Kaerensa Craft, LCSW, PSYCHOTHERAPY

Are you drinking more than you think? A full wine glass or a pint of beer usually comes out to more than a single standard serving of alcohol, and cocktails often contain 2-3 servings, sometimes more. This Standard Drink Conversion and Standard Drinks can help you determine how many drinks you are actually consuming.

Blood Alcohol Concentration (“BAC”), also referred to as Blood Alcohol Level (“BAL”), represents the percent of your blood that is concentrated with alcohol during a drinking episode. A BAC of .10 means that 0.1% of your bloodstream is composed of alcohol.

Many factors affect your BAC when you drink. Some of these include your size, gender and physical condition; what you have had to eat; how much sleep you have had; what medications you are taking and, especially important, how much alcohol you consume over what period of time. BAC provides a rough measure of mental, emotional, behavioral, and physical impairment from alcohol consumption. Read about the progressive effects of elevated BAC, estimate your BAC over 1-6 hours, or use this online tool to calculate your BAC based on your gender, weight, drinking time, and amount and type of alcohol.

Moderated drinking, also referred to as Moderate Drinking or Moderation, refers to limiting the number of drinks to fall within the prescribed guidelines by the National Institute on Alcohol Abuse and Alcoholism (a division of the National Institute of Health). For men, the recommendation is up to 2 drinks per day, and for women, 1. However, it is still considered relatively safe for men to consume up to 14 drinks in a week, though no more than 4 drinks in a day; and for women, as well as adults 65 years or older, up to 7 drinks in a week, and no more than 3 in a day.

The CAGE Questionnaire is a brief assessment instrument used in many primary care settings to initially identify problem drinking. Answering “Yes” to any of the questions is an indication of alcohol problems. “Yes” to 2 or more questions is considered clinically significant.

• Have you ever felt that you should Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking?
• Have you ever felt bad or Guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (“Eye opener”)?

(Developed by Dr. John Ewing, founding Director of the Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill.)

The Alcohol Use Disorders Identification Test (AUDIT) is a very reliable and simple screening tool developed by the Department of Mental Health and Substance Dependence of the World Health Organization.

The AUDIT is sensitive to early detection of risky and high risk (or hazardous and harmful) drinking. It has three questions on alcohol consumption (1 to 3), three questions on drinking behavior and dependence (4 to 6) and four questions on the consequences or problems related to drinking (7 to 10).

Several factors can determine which goal will be more appropriate for you, including your history of drinking and treatment, the consequences associated with your drinking​, and your history of success with behavioral change. Probably the easiest place to start is to just see if you can reduce your drinking on your own, perhaps trying to use some of the tips and strategies suggested below. If you give it a try and run into trouble, you may benefit from an assessment and some initial sessions to discuss your motivations for wanting to change and to identify strategies that can help. If you continue to have difficulties, additional treatment and/or a commitment to abstinence may be indicated.

There are a number of behavioral strategies that can help you with reducing your drinking. Troubleshooting with your therapist can help you tailor the strategies to your particular situations for more effective results. Additionally, medications are available to help in the process of drinking less or abstaining altogether.

The Short Alcohol Dependence Data (SADD) Questionnaire was designed to assess alcohol dependence among patients seeking help with alcohol problems. It is commonly used with male and female clients of substance abuse treatment programs, although some studies also have used the SADD with nonclinical patient samples.

The Diagnostic and Statistical Manual (DSM-5), recognized by the medical community and insurance companies, lists 11 criteria for a diagnosis of Alcohol Use Disorder. Meeting 2 of the 11 criteria during the same 12-month period qualifies for a diagnosis of Alcohol Use Disorder. The severity—mild, moderate, or severe, is based on the number of criteria met. For information about the Diagnostic and statistical Manual (DSM-5), click here.

Film and television have routinely portrayed characters with drinking problems so severe as to warrant an in-patient stay at a 28-day rehab, or immersion in Alcoholics Anonymousand a lifelong commitment to abstinence—or both. In reality, there are several different levels of treatment, depending on the severity of the drinking problem. Click here to learn about the different levels of care available

Alcohol Treatment and Medications

Alcohol withdrawal syndrome is a potentially life-threatening condition that can occur in people who have been drinking heavily for weeks, months, or years, and then either stop abruptly or significantly and rapidly reduce their alcohol consumption.

Withdrawal symptoms can begin as early as two hours after the last drink, persist for weeks, and range from mild anxiety and shakiness to severe complications, such as seizures and delirium tremens (also called DTs). The death rate from DTs—characterized by confusion, rapid heartbeat, and fever—is estimated to range from 1% to 5%.

