How Do I Know If I Have a Problem?

Questions worth sitting with, and why the fact that you are asking at all is the part most people talk themselves out of.

There is no line you cross. Most people are waiting to find one: a number of drinks, a lost job, or a particular morning that would settle the question for them. It does not exist. What clinicians actually look at is not how much you use but what your use is costing you, and whether it keeps costing you after you have decided it shouldn't.

The second thing worth saying is simpler. People who do not have a problem with alcohol or drugs generally do not spend their evenings researching whether they have a problem with alcohol or drugs. The question itself is information. It does not settle anything, and it is not a diagnosis. But it is rarely nothing.

What do professionals actually look for?

Clinicians use a set of eleven criteria in the DSM-5 to identify a substance use disorder, and severity is graded by how many are present over a twelve-month period: two or three indicates a mild disorder, four or five moderate, and six or more severe. What is notable about that list is how little of it concerns quantity.

The criteria cluster into four areas:

1. Impaired control is wanting to cut down and not managing it, spending significant time obtaining or recovering from use, and craving.

2. Social consequences involve use interfering with work, school, or home, continuing despite conflict with the people close to you, and giving up things you used to care about.

3. Risky use, or using in situations where it is physically dangerous, or continuing after you know it is causing a physical or psychological problem.

4. Physical adaptation is needing more for the same effect or experiencing withdrawal when you stop.

Notice that only the last category is about the body. The rest is about your life. This is why the question "How much is too much?" almost never produces a useful answer and why two people drinking identical amounts can be in entirely different situations.

What questions are actually worth sitting with?

Not a quiz. A quiz invites you to score yourself and argue with the result. These are questions to sit with honestly, ideally more than once.

• Have I tried to cut back? Have I not thought about it or actually set a rule for myself? What happened to the rule?
• Am I managing the appearance of it? Timing, hiding, spacing out purchases, being careful about who sees what. Managing the perception takes effort that not having a problem does not require.
• Has anyone who loves me said something? Once can be dismissed. More than once, from more than one person, is data.
• What has it already cost? A relationship, a job, money, a morning, a promise. Not what it might cost eventually. What it has taken already.
• What happens when I cannot? A weekend away, a dry stretch, a day it is not available. Is that uneventful, or is there a low hum of planning underneath it?
• Is it doing the job it used to? Most people start because something works. When it stops working and continues anyway, that shift is worth naming.

If you found yourself constructing an explanation while reading any of those, that is worth noticing too. The explanations are usually true. That is what makes them effective.

Isn't it different if I'm functioning fine?

High-functioning is a description of your circumstances, not of your relationship with a substance. Employment, marriage, church attendance, and a mortgage paid on time do not rule anything out. They frequently delay the question by years because functioning gives everyone around you a reason to accept the explanation and gives you a reason to keep offering it.

The relevant question is not whether things have fallen apart. It is what you are spending to keep them from falling apart.

Do I have to call it something?

No. The labels matter to clinicians and to insurance companies; they do not have to matter to you today. You do not have to call yourself an alcoholic or an addict to talk to somebody, and you do not have to have decided to quit before you are allowed to ask a question. A great many people begin this conversation somewhere in the middle, not sure, not committed, not ready, and that is a legitimate place to begin.

What is worth avoiding is the deal where you agree to keep the question private until you are certain. The certainty tends not to arrive on its own.

Where does faith fit in this?

It fits at the point where honesty gets hard. Scripture does not ask us to have our conclusions in order before we speak; it invites us to come as we are, at whatever point in the middle we are standing.

There is a particular kind of loneliness in carrying a question like this privately for a long time, sitting in a pew on Sunday with it, praying around the edges of it. That secrecy does more damage than the answer usually does. The searching in Psalm 139 is not surveillance. It is an invitation to be fully known by someone who is not going to be shocked.

What do I do next?

Talk to one person. That is the whole next step, and it is smaller than deciding anything. A doctor, a licensed clinician, a pastor, a recovery coach, or one honest friend. Saying it out loud to another human being changes the question from something you are managing alone into something you are looking at with help.

If you want a formal screening, your primary care doctor can do one in a routine appointment, and the SAMHSA national helpline (1-800-662-4357) is free, confidential, and available around the clock. If you want to understand what levels of care exist before you talk to anyone, our earlier article on detox, inpatient, and outpatient treatment maps them in plain English.

You do not need a verdict today. You need one conversation.

If this was useful

Mark Twelve Recovery Foundation provides low-cost and no-cost Christian recovery coaching to individuals, families, and veterans across Massachusetts. You can learn what coaching with us looks like at marktwelverecovery.org. A first conversation costs nothing and commits you to nothing, including any commitment to quit.