Ask Doctor K: When you should be concerned about your drinking

DEAR DOCTOR K: During my daughter’s wedding, and all the events surrounding it, I started drinking more than usual. But that was six months ago, and I haven’t cut back to where I was before. When do I get concerned that I might have a drinking problem?

DEAR READER: It’s not easy to answer your question. What constitutes “healthy” versus “harmful” drinking can vary quite a bit from person to person. So where is the line between social drinking and problem drinking? Does drinking every day or drinking a certain amount indicate a problem?

Here’s the bottom line: If your pattern of drinking creates difficulty for you personally, socially or at work, then your drinking is likely harmful to your health.

Now, that sounds reasonable, but it raises some important questions. Most important, are you the best judge of whether your drinking is creating difficulties for you? Would your family, friends and co-workers share your judgment?

Another important question: Could your drinking be affecting your health without you knowing it? I’ve known people who drank throughout the day and were damaging their liver. But in the earliest stages of liver damage from excessive drinking, there often are no symptoms. And some of the damage that is silently done is irreversible.

Several screening tests can help determine whether you might have a drinking problem. (I’ve put two of the tests, the CAGE questionnaire and the AUDIT, on my website, AskDoctorK.com.)

Alcohol use occurs along a spectrum. Alcohol dependence is the most severe type of alcohol misuse. It is marked by complete loss of control over drinking behavior. You’re preoccupied with drinking and have a strong desire to drink. You start to tolerate alcohol; you don’t get tipsy as easily. You start to feel a little nervous and shaky several hours after your last drink, and you learn that another drink can quiet the shakes.

Alcohol abuse is a milder problem. You don’t have the same compulsion or physical need to drink as those who are dependent on alcohol. But you do drink excessively – and if you keep drinking excessively, you are very likely to go on to alcohol dependence.

Even if you aren’t suffering from alcohol dependence or abuse, your drinking still could be cause for concern. I’ve known people who don’t drink excessively, but even a couple of drinks cause them to say things they may not mean, and surely should not say – to their spouses, friends, co-workers or bosses. That makes their drinking hazardous to their home and work life, and to relationships with family and friends. It also puts them at risk for developing more serious problems with alcohol down the road.

So while I don’t know enough about you to answer your question, the fact that you were concerned enough about your drinking to ask me about it indicates that it may be a problem. Talk to your doctor about your alcohol use. If you do have a problem, you can work with your doctor to determine the best treatment options for you.

(This column is an update of one that ran originally in February 2013.)

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)