Are You An Almost Alcoholic?
A new book would classify most of us who consume alcohol as "almost alcoholics."
Clinical psychologists Joseph Nowinski and Robert Doyle are pitching a new book that would classify most of us who consume alcohol as “almost alcoholics.” They preview their argument in The Atlantic.
[P]rofessionals have long viewed the problem of alcoholism and addiction in absolute terms: either you are addicted, or you are not. The official psychiatric diagnostic category — alcohol dependence — is what is commonly called alcoholism. The alcoholic must drink more or less continuously to maintain a level of alcohol in his or her body. If all the alcohol is metabolized the alcoholic goes into withdrawal and experiences severe, even life-threatening physical symptoms.
A second category that is used by mental health and other professionals to render a diagnosis – alcohol abuse — was added to the official Diagnostic and Statistical Manual (DSM) long after alcohol dependence. Alcohol abuse is the diagnosis used when an individual is not yet physically dependent on alcohol but has nevertheless experienced one or more severe consequences directly attributable to drinking. Examples of such consequences would be an arrest for driving under the influence or domestic violence, a severe illness such as diabetes, or the loss of a job due to poor performance.
The authors argue for a “paradigm shift” that would view alcoholism along a spectrum.
Here are a few signs that an individual may have moved out of the normal social drinking part of the spectrum and into the almost alcoholic zone:
- You drink to relieve stress.
- You often drink alone.
- You look forward to drinking.
- Your drinking may be related to one or more health problems.
- You drink to relieve boredom or loneliness.
- You sometimes drive after drinking.
- You drink to maintain a “buzz.”
- Your performance at work is not what it used to be.
- You aren’t comfortable in social situations without drinking.
- You find that drinking helps you overcome your shyness.
The almost alcoholic zone is actually quite large. The people who occupy it are not alcoholics. Rather, they are men and women whose drinking habits range from barely qualifying as almost alcoholics to those whose drinking borders on abuse. One thing we do know about them is that the more their drinking correlates with the above statements the more likely they are to drift further into the almost alcoholic zone.
Now, I support the baseline argument. Like most things, problem drinking likely exists on a continuity with varying degrees rather than being an all or nothing phenomenon. And I’m amenable to persuasion that answering Yes to a lot of the questions on the above list may be an indicator to problem drinking. But most of the questions in and of themselves is answerable as Yes by many if not most drinkers.
If we’re honest with ourselves, most of us who consume alcohol do so at least partly to relieve stress. A nice cocktail or even a beer or glass of wine is a nice transition from the work day to the rest of the evening.
I often drink alone because I’m often alone. Or, at least, don’t have other adults around. I like to drink. I like to be alone. So, quite often, I do them simultaneously.
For introverts, generally, drinking indeed acts as a “social lubricant” and in that regard helps overcome shyness.
It strikes me that these questions all need some indicator of degree. It’s not “drinking” that’s the issue but drunkenness.
Having come of age in the post-MADD era, I’ve never driven while intoxicated. But I’ve certainly driven after drinking. I enjoy having a beer or glass of wine with dinner. But I’m in excess of 200 pounds and metabolize alcohol quickly, so I can have a drink early in the meal and be well under the legal limit before getting behind the wheel. Similarly, I quit drinking well before leaving a bar or party if I’m going to be driving home.
Am I more relaxed after a drink or two? Absolutely. Do I need several drinks to function socially? No.
It would appear that–at least in the short form of their argument that appears in the article–Nowinski and Doyle fall prey to exactly the trap they’re arguing against. That is, these indicators aren’t Yes/No questions but should be evaluated along a spectrum.
Those who don’t remember history (in this case, what happened after Prohibition began) are doomed to repeat it. I’ve seen this play before, specifically 100 years ago.
@steveegg:
Indeed, there’s considerable evidence that alcholism actually increased during Prohibition
Yeah, almost but I think with a little more work I can finally get myself over the finish line!
Another thought.
Does an “Almost Alcoholic” go through a 6 Step Program?
I don’t even think that occasional drunkenness is a problem. More-than-occasional? Maybe yes. Driving while under the influence? Definitely.
My performance at work isn’t what it used to be but that has nothing to do with the two glasses of wine a week that I drink. It has more to do that I’m 40 years older and don’t work as many 18 hour days as I used to.
