June 9, 2022

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.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

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.

Related Articles

Closeup of people holding up shot glasses
February 15, 2024
What Does Alcohol Do to Your Body? 9 Ways Alcohol Affects Your Health

Alcohol affects your whole body, from your liver and immune system to your brain and mental health

male with beer belly on treadmill, with giant mug of beer next to
January 1, 2024
Does Beer Really Cause a ‘Beer Belly’?

Getting rid of excess abdominal fat will take more than just cutting back on cold ones

man daughter reading food label in market
April 10, 2023
What You Should Know About Sugar Alcohols

Often labeled as ‘diabetes-friendly’ or ‘calorie-free,’ this sugar substitute warrants caution

Empty liquor bottles and glasses in front of a brown cloud.
March 12, 2023
Blackouts and Your Brain: How To Avoid Memory Loss

Excess alcohol and substance use can cause temporary and permanent memory loss

Red wine being poured.
March 8, 2023
Is Red Wine Good for Your Heart?

Studies point to potential benefits, but don’t open a bottle just to improve your health

illustration of no alcohol for a month
December 16, 2022
Why a ‘Dry January’ Is Good for Your Health

Your liver, heart and skin will all thank you for the break from alcohol

Closeup of a happy person drinking red wine.
November 14, 2022
How Alcohol Affects Your Heart

Alcohol use may cause an irregular heartbeat, raised blood pressure and more

Anxious person trapped in a wine glass.
September 15, 2022
Anxiety and Alcohol: Does Drinking Worsen Symptoms?

Drinking can make you anxious or jittery

Trending Topics

close up of keto gummies
Do Keto Gummies Work for Weight Loss? Are They Safe?

Research is inconclusive whether or not these supplements are helpful

Person in yellow tshirt and blue jeans relaxing on green couch in living room reading texts on their phone.
Here’s How Many Calories You Naturally Burn in a Day

Your metabolism may torch 1,300 to 2,000 calories daily with no activity

Older person postioned sideways showing dowager hump.
Dowager’s Hump: What It Is and How To Get Rid of It

The hump at the base of your neck may be caused by osteoporosis or poor posture