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Signs and Symptoms of Alcoholism

Signs of alcoholism can be behavioral or physical. Drinking alone, hiding or lying about drinking, prioritizing drinking over responsibilities, blacking out, sleep disorders and tremors are only a sample of the many signs of an alcohol use disorder.
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Alcoholism is on the rise in America. One in eight adults in America struggles with alcohol addictiona chronic disease characterized by lack of control of over one’s drinking, a preoccupation with alcohol and continued drinking despite adverse consequences.

Despite its prevalence, alcoholism often goes undiagnosed and untreated.

Many individuals with alcoholism are in denial or unaware that they have a problem. Others may realize something is wrong but go to great lengths to hide their problem out of fear or shame. Family and friends can also fail to see the warning signs.

While alcoholism is a complex disease and diagnosing it isn’t an exact science, several signs and symptoms can indicate when your drinking has crossed the line into addiction.

Behavioral Signs of Alcoholism

Because alcoholism rewires the brain and affects a person’s mood, thinking and behaviors, it’s classified as a mental illness. Thus, many of the hallmark signs of alcoholism involve changes in behavior.

Common behavioral signs of alcoholism:

Loss of Control
Regularly drinking more than you had planned to or for longer than you’d intended and not being able to quit or cut down on your drinking even when you want to.
Risk-Taking
Getting into potentially dangerous situations while drinking that could result in injury, such as driving under the influence or having unsafe sex while intoxicated.
Prioritizing Drinking
Spending a lot of time drinking or recovering from drinking and finding that alcohol is taking precedence over other things in your life.
Neglecting Responsibilities and Activities
Allowing drinking to interfere with work, school or family obligations. This might include missing work or school or performing poorly at your job because of hangovers or intoxication.
Continuing to Drink Despite Negative Consequences
Continuing to drink even though alcohol is causing problems at work, harming your relationships or negatively impacting your health.

Source: National Institute on Alcohol Abuse and Alcoholism

Other red flags for alcoholism can include:

  • Hiding or lying about your drinking
  • Getting arrested or getting into legal trouble because of drinking-related behavior
  • Making excuses for drinking
  • Drinking at odd times of the day
  • Drinking alone
  • Feeling bad or guilty about your drinking
  • Drinking first thing in the morning
  • Feeling like you should cut down on your drinking
  • Feeling like you need a drink to get through the day
  • Noticing others making comments about your drinking
  • Worrying about having enough alcohol for an evening or weekend
  • Feeling annoyed when others criticize your drinking

Heavy drinking in and of itself doesn’t make someone an alcoholic. In fact, an estimated 40 million adults in America drink too much, and most — 90 percent — are not alcoholics.

That said, regular heavy drinking is an important warning sign for alcohol addiction, according to addiction experts at the National Institute of Alcohol Abuse and Alcoholism. Heavy drinking in conjunction with other behaviors can also signal a problem.

Physical Symptoms of Alcohol Addiction

When alcoholism is severe, an individual may develop a physical dependence on the drug.

Symptoms of dependence include becoming tolerant to some of alcohol’s effects and experiencing withdrawal symptoms when alcohol is not consumed. A person who is physically dependent on alcohol may also experience cravings — an intense need or desire to drink.

 

Dr. Kevin Wandler of Advanced Recovery Systems describes how tolerance and withdrawal symptoms are indicators of alcohol dependence.

Tolerance symptoms include a need to drink more than you once did to achieve the desired level of intoxication. People experiencing this phenomenon might even switch up their drink of choice — moving from beer or wine to hard liquor, for example, to accommodate their need for more alcohol.

Not everyone with an alcohol use disorder develops a physical dependence to alcohol, but people may exhibit other physical symptoms. Because long-term heavy alcohol use can damage almost every organ in the body, a person with an alcohol use disorder can develop an array of alcohol-related diseases and disorders that cause many symptoms.

