Gray-Area Drinking: Is It Problematic?
Picture this, you just woke up after a fun night out bar hopping with friends before ultimately scrounging for pizza at 2:00 am. Your first thought (after acknowledging the all-too-familiar hangover) sounds something like, “Ugh, how much did I drink last night?” It may have even started with you telling your friends you weren’t planning on staying out late or drinking that much, but alas, the temptation to keep the buzz going pulled you in... again. If this hits a little too close to home or if you have ever wondered why you can sometimes have one or two drinks and other times your drinking seems out of control, you may be considered what’s termed a gray-area drinker.
“But I’m not an alcoholic!”
You do not have to identify as an “alcoholic” in order to question your relationship with alcohol. In fact, it is more common now than ever for people to make the choice to stop drinking or to explore sobriety (i.e. the sober curious movement). A study conducted by the University of Michigan and Texas State University showed that between 2002 and 2018, there was an increase in adults aged 18-22 who abstained from alcohol, ranging from 20-28% for those in college and 24-30% for those not in college. This study also showed that alcohol abuse among these groups decreased by about half! Needless to say, if you’re thinking of jumping on the wagon, it won’t be a solo ride.
How Addiction is Diagnosed
Speaking of alcohol abuse, the DSM-5-TR (Diagnostic and Statistical Manual, 5th Edition, Text Revision) that therapists use to diagnose mental health and addiction disorders doesn’t even use the terms alcoholism or abuse in their criteria for alcohol addiction. The DSM classifies alcohol use disorder using three levels of severity (mild, moderate, and severe) and notes criteria that assess the negative impact that drinking has on the person’s life to determine the level assigned. This means that you could have one or two drinks every day and still not have an alcohol use disorder if you do not experience negative consequences as a result. On the flip side, you could drink only once every couple of weeks but if your consequences keep piling up, your behavior could indicate a problem.
Among other reasons, it is helpful to separate the diagnosis into varying levels because addiction is a progressive disease. Someone who is diagnosed with a mild alcohol use disorder one day may be diagnosed with a severe alcohol use disorder a couple of years (or maybe even months) later. The progression of addiction is different for everyone and depends on various factors. This includes, but not limited to, how old you were when you started drinking, how long you have been drinking, and family history of addiction. Seeing as it is progressive in nature and there isn’t a clear timeline on how quickly it advances, it can really sneak up on you. Before you know it, you are experiencing negative impacts from your drinking like strained or loss of relationships, DUIs or other legal problems, or having a hard time keeping a job.
It Can Be a Slippery Slope
Now back to gray-area drinking. If the DSM doesn’t recognize this as a disorder, then what does it mean? Gray area drinking is a bit vague in its definition, mostly because it encompasses such a wide range of behaviors regarding alcohol consumption. Typically, someone who falls into this category may have experienced some negative consequences relating to their drinking but they tend to be mostly internally focused. You may regret how much you drink or things you did while you were drinking. You may also experience the dreaded “hangxiety” - the days following binge drinking. A clear distinction between people who fall onto this spectrum and those who have a more severe alcohol use disorder is that they do not experience physical dependence on alcohol and do not experience withdrawal symptoms when they stop.
Remember, alcohol use disorder is a progressive disease. While “mild” is the lowest severity level identified by the DSM, people don’t immediately start there when they begin drinking. When asking the question, “Do I have a problem with alcohol?” the answer may not be a clear yes or no - but it may be along the lines of “not yet.” There are several factors to consider when looking at what makes someone in the gray area drinking realm more at risk of developing an alcohol use disorder. In the book, Not Drinking Tonight, by Amanda White, LPC, she lists experiences that make it more difficult to achieve moderation. These include your personal addiction history, if you rarely drink without getting drunk, if you use alcohol to deal with stress, or if you have a history of trauma, PTSD, or other mental health concerns. Another reason that moderation can be difficult is due to the consistent decision-making that is required to sustain it. If you break it down into every choice you have to make around consuming, it can get overwhelming pretty quickly. Am I planning on drinking tonight? What do I want to order? Do I want another? Should I take this shot? How many do I want to have tonight? What time do I want to stop? Decision fatigue shows up in all areas of life, but because of the way alcohol affects our decision-making capabilities, it gets increasingly tiresome the more we drink.
The Numbers Don’t Lie
Despite moderation being impossible for some, others can achieve it. When deciding what to do about their consumption, most people, regardless of where they are on the addiction rollercoaster, attempt to reduce before ever stopping completely. This could be considered a harm reduction approach for heavy users and a lifelong change in pattern for people in the gray-area category. If you are the type of drinker who finds themselves bingeing on the weekends and abstaining throughout the week, something to keep in mind is what classifies as binge drinking. For men, this is usually 5 or more standard drinks in a two-hour time frame. For women, it is 4 or more. Another number to be aware of is what the National Institute on Alcohol Abuse and Alcoholism classifies as low-risk drinking. For men, it is considered no more than 4 in a day and no more than 14 in a week. For women, this is no more than 3 drinks on any single day and no more than 7 per week. You might be wondering why men get to drink more in these guidelines. That’s because of our biological differences and how we metabolize alcohol.
So, now what?
What happens next is up to you. If after reading this you are thinking of either getting help for your drinking or looking to be more intentional about your alcohol use, a good place to start is by tracking how much and how often you drink. The numbers might surprise you! Then, set a goal for yourself to either reduce the number of drinks you have per week or challenge yourself to a dry thirty days. If attempting to moderate becomes difficult for you or you find yourself falling back into old patterns, it might be time to consider reaching out to someone.
Sobriety, addiction recovery, or exploring your relationship with alcohol is not linear and there isn’t a “right” path to getting there. When looking for someone to help you figure out what will work best for you, I recommend finding a therapist who specializes in substance addictions which is usually denoted by the credential, LCAS (Licensed Clinical Addiction Specialist). They will be able to accurately assess your relationship with alcohol and provide you with more education on the addiction and recovery process. You will also be assisted in addressing the underlying causes of your drinking and ultimately be able to rely on more effective and positive coping skills, rather than feeling the need to turn to alcohol. If you’re feeling a bit lonely in your journey, you may also benefit from participating in sober community activities or joining sober-curious groups. Change of any kind can be challenging, but the multitude of benefits that come with drinking less or abstaining from drinking entirely are more than worth the effort.
References:
Study; More young adults are abstaining from alcohol:
https://www.sciencedaily.com/releases/2020/10/201012120007.htm
Book: Not Drinking Tonight: A Guide to Creating a Sober Life You Love by Amanda E. White, LPC
NIAAA low risk drinking and binge definitions:
Are you thinking of getting help for your drinking habits or looking to be more intentional about your alcohol use? To find out more about our approach or to connect with a therapist that is right for you, contact us for a free phone consultation. Our team of therapists are licensed, experienced, and specifically trained in treating betrayal trauma, complex trauma, addiction, and rebuilding relationships.
About the Author
Katy Post is a Licensed Clinical Mental Health Counselor, Licensed Clinical Addiction Specialist Associate, and Certified Sex Addiction Therapist Candidate. She works with individuals to support them through addiction recovery and healing from trauma.