I’m reminded of the episode of Rumpole of the Bailey in which Rumpole’s physician advises him to give up plonk and red meat and eat some cereal pap as his regular diet. At the end of the episode Rumpole’s physician, younger than he, dies of sudden cardiac arrestt and Rumpole returns to his old, evil ways.
@Doug Mataconis:
Is there? My recollection is that it decreased at the beginning and slowly increased over the years but never went back to its pre-Prohibition levels. I’d be interested in a citation.
@Dave Schuler: Indeed all around. And, yes, the combination of being older and children-induced sleep deprivation have done far more to my productivity than alcohol.
I’m a member of DDAMADD.
@Dave Schuler:
Stampedes back, you mean. I certainly wouldn’t have gotten between Horace and that buffet table.
@Dave Schuler:
I suppose what I’m referring to there is that, during Prohibition, people who drank were more likely to be drinking to excess both because of the illegal nature and because of the atmosphere that was created around the illegal consumption of alcohol.
For sure, there was a serious problem with alcohol consumption prior to the rise of the prohibition movement perhaps one that makes what people consider “problem drinking” now seem tame by comparison. To a large extent that did disappear early on and there were some people who didn’t break the law. Even after repeal, the Saloon culture didn’t really return.
Here’s a little motivation for moderation:
U.S. Cancer Rates Could Be Cut in Half Today Based on What’s Already Known
Re: Prohibition drinking: There’s ample evidence that alcoholism didn’t increase during prohibition but followed the trend mentioned by Dave Schuler — see here. At least, officially that was the result. But I think the words of Charles Morris are relevant here: “In making out death certificates (which are basic to Census Reports) private or family physicians commonly avoid entry of alcoholism as a cause of death whenever possible. This practice was more prevalent under the National Dry Law than it was in preprohibition time.”
It’s also relevant that methyl alcohol (“wood alcohol”) deaths went up substantially, this at a time when confirming that cause was relatively difficult.
@James Joyner
Off- topic: I hope you and your girls are doing well.
8 of 10 for me. Whatever that means.
My definition of being an alcoholic is that if one cannot function without alcohol, or if one goes into withdraw without alcohol, then one can comfortably be called an alcoholic. Otherwise, one simply enjoys alcohol. Whether or not you enjoy it alone, or enjoy it because of X, Y, or Z, is irrelevant.
I’m enjoying a Guinness right now, in fact. And I intend to enjoy several more before the day is through. I’m alone, but because I participate in online discussions, in a way, I’m not alone. Are you people strangers? Yes. But if I go to my local pub to drink with fellow publicans and become familiar with them, that is supposed to be better??? I doubt it. Besides, the people in my local pubs are idiots… and they don’t stock Guinness.
When I told my doctor (just last week in fact) that I often drink 2 or 3 times a week, and I drink enough to catch a “buzz”, she said I should cut down.
I thought, ‘well, I know more old drunks than I do old doctors.’ So, there’s that…
Sláinte.
The spectrum thing: absolutely. I also agree with your argument, James, that it might be best to look at the answers along a spectrum as well (perhaps a 1 to 5 scale). Also, it seems to me you’d still want to look at frequency of drinking & amounts consumed (with the understanding that people differ in how much their bodies can metabolize, of course).
Redundant. 😉
4 of 10 for me. I could think of some other questions the answers to which might be more damning for me, though.
@ptfe:
Then perhaps I’m mistaken in my recollection of the stuff I’ve read about Prohibition.
One fact worth noting that I was reminded of when watching Ken Burns’ excellent PBS documentary on this subject — before Prohibition social drinking was almost exclusively a male activity, after Prohibition it became unisex.
This would all be so much more interesting if the authors would wear 19th-century temperance dress and go after saloons with axes.
@Doug Mataconis:
I think this had more to do with changing social mores than prohibition per se. Without prohibition women would still have taken to the bottle in large numbers. Interestingly prohibition was the last conservative amendment to be made to the constitution. Republican presidents did nothing. And it turned into a huge social disaster. They have various other ideas for constitutional amendments hovering around at present (eg. balanced budget amendments, abortion amendments etc etc) which have just as much potential for creating disasters. Happily none are going to happen.