Common physical symptoms of an alcohol use disorder:

  • Experiencing repeated blackouts (episodes of drinking where you don’t remember what happened)
  • Mood swings, depression, anxiety or panic attacks
  • Sleeping problems or insomnia
  • Headaches
  • Gastrointestinal problems (upset stomach, diarrhea, abdominal pain, bloating, nausea, vomiting or vomiting blood)
  • Itching (related to alcohol-induced liver damage)
  • Erectile dysfunction
  • Appetite changes
  • Falls, dizziness or poor balance
  • Burning, tingling or numbness in the arms, legs or feet
  • Chronic fatigue
  • Difficulty concentrating
  • Memory loss

Needing a drink first thing in the morning — or even in the middle of the night — to stave off nausea or stop the shakes are signs of dependence and withdrawal. Typical alcohol withdrawal symptoms include sweating, shaking, nausea, anxiety and insomnia. In severe cases, a person may develop delirium tremens, a potentially life-threatening condition that causes hallucinations, confusion, seizures and psychosis.

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Visible Signs of Alcoholism

While symptoms are things that we feel or experience, signs are external clues that can signal to others there’s a potential problem.

Alcoholism can be difficult to detect from the outside, particularly early in the course of the disease. But as it progresses, the disease has an array of effects on the body, and a number of physical signs may become apparent.

Physical signs of alcoholism can include:

  • Broken capillaries on the nose and face (red splotches or obvious small red veins)
  • Bloodshot eyes
  • Jaundice (yellow discoloration of the eyes and skin from alcohol-related liver damage)
  • Reddening of palms of the hands
  • Frequent smell of alcohol on the breath
  • Tremors or an unsteady gait
  • Notable weight loss or weight gain
  • Flushed appearance

People who are addicted to alcohol may also show a deteriorating physical appearance from poor nutrition and personal neglect.

Laboratory Tests as Indicators

While there’s no specific blood test that can diagnose an alcohol use disorder, certain lab results can point to chronic alcohol abuse and possible alcohol addiction.

Elevated Liver Enzymes

Your doctor can see how well your liver is functioning by testing the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Eighty percent of patients with alcoholic liver disease have elevated liver functions and an AST that is double their ALT level. Elevated levels of gamma-glutamyltransferase (GGT) can also indicate excessive alcohol consumption.

Anemia (Low Red Blood Cell Count)

Alcoholics often have defective red blood cells that die prematurely, which can cause a lower-than-normal red blood cell count. Gastrointestinal bleeding, a symptom some alcoholics experience, can also cause anemia, as can iron deficiency.

Thrombocytopenia (Low Platelet Levels)

Between 3 and 43 percent of alcoholics suffer from thrombocytopenia, a low level of platelets in the blood. Low platelet counts affect the body’s ability to make clots to stop bleeding.

High Levels of Carbohydrate-Deficient Transferrin (CDT)

High levels of a protein in the blood called CDT are associated with recent, prolonged and heavy alcohol use. Combined with elevated GGT levels, high CDT readings have an 85 to 90 percent accuracy for indicating alcoholism.

Elevated Mean Corpuscular Volume (MCV)

MCV is the average concentration of hemoglobin in a red blood cell. After a month or two of excessive drinking, MCV levels rise. Elevated MCV is found in approximately 50 to 60 percent of chronic heavy drinkers. When people quit drinking, their MCV levels typically return to normal within two to four months. The combination of increased MCV levels and elevated GGT levels has a 90 percent sensitivity for detecting alcohol abuse, according to a study published in Current Psychiatry.

At the end of the day, the signs and symptoms of alcoholism may differ depending on the stage of alcoholism and the type of alcoholic. But a good indicator of an alcohol addiction is when something is “out of whack” in your life, according to Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism.

“Is your personal life deteriorating because of your drinking? Are people starting to shun you? If you’re feeling generally miserable, that’s a warning sign,” Koob remarked in an article on the National Institutes of Health’s website. “You don’t have to hit bottom. You’ll save yourself a lot of damage socially, professionally and probably in your own body if you attend to an alcohol problem a lot earlier.”

Author
Amy Keller, RN, BSN
Content Writer, DrugRehab.com
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.
@DrugRehabAmy
Editor
Joey Rosenberg
Joey Rosenberg,
Editor, DrugRehab.com
Medical Reviewer
Ashraf Ali
Psychiatrist, Los Angeles County Department of Mental Health

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