The title of her book, Drinking: A Love Story, by Caroline Knapp, succinctly captures the essence of the late Carolyn Knapp?s gradual descent into alcoholism. This end point 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: pause, reflect, and ultimately to decide if they want to pursue solutions for turning back.
Three Kinds of ?Relationships?
One way that we have found useful in terms of thinking about the different zones in the above 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.
Casual Friendship
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 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.
Serious Relationship
When we say we?ve gone from being casual friends with someone to having a ?serious 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).
Related: Commit to Drug Prevention and Help Loved Ones
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.
Rather than stepping over a sharp line in the sand, a person gradually slips away from social drinking and into the almost alcoholic zone. At some point the symptoms and behavior patterns associated with being an almost alcoholic start to appear.
The man or woman who is developing a serious relationship with alcohol is someone who may begin to drink alone as well as socially. This is an important change in drinking behavior because as a person crosses that boundary from drinking mainly in social situations to increasingly drinking alone their relationship with alcohol gets serious. It?s no longer just a casual friend but rather a reliable ?buddy.?
Drinking at this stage represents an intentional and consistent effort to either pursue desirable emotional effects, to allow us to engage in certain behaviors, or to overcome negative emotions such as social anxiety and their consequences (shyness, self-consciousness). As time goes on and we come to rely on our ?buddy? alcohol, we can easily find ourselves drinking more consistently (and in larger quantities) than regular social drinkers. As a result we are 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 a metabolizing alcohol with the result that we feel tipsy more quickly, which can lead us to behave in ways that later embarrass us, or make us more likely to fail a sobriety test after drinking the same amount that before wouldn?t have put us over the limit.
Commitment
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. Loved ones often relate very well to this idea of someone having made a commitment to drinking. By the time drinking has progressed to this stage they can see how that commitment is not only intimate (like a marriage) but is also one that begins to seriously compete with drinkers? other commitments?to spouses, children, friends and work.
Related: 10 Ways to Quit a Bad Habit
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.? If that last comment isn?t an image of commitment, we don?t know what would be!
Definite personality changes begin to appear as a person drifts into the commitment stage. In the emotional sphere, these changes most often include a growing emotional instability, increased aggressiveness and irritability, and depression. Psychologically, the habitual drinker becomes progressively more self-absorbed, unreliable, and demanding?in a word, childlike.
Related: Whitney Houston Reminds Us, Confront Substance Abusers
At this stage of drinking, significant others experience anger and anxiety as well as increasing frustration as repeated attempts to control the other person?s drinking fail. Confrontations over drinking may occur more frequently and come to threaten the stability of relationships with loved ones.
Once drinking has become a commitment, turning back and returning to normal social drinking is, in our experience, extremely difficult, if not impossible. If a committed drinker wants to do that we 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. But we do not want to mislead anyone: turning back from a casual friendship is one thing, but turning back from a true commitment in another thing altogether.
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Joseph Nowinsk
About the authors:
Joseph Nowinski, Ph.D., and Robert Doyle, M.D., are the authors of Almost Alcoholic: Is My (or My Loved One?s) Drinking a Problem? (The Almost Effect). Nowinski is a clinical psychologist and was assistant professor of psychiatry at the University of California?San Francisco and associate adjunct professor of psychology at the University of Connecticut. Doyle is a nationally recognized expert on alcoholism, a clinical instructor in psychiatry at Harvard Medical School and is on the medical staff at Harvard?s prestigious teaching hospital, Massachusetts General Hospital. For more information visit www.TheAlmostEffect.
More from Dr. Joseph Nowinski: How to Protect Your Child From Hazing
Category: Health, Mind Body Connections, Nutrition, Stress Management
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