When should a person be concerned about their drinking? As a psychologist who specializes in helping people with substance abuse, people often ask me a question that goes something like this: “I drink _______. Does that mean I’m an alcoholic?”
A New Perspective on an Old Problem
Questions like the above reflect a way of thinking about drinking that, ironically, has its origins in medicine’s attempt to define a disease and thereby identify those men and women who need help. Accordingly, the American Medical Association and the American Psychiatric Association developed a list of objective criteria that qualified a person as an alcoholic. Those criteria included symptoms such as experiencing withdrawal when a person stops drinking, has had blackouts, and so on. As useful as this paradigm may have been when it was adopted, it also has led to a way of viewing what I call “the drinking world” in terms of a dichotomy. That dichotomy can be represented by a diagram such as the following:
What this diagram implies is that the world is divided into two kinds of people: alcoholics and non-alcoholics. It also implies that there is a fairly sharp line separating alcoholics from everyone else. Finally, it leads people to ask me questions like the above, or “Where is the line separating normal drinking from problem drinking?”
What I like to tell people is that they don’t need me to answer these question — they can answer them for themselves. But first they need to shift their thinking and conceptualize “the drinking world” using a different paradigm. Specifically, they need to entertain the notion that the “drinking world” is not simply divided into two kinds of people, but that in reality the real drinking world looks more like the diagram below:
If you look closely at this second diagram you will see that drinking really exists on a spectrum. It’s divided into several areas, all of which blend into one another. For example, a person does not step over some “bright line” from the normal social drinking zone into the almost alcoholic zone. At the other end of the spectrum, people tend to slip into alcohol abuse or alcoholism over time. This paradigm actually better fits research data that show, for example, that on average it takes many years for a person who is a heavy drinker to progress to alcoholism.
What this new paradigm suggests is that people whose drinking may be causing significant problems in their lives may fall well short of what would qualify for a diagnosis of alcohol abuse or alcohol dependence. These men and women are not alcoholics; rather, their drinking falls somewhere in that almost alcoholic zone. And there is good reason to believe that there are many more almost alcoholics than alcoholics in the world.
What kinds of problems can “almost alcoholic” drinking cause? The list includes health problems (diabetes, hypertension, heart disease), emotional problems (depression), declining performance at work, and family problems. Usually, the almost alcoholic does not “connect the dots” and see how drinking is related to these problems.
The Alcohol Audit
How can you tell if you are (or someone you love is) an almost alcoholic? First, you can take a minute or two to do a personal alcohol audit by asking yourself the following questions:
- Do you drink to relieve stress?
- Have you come to rely on a drink or two to “unwind” or “de-stress” pretty much on a daily basis?
- Do you drink alone?
- Though there may have been a time when you drank mostly or only in the company of others, these days are you are just as likely to have one or more drinks when you are alone?
- Do you look forward to drinking ?
- Do you find yourself anticipating that cocktail, glass of wine, or beer every day when you get home from work, or when the kids go to bed?
- Could your drinking be contributing to one or more health problems?
- Do you have hypertension or diabetes? Are you a cancer survivor? You may not realize that even a couple of drinks can worsen those conditions and increase your risk for cancer recurring.
- Do you drink to relieve boredom or loneliness?
- Are you are retired, widowed, a single parent, or unemployed? Do you feel lonely or bored at times, and find that a drink or two is comforting?
- Do you drive after drinking?
- You may never have been pulled over for driving while intoxicated, but how often have you driven when your blood alcohol level was most likely over the legal limit?
- Has your performance at work declined?
- If you look at it objectively, are you as sharp at work these days as you were a couple of years ago? Have you made more mistakes, or had a poorer annual performance evaluation than you were accustomed to?
- Are you uncomfortable in social situations where there is no drinking?
- Are you likely to turn down invitations to social events where you know that no alcohol will be available?
Some people may think that answering “yes” to several of the above questions qualifies them as an alcoholic, but that is not necessarily the case. Many people continue to function at a fairly high level despite being in the almost alcoholic zone. The effects of drinking are there, but they may be more subtle than obvious, and they are not likely to make the connection between these problems and drinking for years, if ever.
If you answered “yes” to quite a few of these questions (meaning that you do these things on a fairly frequent basis), you probably are somewhere in the large almost alcoholic zone. Maybe you’ve only recently crossed into it, and are not yet in too deep. Alternatively, perhaps you’re somewhere in the middle and have been there for a long time. In either case, having this awareness the choice is now yours: Do you think you ought to consider “shifting left” on the drinking spectrum, or are you content to stay where you are?