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The Risk of Becoming an 'Almost' Alcoholic

As we age, alcohol affects us differently and social drinking can become problem drinking

By Joseph Nowinski, PhD

A lot of people, including many health care professionals, believe the world is made up only of alcoholics and nonalcoholics. But our research shows us that there is another group. These people are not alcoholics, although they may experience some of the symptoms that alcoholics typically report. They drink regularly, but may not realize that some of their physical or emotional concerns are connected to their alcohol consumption. These are the "almost alcoholics," and while anyone can become one, middle-aged and older adults are especially at risk of joining the group.

As we age, our body’s ability to metabolize alcohol decreases. In practical terms, this means it takes less alcohol for a man or woman over 60 to get tipsy than it does for a typical 40-year-old. It also means that alcohol remains in our bloodstreams longer, making it more likely to contribute to problems including depression, diabetes, hypertension, heart conditions, memory issues, insomnia, poor nutrition and frequent falls. (Learn more about the changing effects of alcohol from Next Avenue.)
Because of these changes in our bodies, some people who were moderate social drinkers in their 40s can, over time, slip into what I call the almost alcoholic zone, a middle ground between normal social drinkers and alcoholics. It's important to note that these people typically fall far short of the clinical diagnosis of alcoholism, which is characterized by symptoms including: a need for markedly increased amounts of alcohol to achieve intoxication; physical symptoms of withdrawal; unsuccessful efforts to control alcohol abuse; and the abandonment of important social, occupational or recreational activities in favor of drinking.

But almost alcoholics still face serious health and social risks. Some may begin to find themselves drinking to relieve physical pain or boredom; many will say they drink because it helps them fall asleep, or takes the edge off what they consider to be depression. Ironically, as we now know, having more than a drink or two tends to both disrupt our sleep and worsen depression.

We in the medical profession may be seriously underestimating the extent of almost alcoholism, because we're not asking the right questions. A recent survey of 101 primary care physicians found that less than half ever asked their existing patients over 65 to describe their drinking habits; only two-thirds asked new patients over 65 how much and how often they drank. As a result, some of the problems these patients report, which could be related to their alcohol consumption, may be mistakenly diagnosed as psychiatric or physical illnesses.

If you have a loved one whose physical or mental health seems to be declining, it may be wise to consider whether these consequences could be due to their drinking, especially as most almost alcoholics fail to connect the dots between their mental or physical ailments and their alcohol consumption.
Here are some things to watch for in a loved one's (or your own) drinking habits. It is not only if a person exhibits these behaviors, but how often that can be an indicator of how far he or she may have ventured into the almost alcoholic zone.

  • Looking forward to drinking. They eagerly anticipate their wine, beer or cocktails.
  • Drinking alone. They enjoy drinking not only in company, but when they are by themselves.
  • Drinking to control emotional and/or physical symptoms. They have come to rely on a drink (or two or three) to “unwind” most days of the week.
  • Continued drinking despite at least some negative consequences. These may include insomnia, fatigue, depression or problems at work or within one's family, all of which can be either triggered or worsened because of our decreased ability to metabolize alcohol.

Social drinking will not always lead to problem drinking, and we should not label people who do not have a problem. But we should recognize and help people who have entered the large gray area beyond social drinking. If the above descriptions apply to you or someone you care about, consider that you or they may have slipped into almost alcoholism. These people are not alcoholics, but alcohol is playing a role in their physical or emotional problems and they need support.

Fortunately, unlike alcoholics, for whom controlled drinking is by definition almost always unsuccessful, many almost alcoholics can shift their habits and regain control of their social drinking. Often it requires professional help, to point out the physical risks in one's drinking habits or to offer new strategies to address underlying problems like loneliness, stress or boredom. But our research has shown us that many people in the almost alcoholic zone are able, with effort and support, to shift back to a healthier zone of social drinking, and stay there.

Joseph Nowinski, PhDNowinski is a clinical psychologist and the co-author of "Almost Alcoholic" (Harvard Health Publications, 2012) and "Saying Goodbye" (Berkeley, 2011). He works for the University of Connecticut Health Center and maintains a private practice. Read More
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