These 4 Questions Help Reveal If You're Drinking Too Much

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

Do you find yourself questioning if you drink too much, or has your nightly glass of wine turned into a few a night, a few days a week? It might be time for a drinking checkup with your family doctor. 

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 2006 to 2010, an estimated 88,000 alcohol-attributable deaths occurred annually in the United States. These deaths were caused by both injuries from motor vehicle collisions and chronic conditions such as alcoholic liver disease. After review of this evidence, the United States Preventive Services Task Force (USPSTF) recommended in late 2018 that all adults, including pregnant women, should be screened for unhealthy alcohol use by their primary care physicians. 

As important as it is to examine drinking patterns for both men and women, women are especially vulnerable to alcohol’s negative effects.

Is alcohol truly worse for women?

Unfortunately, yes: 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, which then increases risk for 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 very 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, in fact, 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 abusive or dependent relationship with alcohol. To determine if it's problem drinking, it’s more important to focus on alcohol’s effect on your daily functioning and your relationships.

You also should keep in mind that most people engage in some type of risky behavior on a fairly regular basis. Every day, you need to make responsible decisions about how much risk is reasonable and appropriate. Being sedentary is risky, certain medications are risky, overeating is risky, even getting into a car 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 husband, 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 no more than 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, and this puts you at higher risk for a physical injury or a car accident.

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 talk to 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 actually 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 there’s a lot your health care provider can suggest to help you.

Call 888-847-8823 to schedule a checkup with a Virtua Health primary care provider today. 

Updated March 30, 2021

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