Signs of Being an Alcoholic: How to Recognize Problem Drinking Patterns

The signs of being an alcoholic exist on a spectrum, and recognizing them early gives you more options for making changes.

What You'll Discover:

• What the term "alcoholic" means in modern medical understanding.

• Behavioral signs that indicate drinking has become a problem.

• Physical symptoms of alcohol dependence.

• Emotional and mental warning signs.

• The clinical criteria used to diagnose alcohol use disorder.

• Why alcohol problems exist on a spectrum rather than all-or-nothing.

• What options exist if you recognize these signs in yourself.

According to the National Institute on Alcohol Abuse and Alcoholism, approximately 29 million adults in the United States had alcohol use disorder in 2022. Many of these people are still functioning in their daily lives, which shows that the signs of being an alcoholic don't always match the stereotype of someone who has lost everything.

Understanding what to look for can help you assess your own drinking patterns or those of someone you care about. The signs fall into several categories: behavioral, physical, and emotional.

What Does "Alcoholic" Mean Today?

The term "alcoholic" is still widely used, but medical professionals now prefer "alcohol use disorder" (AUD). This shift reflects a more accurate understanding of how alcohol problems develop and present.

The first thing to know is that alcohol use disorder exists on a spectrum. It's not an all-or-nothing condition where you're either fine or severely addicted. The severity is determined by how many diagnostic criteria a person meets.

According to the DSM-5, the diagnostic manual used by healthcare providers:

• Mild AUD - Meeting 2 to 3 criteria

• Moderate AUD - Meeting 4 to 5 criteria

• Severe AUD - Meeting 6 or more criteria

This spectrum concept matters because someone with mild AUD still has a diagnosable condition that can benefit from treatment. You don't need to wait until you're at the severe end before addressing concerning patterns.

For a deeper look at how alcohol use disorder is defined, see our article on understanding alcohol use disorder.

Behavioral Signs of Being an Alcoholic

Behavioral signs are often the earliest indicators that drinking has become problematic. These patterns typically develop gradually, which makes them easy to rationalize or overlook.

Drinking more than intended - You decide to have two drinks and consistently end up having four or more. A good example of this is going to happy hour planning to have one beer and leaving three hours later after several rounds. If setting limits and breaking them is a regular pattern, that's notable.

Failed attempts to cut back - You've decided to drink less, take a break, or stop entirely, but you keep returning to previous patterns. Maybe you've done Dry January or set rules like "no drinking on weekdays" only to abandon them within a few weeks.

Spending significant time on alcohol - This includes time spent drinking, recovering from drinking, and thinking about when you'll drink next. If a meaningful portion of your mental energy goes toward alcohol, that's worth examining.

Drinking in secret or alone - Hiding how much you drink from others, having drinks before events so you already have a buzz when you arrive, or preferring to drink alone rather than socially. These behaviors often indicate some internal awareness that your drinking might be a concern.

Neglecting responsibilities - Calling in sick to work because of hangovers, missing commitments, falling behind on obligations, or disappointing people because of drinking. When alcohol starts interfering with your ability to function, it's a clear warning sign.

Continuing despite problems - If drinking has caused issues with your relationships, health, work, finances, or legal situation and you continue anyway, this is one of the most significant behavioral signs.

Something to consider is that no single sign necessarily indicates a problem on its own. Patterns and combinations of behaviors are more telling than isolated incidents.

Physical Signs of Alcohol Problems

Physical signs can indicate that your body has adapted to regular alcohol consumption. Some of these signs reflect tolerance, while others indicate dependence.

Tolerance - Needing more alcohol to achieve the same effects you used to get from less. If you used to feel buzzed after two drinks and now need four to feel the same way, your body has developed tolerance. This happens because the brain adjusts to alcohol's presence and becomes less responsive to it.

Withdrawal symptoms - Experiencing physical or mental discomfort when not drinking. Withdrawal symptoms can range from mild to severe:

• Mild symptoms - Anxiety, irritability, shakiness, sweating, headache, nausea, trouble sleeping

• Moderate symptoms - Increased heart rate, elevated blood pressure, confusion, fever

• Severe symptoms - Seizures, hallucinations, delirium tremens (a medical emergency)

The presence of withdrawal symptoms is particularly significant. It indicates physical dependence, meaning your body has adapted to alcohol's presence and reacts negatively when it's absent. Withdrawal symptoms typically begin 6 to 12 hours after the last drink and peak around 24 to 72 hours.

Sleep problems - Relying on alcohol to fall asleep but experiencing poor sleep quality. Alcohol disrupts REM sleep, so you might sleep for 8 hours and still wake up exhausted. Over time, this creates a cycle where you drink to sleep but the drinking makes you sleep worse.

Physical appearance changes - Regular heavy drinking can cause facial redness or puffiness, bloodshot eyes, unexplained weight changes, and poor skin condition.

