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Providing non-judgmental and non-criticizing support for family and friends of end-stage alcoholics through one-on-one coaching, support groups, blog posts, workshops and public speaking.

Friday, April 13, 2012

Almost Alcoholic...

Today I have a guest poster. The guest is Joseph Nowinski who is the co-author of the book "Almost Alcoholic." I've been asked to review the book and so far, I'm finding it fits right in with my "frog soup" theory. I hope you find his post informative and helpful.

The Almost Alcoholic and Family Life
Our book, Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem? addresses the issue of how drinking that does not rise to the level of qualifying for a formal diagnosis can nevertheless have serious consequences both for the drinker and his or her family. Here is an example:

Kim is married and has two teenage children, the oldest of whom, a daughter, is a senior in high school and will soon be leaving to attend a college that is some distance away. Kim loves her younger son, of course, but the truth is that the mother-daughter bond has always been more intimate.

Kim recently saw her doctor for what she described as mild depression and trouble sleeping. She did not disclose the fact that over the past year her drinking has increased, because she did not see any need to do so.

Kim readily admits that she’s always been someone who enjoyed a glass of wine, but rarely more than that. She usually drank in the company of her husband, in the evening, and she did not drink every night. Starting when her mother was diagnosed with cancer, however, Kim began drinking a couple (and sometimes three) glasses of wine pretty much every night. She also started drinking before her husband, Steve, got home from work. The reason she drank, she explained, was because it helped her to relax, especially on those das when she would take her mother for chemotherapy treatments.

After her mother’s cancer was treated and declared in remission, Kim’s drinking pattern did not change. That was when she began to have trouble sleeping soundly at night. The habit that was now firmly established was that she would drink her last glass of wine shortly before going to bed, because she thought it helped her fall asleep. That was true, but within a few months she found that she would often wake up at two or three in the morning and then have a hard time getting back to sleep. Then, when she woke up the next morning, she would feel groggy, not rested.
 Kim does not believe she has a “drinking problem,” and she would bristle at the idea that she is an alcoholic. Instead, she believes she has a “sleeping problem” and also that she may be “a little depressed.” She says her husband has not suggested that she had a drinking problem, either, though he has pointed out the change in her drinking, as well as the fact that she sometimes falls asleep on their family room couch well before they were used to going to bed.

Another consequence of Kim’s drinking is that she definitely feels that she has less energy than she once did. She exercises less often, and her son in particular has complained more than once about the fact that she buys take-out food much more often than he would like. In addition, his grades this year, as he entered high school, have slipped for the first time in his life. Finally, when asked about her relationship with her daughter, Kim acknowledges that “we are a little less close than we used to be,” but she attributes this to the fact that her daughter is a senior and spends a great deal of time studying, playing lacrosse, and socializing.


From our perspective Kim probably had two very real “problems,” the first being lingering depression related, at least in part, to the stress of her mother’s illness, combined with her daughter’s impending leaving for college. She also, however, has a second problem: she has become an almost alcoholic. Allow me to explain.

“The Drinking World”

For many years health care professionals have been accustomed to thinking about drinking in terms of just two diagnostic categories: alcohol abuse and alcohol dependence. In order to qualify for one of these diagnoses an individual has to suffer some fairly severe and obvious consequences directly related to drinking: a major health crisis, an arrest, loss of a job, etc. To be diagnosed as alcohol dependent a person also has to experience physical symptoms of withdrawal if he or she stops drinking. Meanwhile, men and women whose drinking is not severe enough to qualify for one of these two diagnoses have essentially been considered “normal.” A major limitation of this approach to diagnosis is that it fails to address the very real problems caused by drinking that doesn’t rise to the level needed for a diagnosis.

As it works on the first major revision of its Diagnostic and Statistical Manual (DSM) in 15 years, the American Psychiatric Association is contemplating moving from categorical thinking like the above with respect to a number of diagnoses. In its place they are considering viewing a number of diagnoses in terms of a spectrum. This is where the concept of almost alcoholic fits in. And like Kim, it may apply to you or someone you love.
Rather than thinking in terms of just three categories (Normal, Alcohol Abuse, Alcoholism), it is probably more productive to look at drinking in terms of a spectrum like that depicted below:


This illustration more accurately reflects the real “drinking world.” What it suggests is that an individual’s drinking can range anywhere from normal social drinking at one end of the spectrum, to almost alcoholic in the mid-range, to alcohol abuse or dependence. Moreover, these different areas are not separated by sharp lines. Rather, they blend into one another. Of the three “problem” zones, the almost alcoholic zone is by far the largest.

