28-Year-Old Sales Executive from Mumbai Overcomes Binge Drinking Triggered by Work Stress
Binge Drinking Case Study: Patient Background
This binge drinking case study follows Karan (name changed), a composite example that reflects how binge drinking commonly develops and how it is assessed and treated at Calida Rehab. The details are illustrative and do not describe any one identifiable person.
Karan is a 28-year-old sales executive from Mumbai. He lives with his wife in a rented flat in Andheri, and his parents live in Nashik. He had his first drink in college and for years drank only at parties. After he moved into a target-driven sales job at 24, drinks with colleagues on Friday and Saturday nights became his way of switching off from a stressful week. He did not drink on weekdays, so he never saw himself as someone with a problem. But once he started on a weekend night, he rarely stopped at one or two. Most weekends he had seven to ten drinks, often within two to three hours. Over two years the blackouts, the hangovers that wrecked his Sundays and the arguments at home increased. His wife brought him to Calida Rehab after a night he could not remember ended with a fall on a staircase and a fractured wrist.
Before the case itself, a short note. Binge drinking means drinking a large amount of alcohol in a short time. The US National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes it as a pattern that brings blood alcohol concentration to 0.08 g/dL, which usually takes about five or more drinks for a man or four or more for a woman in roughly two hours. It is not the same as daily drinking, and not everyone who binge drinks is dependent. But it carries real risks, and for many people it grows into alcohol use disorder. For more, read our page on alcohol addiction treatment and our guide to binge drinking.
Symptoms: How Binge Drinking Showed Up
Binge drinking is easy to miss because the person may not drink every day and may feel in control between episodes. The signs below are common.
Signs of a harmful binge pattern
- Drinking much more than planned once the first drink is had
- Finding it hard to stop after one or two drinks
- Blackouts or gaps in memory the next day
- Drinking quickly, in rounds or in drinking games
- Hangovers that disrupt work, family time or plans
- Risky behaviour while drunk, such as driving, fights, unsafe sex, falls or overspending
- Planning the week around the next drinking occasion
- Promising to cut down and not keeping the promise
Effects on the body
- Vomiting, severe headache, dehydration and acidity after heavy nights
- Poor sleep and tiredness for days afterwards
- Injuries from falls or accidents
- A racing or irregular heartbeat, or raised blood pressure, after heavy episodes
- Raised liver enzymes on blood tests over time
Signs the pattern is moving towards dependence
- Drinking on weekdays, or drinking to cope with stress, anxiety or low mood
- Needing more alcohol to feel the same effect
- Shakiness, sweating, anxiety or irritability the morning after (mild withdrawal)
- Cravings during the week
- Continuing to drink despite harm to health, work or family
In this case: Karan said drinking was the only way he knew to switch off after a week of sales targets. Once he began, he found it hard to stop, and at least once a month he had no memory of how the night ended. On Sunday mornings he woke with a pounding headache, nausea, sweating and a shaky hand, felt anxious and low, and twice had a beer to steady himself. He missed family lunches, snapped at his wife and was spending heavily on bar bills. He told us he did not think of himself as a heavy drinker because he never drank on weekdays.
Doctors do not go by a single symptom. Binge drinking is a pattern, not a diagnosis in itself. When the pattern causes harm and a person shows at least two of the eleven signs listed in the DSM-5 within a year, alcohol use disorder is diagnosed. Two to three signs is mild, four to five is moderate and six or more is severe.
Why Binge Drinking Often Goes Unnoticed
Binge drinking often goes unnoticed for years. Drinking is part of many celebrations, office parties and friend groups, so heavy drinking on a night out can look normal. Because the person does not drink every day, they and their family may think there is no problem. Blackouts are laughed off as a good night, and people picture an addicted person as someone who drinks daily and has lost everything, which is not what they see at home.
The risks are real even without daily drinking. In the short term, heavy episodes can cause accidents, falls, fights, unsafe behaviour and alcohol poisoning. Over time, repeated binges are linked with liver damage, high blood pressure, heart rhythm problems, poor sleep, anxiety and low mood, and problems with memory. They also raise the chance of developing alcohol use disorder. The sooner the pattern is recognised, the easier it is to change.
In this case: Karan’s friends joked about the nights he could not remember, and his wife kept hoping he would cut down on his own. He told himself it was only weekends and that he could stop whenever he wanted, but his attempts to skip a weekend never lasted more than a couple of weeks. The first real alarm was the fall that fractured his wrist. That belief that weekend drinking was harmless delayed help.
