Social Drinking Can Mask Deeper Issues Beneath The Surface

Alcohol is the only drug you have to justify not using. Decline a drink at a braai and someone will ask if you are pregnant, sick, or “being dramatic.” Drink every weekend until Sunday disappears and it is called blowing off steam. Wake up shaky on a Tuesday and you call it stress. Somewhere in that mess, alcoholism grows quietly, because the culture around alcohol gives it cover.

That is why the question “How is alcoholism diagnosed?” matters, but not in the neat way most people want. Families want a clean line. One side is normal drinking. The other side is alcoholism. They want a test, a label, and a simple instruction manual. What they usually get instead is months or years of excuses, fights, broken trust, and a slow moving collapse that everyone sees but no one names out loud.

Diagnosis is not a moral court case. It is not about proving someone is “bad enough.” It is about identifying a pattern that has started to run the person’s life, and is beginning to take things from them. If you are waiting for a dramatic moment, you are already late.

The Basic Problem With Alcoholism Diagnosis

Alcoholism does not arrive as a single symptom. It arrives as a relationship with alcohol that changes over time. At first alcohol is a social tool. Then it becomes a coping tool. Then it becomes a requirement. The person does not always drink more in volume at first, they drink more in meaning. Alcohol starts doing jobs it was never meant to do.

It becomes the off switch after work, the courage before a social event, the sleep aid at night, the comfort after an argument, the reward after a hard week, the medication for anxiety, the buffer for loneliness, the escape from feeling like a failure. This is why high functioning alcoholism is so common. People can still perform while the dependency grows in the background.

So diagnosis is less about catching someone drunk and more about noticing what alcohol is doing in their life, what it is replacing, and what happens when it is not available.

What Alcoholism Actually Is

Alcoholism is persistent alcohol use despite harm, with reduced control over drinking and a pattern that starts to reshape behaviour, mood, relationships, and health. Some people call it alcohol dependence. Modern clinical language often uses Alcohol Use Disorder and grades it by severity. The label matters less than the reality.

The reality is this, if alcohol is repeatedly taking more than it gives, and the person keeps returning to it anyway, something has shifted.

Alcoholism is not defined by drinking every day. Plenty of severe alcoholics do not drink daily. It is defined by loss of control, compulsion, and continued use despite consequences.

The Two Questions Families Should Ask First

Before you get lost in medical terms, ask these two questions.

• Can they reliably stop once they start?
• Can they reliably stay stopped when they decide to stop?

If the answer is no, you are not dealing with casual social drinking. You are dealing with a control problem, and control is a central issue in alcoholism.

Families often get distracted by details like what the person drinks, how expensive it is, whether they “only drink beer,” whether they “never drink in the morning.” Those details are noise. Focus on behaviour, control, and consequence.

Why Denial Makes Diagnosis Feel Impossible

Denial is not just lying. It is a psychological defence that lets the person keep drinking without confronting what it is costing them. And because alcohol is socially acceptable, denial has an endless supply of excuses.

They will point to work performance, parenting tasks, bills being paid, and the absence of police involvement as proof that things are fine. They will compare themselves to someone worse. They will blame stress, a rough patch, the economy, their partner, their boss, their childhood, their health, their sleep, their anxiety. Some of these factors might be real. None of them cancel out alcoholism.

The painful truth is that families often join the denial without realising it. They do not want to believe it. They do not want the fight. They do not want the shame. They do not want to admit their home is not safe emotionally. So they accept half explanations, and the drinking continues.

The Signs Families Notice

Most families can describe alcoholism without using the word. They describe mood swings. They describe a person who is either charming or hostile. They describe walking on eggshells. They describe constant conflict about drinking. They describe broken promises. They describe a person who is physically present but emotionally absent.

Alcoholism often shows up as unreliable behaviour that gets defended aggressively. You bring it up and the person attacks the messenger. They accuse you of being controlling. They say you are overreacting. They remind you of your flaws. They change the subject. They turn it into a fight about anything except alcohol.

That pattern is important. People with a healthy relationship to alcohol can discuss it honestly. People with a dependence problem often cannot.

Blood Tests, What They Can and Cannot Do

Blood tests can support a diagnosis, but they do not diagnose alcoholism on their own. They can show the toll alcohol is taking on the body, and they can reveal patterns that match heavy drinking.

Doctors may look at liver related markers, nutritional issues, and blood cell changes that are common in chronic heavy drinkers. They may also check electrolytes and overall organ function, especially if withdrawal risk is present.

The important point is this, you can have severe alcoholism with “okay” blood results, especially early on. You can also have poor blood results without alcoholism. Tests inform the picture, they do not replace it.

Why Many People Want a Diagnosis

Families often want a diagnosis because they think it will force change. They imagine a doctor saying, you are an alcoholic, and the person suddenly agrees to help. That is not how it usually works. Many people hear the diagnosis and argue it. They say the doctor is exaggerating. They say they will cut down. They say they will handle it privately.

That is why family action matters. The person may not be able to see the problem clearly while they are trapped in it. Waiting for insight can be a long wait. Pressure is sometimes what gets them into a detox and into treatment, not because pressure is cruel, but because addiction does not respond to polite suggestions.

The Point Of Diagnosis Is Action

Diagnosis is not a label to win an argument. It is a decision point. If alcohol is running the show, it is not going to politely step aside. It needs a structured response.

A proper plan might include detox, inpatient treatment, outpatient support, therapy, and ongoing recovery structures. What matters most is that the response matches the severity of the problem, not the pride of the person.

Alcoholism thrives in delay, secrecy, and excuses. If you suspect it, do not waste time trying to prove it beyond doubt while things deteriorate. Get assessment, get guidance, and make a plan that protects life, health, and family stability.