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Are You Addicted to Alcohol?

Denial is common for many living with addiction, but behavioral red flags don’t lie

Symbolic illustration of a person chained to a bottle to represent addiction

It’s just a few drinks, right? Nothing to be concerned about. For approximately 15 million Americans with alcohol use disorder (AUD), that’s a statement of denial.


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Alcohol use disorder is a chronic disease that often goes ignored by the millions in its grasp. Nearly 1 in 13 American men has AUD. For women, it’s 1 in 25. More than 400,000 children are dealing with addiction, too.

“Sadly, it’s common,” says addiction psychiatrist Akhil Anand, MD. “And often, people don’t recognize that they have a problem.”

Here’s how to tell.

Red flags for alcohol addiction

Dr. Anand talks about the “Four C’s” regarding alcohol addiction. It’s a simple way of looking at alcohol consumption and determining if it has reached a concerning (and possibly dangerous) level.

The Four C’s of alcohol addiction are as follows:

  1. Cravings. Getting a drink — whether it’s a beer, glass of wine or cocktail — mimics a physical need. The urge can be as demanding as a hunger pain. It often manifests as restlessness, irritability and trouble sleeping.
  2. Compulsion. Finding a drink becomes the main mental objective. “It becomes irresistible and overpowering,” says Dr. Anand. “You’re always thinking about it and looking for it.”
  3. Control. It’s Friday night and you plan on having one drink. But you lose control. A few hours of binge drinking later, you’ve built quite a collection of empty bottles or glasses … and you’re unable to say no to the next one.
  4. Consequences. Regularly drinking alcohol in mass quantities often brings behavioral changes and unintentional problems, notes Dr. Anand. Negative consequences could include:
  • Relationship issues and people problems. Arguments, lying, unreliability and even violence can all flow out of a drinking episode and harm those closest to you.
  • Health troubles. “Alcohol causes more than 200 different medical diseases,” states Dr. Anand. The list includes various cancers, diabetes, high blood pressure, liver damage, osteoporosis, early-onset dementia and more.
  • Accidents. Alcohol increases impulsivity, disinhibition and fatigue, a combination that can lead to mishaps.
  • Work worries.AUD can lessen your ability to problem solve, while diminishing your strength, stamina and focus.

Addiction and personality metamorphosis

Let’s start with this basic fact: An addiction is a brain disorder.

Addictive substances like alcohol essentially commandeer the “reward pathway” in your brain. The reward pathway makes mental connections between activity and pleasure.

“Natural things like romance and exercise stimulate the same pathway,” explains Dr. Anand. “But addictive substances artificially hijack it. So, even things that you used to naturally enjoy, you suddenly can’t — because it’s all about that addictive substance.”

Basically, a person with an addiction develops a relationship with a substance that can eventually override everything else in their life. What follows is often described as a “personality metamorphosis.”

“At that point, a person’s actions are built around obtaining whatever their substance of choice is,” says Dr. Anand. “That’s the relationship they work the hardest to protect.”


Behaviors linked to addiction

People who struggle with addiction “do all kinds of terrible things” that impact themselves and those around them, warns Dr. Anand. Someone with AUD will:

  • Issue denials.
  • Minimize their actions.
  • Justify or rationalize their behavior.
  • Manipulate people.
  • Engage in victim-blaming.
  • Take “emotional hostages.”
  • Use deception to get what they want.

“I always emphasize that these behaviors illustrate the severity of addiction, not the person,” stresses Dr. Anand. “It’s important to understand this if you’re trying to communicate with someone who has an addiction.”


Getting help for alcohol addiction

Reaching out after recognizing you have an addiction — or talking to someone else about their addiction — can be extremely challenging. Emotions run deep. There are often worries and concerns, and even anger.

“It’s not easy,” acknowledges Dr. Anand. “If you have a loved one who struggles with addiction, be honest, open and nonjudgmental when speaking with them. Communicate in a succinct manner that’s calm and constructive and not emotional. Remember that the goal is to get them help.”

Treatment for AUD often revolves around a plan that includes rehabilitation, care from addiction specialists and self-help programs such as Alcoholics Anonymous (AA). But the process starts with simply identifying the issue.

If you see yourself in the description of the Four C’s or the behaviors connected to personality metamorphosis, talk to someone. Maybe it’s your doctor, another healthcare professional, a family member or friend, or someone in recovery.

“Find someone who can give you support and start the process,” advises Dr. Anand. “Don’t be afraid to take that first step.”

To hear more from Dr. Anand on this topic, listen to the Health Essentials Podcast episode, “How To Help Someone With an Alcohol Addiction.” New episodes of the Health Essentials Podcast are available every Wednesday.


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