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How You Can Recognize Signs that You May be Abusing Alcohol

May 2000

If you are like many Americans, you may drink alcohol occasionally.

Or, like others, you may drink moderate amounts of alcohol on a more regular basis. If you are a woman or someone over the age of 65, this means that you have no more than one drink per day; if you are a man, this means that you have no more than two drinks per day.

Drinking at these levels is usually not associated with health risks and can help to prevent certain forms of heart disease. But did you know that even moderate drinking, under certain circumstances, is not risk-free? And that if you drink at more than moderate levels, you may be putting yourself at risk for serious problems with your health and problems with family, friends and coworkers?

This article explains some of the consequences of drinking that you may not have considered.


Interactions with Medications

Alcohol interacts negatively with more than 150 medications, including many of those commonly used to treat HIV.

Heavy use of alcohol over a sustained period of time can be destructive to the liver and negatively influence the effects of HIV medications. Didanosine can increase the risk of pancreatitis, which excludes Videx as a treatment option for heavy users of alcohol. Alcohol has also been shown to increase abacavir (Ziagen) levels and increase the risk of kidney stones in those taking Crixivan (indinavir).

Using alcohol can also change your behavior, resulting in missed doses of your medication. For example, alcohol may impair judgment by causing sleepiness after drinking and interfere with medication taking. To avoid returning home sleepy and forgetting to take your HIV meds, it is wise to take your meds before going out with friends.

If you drink alcohol and are taking antihistamines for a cold or allergy, the alcohol will increase the drowsiness that the medication alone can cause, making driving or operating machinery even more hazardous. And if you drink alcohol and are taking large doses of the pain killer acetaminophen, you risk seriously damaging your liver. If you are taking any over-the-counter or prescription medications, check with your doctor or pharmacist before drinking any amount of alcohol.

Interpersonal Problems

The more heavily you drink, the greater the potential for problems at home, at work, with friends, and even with strangers. These problems may include:
  • Arguments with or estrangement from your spouse and other family members;

  • Strained relationships with coworkers;

  • Absence from or lateness to work with increasing frequency;

  • Loss of employment due to decreased productivity; and

  • Violent behavior or being the victim of violence.

Drinking and Driving

It may surprise you to learn that you don't need to drink much alcohol before your ability to drive becomes impaired.

Certain driving skills -- such as steering a car while, at the same time, responding to changes in traffic -- can be impaired by blood alcohol concentrations (BACs) as low as 0.02 percent. (The BAC refers to the amount of alcohol in the blood.) A 160-pound man will have a BAC of about 0.04 percent one hour after consuming two 12-ounce beers or two other standard drinks on an empty stomach. And the more alcohol you consume, the more impaired your driving skills will be.

Although most states set the BAC limit for adults who drive after drinking at 0.08 to 0.10 percent, impairment of driving skills begins at much lower levels.

Alcohol-Related Birth Defects

If you are a pregnant woman or one who is trying to conceive, you can prevent alcohol-related birth defects by not drinking alcohol during your pregnancy.

Alcohol can cause a range of birth defects, the most serious being fetal alcohol syndrome (FAS). Children born with alcohol-related birth defects can have lifelong learning and behavioral problems. Those born with FAS have physical abnormalities, mental impairment, and behavioral problems.

How much alcohol it takes to cause alcohol-related birth defects is not known. Therefore, it is best not to drink any alcohol during this time.

Long-Term Health Problems

Some problems, like those mentioned above, can occur after drinking over a relatively short period of time. But other problems -- such as liver disease, heart disease, certain forms of cancer, and pancreatitis -- often develop more gradually and may become evident only after long-term heavy drinking.

Women may develop alcohol-related health problems after consuming less alcohol than men do over a shorter period of time. Because alcohol affects many organs in the body, long-term heavy drinking puts you at risk for developing serious health problems, some of which are described below.

Alcohol-Related Liver Disease

More than 2 million Americans suffer from alcohol-related liver disease.

Some drinkers develop alcoholic hepatitis, or inflammation of the liver, as a result of long-term heavy drinking. Symptoms include fever, jaundice (abnormal yellowing of the skin, eyeballs and urine), and abdominal pain. Alcoholic hepatitis can cause death if drinking continues. If drinking stops, this condition is often reversible.

About 10 to 20 percent of heavy drinkers develop alcoholic cirrhosis, or scarring of the liver. Alcoholic cirrhosis can cause death if drinking continues. Although cirrhosis is not reversible, if drinking stops, one's chances of survival improve considerably. If drinking stops, those with cirrhosis often feel better, and the functioning of their liver may improve. Although liver transplantation may be needed as a last resort, many people with cirrhosis who abstain from alcohol may never need liver transplantation. In addition, treatment for the complications of cirrhosis is available.

Heart Disease

Moderate drinking can have beneficial effects on the heart, especially among those at greatest risk for heart attacks, such as men over the age of 45 and women after menopause. But long-term heavy drinking increases the risk for high blood pressure, heart disease, and some kinds of stroke.


Long-term heavy drinking increases the risk of developing certain forms of cancer, especially cancer of the esophagus, mouth, throat and voice box. Women have a slightly increased risk of developing breast cancer if they drink two or more drinks per day. Drinking may also increase the risk for developing cancer of the colon and rectum.


