Total levels of alcohol consumption are rising. We explore how we can tell if our drinking is at a harmful level.
Learn more about alcohol abuse and addiction here.
What is excessive alcohol consumption?
There are many forms of excessive alcohol consumption that can cause substantial risk or harm to anyone of us. Some people drink large amounts of alcohol each day. Others have repeated episodes of drinking until they are drunk, so-called binge drinkers. Others keep drinking despite the fact that their alcohol use is causing them physical harm or harm to their mental health. Lastly, some people drink in a way which is dependant or addicted to alcohol and so they find it very difficult to stop.
Excessive alcohol drinking causes illness and distress to the drinker, but also to his or her family and friends. It is a major cause of the breakdown of relationships, of trauma, of hospitalisation, of prolonged disability and of early death. Alcohol-related problems represent an immense economic loss to many communities around the world.
Today, we are going to look at the World Health Organisation (WHO) “Alcohol Use Disorders Identification Test” (AUDIT), published by Thomas F Barbor et al. The aim of the test is to try and find out whether our drinking:
- is modest and within safe limits
- is hazardous and risks causing harm to our physical or mental health
- ois already likely to be harmful and is already damaging us or
- is actually dependant and likely to be difficult to stop.
What are the risks of excessive drinking?
According to the WHO, “alcohol is implicated in a wide variety of diseases, disorders and injuries, as well as many social and legal problems". Alcohol use is associated with road traffic accidents and pedestrian injuries with falls and injuries at work. It is a major cause of cancers of the mouth, oesophagus and larynx as well as cancer of the breast. It is associated with damage to organs, such as liver psoriasis and pancreatitis, especially after long-term excessive consumption. Alcohol causes harm to the developing baby in the womb and may lead to growth retardation or learning disability or so-called foetal alcohol syndrome.
Alcohol also exacerbates many common medical conditions, such as hypertension, gastritis, diabetes and some forms of stroke. These may be aggravated by even occasional or short-term alcohol consumption, as are many mental health disorders, such as depression.
The risk related to alcohol is linked to the amount of the consumption and to the pattern of drinking. Obviously, these risks are most prominent in people who are dependent on alcohol. This is simply because there are people who drink more than other people. However, the bulk of harm associated with alcohol occurs amongst people who are not dependent, if only because there are so many of them.
The identification of drinkers with various types and degrees of at-risk alcohol consumption has a far greater potential to reduce all types of alcohol-related harm and ill-health. No one develops alcohol dependence without first having engaged for some time in hazardous alcohol use. Screening for alcohol misuse and dependence is worthwhile, but it is most useful in those people who are not dependent yet who may be well advised to reduce or stop their alcohol use because of the hazardous or harmful consequences that it is already having.
Many of us are ignorant or unaware of the safe limits of alcohol use and there are many social and cultural pressures on us to drink heavily. Heavy alcohol consumption is part of our custom and this can be a very big pressure on us. Many of us indeed may simply be in denial about our alcohol use, so that using a screen such as the audit tool is helpful because it allows us to take the preventative measures which are proven to reduce alcohol-related risks.
How can I tell if I am drinking too much?
Download and complete the Alcohol Use Disorders Identification Test below.
The test was developed for health professionals, general practitioners and community nurses, but it can also be taken as a self-report measure. All we are doing now is to try and facilitate a guide and allow you consider your own alcohol use. By giving you the tool that your doctor is likely to use, you can understand where the assessment is coming from and perhaps benefit from it all the more.
This test should help reveal whether we are:
- modest drinkers who need to be advised about safe drinking
- hazardous drinkers who need to recognise the danger alcohol consumption puts us in
- harmful drinkers who are already damaging our physical or mental health, or
- dependent drinkers who need to seek professional help and should do so as soon as possible.
Each of these groups can benefit from education.
If your alcohol use is in the hazardous region, then you need to consider this evidence and consider reducing your alcohol use or even abstaining. You need to get the best possible support for this; ideally, speak to your doctor and seek advice and encouragement. If your alcohol use is already causing you harm, you need to consider stopping drinking and you may need some brief form of counselling or continued monitoring to help you do this. If you are already in the dependent region and are addicted to alcohol, you should seek specialist support for further evaluation and treatment.
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How to understand your score
An AUDIT score of less than seven suggests that your drinking is modest and that you should be educated about it and try and drink safely.
If, however, your score is between eight and 15, you are now in the hazardous drinking zone and you need advice about this.
If your score is between 16 and 19, you need advice and possibly some counselling, because your alcohol use is causing actual harm to your mind or body.
If your alcohol AUDIT score is greater than 20, it’s likely that you have an alcohol dependent problem and should seek greater help and advice, ideally through your general practitioner and possibly through a specialist.
Alcohol is described as our favourite drug. The more we understand about the amounts of alcohol we are using and the dangerous patterns we have in our alcohol consumption, the more we can openly and honestly address the serious consequences of alcohol abuse for ourselves, our families and our society.
Our use of a simple screen like the AUDIT measure is an interesting way of addressing these questions and honestly answering them. Taken in sincerity and in sobriety, the answers are remarkably helpful and have proven to be predictive and accurate.
Prof Jim Lucey
Professor Jim Lucey was Medical Director of St Patrick’s Mental Health Services (SPMHS) from 2008 to 2019, and a Consultant Psychiatrist with our team until 2023.
He is Clinical Professor of Psychiatry at Trinity College Dublin. He has been working for more than 30 years with patients experiencing mental health difficulties.
During his time with us in SPMHS, in addition to medical management, Professor Lucey specialised in the assessment, diagnosis and management of Obsessive Compulsive Disorder (OCD) and other anxiety disorders. He gave public lectures and was a regular broadcaster on mental health matters on RTÉ radio, featuring on Today with Sean O’Rourke for many years.
