The title of her book, Drinking: A Love Story, by Caroline Knapp, succinctly captured the essence of the late author's gradual descent into alcoholism. The end point of this tragic journey lies at the far right end of the drinking spectrum, depicted below. In order to get to that final stage, however, Ms. Knapp had to first pass through two other areas that define problem drinking, including a large gray zone that until now has received little attention. This is the "almost alcoholic" zone, and helping people to identify at what point they may have slipped into this zone offers them an opportunity: to pause, reflect, and ultimately to decide if they want to pursue solutions for turning back.
Three kinds of "relationship"
One way that we have found useful in terms of thinking about the different zones in the diagram is in terms of different degrees of relationship. Just as our interpersonal relationships can differ in terms of intensity, so can our "relationship" with drinking. Moreover, these differences aren't separated by sharp lines; rather, they tend to blend into one another. Let's look at these different kinds of relationships.
People whose relationship with alcohol falls into this stage drink primarily in social settings. This is what we mean by "normal social drinking." It's a glass or two of wine at a wine-and-cheese get-together among friends, a couple of beers at the Sunday afternoon football party with friends, or an occasional happy hour cocktail with people from work. If we do drink alone at this stage of use, it is not typically on a daily basis, and it involves only a drink or two in one sitting.
Social users never binge, and they are neither psychologically nor physically "dependent" on drinking, for example, in order to overcome social anxiety. People have used alcohol socially — indeed, it has been called a "social lubricant" — for literally centuries. Drinking in this context is said to help people "loosen up" or "relax." Indeed, in small quantities alcohol may do this. A glass of wine or a beer can take the edge off just about any common stress we may be feeling. It can lower our inhibitions us just a bit (hence the term "unwind"), and thereby facilitate social interaction. Negative consequences, of course, can occur at any stage of drinking, but they are relatively rare at this stage. Viewed in terms of a relationship, at this stage alcohol can best be thought of as a casual friend. In terms of the drinking spectrum, a casual friendship with alcohol falls at the left end.
When we say we've gone from being casual friends with someone to having a "relationship" with them we are implying a stronger connection. So it is with alcohol. In this second stage, a person has learned to use alcohol consistently for one of two reasons: either to create certain positive feelings (e.g., relaxation, euphoria) or else to avoid certain negative feelings (e.g., anxiety, loneliness).
This type of drinking is represented by the large gray area that we have defined as the "almost alcoholic" zone on the drinking spectrum. It is indeed a "gray area" because, first, there is no sharp line that separates normal social drinking from becoming an almost alcoholic. Second, there are even degrees within that zone, with some people being much closer to true alcoholism than others. In other words, as a person moves to the right on the drinking spectrum the stronger their "relationship" with alcohol becomes.
Rather than stepping over a sharp line in the sand, a person gradually slips away from social drinking ("casual friendship") and into almost alcoholic drinking ("relationship"). At some point the symptoms and behavior patterns associated with being an almost alcoholic start to appear, especially drinking consistently alone and in an effort to either create feelings (relaxation) or mute them (anxiety, depression), or to influence behavior (to socialize, to get to sleep). At this point alcohol has become a reliable "buddy."
Drinking at this stage makes a person more vulnerable to certain negative consequences, such as more frequent hangovers, unpredictable mood changes, or lack of concentration and mental acuity. If we move deeper into the almost alcoholic zone, our bodies become less efficient at metabolizing alcohol, with the result that we feel tipsy more quickly, which can lead us to behave in ways that later embarrass us. Finally, at this stage loved ones become aware of our drinking and may experience a degree of jealousy over our "relationship" with alcohol.
This corresponds to the two areas at the far right of the drinking spectrum: alcohol abuse and alcoholism. These stages, which are associated with severe symptoms and consequences that qualify for a formal diagnosis, mark the end of the "love affair." At this stage, drinking has progressed from being a serious relationship to the level of what could be called a commitment that the drinker has made with alcohol. The committed drinker makes sure that he or she is never far from alcohol. Over time, his or her life style begins to revolve around more and more around drinking. One husband described how his wife, as she moved into this stage of drinking, refused to go anywhere that she could not drink. She refused, for example, to take a bus tour with him to visit three national parks because she could not take liquor on the bus. And as one wife put it, "My husband won't go anywhere without his cooler. It's as attached to him as his wedding ring."
By the time drinking has progressed to this stage, loved ones begin to harbor deep resentments and can become increasingly alienated from this "commitment" that is not only intimate (like a marriage) but which seriously competes with or overshadows the drinker's other commitments — to spouses, children, friends and work.
Once drinking has become a commitment, turning back and returning to normal social drinking is extremely difficult, if not impossible. If a committed drinker wants to do that, I strongly recommend that he or she begin with an extended period of abstinence — six months at a minimum. The help of a counselor experienced with treating addictions is also essential.
In contrast, men and women who realize that they have slipped somewhere into the almost alcoholic zone have many more options available to them. Unlike Ms. Knapp, they may still have the option of "shifting left" and ending their relationship before it becomes a commitment.
What is your relationship with alcohol?
For more information visit www.TheAlmostEffect.com or read Almost Alcoholic: Is My (or My Loved One's) Drinking a Problem?
Copyright 2012 by Dr. Joe Nowinski.