- Binge Drinking is defined as drinking five or more drinks for men and four or more drinks for women in a two-hour period on at least one day over the course of one month.
- Heavy Alcohol Consumption is defined as binge drinking on five or more days over the course of one month.
These definitions are straightforward and align with what most people know through direct personal experience or typical social contact. Moderate consumption is synonymous with the default notion of responsible, social drinking; binge drinking largely occurs during college years or early adulthood; heavy drinking is what happens when consumption gets out of hand and becomes a relatively obvious problem. Clear as these delineations may be, they beg another question: “What constitutes one drink?” This is important to understand, because serving sizes and alcohol content vary depending on a variety of factors. Drinking at a bar or restaurant is not the same as drinking at a private party, and the amount of alcohol in a drink depends on the drink in question: beer, malt liquor, wine, and distilled spirits all contain different percentages of alcohol. Here’s how the NIAAA defines a standard drink:
- 12 ounces of beer containing around 5% alcohol. Think of a regular can of beer.
- 8-9 ounces of malt liquor containing around 7% alcohol. Think of a pint glass around half-full.
- 5 ounces of wine containing around 12% alcohol. Think of a regular glass of wine you might get with dinner at a restaurant.
- 5 ounces of distilled spirits (liquor like vodka, whiskey, gin, or tequila) containing around 40% alcohol (80 proof). Think of a regular-sized shot glass.
Are You at Risk of Developing an Alcohol Use Disorder?
Based on the figures above, the NIAA defines low-risk drinking as:
- Less than three drinks a day and seven drinks a week for women.
- Less than four drinks a day and fourteen drinks a week for men.
NIAA research shows that only around two percent of people who drink within these limits – i.e. low-to-moderate drinkers – develop an AUD. Consumption above these levels increases the chance of developing an AUD. The 2015 SAMHSA Survey on Drug Use and Health estimates that 15.1 million adults and 623,000 adolescents have crossed the threshold and developed alcohol use disorders. The same survey reveals another disturbing fact: of those 15.1 million adults and 623,000 adolescents, less than 10% receive professional treatment in a specialized substance abuse facility. If you fall into the at-risk category, it may be time to consider treatment options – but before you follow through on the decision to quit drinking and seek help, it’s important to understand both the health risks of drinking and the dangers of detoxing without the assistance of a qualified substance abuse professional.
Health Risks of Alcohol Abuse: The Big Picture
The Centers for Disease Control (CDC) report that alcohol is the fourth leading cause of preventable death in the United States, accounting for around 88,000 fatalities per year. A study published by the American Journal of Preventive Medicine estimates the economic burden of excessive alcohol use at $249 billion for the year 2010. Data from The World Health Organization indicates that alcohol consumption contributes to around 3.3 million deaths per year – roughly 6% of all global fatalities.
Alcohol and The Human Body
Ongoing patterns of excessive alcohol consumption have significant negative health consequences. Heavy consumption over a long period of time can damage the brain, the heart, the liver, and the pancreas. This NIAAA list details the effect of alcohol on each organ: Brain: Heavy alcohol consumption disrupts key chemical communication pathways – called neurotransmitter systems – such as GABA, glutamate, serotonin, and dopamine. This disruption can affect cognitive function, mood, behavior, hormone regulation, and movement. Heart: Heavy alcohol consumption can contribute to problems that lead to hypertension, stroke, arrhythmia, and cardiomyopathy. Liver: Heavy alcohol consumption leads to pathologies such as cirrhosis, fibrosis, alcoholic hepatitis, and steatosis. Pancreas: Heavy alcohol consumption results in the production of toxic chemicals that can lead to pancreatitis. Long-term heavy alcohol consumption also compromises the immune system, making it easier to succumb to diseases like tuberculosis and pneumonia, and elevates the risk of developing cancers of the mouth, esophagus, throat, liver, and breast.
Acute Alcohol Withdrawal Syndrome (AW)
The human body is an incredibly adaptive and resilient group of complex and complementary physiological systems. One characteristic of the body is its ability to achieve homeostasis – a.k.a. balance – in the face of extreme stress, the presence of harmful toxins, and despite the self-destructive behaviors common to humans, some of which persist for decades before damage disrupts day-to-day living. With regards to long-term exposure to alcohol due to chronic heavy drinking, the body adjusts over time and finds a way to keep functioning. When alcohol is abruptly removed from the system, however, the body does not have time to adapt, and things can turn very bad very quickly. In 1998, a group of physicians on the faculty of Yale University published the article “Complications of Alcohol Withdrawal” which describes the dangers of acute alcohol withdrawal in no uncertain terms: “Disease process or events that accompany acute alcohol withdrawal (AW) can cause significant illness and death. Some patients experience seizures, which may increase in severity with subsequent AW episodes. Another potential AW complication is delirium tremens, characterized by hallucinations, mental confusion, and disorientation. Cognitive impairment and delirium may lead to chronic memory disorder (i.e. Wernicke-Korsakoff Syndrome). Psychiatric problems associated with withdrawal include anxiety, depression, and sleep disturbance. In addition, alterations in physiology, mood, and behavior may persist after acute withdrawal has subsided, motivating relapse to heavy drinking.” In plain language, this means alcohol detox can kill, cause brain damage, and lead to extreme psychiatric disorders. Further, the likelihood of these negative effects increases with each withdrawal episode and may lead to relapse. The onset AW symptoms can occur as quickly as six hours after the cessation of alcohol consumption. For some, mild tremors, anxiety, nausea, and insomnia form the totality of AW and can resolve untreated after several days. In approximately 10% of cases, severe AW includes seizures, delirium tremens (DTs), Wernicke’s Encephalopathy (WE), Wernicke’s-Korsakoff Syndrome (WKS), and “disturbances of thought, mood, and perception.” Among patients who experience DTs, the mortality rate is 5-25%. Among those who develop WE/WKS, approximately 80% experience permanent brain damage resulting in chronic amnesia and the inability to learn new information.
Medically Assisted Alcohol Detox
This article began by claiming that the question of whether to quit drinking alcohol or not is a serious one. The potential complications associated with alcohol withdrawal discussed above underscore the gravity of the question and all it implies. Most people, even those in recovery, don’t know that alcohol detox is more dangerous and has more severe complications than detox from almost all other drugs of abuse, including opiates, narcotics, benzodiazepines, and amphetamines. Detox from heroin, for example, can be extremely uncomfortable, but it won’t kill you, whereas detox from alcohol most certainly can. It doesn’t have to, though. It’s possible to avoid the life-threatening complications of alcohol detox by consulting a medical professional with specific experience in addiction and medically-assisted detox protocols. A qualified physician can formulate a safe detox plan and prescribe medications to prevent seizures, DTs, and alleviate the psychological and psychiatric side-effects of withdrawal. Medically assisted detox can also successfully treat Wernicke’s Encephalopathy and prevent the onset of Wernicke’s-Korsakoff Syndrome.
Alcohol Detox at Summit Estate
You can detox from alcohol without suffering permanent brain damage or killing yourself – but you should not try it alone. Summit Estate offers custom-designed, individual detox programs managed by highly skilled substance abuse and addiction experts. State-of-the-art luxury facilities, peaceful surroundings, and healthy, delicious food keep you as comfortable as possible while on-site staff monitor your vital signs and self-reported symptoms to mitigate health risks, ensure the efficacy of the detox protocol, and create a solid foundation for sustainable, life-long recovery.