What Does It Mean To Have A Serious Drinking Problem?

Alcohol was my stress reducer, my reality fighter,
the conferrer of artificial joys.
It was also wreaking havoc on my life.

By Nancy Wartik
Published in The New York Times on January 31, 2020

One day in the fall of 2018, I woke up feeling wrecked. The night before I’d had beers with colleagues and wound up braying loudly to one of them about something she’d confided and what I thought she should do.

“I wish I’d never told you this,” she finally blurted, and I knew I’d betrayed a trust.

A few nights before, I’d been more inept. A group of us had held a memorial for a friend. At a gathering later, I’d had a martini with prosecco chasers, then picked a senseless quarrel with our hostess, a close friend as bereaved as I was.

Now I sat there, head pounding, stomach roiling. It was another in a string of mornings when I’d woken wanting to smother myself with a pillow.

Booze: It didn’t take much for me to feel the effects. Alcohol could make nights glittery and fun, make me love all humankind. It could also, and unpredictably, rouse demons that turned me into a wifely shrew, sparked bruising arguments, unleashed embarrassing faux pas. This morning, a new thought struck, penetrating to the bone.

“I can’t do it anymore. I quit.”

Although I’d grappled for decades with my relationship to alcohol, I didn’t consider myself an alcoholic. In online quizzes asking how many drinks I typically had per day, I could fairly accurately answer “two” (very generous drinks).

On the World Health Organization’s AUDIT quiz, which tests for drinking problems, I scored eight of 40 points, making me a “medium” drinker with a “risky” pattern. But medium didn’t sound too bad and the website said I could alter my drinking “without too much difficulty.”

Plus, I had the vaunted female triumvirate: husband, kid, respectable job. Friends, when they weren’t mad at me. O.K., sometimes I overdid it. But it was easy to imagine myself as your average fun-loving Parisian oenophile.

And yet.

I was in my late teens when I discovered what alcohol could do: quash my inhibitions; kindle false intimacies; provoke brilliant revelations that I soon forgot. Alcohol made me the outgoing person my unconfident self wanted to be, let me talk to people I normally wouldn’t have. Yes, occasionally I awoke to see a head on the adjoining pillow and felt a bolt of regret.

“Damn! Why did this guy seem cute last night?”

But I’d call a friend: “Guess what I did this time?” I’d ask, turning discomfort into a hilarious anecdote.

Or a friend would inform me of my revelry: “Nancy, the bartender threw you out. You couldn’t stay on your stool.”

Alcohol was also medication. I drank to quiet angst or because I was lonesome. I drank, it took years to realize, because I had clinical depression. Eventually I treated the depression but kept drinking. Alcohol was my stress reducer, my reality fighter, the conferrer of artificial joys.

Life changed in my 40s. I married, and with my husband, adopted our beloved daughter, now 17. Working from home, I made dinner, drinking wine with a neighbor mom. My morning-after headaches were worsening, though. Nights, rather than reading or chatting with my husband, I’d crash. I feared my drinking was destroying brain cells. I’d written about how alcohol is harder on women than men and that worried me, too.

Some years ago, to prove I had control, I cut down to five nights a week. It was tough. How could I not drink after a rough day? I couldn’t manage two consecutive sober nights. Achieving my two sober nights was always an exercise in military-level strategizing. But every Sunday, I felt virtuous. An actual alcoholic couldn’t skip any nights, I thought. But I could.

What does it mean to have a serious drinking problem? The answer is surprisingly vague.

“Alcoholism” isn’t an actual diagnosis. In 1980, the American Psychiatric Association’s authoritative Diagnostic and Statistical Manual of Mental Disorders established two different classifications: alcohol abuse and alcohol dependence. In 2013, the D.S.M. combined the categories to create “alcohol use disorder,” a spectrum ranging from mild to severe, based not on how much someone drinks but on how many of 11 behavioral or psychological symptoms a person has.

Meanwhile, the Centers for Disease Control and Prevention has its own standards, focused more on quantity of alcoholic consumption. Seven drinks per week or fewer is considered safe for women, 14 or fewer for men. But guidelines fluctuate internationally, according to a Stanford University study from 2016. In Canada or France, you can drink more weekly and be considered “low risk.”

Moreover, a recent study in The Lancet concluded alcohol is so tough on health that there’s no safe level.

In short, if you wonder whether you drink too much, sometimes it’s best to trust your gut.

I don’t know exactly what happened that fall morning as I sat in bed, achy and humiliated. As viscerally as I’ve known anything, I knew I was in trouble. So what if I didn’t swig a bottle of Scotch daily? I’d hit “medium drinker” rock bottom and it was enough.

Despite the website saying I could change my drinking “without too much difficulty,” quitting booze is one of the hardest things I’ve ever done. I pined for it: At restaurants, I’d gaze at ruby goblets as if at a divine elixir. After workouts I’d crave a beer. And what was the point of socializing sober?

