Whether it be happy hour with co-workers, grabbing drinks with friends on the weekend, or a glass of wine with dinner—drinking alcohol from time to time is generally considered pretty normal and pretty OK. But with more research on the adverse effects of even just one drink of alcohol and the widespread normalization of excessive drinking, where that line is between “healthy” alcohol use and what constitutes a cause for concern can feel fuzzy.
First and most important, remember that normalized ≠ normal or healthy. So, if throughout this blog you notice yourself minimizing the significance of some behaviors considered concerning; I urge you to reflect on why and what it would mean to you if these identified behaviors truly were cause for concern.
Risky alcohol consumption is often most normalized and at its highest among young adults. Research shows that young adults, specifically those between the ages of 18-34 years old, most commonly engage in binge drinking behavior (CDC, 2022). Binge drinking is a chain of the behavior of alcohol consumption that brings an individual’s blood alcohol level to 0.08% or above; on average, this amounts to ~5 drinks for men or ~4 drinks for women on one occasion, usually within about two hours.
Binge drinking is considered the most common pattern of excessive alcohol use in the US, with “excessive alcohol use” being an umbrella term for any alcohol consumption that is cause for concern (CDC, 2022). Repeatedly binge drinking (i.e., on five or more occasions in the last 30 days) (SAMHSA, 2021) or consuming 15 or more drinks in one week for men/8 or more drinks in one week for women (CDC, 2022) is considered heavy alcohol use.
Why Young Adults?
When considering why excessive drinking is highest among young adults, it’s helpful first to consider the fact that, for many, their first exposure to substance use (primarily alcohol, cannabis, and nicotine) occurs before they have graduated high school. Although youth consume less alcohol than adults when they do drink, they drink more: 90% of the alcohol consumed by adolescents is consumed while binge drinking (NIAAA, 2022).
Though it becomes more common as adolescents age, most do not engage in alcohol use. However, when asked, most adolescents (wrongly) presume that most of their peers are drinking alcohol. This statistic is worth noting because it indicates how early the normalization of unhealthy alcohol use begins and how much peer pressure people may feel about drinking starting at a young age.
We may also consider the culture of substance use on college campuses throughout the US. While some college students may enter college with pre-established drinking patterns from early exposure to alcohol use, the culture of college also plays a significant role in shaping many students’ relationships with alcohol. According to a national survey, in the past month, nearly 53% of full-time college students drank alcohol, and 33% engaged in binge drinking during the same time frame (SAMHSA, 2019). Additional factors, such as belonging to various social groups (sororities, fraternities, sports teams), are correlated with an even higher rate of alcohol use and binge drinking (McCabe et al., 2018).
Ramifications of Excessive Alcohol Use
Now, engaging in excessive alcohol use does not necessarily mean one has an alcohol use disorder (AUD); in fact, most people who drink excessively do not meet the criteria for AUD. However, the absence of AUD does not absolve one from the health risks associated with the overconsumption of alcohol. Over time, excessive alcohol use increases one’s risk for numerous health issues, including liver diseases, heart diseases, various cancers, and more.
Excessive alcohol use is also correlated with effects on one’s mental health, though this is a bit of a two-way street. Our thoughts, feelings, actions, and moods are heavily influenced by a delicate balance of chemicals in our brains that any amount of alcohol will disrupt. In the short term, people often report feeling more confident, relaxed, and less anxious after a drink or two; however, once the alcohol has worn off and as the brain is trying to regain this delicate balance of chemicals, people may feel more anxious and more depressed than their baseline mood. The more we drink, the more impact alcohol has on our brain functioning and the higher the likelihood that our mental health will experience long-term negative effects.
In some instances, someone already struggling with their mental health may reach for alcohol to help alleviate the distressing symptoms associated with, for example, anxiety or depression. This immediate gratification is enough to keep someone returning for more; however, relying on alcohol exacerbates the issue once the intoxication wears off. It can lead to increased reliance on—and tolerance to—alcohol for relief of negative thoughts and feelings and a dangerous dependence on alcohol.
Signs of Alcohol Use Disorder
The extensive normalization of excessive alcohol use can make it difficult to spot the beginnings of an AUD. An AUD, sometimes colloquially referred to as alcoholism, is classified by an inability to stop or control problematic patterns of alcohol consumption despite adverse social, occupational, or health consequences and may be identified as mild, moderate, or severe depending on the number of symptoms—outlined in the DSM-5—present.
Like any mental health disorder or medical condition, certain risk factors increase one’s likelihood of developing AUD. Prolonged patterns of excessive alcohol use, drinking for the first time at a young age (15 years or younger), the presence of other mental health disorders or a history of trauma, and a family history of alcohol issues are all risk factors associated with AUD.
Spotting early-stage AUD can be tricky as it may be impossible to discern from social or occasional drinking that is excessive and risky, putting loved ones and mental health providers at a disadvantage for intervening early. However, there are some signs of being on the lookout for if you’re concerned that a friend or loved one may be struggling with AUD, including:
- Drinking alone or in secrecy
- Drinking excessively despite known negative social, occupational, or health consequences
- Making excuses to drink (e.g., to relax, manage stress or anxiety, etc.) or craving alcohol more often
- Becoming emotionally withdrawn and isolated from friends and family
- Choosing to drink instead of attending to responsibilities or other obligations
- Deciding to drink instead of spending time engaging in other hobbies
- Drinking more or for longer than initially planned
- Vowing to cut back or quit drinking without successful follow-through
- Developing an increased tolerance for alcohol
It is also worth mentioning that denial, defensiveness, minimization of consequences, and secrecy of concerning behavior are common among those struggling with AUD.
It can be incredibly nerve-racking to notice signs of alcohol use disorder in a friend or loved one, and navigating the next steps can be confusing. If you feel comfortable, it’s encouraged to have a conversation with your friend or loved one about your concerns. There’s no “perfect” way to have this sort of conversation, and it’s OK if it feels awkward or uncomfortable. Focus on conveying your support and the urgency of seeking help from a mental health professional.
Ultimately, having this conversation is about as much as you can do to help a friend or loved one you’re worried about. Whether or not your message is heard depends on their willingness to hear it, and it is not your reasonability to ensure they receive treatment. Fortunately and unfortunately, people will only accept and respond to help if they want it—others cannot want it more than they do. Being a supportive figure is no easy feat and can leave you feeling powerless and heartbroken, so it’s important to consider what kind of support you may need.
Regardless of if you’re noticing early signs of AUD in yourself or in someone you know, if you find yourself feeling overwhelmed, uncertain, or in need of extra support for any reason, reaching out to a mental health professional is an essential first step in navigating whatever you’re going through.