Robert L. Doyle, MD, clinical instructor in psychiatry at Harvard Medical School in Boston. He has a private practice in Cambridge, Massachusetts, and is coauthor of Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem?.
Everyone knows that alcoholism poses a real danger to health, relationships and work. On the other end of the spectrum, modest alcohol consumption can be pleasant and harmless for most people and may even bring some health benefits.
What many people aren’t aware of: There’s a large gray area between these two scenarios—drinking that doesn’t fit the criteria of alcohol abuse or addiction, yet may be taking a subtle or substantial toll on a person’s life. This area is known as almost alcoholism.
Chances are you know someone whose drinking falls into this gray area…or you might even suspect that you’re an almost alcoholic.
Because the physical and mental reaction to alcohol varies from person to person (and even from one time of life to another), the number of drinks you have per day or week is not a reliable indicator of an alcohol problem.* The type of alcohol you drink—hard liquor versus beer or wine—is not of utmost importance either. Instead, if you have concerns about your alcohol habits, take this quick quiz…
If you said yes to the first or last question, drinking definitely is a problem—even if amounts are modest and harm seems minor—and you need to make changes. But if you answered affirmatively to any question (especially more than one), you also should give serious thought to the role of alcohol in your life and whether you need to make changes. What else may be behind some of the questions above…
Looking forward to drinking may seem natural—we anticipate what we enjoy—but this can be a sign that your relationship with alcohol is heading down a dangerous path. Maybe it’s becoming too important to you, stressing significant relationships or affecting your daily responsibilities or schedule.
Ask yourself: Do you often stop by the local bar or hurry home to have a drink after work? If you refrain from drinking during the week, is alcohol a major reason you look forward to the weekend?
Drinking alone isn’t always a problem either but can be a danger sign. For most people, drinking is primarily a social activity—it’s part of the fun of getting together. But drinking alone, or being the only one drinking in a group, suggests that a person may be drinking solely to get intoxicated, which is unhealthy physically and emotionally.
Drinking alone is of particular concern if boredom or loneliness is involved because, while drinking may be a distraction, it doesn’t help solve these problems. Better solutions include finding fun activities to replace boredom or cultivating new friends to alleviate loneliness.
Important: Social drinking isn’t necessarily benign. If watching sports on TV with friends is a favorite pastime, is it the friends, the game or the chance to drink more beers than usual that’s the attraction? Would you spend so much time with those friends if alcohol weren’t involved?
Drinking to ease unpleasant emotions or stress isn’t necessarily bad if it’s occasional and part of a repertoire of coping strategies, such as exercising, talking to friends or pursuing a hobby. But relying on alcohol may keep you from using healthier solutions to resolve distress.
Ask yourself: During a stressful day, do you often find yourself thinking, I really need a drink? Is alcohol your usual remedy for feeling down, stressed or nervous?
Sometimes almost alcoholism slips under the radar because the change from normal drinking has been gradual and the damage hidden. If you are still concerned, ask yourself these additional questions…
Helpful: To clarify alcohol’s effects on your life, go without it for two weeks to a month. The time frame is up to you. How do you feel? Are you sleeping better, working better? Is it harder or easier to deal with stress? Due to differences in metabolism and previous drinking patterns, some people will notice a difference right away, while for others it can take longer.
If you find it very difficult—or impossible—to do without alcohol temporarily, you know you need to make some changes.
Important: People with significant to severe alcohol dependency may need to taper off alcohol or go through detoxification under the guidance of a clinician to prevent withdrawal side effects.
Change your routine. If drinking is an integral part of your schedule, substitute other activities. For example: Instead of stopping off for happy hour, treat yourself to a workout at the gym.
Make new friends. If much of your social life includes drinking, cultivate new friends who don’t drink as much.
Practice refusing drinks. Health concerns are a socially acceptable reason to say no. Examples: “No, thanks. I’m watching my weight, and a glass of wine has about 100 calories.” Or you could simply say, “I’m not crazy about the way alcohol makes me feel.”
Find new ways to deal with stress. Doing relaxation exercises, listening to calming music and practicing meditation are healthier ways to unwind than drinking alcohol. However, you may need to confront your stress at the source, whether it means working on a personal relationship or finding a new job.
Get help if you need it. If you determine that you’ve been drinking to “self-medicate” depression or anxiety, speak to your family doctor about addressing these problems with lifestyle changes, psychotherapy and/or prescription medication.
Alcoholics Anonymous (AA) isn’t just for people who identify themselves as alcoholics. Anyone interested is welcome to attend most AA meetings, and many people who are concerned about their drinking find the approach very helpful.
If you’re concerned about a loved one’s drinking, encourage him to think carefully about his alcohol use and consider the need to change. Be empathetic and avoid creating guilt or shame or name-calling.
You might say something like, “I notice when you drink you seem to be kind of flat. You’ve also said that you feel depressed lately. I wonder if alcohol is making it worse.”
Suggest that your loved one have a discussion with his family doctor about mood problems and other issues associated with drinking.
*If you do drink, the recommended limit is up to one drink a day for women and up to two drinks a day for men.
Note: People also can be almost addicted to drugs, such as prescription painkillers, anti-anxiety drugs, sleeping pills, pot or street drugs. For more on that topic, click here.