Eventually, I had to try. Guzzling nonalcoholic beer — before I wisely switched to seltzer — while chatting with people savoring complex pinot noirs was initially daunting. But astonishingly, my non-intoxicated brain still found what they said funny, touching or interesting.

I didn’t join AA, though I don’t rule it out. I sought support from my husband, daughter and friends — those I’d offended, those surprised I even had a problem. I devoured others’ stories, watching movies about alcoholics, reading memoirs, lurking in sub-Reddits for people struggling to quit. But what really kept me on the path was the remarkable difference between the drinking and not drinking me. I hadn’t grasped the degree to which a sense of shame had insidiously undergirded my life. Now it was gone, replaced by an unaccustomed pride.

The longer I abstained, the better I felt, in ways that spilled into marriage, work, parenting, friendships. Recently, someone unaware I’d quit told me I looked years younger. I’m more patient. My headaches are infrequent, my energy up.

Those results fit with a study published in the Canadian Medical Association Journal, among the first focused on moderate drinkers’ mental health. Researchers studying cohorts of people in Hong Kong and the United States found even “safe” drinkers, women in particular, showed improved well-being if they stopped.

Today, I can label myself. I had moderate alcohol use disorder, a “chronic relapsing brain disease” marked by loss of control over alcohol. The National Institute on Alcoholism and Alcohol Abuse says 6.2 percent of American adults, more than 15 million people, are on the alcohol use disorder spectrum. (Other research puts the numbers higher.) I’d guess many, like me, drink modestly enough that they don’t believe they have a problem. I feel lucky I quit before anything worse happened.

Sobriety can still be a challenge. If all goes according to plan, I’ll never again experience the soft scrim that drops between me and reality, as wine drains from my glass. It seems sad, until I remember that three times since quitting, I’ve tried a celebratory drink. Most recently, in Peru, I had one of the country’s famous pisco sours. It gave me a mild buzz and a hangover. I haven’t had a drop since.

These days, I awaken clearheaded. I’m closer than ever to being the mother, wife, relative and friend I want to be. It feels good. Really good. I get up the next morning. I do it again.


 

12 Responses

  1. Clara M. says:

    The terms “alcohol abuse” and “alcohol use disorder” have been championed by the multi-billion dollar alcoholic beverage industry, the same folks that brought us “drink responsibly.” The concept of alcoholism as an innate physiological condition treatable through abstinence is anathema to Big Alcohol.

    The physiology underlying alcoholism was described in Dr. Milam’s book “Under the Influence: A Guide to the Myths and Realities of Alcoholism” way back in 1983. About ten percent of humans break down alcohol more slowly than “normal” humans, producing a build-up of toxic acetaldehyde in their bodies. A small subset of the ten percent gets violently sick after ingesting only a single alcoholic drink (or less). The rest of the ten percent physically adapt to the toxin acetaldehyde through an internal chemical process. As Milam describes it:

    Acetaldehyde […] is a volatile substance which reacts with just about any other chemical which happens to be in the vicinity. The brain amines, which have been piling up while the acetaldehyde preoccupies their enzyme, interact with acetaldehyde to form compounds called ‘isoquinolines.’ […] For alcoholics, the isoquinolines have one characteristic which makes their other properties pale in significance. They are astonishingly like the opiates, and researchers suggest that they may act on the opiate receptors in the brain, thus contributing to the addiction of alcohol.

    Drugs such as Antabuse disrupt the process, as does Naltrexone, the drug promoted by the Sinclair Method.

    Normal drinkers’ bodies cannot adapt to acetaldehyde toxicity, no matter how much or how frequently they drink. They learn they have an unchanging drink limit. If they go beyond it, acetaldehyde toxicity produces excruciating physical symptoms such as vomiting, diarrhea, dizziness, etc.

    There is a defining physiological difference between alcoholics and non-alcoholics. And yet there is variation in alcoholic drinking behavior. Can the variation accurately be termed a “spectrum”?

    There are maintenance drinkers who ingest alcohol at regular intervals all day, every day. There are binge drinkers who go for days, weeks, or months without consuming alcohol, then go on days, weeks, or months-long benders. There is a hybrid, what I call the daily binge drinker, who starts drinking at 5-6pm, consuming 16 or more units of alcohol in a 2-4 hour period. This was me. When I tried maintenance drinking (it seemed like a good idea at the time), I was extremely nauseous. I assume my body’s ability to counter acetaldehyde toxicity has limits. Through experience, I learned I required a 12-16 hour alcohol-free stretch every day. Then there are the lightweight alcoholics who act extremely drunk or high after only one or two drinks, contrary to what most alcoholics experience. The best-known is Ulysses S. Grant; based on the article, the author may also be in the lightweight category.