@PogueMahone:
I have a martini or alternative most days so am obviously doomed although I’m as fit as a flea.
@Brummagem Joe:
Likely true, although one of the historians interviewed for the documentary noted that it also had a lot to do with the end of the Pre-Prohibition almost exclusively male saloon culture and the beginning, after 1932, of social drinking occurring in establishments that presented a more comfortable environment for women.
@Doug Mataconis:
But there were a lot of exclusively male cultural activities changing…..voting…..driving….riding astride rather than sidesaddle.
Don’t be so sure you haven’t driven while intoxicated.
You may not have driven while raging drunk and barely able to stand, but even modest amounts of alcohol below the legal limit can impair your reaction times and make you almost as dangerous as someone with a cell phone. And alcohol affects your ability to figure out how much alcohol you’ve drunk.
Not to get all preachy MADD, but if you’ve stopped off for a drink or two, and they were some fancy-dancy microbrew or an unfamiliar scotch with higher alcohol content than you’re expecting, it’s pretty easy to make a mistake.
Much of America doesn’t have a decent public transportation system, and the only way to get to bars is to drive. Much of America has a good chunk of the drinking population driving drunk as a result.
Of course, I think part of driver’s ed should involve a fifth of whiskey and a driving simulator, so what do I know…
@Gustopher:
MADD is in my experience an organised revenge society.
Joe,
MADD ostensibly serves a noble purpose and, after all, who can be against Mothers and for drunk driving?
From what I’ve seen in recent years here in Virginia, though, they’ve just become more and more unreasonable in their demands for stricter DUI laws. Now that they’ve succeeded in getting the .10 BAC level reduced to .08 in pretty much every state in the country, they seem to be on a mission to get it lowered even more. From my perspective all that’s likely to do is catch more mostly innocent people in a web that ends up being fairly burdensome. The consequences for the first time DUI here, even at the lowest end of the BAC scale, are pretty severe and the long term financial consequences in terms of higher insurance rates are unbearable for some people.
I used to handle DUI cases when I did more criminal law, and we’re at the point now where the opportunities to defend a case are almost non-existent, especially in jurisdictions where the prosecutors refuse to plead down a DUI where the Defendant is just over the limit to something less severe like reckless driving. I’m not sure what that’s accomplishing
@Doug Mataconis:
So you’re more or less agreeing with me. I can only recount a personal experience. In the midwest. A woman who used to work in one of our companies tragically lost her 17 year old daughter in a car crash where all those in the car were smashed. Her daughter had left home about a month earlier to cohabit with the driver. He was charged with various offenses. The mother becomes active in MADD and demands this 18 year old kid get some horrendous sentence like ten years or something. She come around with a petition and buttonholes me asking for a signature. I refused. It’s the prohibition syndrome all over again, women were the main movers.
I only drink when I’m reading and commenting on this blog.
Does that count as “almost alcoholic”?
I sense that coming ‘drift’ toward teetotalism as the only alternative. Last night, at dinner, I allowed myself both one beer my meal and one whiskey with my coffee afterward. Reason? Someone else was driving! I hadn’t done that in years, knowing that the state in which I live has a huge economic incentive to create as many DUI cases as it can churn.
Sugar in my iced tea will soon be a target, I fear. Can’t flirt with that diabetes thing, you know. Then there’s the fat and salt content of my fried chicken. Milk has all those carbs, even in skim.
Alcoholism, real alcoholism, is a horrible thing. All my father’s siblings died of it, even though the doctors signed death certificates with other causes of death.
This campaign to create ‘almost alcoholics’, with its cash rewards for the state, the insurers and ‘health professionals’, will discredit the diagnosis over time.
And more will die miserable deaths, taking many others down into despair with them.
Three signs that you have children.
@john personna:
I think, jp, that certain major diseases such as some cancers, heart disease, or diabetes are incontrovertably related to, say, smoking, viruses or obesity.
I think any definitive or strong causality between diseases and inputs diminishes quickly. eg Vitamin E, advocated by many, is now being said to relate to prostate cancer, as is a B vitamin.
Shorter: pick your poison
They gave us “almost diabetics” so now there are “almost alcoholics”. It makes perfect sense. Millions of perfectly healthy people have been conned into believing they are diabetics, or are going to be. They are given medication that is dangerous, and they should never be given. Now they’re talking about doing pre-natal surg. on the fetus of pregnant women to prevent them from becoming obese because they will become diabetics. What next – almost senile – almost Alzheimer’s?
Speaking of which, my family has been dealing with my father’s Alzheimer’s for a year. He is a diabetic. We’ve discovered if he stays on the diabetic diet, he literally loses the ability to think and function. If we hop him up on sugar, carbs, B-12, unless you know he has the disease you don’t know it. I think we are going to discover that the treatment for “almost diabetics” will be causing an entirely new epidemic of Alzheimer’s in the near future.
SJR
The Pink Flamingo
@michael reynolds:
Indeed, amigo, indeed.
(especially once they are teens/pre-teens).
You often drink alone.
You look forward to drinking.
IOW, you are an “almost-alcoholic” if you enjoy drinking.
Way to trivialize alcoholism, guys.
Considering the number of tests/presentations/oral exams I had a glass of sherry before heading off to…yah, have used alcohol to relieve stress.
(Will probably do the same thing for the bar exam. Study like hell, then a glass of wine beforehand to take off the prickly edge of panic. Works for me.)
And at present wish that MADD would stop worrying so much about drunk driving and worry more about driving-while-texting. But most of the humans idiotic enough for that are their innocent little flowers of teenagers, so we can’t come down hard on that, can we?
I don’t drink any more….
I don’t drink any less either.
This reminds me of one of my professors in graduate school, who used to say “never ask a barber if you need a haircut”.
Joe & Bob have a book to sell, NHI research grants to apply for, and consulting fees to make, plus possibly a good number of Congressional hearings, TV shows, and magazines to talk to.
Meanwhile, I look forward to enjoying (alone) a nice malbec on the porch this evening while dinner cooks. It’s the perfect way to relieve the day’s stress. ¡Salud!
@Fausta: make that “NIH grants”
Excerpted from Gene Weingarten’s book “The Hypochondriac’s Guide to Life. And Death.”
ARE YOU AN ALCOHOLIC?
The chapter begins with my assertion that the standard test for alcoholism, which is written by AA, has waaay too low a threshhold. Asking AA whether you are an alcoholic, I said, is like asking your kid if you need a puppy.
Example: A typical question from the AA quiz is, “Do you ever drink alone?” Another: “Have you ever felt guilty after drinking too much?” According to AA, answering “yes” to both those questions means you are probably an alcoholic.
So here was my Replacement Test, with a scoring guide at the end:
1. Have you ever felt guilty about your drinking? Did another drink help?
2. Do you ever drink alone? Are you drinking alone right now? Directly from the bottle? Standing naked in the shower in case you vomit?
3. Do people sometimes criticize you for your drinking? When you attempt to punch them in the face, do you fall down?
4. When you drive drunk, are you generally sober enough to keep one eye closed, so your vision is not double? Good for you!
5. Have you ever “eaten the worm,” only to discover that it was not, in fact, the worm, but something else wormlike that happened to be in the vicinity of the bottle, such as an egg sac from a cockroach?
6. Have you ever wakened in an intensive care unit, with uniformed police officers all around you, arguing with doctors who were saying you could not be questioned until you were “out of the woods.”?
7. Are you ever slightly embarrassed to discover you have one alcoholic beverage in your hand, one on the table, and a third in a hypodermic syringe you are about to inject straight into your stomach for a better “rush”?
8. Do you sometimes find that you have been made the butt of a sucker bet among your friends, such as whether you will actually drink from the toilet with a flavor straw, for a quarter?
9. At times when no alcohol was available, have you ever consumed other substances because you thought they might contain alcohol, such as naphtha or Massengill Sta-Fresh douche?
10. Have you ever urinated into an empty beer can to avoid having to negotiate your way to the bathroom, and then forgotten you had done this and … you know? Has this ever happened more than once in the same night? Do you think it might have ever happened and you did not notice?
—-
Scoring: You are not an alcoholic.
Nice post. I work in the alcohol field and this is my take.
http://www.samefacts.com/2012/04/health-and-medicine/drinking-alone-does-not-necessarily-mean-you-have-a-drinking-problem/