Do you drink too much?

I often present the scientific facts about the health benefits of moderate alcohol consumption. And I actually encourage you to enjoy a toast or two — even three — when celebrating the holidays this year.

But neo-prohibitionists continue to push for lower and lower blood alcohol limits for drivers, and other limits. Ultimately, I believe they seek to effectively ban all alcohol consumption for everyone. This draconian approach needlessly punishes the 92 percent of responsible drinkers…and fails to meaningfully help the 8 percent of drinkers who do have dependency problems.

My colleague, Dr. George Lundberg, recently wrote about this issue in Medscape, an online journal for physicians he founded 10 years ago. (Of course, George is also a forensic pathologist, so he knows a thing or two about the physical and societal harms of alcohol abuse. Plus, he also served as editor-in-chief of the Journal of the American Medical Association for 20 years.)

About the problem of alcohol dependency, George aptly wrote:

Among the horrors of the American opioid epidemic; our miserably failed professional mismanagement of pain; and the unintended tragedies of addiction, overdose, and death, it may be easy to overlook that longstanding human nemesis, ethyl alcohol. Alcohol is by far the most commonly used psychoactive drug (excluding the generally harmless caffeine) in Western society….

So, let’s look at the statistics…

Out of every 100 Americans who drink, about 12 are considered in need of treatment for an alcohol use disorder, and eight will become chemically dependent on alcohol. Of those eight Americans, one will become addicted very early, even after the first drunken episode.

Unfortunately, we don’t have a good “screening test” to determine who will develop a problem. So, we must rely on good, old-fashioned surveys. I actually find these types of profiling approaches to be useful, as they provide a kind of “psychometric” profile of the person at risk.

Here are two widely used surveys that you can take to help gauge your drinking…

Michigan Alcohol Short Test (MAST)  

Here’s a sampling of a few survey questions:

  1. Do you feel that you are a normal drinker?
    (“Normal” meaning you drink just as much or less than most other people.)
  2. Do friends or relatives think you are a normal drinker?
  3. Are you able to stop drinking when you want to?
  4. Can you stop drinking without a struggle after one or two drinks?
  5. After heavy drinking, have you ever had delirium tremens or severe shaking, or heard voices or seen things that are really not there?
  6. Have you ever been arrested for drunk driving, driving while intoxicated, or driving under the influence of alcoholic beverages? (If yes, how many times?)
  7. Have you ever been arrested or taken into custody, even for a few hours, because of other drunk behavior? (If yes, how many times?)

For the first four, a yes answer is good. For questions 5, 6, and 7, a yes answer is bad. (You can take the full 24-question MAST test by clicking here.)

The second survey is the CAGE Questionnaire, which is popular with primary care physicians. It’s relatively simple, and it poses slightly different questions. The name is an acronym formed by the emphasized word in each question.

CAGE Questionnaire

  1. Have you ever felt that you should cut down on your drinking?
  2. Have people annoyed you by criticizing your drinking?
  3. Have you ever felt bad or guilty about your drinking?
  4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (i.e., an eye-opener)?

Two or three yes answers indicate a problem. A yes answer to number 4 indicates a big problem. (You can see the official questionnaire here.)

If you have any concerns about your drinking after taking these surveys, do yourself a favor and get medically evaluated as soon as possible.

Serious alcohol dependence (exceeding moderation) and severe intoxication is dangerous to you and those around you. In fact, there are 50,000 deaths each year due to alcohol-related overdoses, falls, drowning, motor vehicle accidents, homicides, and suicides. And again, these are among the 8 percent of drinkers who truly have an issue with alcohol.

Lastly, I’d like to share a few quick reminders from George that we should all remember during the holidays, and all year-round:

  • If you drink, don’t drive. Designate a driver beforehand.
  • If you drink, don’t walk either, at least not around motor vehicles. Dead pedestrians often have high blood alcohol levels.
  • Mixing alcohol and guns is especially dangerous.

Enjoy the holidays, but enjoy them safely.

And ask for help if you need it — it’s nothing to be ashamed of. I guarantee it’ll be one of the best things you do for yourself and the people you love. There are plenty of places to find support and resources. Your local place of worship,, or Alcoholics Anonymous are all great places to start in getting the information you need to make the first step.

Thanks again, George, for the practical recommendations.


“Are you an addict?” Medscape ( 10/12/2018