I have often been asked by family members in my 18 years of working with substance abusers, “How do I know if there is a problem?”, “What do I look for?”. I can appreciate why this is important, not just because people want to get their loved ones help, but because this is a deadly illness if it goes untreated. So, in an effort to help those who are concerned, here is the list of topics/questions that are asked to determine if there is a problem.

  • Increase in Tolerance: How much does it take to get a buzz? Does it take more than it used to? If so, tolerance does not increase unless there is regular drinking occurring. When someone drinks a 6 pack a night, we have to acknowledge that it didn’t used to be that amount.
  • Have there been any Withdrawals: Withdrawal symptoms include some of the obvious like shakes, chills, nausea, and hallucinations. However, some of the less obvious ones are an increase in anxiety or irritability when not drinking, and mood instability. Also, when someone stays sober for a short period of time, if they crave sugar and sweets a lot, this can be a symptom as well.
  • Loss of Control: This is not when someone “proves” that they can control it by stopping for a few days or a week. This is when they can no longer reliably predict how much they will drink. Sometimes, they will say they will have 1 or 2 and do just that. Then, there will be times they will drink 6 or 12 or more.
  • Failed Attempts to Control: This symptom is pretty obvious. But, please know that when someone has to try to cut back, this is being done for a reason. They may be able to control it for a while, but they usually go back to the way they were drinking before they tried to cut back.
  • Preoccupation: Does alcohol determine where they go and where they stay away from? Does it determine who they spend time with and who they stay away from? Does it determine the restaurants they go to and those they stay away from? Preoccupation could also include changing a schedule around to get a drink or two before going home or somewhere social.
  • Social Withdrawal: Have friends been avoided or changed to be around those who drink? Check out who they spend time with and see if they all drink or not.
  • Life Impairment: Has the use of alcohol put that person’s life or the life of others in jeopardy or just make life more difficult? This could be in areas that are physical (health), social (friends), legal, or with work (suspended, missing days, going in late) to mention a few.

If anyone meets three of these criteria, this is a serious problem. To be honest, if only one is met, it is likely worthy of attention. So, don’t minimize the issue. Share your concerns. Encourage them to or you speak with their primary care physician. A mental health expert can do a chemical dependency assessment to determine if there truly is a problem and to recommend the appropriate level of care. This may include individual therapy and/or 12-step meetings. When a higher level of care is needed, an Intensive Outpatient Program can be very helpful. This level of care typically meets for approximately three hours per day, three days per week for six to seven weeks. The emphasis is on learning coping skills instead of using chemicals or other destructive coping behaviors. At times, inpatient hospitalization or residential treatment is needed.

Michael J. Pollak, PCC, LICDC Director, Dual Diagnosis Intensive Outpatient Program