When Drinking Has Become a Problem: Talking to Your Doctor and the AUDIT-C Screen

The line between a daily drink that is fine and a daily drink that is a problem is not always obvious. Most older adults who develop alcohol problems do so gradually — a glass at dinner becomes two, becomes a nightcap, becomes a refill, over years. The signs are often hidden in plain sight: a fall in the night, a forgotten appointment, a tense conversation with an adult child, a higher blood pressure reading at the doctor visit. None of those signs is proof. But several together, especially within a few months, is reason to take a closer look.

The medical world uses a short screening called AUDIT-C, three questions developed by the World Health Organization. It takes one minute. The questions are: 1) How often do you have a drink containing alcohol? Never (0), Monthly or less (1), 2-4 times a month (2), 2-3 times a week (3), 4 or more times a week (4). 2) How many drinks containing alcohol do you have on a typical day when drinking? 1-2 (0), 3-4 (1), 5-6 (2), 7-9 (3), 10 or more (4). 3) How often do you have six or more drinks on one occasion? Never (0), Less than monthly (1), Monthly (2), Weekly (3), Daily or almost daily (4).

A score of 4 or more for men or 3 or more for women suggests further conversation with a doctor. A score of 6 or more for men or 5 or more for women suggests likely problem drinking. The score is not a diagnosis. It is a starting point for a conversation. You can take the AUDIT-C yourself at niaaa.nih.gov or rethinkingdrinking.niaaa.nih.gov.

Other signs to watch for, especially in combination: drinking earlier in the day than you used to, hiding bottles or empty cans, feeling defensive when a family member mentions your drinking, needing more alcohol to feel the same effect (tolerance), morning shakiness or anxiety that improves with a drink (a key warning sign of physical dependence), recent falls, memory gaps, missed pills, weight changes, depression, or a drift away from activities that used to matter.

Talking to your doctor about drinking can feel embarrassing. It is not. Primary care doctors screen every patient for alcohol use at the annual physical now under federal guidelines, and most have the conversation several times a day. Their training treats alcohol problems as a medical condition, not a moral failing. They will not write Alcoholic in your chart. They will run the AUDIT-C, check your liver enzymes (a simple blood test), and discuss options — which may include cutting back rather than quitting, depending on the situation. Insurance and Medicare cover annual alcohol screening and brief intervention as a preventive service with no copay.

If you would rather not bring it up with your doctor first, the SAMHSA national helpline at 1-800-662-HELP (4357) is free, anonymous, 24 hours, and staffed by trained counselors. They will listen, ask questions, and connect you to local resources if you want them — peer groups, treatment programs, online options, or a referral to a specialty doctor. They do not push you toward any specific outcome. The call leaves no record.

(Sources: NIAAA Rethinking Drinking AUDIT-C screening tool; U.S. Preventive Services Task Force Alcohol Screening Recommendation 2024; SAMHSA National Helpline; Medicare Preventive Services coverage, accessed May 2026)