What are the signs of alcoholism in someone you love?

In short

• The signs of alcoholism that families see first are loss of control, secrecy and a growing price. More drunk than planned, promises that do not hold, bottles in odd places, evenings missed, a mood that swings around the drink. A good job and a tidy house do not rule it out.
• Clinicians count eleven criteria over the past year. Two or three is mild alcohol use disorder, four or five moderate, six or more severe, going by the US National Institute on Alcohol Abuse and Alcoholism (NIAAA). You cannot diagnose someone you love, but you can count what you have seen.
• Do not push a daily drinker to stop overnight. Stopping suddenly can bring shaking, seizures and hallucinations. At Renewed Life Center in Lakeside, Cape Town, detox runs under 24-hour nursing. Admission can be immediate, typically within three days of first contact, and a relative can make the first call.

Worried about someone else’s drinking? Message us on WhatsApp for a free, confidential call about them. It takes twenty to forty minutes, they do not need to be on the line, and we reply the same day.

You have probably been watching for a while. The wine that is finished by Tuesday. The “just one more” at the braai. The way one question about it ends the evening. Below are the signs of alcoholism that families notice first, how a heavy drinker differs from someone who has lost the choice, and what to say and do this week. It is for a wife, a husband, a parent or a grown-up child.

How can you tell if someone you love has a drinking problem?

Look at control and cost, not the number of drinks. Someone has a problem when they drink more, or for longer, than they meant to, have tried to cut down and could not, and carry on despite the trouble it causes. The NHS lists “people you know being concerned about your drinking” as a sign, so your worry counts.

Two people can finish the same bottle of wine each night and only one of them has a problem. The difference shows in the rest of the week. It is also common: the World Health Organization estimated that 209 million people, 3.7% of the world’s adult population, lived with alcohol dependence.

Closer to home, alcohol was the main substance for 26% of the 1,489 people treated in the Western Cape in the first half of 2025, second only to methamphetamine at 30%, according to SACENDU, the South African Community Epidemiology Network on Drug Use run by the South African Medical Research Council. These are treatment figures, not a headcount of everyone who drinks too much. An older national survey, the South African Stress and Health study of 2003 to 2004, found alcohol abuse in 4.5% of people over twelve months and 11.4% over a lifetime.

What do the early signs of alcoholism look like at home?

Secrecy comes first. Drinks are hidden or poured out of sight, the amount is understated, and a simple question meets irritation or silence. Then come the missed evenings, the guilty mornings and the promises that last a week. The NHS also lists feeling guilty or remorseful after drinking among the signs.

If it is a husband or partner who drinks every night, our page on what to do when your husband drinks every night goes further into that one pattern.

A parent’s drinking looks different from the other end of the phone: calls that turn slurred after eight, a birthday that ends early, the same story told twice. Do not rule out the woman in the family either.

What can you see on the body?

Morning shakes, sweating, a flushed face, weight that has moved and less care over appearance are the ones families mention, though none of them proves anything alone. The most telling is the start of the day: the NHS lists craving alcohol, for example needing a drink when you wake up in the morning, as a sign.

Shakiness, sweating, nausea and poor sleep are also on the list of withdrawal symptoms in the NIAAA criteria. When they appear on days someone has not had a drink, the body has adjusted to alcohol being there.

Be careful with the rest. A red face, tiredness or a change in weight can have other causes, and nobody can diagnose alcoholism by looking across the table. Write down what you see and when, and bring the list to the first call: it tells us more than any single sign.

Can someone be an alcoholic and still hold down a job?

Yes. “Functioning alcoholic” is not a diagnosis, but it names a real pattern: the job, the house and the manners stay intact while the drinking runs the evenings. The same criteria apply however well the rest of life looks.

A US national study of adults with alcohol dependence sorted them into five subtypes. Two of the five, about 19% each, had the latest onset and higher psychosocial functioning than the others (Moss and colleagues, 2007). Doing well at work and being dependent on alcohol can go together for years.

The rest of life takes the strain. Work stays in order while the marriage and the weekends pay for it.

The job is the alibi. Long hours and client dinners become the explanation for every glass. “I have earned it.”

Every drink has a reason. A hard week, a good week, the holidays, a bad flight home. The reason changes, and the drink does not.

One is never one. They cannot skip a night even when there is a reason to, they leave a dinner early to get to a drink, and they are fine at nine and someone else at ten.

If this is your household, you are not being dramatic. You are seeing the part colleagues do not.

When do these signs add up to alcohol use disorder?

When they meet two or more of the eleven DSM-5 criteria (the US diagnostic manual for mental disorders) in the past year. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) grades two to three as mild, four to five as moderate and six or more as severe. A clinician diagnoses; you can bring the tally.

Two or three ticks is worth a call with us, and you can make it without them. If the person drinking wants to check themselves, our AUDIT self-test stays private.

Why does alcohol take hold, and why is willpower not the answer?

Because it does a job, and the body adapts to it. For most people alcohol quietened something: anxiety, a memory, a sleepless night, the gap between work and home. With regular drinking the body adjusts, so it takes more for the same effect, and stopping brings symptoms of its own. Willpower has to argue with all of that at once.