Normal social drinking is the person who has a beer or two, or a glass of wine or two, not more than a few times a month, and almost always in a social context. This is the man or woman who meets friends for happy hour after work on Friday, who joins friends to watch a game on television, or who is invited to a party. Millions of people are normal social drinkers, and many of them never go on to be more than normal social drinkers.

As the illustration suggests, there is a large “gray area” that lies beyond normal social drinking but falls short of alcohol abuse and dependence. Many people slip into this gray zone. Some go only a short distance; others venture much deeper over time, but still are not alcoholics. That said, men and women whose drinking patterns lie in the almost alcoholic zone are likely to be suffering, as are their loved ones. For example, they may be experiencing one or more of the following:

• Trouble sleeping soundly
• Mild depression
• Marital or family conflict
• Health problems that aren’t recognized as related to drinking
• Declining performance at work


In the beginning, people who drink, as Kim did, to relieve stress (or boredom, anxiety, or loneliness) don’t consider the possibility that the amount they drink can cause other problems; rather, they drink because they believe it helps them. In Kim’s case, for example, a glass of wine before bedtime initially helped her get to sleep. She did not set out to become an almost alcoholic, but simply slipped into that zone over time. Like most people, she was unaware that two or three glasses of wine a night could slow her metabolism, disrupt her sleep, and contribute to the “mild depression” that nagged her. Similarly, she did not see the connection between her drinking and her declining relationships with her husband and children. Kim was not an alcoholic, but she was somewhere in the almost alcoholic zone.

One thing that has become very clear to us—and a major motivation for writing our book—is that most almost alcoholics (as well as health care professionals) often fail to see the link between drinking and any problems these people may complain of.  Being able to “connect the dots” and see the relationship between drinking and such problems allows the almost alcoholic to make a decision: to remain in the almost alcoholic zone (and risk venturing further toward alcoholism), or to choose to “shift left,” back toward normal social drinking.

Many Pathways, Many Solutions

Again, no one sets out intending to become an almost alcoholic. Similarly, people do not become almost alcoholics for the same reasons. There are many pathways into the almost alcoholic zone, and for that reason, there needs to be many solutions. We discuss several of these pathways--and solutions--in our book.
_____
About the author:
Joseph Nowinski, Ph.D., is a co-author of Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem? (Hazelden, April 2012, with Dr. Robert Doyle). Nowinski is a clinical psychologist and was assistant professor of psychiatry at the University of California—San Francisco and associate adjunct professor of psychology at the University of Connecticut.

12 comments:

Syd said...

The description of Kim would fit my wife before drinking escalated to the next phase. And the excuses for drinking sound so familiar as does the reaction of the daughter and the decline in "family life". Alcohol is cunning, baffling and powerful in its progress to full addiction.

Lance said...

Great post. I can say from my experience that if you are somewhere in that "almost" category then accepting that you have a problem is incredibly difficult - there are just too many ways to convince yourself that you don't meet that "alcoholic" definition. I spun my wheels on the first AA step because of this. Luckily, since there was no gray area, I finally surrendered and went with "alcoholic" so I could seek the help I needed.

Lori said...

My mother has used wine as described and it has escalated over the years. When I was younger I only recall my parents drinking occasionally, and usually 1 or 2 drinks. As I was graduating college I started to observe it was more of a nightly habit for my mom. Eventually, she would start at dinner or sometimes while cooking, then have a glass with dinner, then a glass (or two) after. After a year or so she rarely cooked dinner any longer and seemed to start drinking later, but the wine glass got larger. My brother referred to it as "Mom's goblet". I married and moved away but my younger siblings reported ever increasing drinking and bizarre behavior. I would notice if I phoned her in the evenings her speech was slurred. When I visited I noticed her routine would leave her sitting on the couch with her wine, shooting little barbed insults at everyone, eventually she would quite literally stagger off to bed. She grew more anxious and depressed. Somewhere in all of it she became I believe a full blown alcoholic. The Christmas before last we visited and she was clearly trying to hold off the drinking and became ill. She told everyone she had a stomach flu but I walked into the kitchen and saw her hurrying to swallow down a glass of wine one evening and it was like I finally admitted to myself what had been in front of us all for years. We announced our pregnancy (with their first grandchild) this visit and I remember feeling my mom's tremors as she hugged me in congratulations. Everyone hoped she would clean up her act for the grandbaby but I had doubts and she was too far gone at that point, miserable and depressed. Things in fact worsened until she was involuntarily committed (I had begged my father to take her to the ER as she declined to the point she ate no food and drank hard liquor straight from the bottle, vomiting and passing out only to wake up and do it again). It was terrible but I hoped she had hit rock bottom. Shortly after I had my baby, she came to visit not drinking but she cancelled all her follow up appointments and relapsed shortly after returning home. This time she attempted suicide by taking a bottle of sleeping pills. Our last conversation before she did it she got angry at me (I defended the family choice of bringing her to emergency when she was at death's door) and hung up the phone. She ended up in ICU for a few days, again involuntarily committed. I would have expected to feel sad but I was shocked at my anger. I felt she was selfish and betrayed all of us by never following through with the help offered and then the way she would have so callously left us all. Needless to say, this is not how I thought my adult relationship would be with my mother. I always counted on her, perhaps unfairly so, and now my siblings and I take turns checking in and talking her down from frequent relapses and serious bouts of depression. I hope for a brighter future where she can see she needs help and give herself a chance but I find it healthier to deal in reality and reality suggests that none of us should hold our breath waiting on her recovery. Wow, did not expect to write a novel, something about this post just triggered the words to flow out of me. Thank you Linda for your blog, I continue to root for you! =)

