What's your relationship to alcohol? Is it a "casual friendship," a "serious relationship," or are you among the "truly committed?"
Some new thinking about drinking focuses on that middle category - drinking that has not risen to the level where it would be clinically diagnosed as alcoholic but still contributes to a variety of problems in relationships, work and personal well-being.
"Almost Alcoholic" is the concept, and it's also the name of a new book from Harvard Medical School Health Publications . Health Reporter Anne Glausser explains in today's installment of ideastream's Be Well series.
YOU-TUBE CLIP: "My name is Jim and I'm an alcoholic."
This is the standard opening line, delivered countless times in AA meetings around the country. Its phrasing suggests, you're either an alcoholic or you're not.
But what if it's not that simple?
NOWINSKI: You know I've often been asked the question over the years, it starts like this, "Dr. Joe, I drink XX, does that mean I'm an alcoholic?" So you know the answer would be "no" for a lot of these people, but that doesn't mean you're safe.
Dr. Joe, Nowinski, is a clinical psychologist at the University of Connecticut Health Center and co-author with Harvard psychiatrist Dr. Robert Doyle of "Almost Alcoholic." They are among a growing number of addiction experts who now think of alcohol problems existing on a spectrum - from mild to moderate to severe. "There are no sharp boundaries between stages," the authors say. Instead, the spectrum from casual to committed is separated by fairly large gray areas that people can pass through as their drinking changes over the years.
NOWINSKI: It's really a departure from the black and white if you will or two category thinking.
Often it's the extremes that people think of when they hear the phrase "an alcoholic"--it's those other people, who get DUIs and lose their jobs and have their spouses leave them.
Not necessarily so. Doyle and Nowinski say about 30 percent of drinkers…even moderate ones…experience problems from alcohol but it's a gradual thing. The authors write, "People do not wake up one morning to find that they are now suddenly alcoholics whereas yesterday they were normal social drinkers."
NOWINSKI: If you find that once or twice a week, you have a stressful day at work, you know the economy's bad, you find that you want to have a beer or glass of wine, that's one thing. But have you drifted to the point where you really can't wait to get home every day and you start having two or three or four glasses of wine or two or three or four beers every night, in order to unwind.
Here are other things that can happen as a person moves along the alcohol spectrum: job performance starts to slip, concentration is more difficult, interest in family life declines, temper flares more often.
NOWINSKI: You may be experiencing physical consequences, like trouble sleeping. You may have medical issues like diabetes or hypertension. You may even experience depression.
But often people don't connect the dots between their drinking and symptoms such as these.
So, when confronted with the possibility of a drinking problem, people tend to want a number to gauge themselves against. The National Institutes of Health advise men to have no more than 4 drinks a day, women 3, and they also say men should have no more than 14 drinks per week, and for women, no more than 7 drinks per week.
NOWINSKI: Where to draw the line--is 2 too many? Is 4 too many?--I think that's up to the individual to decide depending on how the drinking is affecting them.
In other words, being "almost alcoholic" is not just about the number of drinks - it's about how drinking affects your body and behavior, and it's about your reasons behind the habit.
Here are some questions that may help you determine if there's a problem: Do you look forward drinking? Do you sometimes use alcohol to relieve anxiety or stress, or loneliness? Has your drinking caused others to suffer? Do you continue to drink despite negative consequences? Any of those is a warning sign that someone is moving from normal social drinking towards full-blown alcoholism.
NOWINSKI: You sort of keep an eye on yourself a bit as to whether you remain in that normal social drinking zone.
"Almost Alcoholic" adds a new layer to the language of addiction and even more controversial, the book suggests that many in the "almost" category may be able to regroup, curb their intake and shift back to "normal" use of alcohol as they learn new ways to cope with their emotions and circumstances, connect with a support network and build new habits.