As a citizen in our image saturated culture, we all have snapshots in our mind’s eyes when we think of “The Alcoholic.” Pause and take a brief minute to reflect on what pops into your head. Do you conjure up the slumped and stinky homeless fella waving the humorous cardboard sign at the busy intersection, the one where he admits all he wants is a “a cold one?” Is it the isolating and reclusive combat wounded veteran suffering from PTSD who needs to drown out the horrors of war? Or is it the happy hour lush, slurring her words between wafts of cheap perfume and cigarette smoke as she stumbles in high heels towards the jukebox to play yet another Bon Jovi song. Maybe it’s the celebrity or athlete who is “suffering from exhaustion” or checks themselves into a posh rehab following an embarrassing post or remark on social media. While many of these exaggerated depictions of hitting rock bottom may be popular tropes for our entertainment or ridicule, they overshadow the common relatability, realities and symptomology of problematic drinking. Many people contend that drinking alcohol socially, recreationally, or even experimentally does not mean they have a problem with alcohol. And for some people, I would agree that they are right. When working with clients, I often offer that alcohol (or any substance for that matter), truly isn’t a problem until it becomes a problem. Once alcohol consumptions begin to interfere with the basics of daily, including functional living such as going to work, maintaining physical health, engaging in healthy relationships, and not getting arrested, it’s fair to say that a problem with alcohol has begun. But moreover, the severity of the effects of alcohol consumption increase steadily over time. The many individuals who tout themselves as functional alcoholics or binge drinkers may experience changes in tolerance and the development of withdrawal symptoms, all of which contribute to a progressive problem of an Alcohol Use Disorder (AUD), which will be discussed in further. It is for this very reason that many people struggle with the stigma of getting help through comparing and rationalizing their drinking to others, or are in flat out denial and minimization of the problems associated with alcohol. As a depressant, alcohol alters the neurotransmitters in the brain over time. This is why alcohol does a great job in sedating and relaxing the brain and making you less inhibited. This is why many people use alcohol to relieve stress or to cope with social or generalized anxiety. And it is also this lowering of anxiety and inhibition that leads to poor decisions of reckless and high-risk behavior. Unfortunately, alcohol is a double-edged sword when it comes to your mental health and wellbeing. AUD is more common to develop in those who already struggle with pre-existing anxiety, panic, stress, depression, schizophrenia, bi-polar disorder, personality disorders and other mental health concerns. Alcohol can both create and/or exacerbates many of these symptoms, particularly anxiety and depression. Further, alcohol contributes to feelings of anger, irritability, aggression and other negative emotional responses. Think about that time you saw, or were involved with, an altercation while out watching a game at the bar, as you witnessed slurred speech, sloppy coordination, stunted reaction times in fist-fight or brawl based on jealousy or a common misunderstanding. Often, such events may be during a blackout period, or the memory may be partial or impaired when trying to recall the next day. Drinking heavily effects both memory in the short and long term. In addition, alcohol is a leading contributor to incidence of domestic violence, as well increased rates in suicide attempts, self-harm, psychotic episodes and even hallucinations. Heavy drinking contributes to depression, and often creates a vicious cycle that is challenging to break. As alcohol lowers serotonin levels in the brain (the very neurotransmitter that helps us regulate and balance our mood), more alcohol is consumed in order to provide relief to the down mood. It is this here that the vicious cycle takes root through the masking and seeking of relief of those depressive symptoms. Further, sleep patterns and cycles are thrown out of whack, and the interruption of necessary deep and restful sleep further exacerbates feeling sluggish, irritable, nervous, and anxious. This is more than just a common hangover or headache. When is comes to the physical and mental symptoms of alcoholism, it is important to look at both withdrawal symptoms as well as tolerance to alcohol. An increased tolerance, or a need to drink more alcohol to get the same effect, indicates a problem with alcohol has begun to develop. If you find that one glass of wine no longer gives you the stress relief and buzz you were looking for after a long day, and instead you are able to drink the entire bottle of wine, you have developed tolerance to alcohol. Similarly, withdrawal symptoms indicate that a physical dependence has begun to develop and can range from headache and nausea the morning after a heavy night of drinking to physical tremors, hallucinations, and seizures. The withdrawal symptoms from alcohol can result in major medical complications, and should be medically monitored. If you are questioning if you may have a negative relationship with alcohol or are struggling with alcoholism, the tools below will help recognize the need for help and support. One simple way to self-assess problems with alcohol is through the CAGE quiz. This four question assessment is often used in healthcare settings, but can be easily self-administered through asking the following four questions: 1:Have you ever felt you should Cut down on your drinking? 2: Have people Annoyed you by criticizing your drinking? 3:Have you ever felt Guilty about drinking? 4:Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? If you answered yes to one question or more in the CAGE quiz, it is an indicator that misuse of alcohol is present. While this is not a diagnostic tools, these questions indicate if a problem with alcohol exists. One assessment tool that is used by professionals in determining if a diagnosable disorder is present, is the The Diagnostic and Statistical Manual of Mental Disorders (DSM–5). The DSM identifies levels of alcoholism based on the prevalence of symptoms to be either mild (2-3 symptoms), moderate (4-5 symptoms), and severe (6 or more symptoms). You may want to ask yourself, or a loved one, the following questions before we explore some of the signs and physical and mental symptoms associated with alcoholism. So, in the last 12 months: 1: Do you often drink in larger quantities, over a longer period of time than you had originally intended? 2: Have you tried to cut back, but been unsuccessful? 3: Are you spending too much time getting alcohol, using alcohol, and recovering from alcohol? 4: Are you having uncontrollable desires and cravings to drink? 5: Is alcohol making you late or missing work? Interfering with success in school? Failure to maintain obligations around the home? 6: Do you keep drinking even though it is causing more problems with family, friends and relationships you value? 7: Are you isolating, have you given up, or are you cutting back on all the fun and meaningful stuff you used to enjoy because you’d rather drink? 8: Because of alcohol, are you doing high risk things like driving drunk, having unprotected sex, or picking fights? 9: If you feel depressed, anxious, suffered a trauma, or are dealing with physical pain or a health problem, do you keep drinking even if it makes the original problem worse? 10: Do you have to drink a lot more than you used to to feel drunk, or anything at all? 11: Are you feeling withdrawals when you stop drinking? Or do you need to keep drinking in because you are having trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? In addition to the diagnostic criteria, individuals that are struggling with alcoholism often display visible symptoms. If you are questioning if your family member of loved one is struggling with alcoholism, you may want to consider the symptoms below. Some of the visual, telltale signs often observed in those who have been drinking excessively over a long period of time include the following: 1: weight gain or weight loss 2: dry skin, brittle hair and nails due to dehydration 3: wrinkles, and appearing older than his/her age 4: smelling of alcohol on breath and in sweat 5: red, blotchy, and flushed skin and face 6: poor hygiene, such as not bathing 7: busted capillaries on face and nose 8: yellow or jaundice skin and white of eyes due to liver damage. These assessments and information above are meant to give you guidance if you are thinking that you are an alcoholic, or if you are concerned that someone in your life is struggling with alcoholism. It is best to allow a trained individual to complete and thorough assessment and help develop a treatment plan to help resolve the issues related to your alcohol use, while addressing the underlying contributors to her substance use. At Apex Recovery, our clinical staff provide empathy, compassion, and support in helping you move forward in addressing your alcoholism.