How Much Is Too Much?

We have all heard the terms social drinking, alcohol abuse, alcohol dependence and alcoholism. Have you ever considered how these terms are defined? Where is the line between each and how do you know when one is crossed? Well, it depends.

There are many different definitions for the degree to which alcohol or drugs affect an individual or the people around them. There are legal definitions, clinical definitions, social definitions and behavioral definitions. Legal definitions set limits on either use (is it legal or illegal) and/or how much can be used legally (legal limits for impairment). Clinical definitions describe the illness or syndrome and the medical consequences associated with use (alcohol abuse, alcohol dependence, alcoholism). Social definitions may be dictated by prevailing cultural or religious norms which can vary widely concerning what is or isn’t considered socially acceptable use (“It’s against my religion to drink any alcohol or use drugs.” Or, it is acceptable for any individual to chew coca leaves in Peru or have wine at every meal in France.) Behavioral definitions are composed by the behavior of an individual that is drinking or drugging and imposed by their interactions with the people around them (“Every time uncle Ed drinks over the holidays he gets mean so we don’t let him drink anymore.”)

Given all of these depictions of addiction it begins to look a little like art. Like art, you will know it when you see it. For a more formal definition of addiction, the American Society of Addiction Medicine (ASAM) lists these five conditions: (a) inability to consistently abstain, (b) impairment in behavioral control, (c) craving, which is an increased “hunger” for drugs or for rewarding experiences (d) diminished recognition of significant problems with one’s behaviors and interpersonal relationships and (e) a dysfunctional emotional response.

Then, there is the question of what is abuse versus alcoholism/addiction? Alcohol or drug abuse is characterized by a pattern of use that results in harm to one’s health, interpersonal relationships, and ability to work or function. Examples might include: (a) failure to fulfill major responsibilities at school, work, or home, (b) drinking or using in dangerous situations such as behind the wheel of a car or while operating machinery, (c) legal entanglements related to drugs or alcohol such as being arrested for DWI or for physically hurting someone while impaired, (d) continued drinking despite ongoing relationship problems that are either caused or exacerbated by drinking or using, and (e) long term use of a substance that can turn into dependence. Alcohol dependence (alcoholism) or drug dependence equals addiction and is a chronic disease unless arrested by recovery or death. Addiction is characterized by: (a) a strong craving alcohol or drugs, (b) continued use despite repeated physical, psychological, or interpersonal problems, (c) the inability to limit use of alcohol or drugs.

One should avoid using the drug type or quantity of drug used as the sole criteria for gauging errors in judgment (drinking too much that one time at the office Christmas party) versus abuse versus dependence or addiction. Still, we use terms like social drinking, heavy drinking and binge drinking. Social drinking may be someone who only drinks occasionally, doesn’t feel compelled to drink alcohol in order to have a good time, never gets into trouble because of drinking, doesn’t do or say things that they regret while drinking, doesn’t spend a lot of time thinking about alcohol or spending time obtaining it, and doesn’t feel the need to control their intake. It is not the amount that everyone else around you is drinking in a social setting such as a party or a “kegger”. In general, social drinking encompasses one 12 ounce beer or one 5 ounce glass of wine or one 1.5 ounce liquor drink per day. It is not meat to be an average amount for a week that is consumed over one or several days.

Heavy drinking is defined as consuming more than two drinks per day for a man and more than one drink per day for a woman. According to the National Institute on Alcohol Abuse and Alcoholism binge drinking is defined as a pattern of consumption that brings the blood alcohol concentration to 0.08% or more. This usually requires five or more drinks for a man and four or more drinks for a woman in a single sitting within about two hours. Illicit drug use and addictive behaviors such as gambling or sex addiction have their own unique set of definitions and qualifiers.

I feel behavior to be the strongest indicator of impairment when it comes to the question of addiction. The most simple definition of addiction that I use mirrors the ASAM definition and goes like this: excessive use of a substance such as drugs or alcohol, negative consequences form that use, continued use in spite of the negative consequences. The main component here is behavior. Negative consequences are the results of impaired behavior. Continued use is the behavior of an addict.

When considering how much is too much there are other contributing factors that must be considered such as age, gender, race/ethnicity, physical condition, nutritional status, rate of consumption, concomitant use of prescription drugs, family history, psychological makeup and others. It would seem that trying to pin down an exact amount for any one individual is like trying to hit a moving target. That why I always go back to behavior.

How much is too much? Well, when it becomes too much. When normal functioning becomes impaired. In the beginning this is not always apparent to the addict or alcoholic because of the barriers presented by way of denial. Addicted brain thinking is something to behold. It may be glaringly apparent to everyone close by the addict that there is a problem but he or she may be the last to know. In the later stages of the disease every  addict knows the answer to the question, “How much is too much?” It’s there is never enough.

Written by

Clark Gaither, MD

2 Comments to “How Much Is Too Much?”

  1. Kenneth Tingen says:

    Thank you so much for your dedication to educate us ALL about addictions of all types. Alcohol combined with prescription drugs are causing devastation to ones I love and to small children innocently involved. Keep up the good work!!!

  2. Clark Gaither, MD Clark Gaither, MD says:

    Thanks Ken!

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