Health issues - Digestive problems like acid reflux, elevated blood pressure, abnormal liver enzymes in blood work, or frequent illnesses can all be related to alcohol use.

Our article on symptoms of alcohol addiction covers these physical signs in more detail.

Emotional and Mental Signs

Alcohol affects brain chemistry in ways that impact mood and mental health. These signs can be harder to recognize because they're internal, but they're equally important.

Drinking to cope with emotions - Using alcohol to manage stress, anxiety, sadness, anger, or boredom. While alcohol can provide temporary relief, relying on it as a primary coping mechanism is concerning. If it seems like a cycle, that's because it often is. You drink to feel better, then feel worse as the alcohol wears off, which creates more desire to drink.

Increased anxiety or depression - Alcohol can temporarily reduce anxiety, but chronic use typically makes anxiety and depression worse over time. This happens because alcohol disrupts the neurotransmitters that regulate mood. If your mental health has declined alongside increased drinking, the two may be connected.

Mood swings and irritability - Emotional volatility that seems out of proportion to situations. This can result from alcohol's direct effects on brain chemistry or from the cycle of intoxication and withdrawal that heavy drinkers experience.

Defensiveness about drinking - Becoming angry, dismissive, or uncomfortable when someone mentions your alcohol use. Strong reactions to questions about drinking often indicate some internal awareness that it's become a concern.

Preoccupation with alcohol - Thinking frequently about drinking, looking forward to it more than other activities, planning your schedule around drinking opportunities, or feeling anxious about situations where alcohol won't be available.

Loss of interest in other activities - Giving up hobbies, social activities, or things you used to enjoy because drinking has taken their place or because you're too tired or hungover to participate.

The DSM-5 Criteria Explained

Healthcare providers use specific criteria from the DSM-5 to diagnose alcohol use disorder. Understanding these criteria helps you evaluate your situation more objectively.

So, what are the 11 criteria? The DSM-5 lists the following:

According to the Mayo Clinic, meeting 2 to 3 criteria within a 12-month period indicates mild AUD, 4 to 5 indicates moderate, and 6 or more indicates severe.

So, how many signs are concerning? The short answer is that meeting just two criteria is enough for a diagnosis of mild alcohol use disorder. You don't need to check every box to have a condition worth addressing.

Signs vs Severity: The Spectrum Concept

One important aspect of understanding the signs of being an alcoholic is recognizing that alcohol problems aren't binary. The outdated image of an "alcoholic" as someone who drinks from morning to night and has lost everything represents only the severe end of the spectrum.

Many people with alcohol use disorder:

• Hold steady jobs and perform well at work

• Maintain relationships and family obligations

• Appear healthy and put-together to others

• Only drink in the evenings or on weekends

• Have never experienced severe consequences

These individuals may still meet criteria for mild or moderate AUD. They may drink more than they intend, struggle to cut back, or notice that alcohol occupies more mental space than they'd like.

For that reason, recognizing signs early is advantageous. Addressing alcohol problems before they become severe is generally easier and more successful. The longer problematic patterns continue, the more entrenched they become.

Our article on do I have a drinking problem can help you think through these questions.

What to Do If You Recognize These Signs

If you see yourself in the signs described above, several options exist depending on your situation and goals.

Talk to a healthcare provider - A doctor can assess your drinking objectively, check for any health impacts, and discuss treatment options. Many people find it easier to talk to a medical professional than to friends or family.

Take a structured self-assessment - Screening tools like the AUDIT questionnaire provide an objective way to evaluate your drinking patterns. These assessments ask specific questions about quantity, frequency, and consequences.

Set specific goals - Decide whether you want to cut back or stop entirely. Make your goals concrete and measurable, such as "no more than two drinks when I go out" or "no drinking on weekdays."

Consider medication - Naltrexone is an FDA-approved medication that reduces alcohol cravings and the rewarding effects of drinking. It works by blocking opioid receptors in the brain so that alcohol doesn't produce the same pleasurable response.

Naltrexone is taken as a daily 50mg tablet. It doesn't make you sick if you drink, and it doesn't require complete abstinence to be effective. Many people use it while gradually reducing their drinking. Research shows naltrexone significantly reduces heavy drinking days compared to placebo.

Combine medication with support - Working with a therapist, coach, or treatment program provides structure and accountability. People who receive both medication and behavioral support tend to have better outcomes than those who receive either alone.

The key recognition is that noticing these signs isn't a failure. It's actually the first step toward making positive changes.

Taking the Next Step

Understanding the signs of being an alcoholic helps you assess your relationship with alcohol honestly. If you recognize concerning patterns, options exist ranging from self-directed changes to medication-assisted treatment.

Take the online Alcohol Use Assessment to learn more about your drinking patterns and see if naltrexone could help you meet your goals.