Furtheron said...

I agree on the grey area ... to many I was a "heavy drinker" but in reality I was alcoholic, the reason I believe that was true was frankly the mental obsession that I had with the drink, I had to plan my day around it and had to do it - even if to some people the quantity and the type of drink I consumed wouldn't have made me the classical definition of an alcoholic (I only drank beer, pretty much always in bars/pubs, I rarely if ever drank spirits and hardly ever drank alone or at home)

However I was by my reckoning definitely an alcoholic by the time I stopped

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Anonymous said...

My husband died because of his alcoholism, my mother is an almost alcoholic and my son is currently in a rehabilitation center for the treatment of his almost alcoholism. Alcohol is the most lethal, socially acceptable drug there is. The misery it caused in my life is undescribable. I wish this on no-one.

Anonymous said...

I still try to convince myself that I don't have a problem, because I've never been arrested or lost a job etc from my drinking. I think I am an almost-alcoholic. I can control my drinking but it takes more effort than a social drinker.

My mother's drinking became a visible and chronic problem 20 years ago, but she was in that gray zone for years before she "snapped" when her mother died. In her case, this information would not have helped because she is just not able to process anything about this disease, and she cannot honestly look at herself for long (history of severe abuse/trauma and in effect bipolar, etc). She's now at death's door with severe cirrhosis and the many accompanying miseries.

In my case, I am unsure whether calling myself an almost alcoholic will help or hurt me. When my mother was hospitalized in Dec 2013, I finally promised my daughters that I would not drink again and "turn yellow like grandma" (referring to the extreme jaundice.) I had slowly increased my nightly 6 oz of wine to, honestly, more like two full standard glasses, could be much more if I was planning a night of "I don't care". I've been sober since January, but I'm not sure I've really committed to it because I imagine those "once in a while" opportunities to hang out with friends or a potential new mate, and how awkward and terrible I'll feel without some wine to relax me. I'm very shy meeting new people. So I think to myself, I'll try to be a social drinker. But I have that fear that it will snowball.. When I was younger, I absolutely abused alcohol and tried other drugs. For now, I've been avoiding all social meetings in hopes I'll have this sorted out.

I was actually going to purchase the book so I could learn how to be a social drinker. But then I thought to myself, perhaps the fact that I'm in this much conflict over whether to drink at all means I'm already skirting the edge of almost-alcoholism and could fall into being a full blown alcoholic.

I think this book may help some people, but for those already closer to alcoholic, this may only help increase denial. It will depend on the reader.

Anonymous said...

I still try to convince myself that I don't have a problem, because I've never been arrested or lost a job etc from my drinking. I think I am an almost-alcoholic. I can control my drinking but it takes more effort than a social drinker.

My mother's drinking became a visible and chronic problem 20 years ago, but she was in that gray zone for years before she "snapped" when her mother died. In her case, this information would not have helped because she is just not able to process anything about this disease, and she cannot honestly look at herself for long (history of severe abuse/trauma and in effect bipolar, etc). She's now at death's door with severe cirrhosis and the many accompanying miseries.

