Everyday drinkers, Social drinkers, Almost alcoholics and Denial.

“Almost Alcoholic” and “Denial”

Henry is a successful real estate broker. He inherited the business from his own father and then grew it. Now sixty, one of his three sons and his daughter are also brokers and partners in the family business. Henry is well known in the community, and has found over the years that being visible, making friends, entertaining, and giving to local charities is good for business.

Henry also enjoys drinking. He does not binge drink; nor has he ever had a blackout. His preference is for expensive bourbon or single malt scotch, which he drinks on the rocks with a splash of water. He never downs a drink quickly, but prefers to sip—and sip, and sip.

Henry “sips” every day. He’s not ashamed to say that he likes “to keep a warm glow,” by which he means drinking slowly but continuously from the time he starts—usually about half an hour after he gets home–until he goes to bed. He then falls soundly asleep, though for the past couple of years has found that, after waking to go to the bathroom around 3 A.M., he often finds it difficult to get back to sleep.

For years Henry has made a habit of buying eight seasons’ tickets for the home football games of the local college. He and his wife, Lorna, load up their large and comfortable recreational vehicle with food and liquor and invite several friends, business acquaintances, or local officials to join them for a tailgate party before the football game. They are hugely popular for doing this.

Last year Lorna spoke with Henry after they got home from one of their tailgate parties. She explained that she was worried about him. Why? In part because he’d been diagnosed several years earlier with hypertension and high cholesterol. More recently his doctor told him that his annual blood test had revealed some slight “irritation” in his liver, and had advised Henry to cut back significantly on his drinking. Despite all that, and despite Lorna’s concerns, Henry continued his habit of “sipping” every night. He’d also “sipped” several drinks at that day’s tailgate party.

The above raises a question: Is Henry an alcoholic? Some might say yes, because he drinks every day and because his habit of sipping serves to maintain a blood alcohol level—what Henry calls a “warm glow.” On the other hand, he always sobers up the next morning and does not begin “sipping” again until just before dinner.

When Lorna suggested—as gently as she could–that Henry might be an alcoholic, she got nowhere. He got huffy and pointed to his ongoing success as a businessman, and the fact that he hadn’t missed a day of work in years. Then there was the fact that he’s never had either a DUI or a drinking-related car accident. And so on. All of this, he argued, was evidence that he could “hold his liquor.” That response on his part is what is referred to as “denial,” a word that is used to mean an alcoholic is refusing to admit to his or her alcoholism.

But Henry might indeed not meet the criteria for a diagnosis of alcoholism, which include symptoms of withdrawal when the alcoholic stops drinking, severe consequences directly related to drinking and difficulty in day to day functioning. However, we also have the fact that Henry has medical problems and that his doctor has recommended cutting down. He also doesn’t sleep well a lot of the time. Finally, his drinking is creating anxiety in his wife.  So, even if he is not an alcoholic, a strong case can be made that Henry is an almost alcoholic. His drinking places him somewhere in the almost alcoholic gray zone in the diagram below:

“Denial” and Stigma

Despite much progress in changing people’s attitudes, the term alcoholic has retained a certain stigma, and it is that stigma that accounts in large part for the kind of “denial” that Henry’s case illustrates. The fact is that the idea of being out of control—not only of drinking, but of pretty much any aspect of our lives—is anathema to most people. In these days of “The Great Recession” many people, both here in America and abroad, have in fact lost control over many important aspects of their lives. They may be unemployed (or underemployed), their homes may be “underwater,” and they may owe more in credit card debts or student loans than they will ever be able to repay. That notwithstanding, the vast majority of these people will persist in attempting to regain control of their lives.

So it is with alcohol. The true alcoholic, as represented in the area on the extreme right side of the above diagram, has reached a point where he or she can no longer reliably limit or moderate his or her drinking. For the alcoholic, one drink is never enough. Difficulty facing this stark reality is what we call “denial.” In truth, Alcoholics Anonymous came into being (and continues to exist) for the sole purpose of helping alcoholics regain control of their lives. To regain control of their lives, however, alcoholics reach out to others for help in dealing with the one aspect of their lives that they cannot control: drinking.

The proportion of men and women in the population whose drinking qualifies them as alcoholics is small as compared to a much larger group who are not (at least not yet) alcoholics, but whose drinking nevertheless is creating significant problems in their lives. These are the almost alcoholics, and they too can vary in severity, from relatively mild to relative severe. Henry, to be sure, is somewhere in that almost alcoholic zone. Rather than argue about whether he is or is not an alcoholic, however, it might be more productive to point out that he is in that zone. Moreover, since he is not yet dependent on alcohol, Henry has the option to pursue any of a number of strategies to help himself “shift left” on the drinking spectrum.

Henry’s Answer

Six months after his confrontation with Lorna, Henry had a follow up blood test which again showed some inflammation in his liver. His doctor then put it to Henry this way: “Personally I don’t think you’re an alcoholic, Henry. But I do firmly believe that you are headed toward cirrhosis if you don’t either stop or cut back to no more than one a day.”

Faced with that reality, Henry decided that he would “take a break” from drinking for several months. Then, based on a “slightly improved” follow-up blood test, he decided that perhaps it would be best if he just didn’t drink at all. He did not say “forever,” but it has now been ten months since Henry had his last drink.

Editor’s note: This article was specially written for Medicinezine.com by Joseph Nowinski, Ph.D. – co-author of Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem?  The story of Henry reflects the experiences of more people than you might think. Do you recognize yourself or your loved one in the story? For more information visit www.TheAlmostEffect.com

Joseph Nowinski, PhD, is a Clinical Psychologist who is currently Supervising Psychologist at the University of Connecticut Health Center. He has held positions as Assistant Professor of Psychiatry at the University of California San Francisco and Associate Adjunct Professor of Psychology at the University of Connecticut.
Dr. Nowinski is internationally recognized for his work in substance abuse treatment. He has a private practice in Tolland, Connecticut. Dr. Nowinski is the author of many books including Saying Goodbye: A Guide to Coping with a
Loved One’s Terminal Illness and Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem?