Addiction Alcohol Use Are You a 'Gray Area' Drinker? How to Tell If Your Drinking Has Become Problematic By Margaret Seide, MD Margaret Seide, MD LinkedIn Margaret Seide, MS, MD, is a board-certified psychiatrist who specializes in the treatment of depression, addiction, and eating disorders. Learn about our editorial process Updated on September 25, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by John C. Umhau, MD, MPH, CPE Medically reviewed by John C. Umhau, MD, MPH, CPE John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). Learn about our Medical Review Board Print Henrik Sorensen / Getty Images Table of Contents View All Table of Contents Alcohol Use During the Pandemic Signs Your Alcohol Use Is Problematic The 'Gray Area' Alcohol is everywhere, and in American culture, it is synonymous with good times, good dinners, weddings, and merriment in general. Add to that the countless social media posts and memes in circulation normalizing and making light of excessive drinking. We have the current dilemma of this legal substance being a pervasive and integral part of our social culture while simultaneously being a potential Pandora’s box of devastating health, psychological, and social consequences. So, how can any individual accurately take inventory of their own personal relationship with alcohol? This article offers guidance on how anyone can thoughtfully appraise their drinking if they are worried about living in that not-so-well-defined gray area between casual drinking and alcohol abuse. Alcohol Use During the Pandemic America’s alcohol consumption has been steadily increasing for the past two decades, but the COVID-19 pandemic and resulting quarantine mandates considerably accelerated this trend. Neilson reported a 54% increase in national alcohol sales for the week ending on March 21, 2020, compared to March 2019. In addition, online sales increased by 262% during that same year. Interestingly, research shows that fewer people used alcohol during quarantine. However, those who did drink consumed larger quantities of alcohol more frequently. Alcohol use before 5 p.m. also increased, as did drinking among women during the pandemic. Press Play for Advice On Dealing With Addiction Hosted by Editor-in-Chief and therapist Amy Morin, LCSW, this episode of The Verywell Mind Podcast shares strategies for coping with alcohol cravings and other addictions, featuring addiction specialist John Umhau, MD. Click below to listen now. Follow Now: Apple Podcasts / Spotify / Google Podcasts This is likely because of two major, somewhat obvious factors. Firstly, the year 2020 was full of uncertainty, sadness, and loss. Secondly, alcohol feels good. It has the ability to decrease anxiety and boost mood by increasing brain levels of dopamine, the pleasure molecule. But how does America reconcile the fact that while all of the above is true, it is also true that unchecked alcohol use is a risk factor for almost 200 illnesses, including seven types of cancer? Furthermore, there are approximately 5 million emergency room visits per year for acute and chronic alcohol-related conditions ranging from psychosis to liver disease. One study found that in the United States, there are 225 deaths attributed to alcohol per day. Those who don’t die acutely do not live as long as their teetotaler counterparts; the lifespan of Americans is cut by a cumulative 2.7 million years annually due to alcohol. In addition, budgetary costs associated with losses in workplace productivity, health care expenditures, and the criminal justice system due to alcohol add up to $250 billion per year. Alcohol consumption is also associated with increased risk of suicide, intimate partner violence, and exacerbating almost every existing mental health diagnosis. Americans Are Using Alcohol to Cope With COVID-19 Stress Signs Your Alcohol Use Is Problematic There can be a thin line between an appreciation for how alcohol enhances an evening or a meal, and troublesome usage. Here are some indications that your drinking may be becoming a problem. Your Alcohol Use Isn't Just Social and Serves a Purpose If you feel like you “need” alcohol to do anything, that is a reason for apprehension. For example, alcohol is associated with socializing, but if you find that you can't enjoy the company of others without it, that is cause for concern. If you use alcohol as a sleep aid, that's also an indication that caution is warranted. Regular use of alcohol to get to sleep is ill-advised. While alcohol can lead to faster sleep onset, it ultimately subtracts from sleep quality because it fragments sleep and disrupts the normal sleep cycles. If you need alcohol to participate or find pleasure in sexual activity, this may indicate an issue with your relationship with alcohol and sex. You may benefit from the input of a therapist to help you explore whatever may be an obstacle to your enjoyment of being sexual while sober, such as a trauma history. The Different Types of Drinking Habits to Avoid You've Created Rules Surrounding Your Use of Alcohol Since 1984, the medical community has used the CAGE questionnaire to quickly and efficiently screen for alcohol use disorders. CAGE is an acronym that helps providers more easily remember the four questions of this assessment tool which are as follows: Have you ever tried to Cut back on your drinking?Have you ever felt Annoyed when others criticized your drinking?Have you ever felt Guilt about your drinking?Have you ever needed a drink first thing in the morning to feel well? This is known as an “Eye-opener”? Note that two CAGE questions deal with a person’s subjective evaluation of their alcohol use and any attempts to restrict usage. Those are the questions about cutting back and guilt, respectively. It is unlikely that you would feel guilty or put limitations on your intake if you didn’t think