Diagnosis: How Binge Drinking and Alcohol Use Disorder Were Assessed at Calida Rehab
There is no single test for binge drinking or alcohol use disorder. The diagnosis is made by a psychiatrist through a careful clinical assessment. At Calida Rehab this typically includes:
- A detailed clinical interview about how much, how often and how fast the person drinks, and about blackouts, hangovers, morning drinking and past attempts to cut down
- The AUDIT questionnaire, the Alcohol Use Disorders Identification Test developed by the World Health Organization, to grade the risk of harm
- A physical examination, including blood pressure, pulse and general health
- Blood tests, such as liver function tests (SGOT, SGPT, GGT), blood sugar, lipids and a complete blood count, to look for early damage
- A withdrawal check using the CIWA-Ar scale if the person has tremor, sweating, anxiety or other signs after stopping
- Screening for other substances, including tobacco and cannabis
- Mental health screening for anxiety, depression and sleep problems
- Input from a family member, with the person’s consent
That mental health check matters, because alcohol use and anxiety or low mood often feed each other. See our anxiety case study, our depression case study and our alcohol addiction case study to see how these conditions can overlap. You can also read about alcohol dependence syndrome.
Result in this case: Karan’s AUDIT score was 17, which falls in the harmful drinking range. He was diagnosed with moderate alcohol use disorder with a binge pattern, along with mild anxiety and poor sleep. His liver enzymes were mildly raised and his blood pressure was on the high side. He had no signs of severe withdrawal. For Karan, learning that weekend-only drinking could still be a disorder, and that it was treatable, was the first real turning point.
Treatment Plan for Binge Drinking
No single treatment suits everyone. At Calida Rehab the plan is built after the assessment, and the family is involved when the person agrees. Most plans combine the following.
Withdrawal care. Someone who drinks heavily every day can have dangerous withdrawal, including seizures and delirium tremens, and should never stop suddenly without medical supervision. A person with a pure binge pattern usually has a lower risk, but mild withdrawal signs such as tremor, sweating and anxiety can still occur, so they are assessed and monitored. Read more on our detoxification page and in our guide to alcohol withdrawal symptoms.
Medicines to reduce craving. A psychiatrist may consider a medicine such as naltrexone or acamprosate, which help reduce the urge to drink. They are prescribed only after checking liver and kidney function, and they work best alongside therapy, not instead of it.
Therapy as the core of treatment. Behavioural therapy helps the person understand why they drink, handle cravings and stress, and build a weekend and a social life that do not revolve around alcohol.
Treatment of other conditions. Anxiety, low mood, poor sleep, raised blood pressure and early liver changes are treated or monitored alongside the drinking.
Family involvement. Families learn what alcohol use disorder is, how to respond to cravings and slips, and how to rebuild trust without blame.
Lifestyle. Fixed sleep and wake times, regular exercise, balanced meals and planned free time fill the gap that drinking leaves behind.
In this case: Karan’s team recommended a structured residential programme of about three weeks, followed by outpatient care, because he had not been able to cut down on his own and his weekend cycle was well established. The first few days were medically observed, and his mild morning tremor and anxiety settled quickly. After his liver tests, naltrexone was started to reduce cravings, along with vitamin supplements. Therapy began in the first week, and his wife joined family sessions to understand what he was dealing with.
Therapies Used in This Binge Drinking Case Study
The therapies below were part of Karan’s plan and are commonly used for alcohol use disorder.
- Motivational Enhancement Therapy (MET): helps the person explore mixed feelings about drinking and build their own reasons for change, instead of being pushed into it. See our motivational interviewing page.
- Cognitive Behavioral Therapy (CBT): identifies triggers such as work stress, Friday-evening plans and peer pressure, and teaches skills to handle cravings and negative thoughts. Read more on our CBT page.
- Relapse prevention planning: a written plan for high-risk situations such as office parties and weddings, early warning signs and what to do after a slip. See our relapse prevention therapy page.
- Stress and coping skills: relaxation, a fixed sleep routine, ways of refusing a drink and healthier ways to unwind after a hard week
- Individual counselling: one-to-one sessions to work through stress, guilt and the pressures behind the drinking. See our individual counselling page.
- Family therapy: sessions that help families communicate, set healthy limits and rebuild trust. See our family therapy page.
Follow-Up Care After the First Phase
Alcohol use disorder is a long-term condition, so care does not end when the first phase of treatment ends. Follow-up usually includes:
- Regular counselling sessions, with more frequent sessions in the first months and wider gaps later
- Review of sleep, mood and anxiety, with treatment adjusted if needed
- Repeat blood tests and a blood pressure check, usually around three months, to track recovery of the liver and heart
- A plan for known triggers such as work events, weekends and celebrations
- Booster sessions to refresh relapse-prevention skills when cravings or triggers return
- Support in rebuilding routine, work and relationships
- Continued involvement of the family, where the person agrees
A slip does not mean treatment has failed. It is a signal to get support quickly. Read our guide on relapse in addiction recovery, and see our alcohol addiction treatment page to understand what ongoing care looks like.
Outcome: What Recovery Looks Like With Binge Drinking
What changed for Karan over the first three months:
- Drinking: he stopped drinking. He had one slip at a colleague’s wedding, where he had two drinks. He recognised it, called his counsellor the next morning and followed his plan, and no binge followed.