    Seems like a spectrum, but I expect additional research will show alcoholic variation springs from relatively minor differences in alcoholic physiology. I assume maintenance drinkers’ bodies can cope with acetaldehyde toxicity for longer periods of time, with fewer and briefer periods of recovery, than binge drinkers. Compared to the typical alcoholic, lightweight alcoholics may have a stronger physiological response to acetaldehyde toxicity with an increased opiate-like effect. Regardless of behavioral differences, all alcoholics have in common an innate physiological response to acetaldehyde toxicity with potentially fatal consequences.

    I prefer alcoholic to describe myself over other terms. But if viewing themselves as a person with alcohol use disorder helps someone get treatment, that’s great. For that reason, I strive not to insist that anyone (including the article author) define themselves as an alcoholic.

    Unfortunately, any term used to describe alcoholics eventually has negative connotations because alcoholism itself is viewed as shameful and often criminal in all cultures. Alcoholic was once upon a time a nicer, softer term, replacing pejoratives such as drunkard, wino, etc. Eventually, alcohol use disorder will carry the same grim baggage of alcoholic.

    Note: while Antabuse and Naltrexone both disrupt the chemical process underlying alcohol addiction, they do not work in the same way. As I understand it, Antabuse increases acetaldehyde toxicity, producing violent sickness when alcohol is consumed, while Naltrexone blocks opiate receptors, resulting in no high.

    Another note: missing life-j a lot.

  2. Dan L says:

    Hello Fellow opinion tossers. First of all thanks to Roger for putting this up. I understand the danger for “real alcoholics” of posting such an article but fortunately for me many of my “fellow” AA’s have explained to me that I am not a “real” alcoholic and the proof is right in our own literature! Sure enough I was directed to page 20 something where it stated that the only salvation for a “real” alcoholic was a literal “salvation” of the churchy kind. Since I had found sobriety after a lifetime of drunkenness by a much less supernatural and more mundane application of the “Principles” by following my own bastardized version of the “Steps” I could not pretend to that status of an Elite Alcoholic. I was only a “heavy drinker”. My dreams of being a full fledged Anonymous Alcoholic were dashed. I was only there for the scintillating conversation and the non-stop repetition of assurances that they would love one another until they could love themselves and that their best day drunk wasn’t equal to their worst day sober.

    That last one got me thinking… “Well I must not be an a ‘real’ alcoholic after all. I was drunk on some pretty good days and sober on some really shitty ones.”

    Well I went to my Higher Power – My Mother. She is 87 years of age and sharper than a shot of gin at 6 AM. She kindly said, “Your friends are full of shit. You are a drunk through and through like you father and half of the rest of this herd! Now be a good boy and run down and buy me a bottle of Chardonnay… one of the fancy screw top ones, I can’t pull the corks out with my teeth anymore. Then get the hell out of here!”

    I go with the definition I was taught. If you think you have a drinking problem you do. If you find out afterwards that you don’t actually have a drinking problem you are probably an alcoholic.

  3. Tim B. says:

    Isn’t it great that we can all abstain from drinking alcohol and have the opportunity to share with each other when so many die from the effects of alcohol or ruin the lives of others because of their drinking? Smoke weed or don’t smoke weed, take prescription medicine or not, I don’t care. For me, I’m just tickled pink that you aren’t driving drunk.

    BTW, I’ve been sober for decades and I still have the desire to sit back with a fatty and watch the world roll by. I don’t do that, but once in a while I think about it. Today, I think it through.

  4. Bob K says:

    My favorite Canadian author, Mordecai Richler, drank himself to death with single-malt Scotch and fine French wines. Noted lay therapist Richard Peabody, and Charles Towns, founder of Bill W.’s rehab of choice, said some similar things 100 years ago. The most unlikely candidates for recovery are the very rich and the very poor. Without a deterioration of my ability to earn a living, pay my debts, insure a car, etc., I’d have just kept going. Functioning alcoholics have the decent homes and paychecks that assure them their drinking problem is a minor one.

    The essay is interesting. I see both ongoing denial, plus some contradiction.

    Women tend to refer to wine-drinking the way I looked at beer. “It’s JUST wine!!” “It’s JUST beer!!” Further, how does two large drinks a day add up to wobbling atop bar stools?

    Following the litany of the benefits of NOT drinking, we get the big reveal at the end about the occasional “celebratory drinks.” I’ve seen people do that. It tends to ramp up to something more serious.

    • Jay says:

      Hey Bob, hey all fellow friends!

      I really like this article and thank Roger for posting it. In my opinion it was not meant as a Keynote at an AA Conference or a message to AA believers 🙂 ! It was likely not even meant as support for recovering people though it could have that effect.

