In today’s society, as we’re slowly breaking down the taboo surrounding mental health issues like anxiety and depression, the conversation around alcohol problems lags behind. Admitting to experiencing depression or anxiety is met with words of comfort, whereas saying, “I think I’m drinking too much,” might prompt discomfort or even dismissal from peers. It seems we’ve become comfortable discussing our fears, phobias, and “obsessions”, yet when it comes to alcohol, the conversation often splits into “one of us” or “one of them”.
This black-and-white mentality overlooks the complex reality of many people struggling with their drinking: between the “teetotaler” and the “alcoholic” lies a vast, varied spectrum of experiences with alcohol
1,2. The binary view of alcohol use — you’re either an alcoholic or not — undermines the nuances of drinking problems and denies many the recognition and help they need.
Most who engage in problem drinking do not exhibit the dependence levels typically required for an Alcohol Use Disorder (AUD) diagnosis (DSM-V)
3. Still, they are at increased risk of transitioning into the disorder
4. In the Netherlands, the advice of the Health Council is to drink little (i.e., one glass per day) or no alcohol
5. While such guidelines aim to delineate healthy from unhealthy drinking, the reality often deviates from these neatly drawn lines. What occurs when one glass escalates to three, or when “just on weekends” slips into “just to unwind after work, too”? It’s not merely about exceeding recommended limits; it’s crucial to consider whether your drinking triggers adverse consequences for yourself or those around you
6.
A global survey conducted by Garnett et al. in 2015 disclosed that nearly 37% of individuals drinking at harmful levels* were unaware of it, believing they drank less than or the same as the average person
7. The experiment by Morris in 2020 shed light on the advantages of perceiving alcohol use as a continuum rather than a binary condition. In the study, harmful drinkers were shown scenarios depicting individuals with past alcohol issues as relatable figures, as opposed to fundamentally different from others. Those exposed to the concept of alcohol use as a spectrum were more inclined to acknowledge their drinking patterns as problematic compared to those stuck in an ‘us versus them’ philosophy
8.
As we dive into discussions about mental health and alcohol use, it’s essential to remember the big difference our small actions can make. This isn’t just about abstract ideas or numbers; it’s about our friends, our family, and sometimes, it’s about us. By moving beyond the black-and-white mentality and acknowledging the shades of grey in alcohol problems, we create a space where those experiencing difficulties feel more comfortable to open up. This shift not only enriches our understanding but could prevent the descent down a slippery slope by promoting openness and compassion.
This blog was written by Milagros Rubio, Radboud University, for RAD-blog, the blog about smoking, alcohol, drugs, and diet.
Additional recommendations and resources
- Shout out to the podcast that was a major spark and inspiration for my blog: The Alcohol Problem Podcast: Labelling & language in mental health & alcohol with Dr Lucy Foulkes, available using Spotify.
- If you or a loved one is navigating these grey areas, exploring resources like the AUDIT self-test (link to self-test) can offer insights and guidance. The AUDIT self-test is a valuable tool that can provide insights and guidance on where you might stand with your drinking habits.
Notes
*Harmful drinking refers to a pattern of alcohol consumption that increases the risk of adverse health consequences for the drinker
9.
References
- Morris, J., Moss, A. C., Albery, I. P., & Heather, N. (2022). The “alcoholic other”: Harmful drinkers resist problem recognition to manage identity threat. Addictive Behaviors, 124, 107093. https://doi.org/10.1016/j.addbeh.2021.107093
- Morris, J., Boness, C. L., & Witkiewitz, K. (2023). Should we promote alcohol problems as a continuum? Implications for policy and practice. Drugs: Education, Prevention and Policy, 0(0), 1-11. https://doi.org/10.1080/09687637.2023.2187681
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5™ (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- National Institute on Alcohol Abuse and Alcoholism. (2024). Understanding Alcohol Use Disorder. Retrieved February 12, 2024, from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
- Ministerie van Volksgezondheid, Welzijn en Sport. (2015). Richtlijnen goede voeding 2015 – Advies. Retrieved February 12, 2024, from https://www.gezondheidsraad.nl/documenten/adviezen/2015/11/04/richtlijnen-goede-voeding-2015
- National Institute on Alcohol Abuse and Alcoholism. (2023). Treatment for Alcohol Problems: Finding and Getting Help. Retrieved February 11, 2024, from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help
- Garnett, C., Crane, D., West, R., Michie, S., Brown, J., & Winstock, A. (2015). Normative misperceptions about alcohol use in the general population of drinkers: A cross-sectional survey. Addictive Behaviors, 42, 203-206. https://doi.org/10.1016/j.addbeh.2014.11.010
- Morris, J., Albery, I. P., Heather, N., & Moss, A. C. (2020). Continuum beliefs are associated with higher problem recognition than binary beliefs among harmful drinkers without addiction experience. Addictive Behaviors, 105, 106292. https://doi.org/10.1016/j.addbeh.2020.106292
- Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption–II. Addiction, 88(6), 791-804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x