Ask a drinker what alcohol gives them and the answer is rarely “pleasure”. It is relief, or sleep, or a way of switching off the day. That is why “why can’t you just stop” never lands. Most of us reach for something to take the edge off, and alcohol works within minutes and is sold on every corner. Take the drink away and the anxiety, the memory or the sleepless night is still there, so treatment has to work on that as well.

Kerry Dominie-Williams, a TRE (tension and trauma release exercises) practitioner at the centre, starts from a line by the physician Gabor Maté: “Don’t ask why the addiction, ask why the pain.” Her next question is where the work at the centre begins: “What wound started this?”

Finding that wound is psychological work, and at Renewed Life Center Dr Ruby Weber leads it. She heads psychology at the centre and has worked in the addictions field for over two decades, with international and South African clients. Anxiety, depression, trauma and poor sleep are treated in the same house, under one plan with the drinking. If you think the drinking is covering something, say so on the free first call. It is confidential, and you can have it without them.

Is it dangerous for them to stop suddenly?

It can be. When the effects of alcohol wear off, some people get withdrawal symptoms: shaking, sweating, a racing heart and, in some people, a seizure or sensing things that are not there. So do not push a daily drinker to stop overnight. Message us first, and we will tell you how to handle the next few days.

Nobody can judge the risk from the sofa, and the person drinking cannot judge it either. At Renewed Life Center, detox begins with a risk assessment before withdrawal starts, and our resident GP does a medical assessment. Nurses are with the person around the clock, and medication is used only where it is clinically indicated and prescribed by a medical professional. Read more about medical detox in Cape Town and how to stop drinking safely.

If someone has a seizure, is confused, or is seeing or hearing things that are not there, call 10177 or 112 from any mobile now. If they talk about ending their life, the Suicide Crisis Helpline is 0800 567 567, day or night.

A drink on waking, or shaking, sweating, sickness or a seizure the last time they cut down, means a sudden stop is not safe for them, and what withdrawal looks like hour by hour shows why. Message us before anyone pushes for a stop: we will tell you whether they need a medical detox and help you get them here.

Not sure whether the drinking calls for detox? Message us on WhatsApp and describe what you have seen. A relative can make it, we reply the same day, and admission can be immediate.

How do you talk to them without a fight?

Pick a calm, sober moment, speak for yourself and stay concrete. Say what you have seen and how it lands on you, ask one question and stop there. The aim is a second conversation. The first one rarely ends in agreement, and that is normal.

There is a longer guide on how to talk about rehab.

You can get help of your own, too. The World Health Organization notes that alcohol causes significant harm to others, not just to the person consuming alcohol. Family therapy is part of treatment with us, in person or by video, and there is a family meeting every Wednesday at 18:00 on Zoom. Al-Anon is the family side of AA, and our guide to AA and Al-Anon in South Africa has their helpline. If you would like to talk through your side of it first, write to us and we will reply the same day.

Why do families choose Renewed Life Center?

Because the medical side and the therapy are in the same house, and the family is part of the work. Detox runs under 24-hour nursing and Dr Ruby Weber leads psychology. A relative can make the first call, and we reply the same day.

One programme. Detox where it is clinically indicated, then individual psychotherapy typically three times a week in the first phase and group therapy five or more times a week, with later phases and sober living part of the same programme. Our page on alcohol addiction treatment in Cape Town walks through it week by week.

People you can name. Dr Ruby Weber heads psychology. Craig Duke is an addiction counsellor and recovery coach with more than twenty years in personal recovery and a UK and Swiss background. Leila Bolland is a social worker and therapist who has worked in the field since 2015. Dr John Wulz is our General Practitioner, with a background in mental health and emergency medicine, and a medical assessment by our resident GP is part of the programme.

The family is inside the treatment. Family therapy in person or by video, and Wednesday meetings at 18:00 on Zoom, so relatives abroad can be part of it.

Direct payment. You pay us directly, and no scheme decides how many days are covered. The fee depends on the programme and its length, so we go through it on the first call and send it in writing the same day.

Lakeside, with the mountain ridge behind the house. The house is in Cape Town’s Southern Suburbs, about two kilometres from Muizenberg beach, with staff on site around the clock. Airport transfers are included both ways for people flying in.

What is the first step?

A free, confidential conversation of twenty to forty minutes, by WhatsApp, video or phone, and you can have it on their behalf. We reply the same day. A clinical assessment of 45 to 90 minutes follows, and admission can be immediate, typically within three days of first contact.

You come away from that first call with a clear sense of whether a medical detox is likely, what the programme would look like for them, and how to raise it at home; the clinical assessment then confirms the plan. Nothing is decided unless you want it to be, and you do not need to be sure it is alcoholism before you ring.

Message us on WhatsApp for them or for yourself, or send us a message if you would rather write first.

Questions people ask

This article is general information, not medical advice.

Sources

1. NIAAA, Understanding alcohol use disorder
2. NHS, Alcohol misuse
3. World Health Organization, Alcohol fact sheet
4. SACENDU Research Brief, South African Medical Research Council, volume 29(1), 2026
5. South African Stress and Health study, 2003 to 2004, South African Medical Journal, 2009
6. Moss et al., Subtypes of alcohol dependence in a nationally representative sample, 2007