Heavy drinking vs. alcohol use disorder
Plenty of people in Maine drink heavily without having an alcohol use disorder, and some people with a serious disorder don't drink as much as you'd guess. Volume isn't the dividing line, control and consequences are. Clinically, the question isn't "how much?" but "what happens when you try to stop, and what has drinking already cost you?"
The DSM-5 lists eleven criteria, cravings, loss of control, tolerance, withdrawal, neglecting responsibilities, continuing despite harm, and so on. Meeting two in a year is mild alcohol use disorder. Six or more is severe. Most people who eventually walk into our Biddeford office met the criteria for years before anybody, themselves included, used the word.
The signs, stage by stage
Early stage
Signs that are easy to explain away
- • Tolerance climbing, three drinks does what two used to
- • Drinking more or later than you planned, repeatedly
- • Looking forward to the first drink earlier in the day
- • Drinking alone, or topping up before a social event
- • Private bargaining: dry Januarys, weekday rules, switching to beer
Middle stage
Signs other people start to notice
- • Defensiveness or irritation when drinking comes up
- • Missed mornings, late starts, declining work quality
- • Hangovers that now include anxiety, shakes, or nausea
- • Hiding bottles, under-reporting counts, drinking before arriving
- • Blackouts or gaps in memory from an ordinary night
- • Dropping hobbies, workouts, or friendships that don't involve alcohol
Late stage
Signs that need medical attention
- • Morning drinking to steady shakes or settle the stomach
- • Withdrawal symptoms, sweating, tremor, racing heart, when you stop
- • Any withdrawal seizure or episode of confusion
- • Drinking despite liver problems, a DUI, or a relationship ending
- • Repeated attempts to quit that fail within days
The "high-functioning" problem
In Southern Maine, the version we see most often isn't the one in the movies. It's a contractor in Saco, a nurse in Portland, a teacher in Scarborough, job intact, kids fed, mortgage paid, and a bottle of wine or six beers every single night that nobody outside the house knows about. Functioning delays consequences; it doesn't stop the physiology. Tolerance keeps climbing, and the first real crisis is often a medical one.
If "I could stop if I wanted to" has been true in theory for a couple of years without ever being tested for more than a week, that's worth noticing.
What families notice first
Families rarely spot the drink count. They spot the pattern around it: the defensiveness, the second personality after 9 p.m., plans quietly rearranged around drinking, the recycling bin, the apology cycle. If you've found yourself managing someone else's drinking, covering, counting, timing conversations for sober hours, you're already living with the disorder, and family therapy exists for exactly that. Our post on the family impact of addiction goes deeper on the roles that form.
Signs that mean don't wait
- • Morning shakes, sweats, or nausea relieved by a drink
- • Any seizure, hallucination, or confusion when stopping
- • Vomiting blood, yellowing skin or eyes, severe abdominal pain
- • Drinking on top of benzodiazepines, opioids, or sleep medication
- • Thoughts of self-harm during or after drinking (call or text 988)
If you drink daily and have any of the first two, do not quit cold turkey, read alcohol detox risks and call before you stop.
What happens when you call
A short, confidential conversation, your drinking history, your health, your schedule, your insurance. No lectures, no pressure to commit to anything on the phone. Most people in York and Cumberland County turn out to fit outpatient care rather than disappearing for a month: evening IOP a few nights a week, day-structured PHP when more support is needed, or weekly outpatient sessions. Medication like naltrexone, prescribed by local providers we coordinate MAT with , takes the edge off cravings for many people, and CBT does the work underneath.
Wondering about the bill first? That's normal, here's how insurance coverage for rehab actually works in Maine. And if the job is the obstacle, people manage it constantly: working during rehab covers the scheduling and legal protections. Our full alcohol rehab program serves Biddeford, Portland, and the towns between.
Common questions
What are the earliest warning signs of alcohol addiction?
Tolerance is usually first, needing more to get the same effect. Then come drinking more or longer than intended, planning the day around drinking, drinking alone or in secret, and a persistent low-grade sense that you should cut back. Physical withdrawal signs come later, which is why so many people miss the early stage.
How is alcohol use disorder actually diagnosed?
Clinicians use eleven DSM-5 criteria over a twelve-month period: cravings, loss of control, tolerance, withdrawal, giving up activities, continued use despite problems, and so on. Two or three criteria indicate mild alcohol use disorder, four or five moderate, six or more severe. Most people who screen positive have no idea they meet the definition.
Can you be an alcoholic and still hold down a job?
Yes, and it's common in Maine. High-functioning alcohol use disorder means the job, the mortgage, and the family calendar all still work while the drinking quietly escalates. Functioning is not the same as being fine; it usually just means the consequences haven't arrived yet.
What signs do families notice first?
Families almost always notice behavior before quantity: defensiveness about drinking, missing or minimizing plans, mood swings the day after, hidden bottles, unexplained money spent, and a change in who someone is at 9 p.m. versus 9 a.m. If you're keeping mental notes about someone's drinking, that observation is itself data.
How much drinking is too much?
The NIAAA defines heavy drinking as more than 4 drinks a day or 14 a week for men, and more than 3 a day or 7 a week for women. But quantity is a poor sole test, what matters more is control, consequences, and whether stopping produces withdrawal symptoms.
What should I do if I recognize these signs in myself?
Don't quit abruptly if you drink daily, alcohol withdrawal can be dangerous. Call us for a free assessment; most people in Southern Maine turn out to be a fit for outpatient treatment that runs around work and family, and insurance typically covers a substantial share.
