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Doctors point out problems facing ‘almost alcoholics’


When psychiatrist Dr. Robert Doyle asked a patient about his relationship with alcohol, the jazz musician reported that he partook of only one drink a day. But it turns out that one drink was vodka poured into a tumbler the size of a 7–Eleven Big Gulp.

“I asked if his drinking was causing problems, and he said, yes, he had been having trouble sleeping. His wife thinks he’s depressed,” said Doyle, a faculty member at Massachusetts General Hospital and Harvard Medical School.

Despite those problems, the patient would not meet the clinical definition of an alcoholic. People diagnosed with alcoholism have had, over a 12-month period, three or more symptoms such as physical withdrawal when not drinking; unsuccessful efforts to cut down; and possibly hiding a supply of alcohol.

Instead, Doyle and psychologist Joseph Nowinski would consider the patient an “almost alcoholic,” their term for people whose drinking goes beyond social drinking, but isn’t alcoholism.

Doyle said the first step for his patient was to see if he could cut back on his drinking. After a few weeks without any alcohol, the man replaced his Big Gulp-size drink with two daily ounces of single-malt scotch.

Those two drinks seemed to work well for him and also fell within the federal guidelines that say for men without chronic health problems, two drinks a day are OK.


Everyone who drinks has a relationship with alcohol, and the premise of a new book authored by Doyle and Nowinski is that many of us fall into a range of being “almost alcoholic.” Without change and perhaps professional help, such almost alcoholics are living with problems brought on by drinking.

“We’re not here to bring about prohibition. There are a number of almost alcoholic people who could just simply stop for a period and see how hard it is to stop,” Doyle said. “It might be that there are just times they’re drinking too much. Simply cutting back to two beers, versus two six packs, might be something that would solve the problem.”

According to the book, “Almost Alcoholic,” there are five key signs that someone is an almost alcoholic:

  • You continue to drink despite at least some negative consequences.
  • You look forward to drinking.
  • You drink alone.
  • You sometimes drink in order to control emotional and/or physical symptoms.
  • You and your loved ones are suffering as a result of your drinking.

Local substance abuse counselor Frank Valentine, site director of the National Counseling Group’s Fredericksburg area office, said everyone is either directly or indirectly affected by alcohol. Consider the average convenience store, where customers must walk by a wall of coolers stocked with beer and flavored malt beverages to reach the bottled water and milk.

Valentine recently took his 9-year-old son to a NASCAR race in Richmond and was surrounded by beer kiosks, advertising banners and spectators who were obviously intoxicated.

“Alcohol is a behavior choice,” Valentine said.

He counsels people who come to the center voluntarily and those sent because of a DUI arrest or other alcohol-related legal trouble.

“If it becomes a problem for you, it needs to be addressed,” he said.


According to the book, everyone’s drinking habits may be charted according to a spectrum of behavior. On one end is normal social drinking, and at the other is alcoholism.

The gray area between, defined by the authors as “almost alcoholic,” is where problems arise. Case studies in the book include a college-age man who cannot get through a weekend without many drinks because of social anxiety. A divorce, death of a spouse or empty-nest syndrome can tip some people into drinking more than usual.

One key message in the book, Doyle said, is that “we’re not thinking of ‘all or nothing’ anymore.”

“ It used to be a person is alcoholic or not,” Doyle said. “Of course, alcoholism is a serious illness, but if you’re not an alcoholic, you could still have a serious problem.”

Another key message in the book: “Although you might not think alcohol is causing you any problems, we often don’t put ourselves in other people’s shoes to see if it’s causing them problems,” Doyle said.

For example, a parent might be spending a few hours each evening sipping cocktails instead of reading to a child.

Doyle said anyone who drinks should periodically examine their relationship with alcohol because that relationship often changes from time to time. The book describes casual relationships, serious relationships and commitments to alcohol.

“Every now and then, we should take a reassessment of our alcohol [intake] and all kinds of things in our life,” Doyle said. “French fries when I was at [college] were not a problem; now I have to worry about every one I even smell.”


Local mental health counselor Linda LaFave agreed re-evaluation is a good practice from time to time.

“One thing I ask people is, ‘Was there a time when you felt better?’” LaFave said.

She often finds this was a time when people were making better lifestyle choices such as eating more healthful foods, drinking more water and surrounding themselves with supportive friends.

“They might have been in better relationships, taking care of themselves socially. Self-care is often a big part of it,” LaFave said. “I personally think that there are people who drink too much but don’t actually have alcoholism. When they improve their lifestyle, their drinking too much resolves itself.”

Many people are afraid to bring up their drinking habits for fear of being labeled an alcoholic, she said. Yet treatment is available and effective for those with an alcohol-related problem. Valentine, who has not read the book, said the premise offers a good primary prevention message.

“However you look at it, if it’s a problem, it’s a problem,” he said. “That’s where people like me and Linda are here to help.”


The definition of mental health disorders, including those related to addiction, will be formally updated when the American Psychiatric Association releases the fifth edition of the Diagnostic and Statistic Manual of Mental Disorders, or DSM, next May.

The newer version will likely include expanded definitions of some addiction-related problems not previously thought of as disorders, such as gambling addiction. The update also is expected to redefine the way alcohol problems are classified (read more at But the very idea of classifying problems such as alcoholism as diseases is controversial.

Patients don’t always match up neatly with DSM definitions. A patient would only meet the DSM classification for depressive disorders if he or she experienced five or more from a list of symptoms, for example.

“What if a person had four of the symptoms and one was a suicide attempt?” said Harvard psychiatrist Robert Doyle. That person might not be diagnosed with clinical depression, but mental health support would likely be in order.

And the very word “alcoholic” is problematic for some mental health professionals.

“The word ‘alcoholic,’ in itself, there’s a stigma associated with it,” said Frank Valentine, a substance abuse counselor and site director of the Fredericksburg branch of the National Counseling Group. “As a counselor, I never call anybody an ‘alcoholic.’ Labels become self-fulfilling prophesies.”

Local mental health counselor Linda LaFave, who has co-authored studies on alternative treatments for substance abuse, advised those who are concerned about problem drinking to get help but to be “a discriminating consumer” of mental health support.

As for the premise of the “Almost Alcoholic” book that everyone’s drinking habits can be charted against a spectrum of behavior, with normal social drinking at one end and alcoholism on the other, Doyle said the idea was based on years of experience with people seeking mental health treatment.

“Just because you’re a problem drinker or almost alcoholic doesn’t stamp you,” Doyle said. “There’s a chance that if you change your behavior, you won’t step over the line.”

Donya Currie is a freelance writer in Stafford County who regularly contributes to Healthy Living and other health-related publications, including the AARP Bulletin. You can write to her at