The pancreas helps to regulate the body's blood sugar levels by producing insulin. The pancreas also has a role in digesting the food we eat. Long-term heavy drinking can lead to pancreatitis, or inflammation of the pancreas. This condition is associated with severe abdominal pain and weight loss, and can be fatal.

What is Alcohol Abuse?

Alcohol abuse differs from alcoholism (a disease characterized by craving, loss of control, physical dependence and tolerance) in that it does not include an extremely strong craving for alcohol, loss of control, or physical dependence.

Alcohol abuse is also less likely than alcoholism to include tolerance (the need for increasing amounts of alcohol to get "high"). Alcohol abuse is defined as a pattern of drinking that is accompanied by one or more of the following situations within a 12-month period:

  • Failure to fulfill major work, school or home responsibilities;

  • Drinking in situations that are physically dangerous, such as while driving a car or operating machinery;

  • Recurring alcohol-related legal problems, such as being arrested for driving under the influence of alcohol or for physically hurting someone while drunk; and

  • Continued drinking despite having ongoing relationship problems that are caused or worsened by the effects of alcohol.

While alcohol abuse is basically different from alcoholism, it is important to note that many effects of alcohol abuse are also experienced by alcoholics.

Help for Alcohol Abuse

If your health care provider determines that you are not alcohol-dependent but involved in a pattern of alcohol abuse, she or he can help you:
  • Examine the benefits of stopping an unhealthy drinking pattern.

  • Set a drinking goal for yourself. Some people choose to abstain from alcohol, while others prefer to limit the amount they drink.

  • Examine situations that trigger your unhealthy drinking patterns, and develop new ways of handling those situations so that you can maintain your drinking goal.

Some individuals who have stopped drinking after experiencing alcohol-related problems choose to attend Alcoholics Anonymous (AA) meetings for information and support, even though they have not been diagnosed as alcoholic. AA is a "worldwide fellowship of men and women who help each other to stay sober." While AA is generally recognized as an effective mutual help program for recovering alcoholics, not everyone responds to AA's style and message, and other recovery approaches are available. Even those who are helped by AA usually find that AA works best in combination with other elements of treatment, including counseling and medical care.

Do not give up! Most people do not cut down or give up drinking all at once. Just like a diet, it is not easy to change. That is OK. If you do not reach your goal the first time, try again. Remember, get support from people who care about you and want to help. Do not give up!

(Materials for this article were adopted from publications from the National Institute of Alcohol Abuse and Alcoholism.):

Al-Anon Family Group Headquarters
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617

Makes referrals to local Al-Anon groups, which are support groups for spouses and other significant adults in an alcoholic person's life. Also makes referrals to Alateen groups, which offer support to children of alcoholics.

Locations of Al-Anon or Alateen meetings worldwide can be obtained by calling 1-888-4AL-ANON between 8 a.m. and 6 p.m. (EST), Monday through Friday.

Free informational materials can be obtained by calling (800) 356-9996 (operating seven days per week, 24 hours per day).

If You or Someone You Know Needs Help

National Institute on Alcohol Abuse and Alcoholism
Scientific Communications Branch
6000 Executive Blvd., Suite 409
Bethesda, MD 20892-7003
(301) 443-3860

Alcoholics Anonymous (AA)
World Services
475 Riverside Drive, 11th Floor
New York, NY 10115
(212) 870-3400
Makes referrals to local AA groups and provides informational materials on the AA program. Many cities and towns also have a local AA office listed in the telephone book.

National Council on Alcoholism and Drug Dependence
12 West 21st St.
New York, NY 10010
(800) NCA-CALL
Provides telephone numbers of local NCADD affiliates (who can provide information on local treatment resources) and educational materials on alcoholism via the above toll-free number.

What are the Signs?

How can you tell whether you, or someone close to you, may have a drinking problem? Answering the following questions can help you find out.
  • Have you ever felt 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)?

One "yes" response suggests a possible alcohol problem. If you responded "yes" to more than one question, it is highly likely that a problem exists.

In either case, it is important that you see your doctor or other health care provider right away to discuss your responses to these questions. She or he can help you determine whether you have a drinking problem and, if so, recommend the best course of action for you.

Even if you answered "no" to all of the above questions, if you are encountering drinking-related problems with your job, relationships, health, or with the law, you should still seek professional help. The effects of alcohol abuse can be extremely serious -- even fatal -- both to you and to others.

What is a Drink?

  • One 12-ounce bottle of beer* or wine cooler

  • One 5-ounce glass of wine

  • 1.5 ounces of 80-proof distilled spirits

*Beer ranges considerably in its alcohol content, with malt liquor being higher in its alcohol content than most other brewed beverages.

Nancy Wongvipat, M.P.H., is a health education specialist in AIDS Project Los Angeles' Education Division. She can be reached by calling (323) 993-1511 or by e-mail at

This article has been reprinted at The Body with the permission of AIDS Project Los Angeles (APLA).

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This article was provided by AIDS Project Los Angeles. It is a part of the publication Positive Living.
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