In my case, I am unsure whether calling myself an almost alcoholic will help or hurt me. When my mother was hospitalized in Dec 2013, I finally promised my daughters that I would not drink again and "turn yellow like grandma" (referring to the extreme jaundice.) I had slowly increased my nightly 6 oz of wine to, honestly, more like two full standard glasses, could be much more if I was planning a night of "I don't care". I've been sober since January, but I'm not sure I've really committed to it because I imagine those "once in a while" opportunities to hang out with friends or a potential new mate, and how awkward and terrible I'll feel without some wine to relax me. I'm very shy meeting new people. So I think to myself, I'll try to be a social drinker. But I have that fear that it will snowball.. When I was younger, I absolutely abused alcohol and tried other drugs. For now, I've been avoiding all social meetings in hopes I'll have this sorted out.

I was actually going to purchase the book so I could learn how to be a social drinker. But then I thought to myself, perhaps the fact that I'm in this much conflict over whether to drink at all means I'm already skirting the edge of almost-alcoholism and could fall into being a full blown alcoholic.

I think this book may help some people, but for those already closer to alcoholic, this may only help increase denial. It will depend on the reader.

deb said...

WOW!! BINGO! after watching my ex husband die or alcoholism my eyes became full open. I wish I had read this book sooo long ago!! All this Friday happy hours that he loved to go to turned our relationship into one that always revolved around alcohol. Even though I complained about that fact it never dawned on me that it was an "Almost Alcoholic" time. Reading these posts, and Oars conversations, as well as this book, is a constant string of "ah ha!" moments. This is a must read!!

deb said...

WOW!! BINGO! after watching my ex husband die or alcoholism my eyes became full open. I wish I had read this book sooo long ago!! All this Friday happy hours that he loved to go to turned our relationship into one that always revolved around alcohol. Even though I complained about that fact it never dawned on me that it was an "Almost Alcoholic" time. Reading these posts, and Oars conversations, as well as this book, is a constant string of "ah ha!" moments. This is a must read!!

Anonymous said...

8-I think that being an "almost alcoholic" is way more common than anyone thinks. Alcohol has always been around, it seems that most of society considers "drinking" normal. In Any City, USA, there are liquor stores on every corner, so it's "normal." Well, at least we have become used to it.

It is rather unfortunate that society is still caught up in a misguided reality. I see many people who think that to be an alcoholic. one has to be a statistic, i.e. losing your job, your family &/or friends, have a DUI, end up homeless This is not true at all. I think that there are many more people in that "grey" area than anyone cares to admit.

While there has been a lot of progress researching addiction, it seems that society thinks that alcoholics are just weak willed people, many people just do NOT believe that alcoholism is an actual disease.

In the true sense of the word disease. It's a trifecta disease affecting the body, the mind & the spirit. Usually the person afflicted, regardless of type of A: the Almost Alcoholic, the Binge Alcoholic, the Functioning Alcoholic, (or the worst & saddest kind) the End-Stage Alcoholic is in a severe state of dis-ease.

It's also a disease for the family & friends of the alcoholic. Relationships are affected & people get hurt, both emotionally & physically. The body starts to break down, sending the "drinker" signals but all too often the signals are misinterpreted and misdiagnosed.

Unless the person is end-stage, it often goes unnoticed & unreported in the doctor's offices. Alcohol is a strong & cunning substance. It can take people & turn them into someone you don't recognize. It can cause the body to rebel in horrific ways. (liver disease, pancreatitis, diabetes & hosts of other physical ailments) It can take the minds & memories of loved ones. (brain bleeds, psychosis & encephalopathies) It can & does take innocent lives, as well as lives of many alcoholics.

Anonymous said...

First I must say it was hard to find a place to post a comment with out tagging on to someone's personal story. So I am posting here, I have read this blog for about 2 years, well before the nice graphics came along, which I like....but please include an easier way to share or post.

Anyway I am living with a semi-end almost alcoholic or I may be kidding myself.

He urinates in our shared bed 3 to 4 times a week.
He is sleeping by 8 pm, which is a blessing.
He is scary, loud and mean.

Here is the thing and my personal request for advice...I own my home, he tells me he will never ever leave. I am afraid of him. He is still able to fool everyone that he is a good guy. Meanwhile I am sleeping in urine every night.

Do I leave my own home that I purchased and worked for. He won't leave and there is NO time when he is capable of a reasonable discussion.

He was controlling,mean and nasty 20 years ago, but he used to have a kind side....it's there somewhere or maybe not.

I don't want to leave my home, my cat or my dog at my house and let him just stay there. I don't want to call the cops.
For now I am just trying to pretend this is not real.


Praying does no good....