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How would you know if a friend or family member had a drinking problem? Because consuming alcohol is a significant part of our culture, it can be hard to recognize the warning signs of a substance use disorder (the diagnostic term for alcoholism). For many friends, it’s considered fairly normal (and celebrated) to go out and drink with the intention of getting drunk on a regular basis. Remember the movie The Hangover?

In my practice as a therapist, I’ve noticed that the line between having fun and having a substance use disorder can be unclear for most. But when alcoholism is the third leading lifestyle-related cause of death in the U.S., it becomes a problem that deserves our attention. April is Alcohol Awareness Month, and its purpose is to raise awareness of the damaging effects of alcohol abuse.

Before taking my substance abuse class in graduate school, my primary exposure to its debilitating effects were limited to what I saw on TV and in movies (think Deacon from ABC’s Nashville). My perspective changed significantly when my class was required to attend a series of Alcoholics Anonymous and Narcotics Anonymous meetings as a supplement to our lectures. It was only then that I realized how much people with a substance use disorder struggle on a daily basis. Here are some of the most surprising things I learned.

There Is Such a Thing as a ‘Standard Drink’

What we might think of as a “normal drink” often contains much more alcohol than what the official definition describes as “standard.” Someone might say they had two drinks last night, but “two drinks” can mean many different things. Two glasses of wine are very different from two glasses of Long Island Iced Tea. The amount of alcohol that is considered a “standard drink” is 14 grams of pure alcohol. That’s 12 fluid ounces of regular beer, 8 to 9 fluid ounces of malt liquor, 5 fluid ounces of wine, or 1.5 fluid ounces of a shot, according to The National Institute on Alcohol Abuse and Alcoholism. So that one shot from the bar last night or that one glass of wine may have really been more than one “standard drink.”

These discrepancies mean that some people underestimate the amount of alcohol they consume. As a result, they may not recognize that their drinking patterns put them in the high-risk category for developing an alcohol use disorder.

Low-risk drinking is defined as having three or less drinks in one day and no more than seven drinks total in a week for women and no more than four drinks in one day and no more than fourteen drinks in one week for men, according to the National Institute on Alcohol Abuse and Alcoholism.

Substance Abuse Is More Prevalent Than We Think

Social drinking is a common part of American society. In a Gallup poll, 26 percent of respondents said they sometimes drink more than they should. And for some, drinking more than they should can mean drinking much more. Ten percent of American adults consume an average of ten drinks a day, according to a study based on the data from National Epidemiologic Survey on Alcohol and Related Conditions. For perspective, the Substance Abuse and Mental Health Service Administration defines binge drinking as five or more drinks on the same occasion at least once in a thirty-day period.

For women, the CDC lowers that number to four. The CDC defines “heavy drinking” as consuming eight or more drinks per week for a woman and fifteen or more drinks per week for a man. So, under the CDC’s definition, the 10 percent of Americans who drink an average of ten drinks a day easily qualify as heavy drinkers. A recent study published in JAMA Psychiatry journal found that 13.9 percent of American adults have had an alcohol use disorder in the past twelve months, and 29.1 percent reported having one at some point in their life.

It Doesn’t Discriminate

One eye-opening realization I had after attending several AA meetings was that the attendees were from different socioeconomic statuses, cultures, ages, and stages in their journey towards sobriety. There were AA meetings all over the area for specific demographics including church-based groups and groups specifically for women, to name a few.

At each meeting, all the attendees, despite their differences, were united in their quest to achieve and maintain sobriety. In one NA meeting I attended, a young woman who had just completed an inpatient program for heroin addiction listened as an older woman shared her story of drug addiction and offered encouragement. Witnessing their support for one another left me with a deep respect for their courage and resilience.

Social Drinking Makes It Difficult to Stay Sober

Social gatherings often involve consuming alcohol: champagne toasts at weddings, half-price drinks at happy hours with co-workers, a glass of wine during a dinner date, bottomless mimosas at brunch, and beer at the football game. For some, even work requires them to be around alcohol. Take Del Pedro, for instance, the fifteen-years sober bartender profiled by The New York Times. This makes those struggling with alcohol substance use disorder more susceptible to a relapse.

AA members often spoke about how challenging it is to avoid the opportunity to drink. Deciding to stay sober can feel like choosing between spending time with friends or isolating yourself to avoid consuming alcohol. If you have a friend or family member who is trying to avoid alcohol, ask them how you can best support them. Be mindful of their needs when planning and inviting them to social events. In a culture where it is difficult to avoid social drinking, they will appreciate your thoughtfulness and support.

There Are Many Ways We Can Help

Alcohol Awareness Month doesn’t mean that we have to orchestrate an Intervention-style confrontation with a friend or family member whom we suspect has a substance use disorder. It means sharing the warning signs that a person’s alcohol use has moved into the unhealthy range.

Warning signs include depending on alcohol to boost your mood, experiencing unpleasant symptoms when they stop drinking, temporary blackouts or memory loss, and drinking alone. The National Council on Alcohol and Drug Dependence’s website contains a detailed list.

This month, check in with loved ones who are recovering from a substance abuse disorder and ask how you can support them. Finally, know what resources to direct someone to if they think they are abusing alcohol. Alcoholics Anonymous (and AlAnon for individuals who have someone in their life with a substance use disorder) is a resource that many people find extremely helpful, though its effectiveness is challenged by some. Many individuals find behavioral therapy to be helpful, and there are several prescription medications that can help curb the urge to drink.

We can each play a vital role in the life of someone who is facing the reality of a substance use disorder. All it takes is offering to listen to and support them. If they are open to them, we’ll be ready with resources to aid in their recovery rather than allowing them to struggle alone.

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