The disease of alcoholism wears many masks. Recognizing these for what they are can be a real challenge to friends and family of those with a drinking problem. That’s because a diagnosable addiction to alcohol—defined by compulsive drinking behaviors like binge drinking that continue despite negative consequences—thrives in secret.
What was once seemingly harmless social drinking, and is now a full-blown alcohol use disorder, can thus prove difficult to catch—not to mention to stop in its tracks. Even the most obvious symptoms and side effects can go unnoticed, (and worse yet, untreated), when the masks that addiction wears elude recognition by those best positioned to notice them.
Fortunately, you don’t have to be a Sherlock Holmes or Columbo to determine whether a loved one is hiding a drinking problem. There are some reliable, telltale signs you can spot without being a brilliant, world-class sleuth. Knowing and being on the alert for these five signals can go a long away to helping friends and family identify the signs of a drinking problem and seek treatment for it.
Sign 1: A high tolerance for alcohol
“Tolerance” refers to the body’s response to the functional effects of alcohol—in other words, how quickly someone under the influence of alcohol becomes intoxicated and impaired. The degree to which the body tolerates alcohol’s effects depends on how long one has been drinking and how much one has been drinking. Over time, the more one drinks, the more alcohol they need to achieve the same effects—and, in turn, the higher their tolerance levels. “Functional tolerance” thus describes how chronic drinkers with very high blood alcohol concentrations can still operate with seemingly little behavioral impairment.
A longstanding pattern of chronic over-consumption of alcohol is a surefire determinant of high tolerance—if not the only one.
Genetic predisposition can be a determining factor as well, as studies comparing children of alcoholic fathers to children of non-alcoholic fathers indicate. Researchers have even discovered what they call an “alcohol tolerance gene”: those who have it reportedly are both better at holding their drink and more prone to abusing alcohol. Other factors, like weight, ethnicity, age, gender and even perception, can also affect how quickly intoxication develops and one’s overall tolerance.
If you’re unsure whether a loved one displays a high tolerance for alcohol, ask yourself the following: Do they show signs of intoxication and impairment after drinking three drinks over the course of an hour? (That’s typically the amount required for the average, 155-pound male to get tipsy.) If not, they may indeed have a high tolerance.
Sign 2: Hiding alcohol in unlikely places
Chances are that if that prized, souvenir bottle of tequila from last year’s trip to Mexico suddenly goes missing from your liquor cabinet, only to turn up beneath your son’s bed or in a spouse’s desk drawer, alcohol abuse may be the culprit.
Alcoholics are masters of covering up their tracks, addiction experts say. Recovering alcoholic William Moyers is the first to admit it: For every drink he’d have in a public setting, he’d have another stashed away in the bathroom. His spouse had no clue, he told NBC News.
Other alcoholics are even more creative, hiding their fix under ceiling tiles, in hollowed-out mattresses, behind books on bookcases—even in sports bottles in the back of their cars.
Sign 3: Drinking before and after parties and other social drinking situations
If a loved one is drinking before and after a party or other social situation, they may also be nursing an addiction under the radar and out of sight. A compulsive drinking problem often manifests itself as an internalized sense of shame on the part of the person struggling, with the result that they often do the bulk of their drinking in secret and alone, rather than in public.
As they develop higher alcohol tolerance over time, they can also find themselves needing to drink more to achieve the same effects. Heavy drinking in private serves this purpose also.
Sign 4: Mysterious and otherwise unexplainable injuries
If a loved one is frequently getting sick or falling prey to bumps, bruises, sprains and cuts, without an adequate explanation as to why, they may be hiding an alcohol use disorder.
It’s not unusual for injuries to happen in the course of an episode of binge drinking after all. Blackouts and falls are common. Consider the experience of one alcoholic who, while in her 40s, broke her foot stumbling down some stairs, after drinking more than 20 beers in one sitting. (When her mother asked what happened, the woman was too ashamed to tell the truth—so she made something up.)
Such experiences are common among those who abuse alcohol. Researchers at Northwestern University set out to study the health effects of binge drinking among college students, and found that one in four will harm themselves while drinking. As blackout rates went up, so did physical injuries, such as falls, burns, gunshot wounds, car accidents and other traumatic injuries. (Strikingly, one in three trauma patients have alcohol in their system.)
A lesser-known fact is how binge drinking compromises the body’s immune system, as another study found.
Sign 5: Using vodka to disguise one’s drinking
The hard liquor, vodka, is a great enabler of efforts to conceal a drinking problem. Vodka’s very high alcohol volume—40 percent—is an easy quick “fix” for alcoholics. It’s also colorless and doesn’t smell, so it’s easy to smuggle. Some alcoholics spike their morning coffee with it. Others slip it into sports bottles, topping it off with an energy drink like Gatorade.
The habit is more common than you’d think: An article in The Atlantic reported that roughly one in four people in their early 20s have mixed vodka with an energy drink of one kind or another. Those who drink alcoholic energy beverages also happen to drink more heavily and for longer periods than those who drink just booze, researchers found. They cited what they believe may be a “masking effect”: those who drank alcoholic energy drinks were more likely to underestimate their intoxication and drink more.
Diagnosing Alcoholism: Assessment, Detox and Treatment
Spotting the above signs is only the start in determining whether a loved one has a diagnosable alcohol use disorder. But it’s an important start. Only an assessment by an addiction professional can ultimately determine whether a loved one’s drinking problem is a diagnosable addiction that will benefit from detox and treatment.