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These 4 Questions Help Reveal If You Are Drinking Too Much

If you've been drinking more or more often—or drinking to cope with stress—you could have an issue with problem drinking. Answer these 4 questions to assess your risk.

Group of young friends drinking beer together outside
Updated November 17, 2022

By Jay (John) Case, MD, Psychiatrist
Program Director, Virtua Behavioral Health
Chair, Department of Psychiatry, Virtua Memorial Hospital 

According to a September 2020 RAND Corporation study, alcohol consumption rose among adults over age 30 by 14% during the pandemic, with heavy drinking by women increasing 41%. These increases were linked to increased stress and anxiety about the pandemic.

If you're concerned that you've been drinking too much or drinking to manage stress, it's time to get help from your primary care provider (PCP). 

The risks of heavy drinking

According to the National Council on Alcoholism and Drug Dependence, excessive alcohol use is one of the most common causes of premature death in the United States. From 2011 to 2015, an estimated 95,000 alcohol-attributable deaths occurred annually in the United States. These deaths were caused by injuries from motor vehicle collisions and chronic conditions such as alcoholic liver disease.

While it's important to examine drinking patterns for men and women, women are especially vulnerable to alcohol's harmful effects.

Is alcohol truly worse for women?

Unfortunately, yes, drinking is worse for women. When women drink, they develop consequences sooner and after drinking smaller amounts. Those consequences include immediate effects like intoxication and blackouts and long-term effects like increased risk for cancer, liver disease, and high blood pressure, as well as heart attack and stroke. 

For women, drinking more than 3 drinks per day, or 7 per week, seems to be the threshold where long-term risks develop. Having more than 4 drinks per occasion is widely considered a dangerous binge.

This doesn't mean that if you have 7 drinks one week, you're instantly in danger. What doctors are concerned about is when that becomes the norm, rather than the exception.

How much is too much?

When helping patients assess their risk for problem drinking, I use a tool called the CAGE questionnaire. CAGE is an acronym for the following four questions:

  1. Have you ever felt you needed to 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 answer yes to 2 or more of these questions, you might be at risk for problem drinking.

The CAGE questions help answer these basics: 'Have you ever thought you're drinking too much?' or 'Have other people thought you're drinking too much?' 

Even though they're simple questions, they're surprisingly effective at revealing problem drinking. If you or someone you care about has ever been concerned about your drinking, then it's probably a concern. It sounds redundant, but it's pretty significant.

It's harder to pinpoint a precise quantity that defines problem drinking. Many people who drink moderately won't experience adverse effects or develop an alcohol use disorder. To determine your risk for problem drinking, it's more important to focus on alcohol's impact on your daily functioning and relationships.

It also helps to keep in mind that most people engage in some risky behavior fairly regularly. Every day, you need to make responsible decisions about how much risk is reasonable and appropriate.

Being sedentary is risky. Taking certain medications is risky. Overeating is risky. Getting into a car and driving is risky.

Drinking alcohol is a part of our culture, and it certainly can be enjoyed reasonably and moderately in social settings or to enhance meals. But it can become a problem for some people, and we all need to be aware of that.

Thinking of cutting back?

If you feel you could benefit from drinking less or would like to consider keeping your drinking safely below the 7-drinks-per-week threshold described above, these ideas can help:

  • Limit your drinking to appropriate or special occasions.
    You could limit drinking to a Friday dinner with your spouse, on your girls' night out, or as an occasional celebratory treat. Try to select occasions that don't occur so frequently that it makes limiting intake a challenge.
  • Schedule regular times when you will drink and regular times when you won't.
    You might choose to drink every other day or only on weekends.
  • In any of these situations, try never to drink on an empty stomach.
    Your blood alcohol levels can rise too quickly when you drink on an empty stomach, putting you at higher risk of physical injury or car accidents.

If you want to cut back but are having trouble, you should talk to your primary care provider (PCP). If you're on edge and you can't relax without a drink, you should speak with your PCP. And, if you're drinking to deal with anxiety or depression, that's a double problem. Alcohol isn't an effective treatment for either problem and can make both worse.

Ultimately, don't be afraid to be completely honest with your PCP about your drinking—the amount and frequency, as well as your reasons for doing it.

You're not alone, and your health care provider can help you.

Get mental health support in Virtua Primary Care

Virtua Behavioral Health offers mental and behavioral health services in 13 Virtua Primary Care offices throughout South Jersey. To help meet patients' mental and emotional health needs, our primary care physicians refer their patients to licensed clinical social workers (LCSWs) who work within the practice. These licensed professionals provide a range of psychotherapy services, including cognitive behavioral therapy and marital counseling, and treat conditions including anxiety, depression, eating disorders, mood disorders, and substance abuse.

Schedule a primary care appointment online now or call 888-847-8823.