you had or were starting to have a problem with alcohol. This is very relevant because it turns out that answering yes to any two of the CAGE questions indicates a 73% chance that you meet the criteria for alcohol use disorder, which is the technicalwording that has replaced the term alcohol addiction in the latest edition of the Diagnostic and Statistical Manual (DSM). So, if you have ever promised yourself things such as I will no longer drink alone or I will only drink on weekends, be wary of the role alcohol is playing in your life. You Have Had Embarrassing Consequences From Your Drinking One of the things that some people find most pleasurable about alcohol is that it lowers inhibition. This can lead to what one may view as favorable experiences, such as being able to let loose and dance like no one is watching on a crowded dance floor when you are normally a reserved, introverted wallflower. However, there may also be a few downsides to this. Unrestrained behavior can lead to cringe-worthy moments in a person’s life. Becoming aggressive or sending emails that are worded in a way that is not reflective of your sober self can damage relationships and potentially your career. If you have said things, texted things, or had sexual encounters while intoxicated that you would not have without the involvement of alcohol, then drinking might be complicating your life. Having to go on an apology tour after a night of drunkenness is awkward. It indicates that you would benefit from gaining insight into your relationship with alcohol with the guidance of a professional. If you or a loved one are struggling with substance use or addiction, research the NIAA treatment navigator or contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. You Have Experienced Blackouts Alcohol-related blackouts are periods of amnesia that reflect the failure of the brain to record memories of what transpires while drinking. Although your brain is not recording, it is still operating in other ways, so you can function in other ways, such as walking and talking. In one study, 68% of college-aged adults reported having at least one blackout episode in the past six months. Blackouts appear to predict an alcohol-related decline in one’s ability to fulfill social obligations such as school or work. Women, those with lower body weight, and those who combine alcohol with other sedating substances are more susceptible to blackouts. Experiencing episodes of drinking that lead to being unable to recall where you were or what you did during any stretch of time is a fairly substantial red flag. How Heavy Alcohol Use Can Damage Memory Function You Start Drinking and Cannot Stop A commonly used adage within Alcoholics Anonymous (AA) is, “One drink is too many, and a thousand is never enough." This refers to one of the fundamental features of alcohol addiction: once an addicted person begins drinking, they cannot stop unless they become extremely intoxicated, ill, or run out of alcohol. The urge to continue drinking feels overwhelming and compulsive following the introduction of alcohol into the body. If you feel triggered to continue ingesting alcohol after having even a small amount, there may be a reason for concern. The 'Gray Area' If your previous idea of someone suffering from alcohol addiction is a person who doesn’t have stable housing, has lost jobs, or had legal issues due to alcohol, you may need to modernizeyour thinking. If you hold on to such a narrow and outdated view of what the struggle with alcoholism can look like, you may miss something important unfolding right before your eyes in your own life or in the life of someone you love. Addiction occurs on a spectrum, and yes, there are extreme states of the condition, but it can also be quite insidious. There is a quietly growing sub-population of functional alcoholics who have it all together by all appearances. Alcohol use disorder can look like someone showing up for work every day but using the substance to cope with loneliness, anxiety, boredom, or feel more comfortable in their skin. Increased rates of depression, compromised immune function, sleep disturbances, and decreased productivity are potential outcomes of problematic drinking that happen well before ruinous disruptions to a person’s life. A 2017 study reported that 1 in 8 Americans met the criteria for alcoholism. The number is thought to be considerably higher for this current year, and many are calling this a public health crisis. Best Online Sobriety Support Groups A Word From Verywell If you have had any of the above experiences, it may be time for a critical look at the dynamics playing out between yourself and alcohol. Many people shy away from discussing their drinking habits with a professional because there is the assumption that they will automatically be told never to have another cocktail for the rest of their lives, which can seem extreme or overwhelming. Know that there are methods available, such as the Sinclair method or certain medications, that can help reduce alcohol consumption without demanding immediate and total abstinence. If you are physically addicted to alcohol, abruptly stopping can have dangerous consequences, including a heightened seizure risk. 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Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry. 2017;74(9):911-923. doi:10.1001/jamapsychiatry.2017.2161 Mann, Karl, Henri-Jean Aubin, and Katie Witkiewitz. "Reduced drinking in alcohol dependence treatment, what is the evidence?." European Addiction Research 23.5 (2017): 219-230. By Margaret Seide, MD Margaret Seide, MS, MD, is a board-certified psychiatrist who specializes in the treatment of depression, addiction, and eating disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Get Treatment for Addiction Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.