When Drinking Too Much Becomes a Medical Problem and How to Know the Difference

On International Day Against Drug Abuse, there is no shortage of conversations worth having about substance use in America. But according to Joseph Volpicelli, M.D., Ph.D., executive director of the Institute of Addiction Medicine, one of the most pressing conversations is also one of the most avoided: the normalization of excessive drinking and the medical condition it can quietly become. As World Cup celebrations fill bars and headlines celebrate fans who drink cities dry, Volpicelli is making a case that most people would rather not hear: America has a serious and seriously normalized problem with alcohol.

The cultural attitude toward drinking, he argues, is one of the biggest obstacles to addressing alcohol use disorder. Excessive drinking is so embedded in celebrations, holidays and sporting events that most people do not register it as a warning sign. When the response to a headline about fans drinking a city dry is competitive pride rather than concern, it reflects how deeply normalized overconsumption has become.

That normalization spills into the doctor's office. Volpicelli notes that while physicians have become more consistent about asking patients regarding smoking, sleep and diet, alcohol often goes unaddressed. The reason is stigma on both sides of the exam table. Physicians worry that raising the topic implies accusation, and patients feel shame or guilt that keeps them from bringing it up themselves. The result is a condition that is both undertreated and underdiagnosed.

So what does alcohol use disorder look like? According to Volpicelli, the defining feature is impaired control over drinking. That means intending to have two or three drinks and ending up with four or five, or committing to a dry January and spending the entire month white-knuckling cravings rather than feeling free from alcohol. Early warning signs include disrupted sleep, worsening anxiety as alcohol wears off, deepening depression over time and a gradual drift away from relationships and activities that once brought joy.

For family members and loved ones trying to help, Volpicelli advises connecting the dots rather than assigning blame. Pointing out observed patterns, such as noting that drinking heavily seems to affect sleep or closeness in a relationship, without judgment or accusation, opens a door that blame tends to shut. The goal is to present the data, name the pattern and offer solutions.

Volpicelli's message is direct: Alcohol use disorder is a medical condition with real treatments, and it deserves the same open, stigma-free conversation as any other chronic disease.