How do you know if your drinking has become a problem? How do you determine whether or not your “social” cocaine use is getting out of hand? Do you really have to stop completely just to satisfy your spouse, girlfriend/boyfriend, boss? These are typical questions posed by clients who are trying to determine if their substance use is a problem. The following information is designed to help you answer that question.

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How much drinking is too much?

Lower risk drinking for men is no more than 4 standard drinks (1 beer, 1 shot, 1 reasonable glass of wine) in any one day and no more than 14 in any one week. For women, the standard is 3 drinks per day, no more than 9 in any one week. Note that these are just guidelines and that your drinking might be problematic even if you are drinking at or below these levels. Source: http://rethinkingdrinking.niaaa.nih.gov.

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Is your substance use a problem?

A social drinker is someone who drinks in moderation, never uses in dangerous situations (like drinking and driving), has no problems stopping when they plan to do so, and there are no significant consequences from their use (legal charges, complaints by family members, failure to live up to responsibilities, etc.). Of note, discussing the notion of “social” use of other substances (i.e. marijuana, cocaine) theoretically follows the same logic.

Alcohol or drug “abuse” occurs when use causes repeated problems or there is continued use in dangerous situations. These problems could include legal trouble, work problems, ignoring family responsibilities, problems with friends, etc.

Substance “dependence”, “addiction”, and “alcoholism” are terms generally considered to mean the same thing. Dependence can be defined as use that results in an inability to control or limit one’s intake. More specifically the following are some of the typical characteristics of addiction.
(Source: http://www.niaaa.nih.gov/FAQs).

Craving: a strong need, or compulsion, to use

Loss of control: the inability to stop using drugs once a person has begun

Withdrawal symptoms: such as nausea, sweating, shakiness, and anxiety, when substance use is stopped

Tolerance: the need for increasing amounts of the substance to get “high.”

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What do I do if I believe I may be using drugs/alcohol too much?

Below are a few options that you may wish to consider.

1. Weigh the pros and cons of your use. Then weigh the pros and cons of cutting back or stopping.
   
   
2. If you’re considering changing your substance use patterns, you’ll need to decide whether to plan to cut down or to quit.

Quitting is strongly advised if you:

1. Try cutting down but cannot stay within the limits you set
2. Had a substance use problem in the past (perhaps with a different substance)
3. Now have symptoms of loss of control
4. Are taking a medication that interacts with the substance you are using
5. Are or may become pregnant

If you decide to "cut down"

1. Many approaches suggest a period of abstinence (often a minimum of three months but a year is sometimes recommended).
2. Once you have completed your abstinance period, establish rules for what you consider to be safe/moderate drinking
3. If you break these rules, you may wish to seek professional help (therapist, doctor, pastor).

CAUTION: If you think you may be dependent on alcohol or prescription medications and decide to stop using completely, don't go it alone. Sudden withdrawal from alcohol and some medications can be life threatening. Seek medical help to plan a safe recovery.

Support for quitting: source: http://rethinkingdrinking.niaaa.nih.gov.)

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If you want to quit drinking, you may find the following strategies helpful.

• Find alternatives. If drinking/using has occupied a lot of your time, then fill free time by developing new, healthy activities, hobbies, and relationships, or renewing ones you've missed. If you have counted on using alcohol/substances to be more comfortable in social situations, manage your moods, or cope with your problems, then seek other, healthy ways to deal with those areas of your life

• Avoid “triggers”. What triggers your urge to drink/use? If certain people or places make you drink/use even when you don't want to, try to avoid them. If certain activities, times of day, or feelings trigger the urge, plan something else to do instead of drinking/using. If drinking/using at home is a problem, keep little or no alcohol/drugs there.

• Plan to handle urges. When you cannot avoid a trigger or an urge hits, consider these options: remind yourself of your reasons for changing (it can help to carry them in writing or store them in an electronic message you can access easily); talk things through with someone you trust; get involved with a healthy, distracting activity, such as physical exercise or a hobby that doesn't involve drinking/using; instead of fighting the feeling, accept it and ride it out without giving in, knowing that it will soon crest like a wave and wash away. Remember, cravings last, at most, 15 minutes as long as you don’t feed into them.

• Know your “no”. You're likely to be offered a drink/drug at times when you don't want one. Have a polite, convincing "no, thanks" ready. The faster you can say no to these offers, the less likely you are to give in. If you hesitate, it allows you time to think of excuses to go along.

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Social support

One potential challenge when people stop drinking/using is rebuilding a life without substance use. It may be important to:

• educate family and friends
• develop new interests and social groups
• find rewarding ways to spend your time that don't involve substance use
• ask for help from others

When asking for support from friends or family, be specific. This could include

• not offering you alcohol/drugs
• not using alcohol/drugs around you
• giving words of support and withholding criticism
• not asking you to take on new demands right now
• going to a group like Al-Anon

Consider joining Alcoholics Anonymous, SMART Recovery, Celebrate Recovery or another mutual support group (see “Links”). Recovering people who attend groups regularly do better than those who do not. Groups can vary widely, so shop around for one that's comfortable. You'll get more out of it if you become actively involved by having a sponsor and reaching out to other members for assistance.

Note that it is common for people with substance use problems to feel depressed or anxious. Mild symptoms may go away if you cut down or stop using. See a doctor or counselor if symptoms persist or get worse. If you're having suicidal thoughts, call your health care provider, or go to the nearest emergency room right away. Effective treatment is available to help you through this difficult time.