In the alcohol field, there has always been a point of contention between what the drinker believes about their drinking, and what the medical profession believes. Anything the drinker might say to excuse or explain why they drink, other than being dependent on alcohol, has typically been disregarded as being a consequence of denial. But alcohol problems don’t develop overnight, and many drinkers consume high levels of alcohol, and never go into treatment.
A major research project I conducted with colleagues in the United Kingdom in the 1990s and 2000s approached the problem of understanding heavy drinking differently. Instead of disregarding what heavy drinkers were saying, as the ramblings of people with a disease and no insight, we interviewed 500 untreated people who were regularly drinking above safe levels. We wanted to understand why they drank heavily, from their own point of view, instead of imposing our own.
One major finding was that heavy drinkers are not obsessed with the effects of alcohol itself, but rather, they have built their lifestyle around people and events that include alcohol. The idea of sitting alone in a room with a bottle of alcohol and getting drunk was abhorrent to them. They saw themselves as individuals with active social lives, and often, enjoyable relationships with others.
Although these heavy drinkers acknowledged that they did not like the idea of life without alcohol, they interpreted questions about alcohol dependence as being about more than just alcohol. While they might be preoccupied with the next drinking occasion, this was not because they were looking forward to alcohol per se, but rather, that they were looking forward to the next social or recreational event that included alcohol.
So alcohol was not considered important in its own right, but rather, as an important part of socializing, leisure activities, relaxing, or switching off.
Why Is This a Problem?
So if people are enjoying alcohol as part of a lifestyle, why would it be a problem? Well, for one thing, if alcohol forms such a central part of your life that you look forward to the next social or recreational activity knowing alcohol will be there, it will be difficult to have many occasions without alcohol. And a great many physical and psychological problems and social harms are caused by heavy drinking, in addition to alcohol dependence.
Another difficulty is that with alcohol being enjoyed within a social context, it’s hard to make changes without a complete change of social life. And this is particularly difficult if that social life is based around long-term friendships, family, or work relationships.
Finally, with high, regular levels of alcohol intake for an extended period of time, it is hard to know how badly your mental and physical state is impaired by alcohol. The chances are that you are functioning well below your potential, and you may be driving over the legal limit without even realizing. You may not even realize the harm alcohol is doing to your internal organs until the damage is irreversible.
What Should I Do?
You can start by taking an honest look at your alcohol intake, and figuring out your Blood Alcohol Concentration (BAC) levels. You may find that you have a greater amount of alcohol in your bloodstream for more of the time than you realized. You may be able to moderate your drinking, using strategies such as substituting low alcohol or alcohol-free drinks for the full strength version.
You may also want to consider getting an assessment for an alcohol problem. The good news is that if your alcohol use has not become severely problematic for you, there is more chance that you can moderate or quit drinking before you become severely dependent. Also, you may be able to reverse, or at least halt, the damage caused by alcohol before it progresses further.
Hartney, E. et al. ”Untreated Heavy Drinkers: A Qualitative and Quantitative Study of Dependence and Readiness to Change.” Addiction Research & Theory, 11:317-337. 2003.
Miller, W. & Munoz, R. Controlling Your Drinking: Tools to Make Moderation Work For You. New York: Guilford. 2005.