- Sleep and mood: his sleep improved within a few weeks, and his anxiety settled.
- Health: his repeat liver tests and blood pressure had improved at the three-month review.
- Work: he stayed in his job and learned to handle client dinners without drinking. His manager noticed that his Monday mornings were sharper.
- Family: trust rebuilt slowly. Weekends at home became calmer, and his wife said she had her husband back.
- Time and money: he took up badminton again and began planning weekend trips with his wife.
It is worth being clear about what recovery means. It is not only a drinking-free weekend. It is a person who relaxes, works and relates to others without alcohol, who understands their triggers, and who knows what to do when a hard phase returns.
What the first six months of treatment usually look like
- Month 1: assessment, medically observed first days, a short structured programme and a written plan.
- Months 2 and 3: therapy skills build. Sleep, mood and blood tests are reviewed. Family sessions continue.
- Months 4 to 6: gains settle in. The team reviews what is working and what still needs support.
This is a general guide. Every person moves at a different pace.
Key Takeaways from This Binge Drinking Case Study
- Binge drinking is a risky pattern even when the person does not drink every day.
- It can cause accidents and health damage, and it can grow into alcohol use disorder.
- Blackouts and morning-after shakiness are warning signs and should be taken seriously.
- Therapy is the core of treatment, and medicines can help reduce cravings when a psychiatrist advises them.
- Anxiety, poor sleep and stress often sit alongside binge drinking and need treatment too.
- A slip is not a failure. Getting help quickly after one is what protects recovery.
When Should You See a Doctor?
Please speak to a doctor if you or someone you know:
- Often drinks far more than planned or cannot stop once started
- Has blackouts or cannot remember what happened after drinking
- Has been hurt, or has put others at risk, while drunk
- Has tried to cut down and could not
- Feels shaky, sweaty, anxious or unwell the morning after, or drinks to feel better
- Is seeing work, health, money or relationships suffer because of drinking
Alcohol poisoning is an emergency. Call 112 or go to the nearest hospital if a person who has been drinking heavily cannot be woken, is confused, vomits repeatedly, has slow or irregular breathing, has pale or bluish skin or has a seizure. Do not leave them to sleep it off. Anyone who drinks heavily every day should not stop suddenly without a doctor, because withdrawal can be dangerous.
If you or someone you know ever talks about hurting themselves, do not wait. Call 112 in an emergency, or Tele-MANAS on 14416. You can also call our 24-hour helpline for a confidential conversation.
Binge Drinking Case Study: Frequently Asked Questions
What is binge drinking?
Binge drinking means drinking a large amount of alcohol in a short time. It is usually defined as about five or more drinks for men, or four or more for women, in around two hours, enough to bring blood alcohol concentration to 0.08 g/dL.
Is binge drinking the same as alcoholism?
No, but the two are linked. A person can binge drink without being dependent, yet repeated binge drinking can lead to alcohol use disorder, and many people who binge drink already meet its criteria.
What are the risks of binge drinking?
Short-term risks include accidents, falls, fights, unsafe behaviour, blackouts and alcohol poisoning. Over time, repeated binges are linked with liver damage, high blood pressure, heart rhythm problems, anxiety, low mood and memory problems.
Can binge drinking cause withdrawal symptoms?
It can. Tremor, sweating, anxiety and irritability the morning after heavy drinking can be mild withdrawal. People who drink heavily every day risk severe withdrawal and should not stop suddenly without medical supervision.
How is binge drinking treated?
Treatment combines a full assessment, behavioural therapies such as Motivational Enhancement Therapy and Cognitive Behavioral Therapy, relapse prevention planning, treatment of any anxiety or sleep problems, and family involvement. Medicines to reduce craving are used when a psychiatrist advises them.
Are there medicines for alcohol cravings?
Yes. Naltrexone and acamprosate are commonly used to reduce the urge to drink. They are prescribed by a psychiatrist after liver and kidney checks and work best together with therapy.
Is my information kept private?
Yes. Assessment and treatment details are confidential and are shared with family or employers only with your consent.
Sources and Further Reading
This page is for information and is not a substitute for medical advice. The case described is a composite example, and details are illustrative. If you think you or someone you know may have a problem with binge drinking or alcohol, please see a doctor or psychiatrist for a full assessment.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022.
- National Institute on Alcohol Abuse and Alcoholism. Understanding Binge Drinking. niaaa.nih.gov
- Babor T. F., et al. The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care, 2nd ed. World Health Organization, 2001.
- Sullivan J. T., et al. Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction, 1989; 84(11): 1353-1357.
- Kranzler H. R., Soyka M. Diagnosis and pharmacotherapy of alcohol use disorder: a review. JAMA, 2018; 320(8): 815-824.
- Ambekar A., et al. Magnitude of Substance Use in India 2019. Ministry of Social Justice and Empowerment and AIIMS, New Delhi.