Is My Loved One Misusing Alcohol? Here’s How to Find Out and What to Do

Realizing that someone close to you might have an alcohol problem can be heartbreaking. You may have noticed some changes in their behavior or habits and wonder whether it’s just a rough patch or something more serious. Alcohol misuse and alcohol use disorders are issues that can affect anyone, regardless of age, gender, or background. But how can you tell if your loved one’s drinking has crossed the line from social to problematic? And if they have, what should you do?

Let’s break down what alcohol use disorder (AUD) is, how you can spot the signs of alcohol misuse in a loved one, and what resources are available to help your loved one make positive changes.

When Does Social Drinking Turn into a Problem?

Everyone’s relationship with alcohol is different. A person might drink casually during social events or have a drink or two at the end of a long day. But when does it become too much?^[1]

Think about these questions:

• Are they drinking more frequently?
• Do they drink more than they used to?
• Has their drinking begun to interfere with their job, relationships, or health?

If the answer to any of these is “yes,” it’s time to look closer.

Alcohol Misuse: How Much Is Too Much?

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), drinking beyond these limits could indicate misuse:^[2]

• For men: More than 5 drinks a day or 15 per week.
• For women: More than 4 drinks a day or 8 per week.

The Centers for Disease Control and Prevention (CDC) defines moderate drinking as two drinks or less per day for men and one drink or less per day for women. This reduces the risk of negative health effects.^[3]

You shouldn’t drink at all, even in moderation, if you:

• Are pregnant or might be pregnant.
• Are younger than 21.
• Have certain medical conditions—like some liver diseases.
• Are taking medications that can interact with alcohol.
• Can’t control the amount you drink.
• Are recovering from alcohol use disorder

You may also want to consider that recent evidence shows that any amount of alcohol is harmful even to healthy adults. The World Health Organization has stated that “when it comes to alcohol consumption, there is no safe amount that does not affect health.”^[4]

What exactly is “one drink”?

It’s not as much as you might think:^[5]

• A 12-ounce can of beer (5% alcohol)
• A 5-ounce glass of wine
• A 1.5-ounce shot of liquor (like vodka, whiskey, or rum)

Just because someone is drinking more than these limits doesn’t mean they have an alcohol use disorder. However, it’s a good idea to keep an eye on how much and how often your loved one is drinking. If you’re still not sure, some tests and screening tools can help.

Signs That Alcohol Use Has Become a Problem

Healthcare professionals often use a tool called the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) to determine the severity of an alcohol use disorder.^[6] Think of it as a checklist of questions to help figure out if someone’s drinking has become a problem:

1. Have they ever drunk more than they planned to?
2. Have they tried to cut down or quit drinking but couldn’t?
3. Have they spent a lot of time drinking or recovering from drinking?
4. Do they often crave alcohol?
5. Has drinking caused problems at work, school, or home?
6. Have they kept drinking even though it hurt their relationships?
7. Have they stopped doing things they used to enjoy so they could drink?
8. Have they gotten into risky situations, like driving, after drinking?
9. Do they keep drinking even though it makes them feel depressed or anxious?
10. Do they need to drink more to get the same effect as before?
11. Do they get withdrawal symptoms (shakiness, sweating, trouble sleeping) when they stop drinking?

The symptoms must be present for a year or longer. If your loved one answers “yes” to 2 or 3 of these questions, it might be a mild alcohol use disorder. If they answer “yes” to more, it could be moderate or severe.

The International standard

In the United States, doctors use the DSM-5 to diagnose alcohol use disorder, but around the world, healthcare professionals use the AUDIT (Alcohol Use Disorders Identification Test). This test checks for unhealthy alcohol use and risky drinking.

AUDIT is based on a global study by the World Health Organization and is available in about 40 languages. It is helpful because it offers a guide for intervention to help someone cut back or stop drinking. While it’s mainly for healthcare workers, people can also use it on their own.

It is valid across genders and in a wide range of racial/ethnic groups. The test is available online. Here are the AUDIT questions:

• How often do you have a drink?
• How many drinks do you have when you drink alcohol?
• How often do you have 6 or more drinks (for men) or 4 or more drinks (for women and men over age 65) on a single occasion?
• Have you or someone else been injured because of your drinking?
• Has a relative, friend, or health professional been concerned about your drinking?
• How often during the last year:
  • …you were not able to stop drinking?
  • …you failed to do what was normally expected from you because of drinking?
  • …you needed a first drink to start your day after heavy drinking
  • …you had a feeling of guilt or remorse after drinking?
  • …you been don’t remember the night before after you drank?

0–7: A person may benefit from education on levels of risk of alcohol use, including those linked to heavier drinking.
8–15: A person may benefit from advice on alcohol use and brief interventions to motivate changes.
6–19: A person would benefit from brief interventions to reduce alcohol misuse.
20–40: A person requires a brief intervention, a clinical evaluation, and treatment.

Do you want to learn how to motivate a loved one to get help? Read this article.

A score of 8 or more on the test is considered harmful alcohol use.
Higher scores can show possible signs of alcohol misuse in a loved one, but the effects of alcohol are different for each person. Things like body weight and metabolism can change how alcohol affects someone, so a healthcare provider should help interpret the score.

Other screening tools

The Michigan Alcohol Screening Test (MAST)
MAST is a quick and effective way to check for alcohol use and related problems over a person’s lifetime. It is helpful because it works across patient populations with different racial/ethnic backgrounds. Patients answer “yes” or “no” to each question and get points based on their answers.^[7]

The test has 22 questions. If a person scores 5 or 6, a clinical evaluation is recommended. If they score 7 or more, a full evaluation is recommended.

CAGE Questionnaire
CAGE is a test that experts recommend avoiding even though it is still widely used.^[8] The test does not identify all patients, as it only captures people who are already drinking heavily. It misses crucial prevention opportunities.

Talking to Your Loved One: What to Say and What to Do

If you are spotting signs of alcohol use in a loved one or think your loved one might have an alcohol use disorder, starting a conversation can be the hardest step. Here are some tips for approaching the topic with compassion:

1. Find a calm moment when they aren’t drinking and there’s no immediate stress.
2. Focus on how you feel and what you’ve noticed. For example, “I’ve noticed you’re drinking more, and I’m worried about you” is less likely to make them defensive than “You’re drinking too much.”
3. Be open to what they have to say. They may deny it at first, but just letting them know you’re there can make a difference.
4. Encourage them to seek help but let them know you’ll support them whether they choose to get help or not.
5. Alcohol Screening is a free, confidential online resource co-developed by Partnership to End Addiction that may be helpful for your loved one. They simply answer a few questions and they will get personalized feedback and support.