What Is Almost Alcoholic?

Two Kinds of People, or Many Different Shades?
Some people believe there are only two kinds of people in the world: alcoholics and nonalcoholics. The generally accepted criteria for diagnosing people with alcohol use issues has supported this concept. Moreover, many people also believe that we are either born alcoholics or we are not. This has been a prevailing view for a long time, and although this statement may seem dramatic to some, it does have some basis in reality. That basis is the fact that those who hold these beliefs tend to be people who have experienced or witnessed the most severe symptoms and/or the most severe consequences of drinking. These symptoms and consequences include the following:

• Being unable to stop drinking, beginning from the first time he or she had a drink
•  having blackouts (i.e., not remembering the next day what happened) after having only a few drinks
• Being arrested multiple times for driving while intoxicated
• Becoming violent on more than one occasion when drinking

We know from our own clinical experience that there are people who develop severe alcohol drinking patterns and behaviors such as the ones just described. Of those people who are admitted into inpatient alcohol treatment programs, a large majority have experienced problems such as those just described. They are true alcoholics. Fellowships such as Alcoholics Anonymous were founded by and for these very people—the so-called hopeless cases. It isn't hard to understand, then, why some people (including many health care professionals) conclude that there are only two kinds of people in the world: alcoholics and nonalcoholics.

Anyone who drinks heavily is at risk for adverse health consequences, but some people appear to face a heightened risk for developing alcohol-related health problems. The reason appears to be largely biological, although environmental factors also likely play a role in this difference. In support of this biological argument, researchers have found, for example, that people differ in how their bodies metabolize alcohol. Since our biological makeup is determined at birth, there is some truth in the idea that we have certain traits that make us more (or less) vulnerable to the effects of alcohol.

 The almost alcoholic concept came through many years of working not only with people who had the kinds of drinking problems just described, but also with a much larger group of people with a variety of drinking patterns that didn't meet the criteria for alcoholism. As noted earlier, the majority of this larger group came to us not because they were concerned (or because others had expressed concern) about their drinking, but for help with some other problems. The connection between the problems they sought help for and their drinking emerged only later.

Excerpted from Almost Alcoholic: Is My (or My Loved One's) Drinking a Problem? by Robert Doyle, MD, and Joseph Nowinski, PhD.   

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