      Good gosh, it was published by the New York Times! My hunch is Nancy W. was writing to a broader audience than us. So to pick at her message from our point of view seems unfair to her in my eyes.

      It would not surprise me if many readers of her NYT story found it candid, now question their relationship with alcohol and are contemplating changes. Isn’t that what this is all about? – Jay

      • Bob K says:

        Hey, Jay. The essay title includes the phrase “A SERIOUS DRINKING PROBLEM” in the title. I’m not a black and white thinker who sees drinking problems, by whatever label, as “pregnant, or not pregnant.” It’s more complex than that. Human behaviors and characteristics tend to fall along a spectrum.

        The author ponders what constitutes “a serious drinking problem” and although she is far from her own stereotypical notion of an alcoholic, she quits drinking. She reports delightfully positive effects — “what really kept me on the path was the remarkable difference between the drinking and not drinking me… The longer I abstained, the better I felt, in ways that spilled into marriage, work, parenting, friendships.”

        I’m in the camp that people with serious drinking problems (the author’s term) need to embrace abstinence, which she did, until she didn’t. The “and we all lived happily ever after” narrative may have been uttered too soon. Time will tell.

        If I had a 16-year-old child who we got to quit smoking, I wouldn’t want to find him or her with a cigarette, telling me they just have one once in a while.

        Good gosh, I refer you to The Sad Tale of the Founder of Moderation Management.

        The late Ms. Kishline exiting rehab sounded a LOT like Ms. Wartik.

        • Jay says:

          Thanks Bob!

          No debate here 🙂 . I simply hope some good comes of Nancy’s article for people who have not spent the time most of us have thinking about these issues who perhaps should engage in healthy introspection on it? Kind regards, – Jay

    • Wisewebwoman says:

      You took the words right out of my mind. Exactly my thoughts. Particularly that celebratory drink biz at the end. Oh no, I thought. She’s in big trouble. Hopefully not fighting it to the death (hers).

  5. John M. says:

    Roger, thanks for bringing this article to our attention. One of the things that sustained my alcohol use for so many years until I got sober at 54 was a phrase she uses that articulates so well alcohol’s powerful attraction for me as a “conferrer of artificial joys.” Of course, when I was actively in my drinking, alcohol was seen by me as solely the conferrer of joy. It was only when I gained the perspective of sobriety that the artificiality of that joy became patent.

  6. Steve V. says:

    To say Alcoholism “isn’t an actual diagnosis” and plucking one example is quite disingenuous. There are many medical type organizations in the world today that are in very close agreement about what constitutes alcoholism/drug addiction and what does not. There are several good assessment tools out there and just because someone has a “drinking problem” doesn’t necessarily mean they meet or exceed the diagnostic criteria for alcoholism. That’s not my opinion, that’s medical and scientific fact.

  7. Kate F says:

    I read this last week in the Times and responded to a comment that was marked as a NYT pick.

    Natalie G wrote that she hasn’t had alcohol in many years,but smokes a bowl of weed every day, and attends AA.

    My response to her comment: “The danger Natalie, is if you’re presenting yourself as a non-user, to the recovering community. When introducing yourself, I hope it’s accurate i.e. my name is Natalie, I’m an alcoholic, and I get high. When a sick and suffering newcomer arrives, hanging on by a thread, it is absolutely essential that they know they’ve arrived at a safe place – that it’s not just the next bunch of liars and scammers. I’m glad You’ve been able to reap the benefits of the fellowship.”

    Kate 5/8/85. My sobriety date means that I don’t drink alcohol and I don’t get high.

    • Mike B. says:

      Kate:

      Being honest at meetings by stating “My name is Mike and I’m an alcoholic” is one thing; a big leap to conclude that I or others are being dishonest by not stating their other addictions and/or use of prescribed medications or recreational drugs.

      If any AA member wishes to remain anonymous regarding outside issues, for any reason(s), it is their right to do so without question or judgement by others.

      I know, accept and openly state “I am an alcoholic” and have a desire to stop drinking today. I attend meetings to listen to others and share my experience, strength and hope when asked. What I share on other/outside issues (I am an atheist, have PTSD and on lots of medications) is my business and mine alone.

      In March I will have been sober (not had a drink) for 30 years next month and will be 75 in May. I speak from living sober and living for many years. I’m told that the only way we get to be AA old timers is don’t drink and don’t die.

      Our literature states that alcoholism is a symptom of my underlying problems which could include child abuse (mental, physical, emotional, sexual and spiritual), mental health disease or physical health disabilities.

      The only requirement for membership is a desire to stop drinking. To call another member dishonest and not sober because they do not meet ours or my personal expectations is wrong at best and dangerous at worst.

      Our members need acceptance, understanding, assistance and love; not judgement and criticism.

      Just one man’s opinion!