Rebecca was here for a follow up after her alcohol detox at the Coleman Institute for Addiction Medicine. Two weeks earlier she and her husband of 38 years had spent the day with us in a quiet, private, comfortable room to help Rebecca carefully stop drinking alcohol. While she had been a daily drinker for some 40 years, over the last 3 years her drinking has escalated to a minimum of 2 bottles of wine each day.

A standard bottle of wine holds 750 ml, about 25.4 ounces, or approximately six glasses.

The National Institute on Alcohol Abuse and Alcoholism defines at-risk drinking:

“For healthy adults in general, drinking more than these single-day or weekly limits is considered 'at-risk' or 'heavy' drinking:

  • Men: More than 4 drinks on any day or 14 per week
  • Women: More than 3 drinks on any day or 7 per week

About 1 in 4 people who exceed these limits already has alcohol use disorder, and the rest are at greater risk for developing these and other problems. Again, individual risks vary. People can have problems drinking less than these amounts, particularly if they drink too quickly.”

We all know how ubiquitous over-consumption of alcohol is in our culture. It is very easy to look around and find other people who are drinking as much as or more than you are, and in that comparison, to let ourselves off the hook. People who are in denial or a pre-contemplative state of being unaware that their drinking is problematic justify their behavior by noting that they are still ‘highly functioning’—they go to work, they train for athletic competitions and are loyal to their workouts, they are highly involved in family and community activities, and don’t believe they drink more than other folks.

It’s important to know that you don’t have to hit a mysterious bottom before you decide to examine your drinking patterns. However, if you are a little concerned that your drinking may be becoming a problem, consider asking yourself these four simple questions.

The CAGE questionnaire is a tool used by health care providers to screen patients for possible alcohol use disorder. A total score of 2 or greater is considered clinically significant.

  • Have you ever felt you should cut down on your drinking?
  • Have people annoyed you by criticizing your drinking?
  • Have you ever felt bad or guilty about your drinking?
  • Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?

Interesting, yes?


Rebecca had clicked positive for the first three questions when she went to see her own primary care provider. She admitted to me later on that she generally opened her first bottle of the day by 11:00 a.m. She poured a glass, nibbled on some cheese, and called her sister for a daily chat.

After that bottle was open, it was pretty easy to get through it as she read her books and magazines, waiting for her husband to come home from work. Rebecca herself had retired from a successful marketing career about four years earlier. This extra free time, she realized was a great trigger for her. When her husband came home from work, she would open the next bottle of wine, he poured himself one glass of scotch, and over the course of the evening, she would easily consume the second bottle.

As her husband became more and more aware of the extent of Rebecca’s drinking, he tried to address it with her. She was very defensive and annoyed (see CAGE questionnaire #2) at his admonishments to cut down. She felt after years of hard work, she deserved to "enjoy herself."

Their relationship had gone from being quite close companions to her falling asleep early, slurring her words, frequent stumbling, and minimally participating in household responsibilities. Her husband was taking on more and more of the chores; it became easier to do them himself than to ask for her help.

His greatest concern was that Rebecca would drink and drive. He worried that if he suggested she keep her drinking down to one bottle, she would drink that, and head out for a second. In order to ‘help’ avoid this scenario, he began to restock the refrigerator every day with two nice bottles of pinot gris— her favorite.

It finally took a drunken fall resulting in a broken wrist for Rebecca and her husband to have a frank and honest discussion about her drinking. Rebecca was, in her words, “disgusted with myself." They went together to her doctor to discuss safe ways to stop this cycle, and her doctor recommended the Coleman Institute.

Our two-week follow up was wonderful. Rebecca was beaming and couldn’t overstate how happy her husband was to "have her back." Rebecca is enjoying the bliss of early sobriety. She feels determined to stay alcohol-free and claims not to miss it at all.

We will continue to follow up with Rebecca. Sometimes when the early blush of sobriety wears off, and triggers such as boredom, frustration, loneliness, or anxiety try to regain their old space, the resolve to stay sober is challenging. Our experienced staff is well-positioned to help guide patients through their challenges with sobriety, whether it is a referral to counseling, joining one of our own groups, or using medication.

Please call us at 877-893-3869 if you would like to learn more about how we can help you.

Joan R. Shepherd, FNP