Because withdrawal symptoms can rapidly worsen, it's important to seek medical attention even if symptoms are seemingly mild. Appropriate alcohol withdrawal treatments can reduce the risk of developing withdrawal seizures or DTs.

It's especially important to see a doctor if you've experienced previous alcohol withdrawal episodes or if you have other health conditions such as infections, heart disease, lung disease, or a history of seizures.

Severe alcohol withdrawal symptoms are a medical emergency. If seizures, fever, severe confusion, hallucinations, or irregular heartbeats occur, either go to an emergency room or call 911.

Heavy, prolonged drinking—especially excessive daily drinking—disrupts the brain's neurotransmitters, the brain chemicals that transmit messages.

For example, alcohol initially enhances the effect of GABA, the neurotransmitter which produces feelings of relaxation and calm. But chronic alcohol consumption eventually suppresses GABA activity so that more and more alcohol is required to produce the desired effects, a phenomenon known as tolerance.

Chronic alcohol consumption also suppresses the activity of glutamate, the neurotransmitter which produces feelings of excitability. To maintain equilibrium, the glutamate system responds by functioning at a far higher level than it does in moderate drinkers and nondrinkers.

When heavy drinkers suddenly stop or significantly reduce their alcohol consumption, the neurotransmitters previously suppressed by alcohol are no longer suppressed. They rebound, resulting in a phenomenon known as brain hyperexcitability. So, the effects associated with alcohol withdrawal—anxiety, irritability, agitation, tremors, seizures, and DTs—are the opposite of those associated with alcohol consumption.

In general, how severe alcohol withdrawal symptoms become depends on how much and for how long a person has been drinking.

Minor alcohol withdrawal symptoms often appear 6 to 12 hours after a person stops drinking. Sometimes a person will still have a measurable blood alcohol level when symptoms start. These symptoms include:

• Shaky hands
• Sweating
• Mild Anxiety
• Nausea
• Vomiting
• Headache
• Insomnia

Between 12 and 24 hours after they stop drinking, some patients may experience visual, auditory, or tactile hallucinations. These usually end within 48 hours. Although this condition is called alcoholic hallucinosis, it's not the same as the hallucinations associated with DTs. Most patients are aware that the unusual sensations aren't real.

Withdrawal seizures usually first strike between 24 and 48 hours after someone stops drinking, although they can appear as early as 2 hours after drinking stops. The risk of seizures is especially high in patients who previously have undergone multiple detoxifications.

DTs usually begin between 48 and 72 hours after drinking has stopped, Risk factors for DTs include a history of withdrawal seizures or DTs, acute medical illness, abnormal liver function, and older age. Symptoms of DTs, which usually peak at 5 days, include:

• Disorientation, confusion, and severe anxiety
• Hallucinations (primarily visual) which cannot be distinguished from reality
• Profuse sweating
• Seizures
• High blood pressure
• Racing and irregular heartbeat
• Severe tremors
• Low-grade fever

If you have mild to moderate withdrawal symptoms, your doctor may prefer to treat you in an outpatient setting, especially if you have supportive family and friends. Outpatient detoxification is safe, effective, and less costly than inpatient detoxification at a hospital or other facility.

However, you may require inpatient treatment if you don't have a reliable social network, are pregnant, or have a history of any of the following:

• Severe withdrawal symptoms
• Withdrawal seizures or DTs
• Multiple previous detoxifications
• Certain medical or psychiatric illnesses

The goals of treatment are threefold: reducing immediate withdrawal symptoms, preventing complications, and beginning long-term therapy to promote alcohol abstinence.

Prescription drugs of choice for treating withdrawal include benzodiazepines, such as diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), and oxazepam (Serax). Such medications can help control the shakiness, anxiety, and confusion associated with alcohol withdrawal and reduce the risk of withdrawal seizures and DTs. In patients with mild to moderate symptoms, the anticonvulsant drug carbamazepine (Tegretol) may be an effective alternative to benzodiazepines, because it is not sedating and has low potential for abuse.

Because successful treatment of alcohol withdrawal syndrome doesn't address the underlying disorder of addiction, it should be followed by treatment for alcohol abuse or alcohol dependence.

Relatively brief outpatient interventions can be effective, but more intensive therapy may be required. Additionally, other medications may be prescribed to help you stop drinking or to maintain abstinence. (If you have experienced Alcohol Withdrawal Syndrome, or have undergone detoxification treatment, a goal of abstinence is recommended. However, medication assisted treatment can also be helpful when the goal is moderate drinking.) A self-help group, such as Alcoholics Anonymous or SMART Recovery, or a comprehensive treatment program offering a combination of a 12-step model, cognitive-behavioral therapy, and family therapy may be recommended.