- “Gray area” drinking is the realm between healthy levels of alcohol consumption and a diagnosed alcohol use disorder.
- Gray area drinking is not an official medical diagnosis. But experts say any level of alcohol consumption that negatively impacts your personal or work life, your own health, or the health of others around you is cause for concern.
- A number of recent surveys found that people living in the United States say they’ve begun drinking more heavily during the COVID-19 pandemic.
Many people in the United States may be drinking more alcohol as a way of dealing with the stress and disruptions of the COVID-19 pandemic, suggest several surveys.
Some may even have slipped into “gray area” drinking — that realm between healthy levels of alcohol consumption and a diagnosed alcohol use disorder.
“Gray area” drinking is not an official medical diagnosis. But experts say any level of alcohol consumption that negatively impacts your personal or work life, your own health, or the health of others around you is cause for concern.
Several surveys suggest that some people are also drinking more frequently.
A recent survey from this past spring by The Harris Poll, which was commissioned by Alkermes, an Ireland-based biopharmaceutical company, found that 17 percent of people 21 years and older reported “heavy drinking” in the past month.
Of those who met the criteria for heavy drinking, 13 percent reported that they were undergoing treatment.
Alkermes sells Vivitrol (naltrexone), a drug used to treat alcohol dependence.
The NIAAA defines heavy drinking for men as more than four drinks on any day, or more than 14 drinks per week.
For women, it’s defined as more than three drinks on any day, or more than seven drinks per week.
The Harris-Alkermes survey used a slightly different definition of heavy drinking: two heavy drinking days (four or more drinks for women, and five or more drinks for men) in a single week at least twice in the previous 30 days.
In particular, women increased their heavy drinking days 41 percent.
In addition, a study from April to September 2020 found that hazardous alcohol use during the pandemic was more common for people in the United States under stay-at-home restrictions than those not under restrictions.
Researchers also found that alcohol consumption was higher among younger people, males, and people who had lost a job due to the pandemic.
Ken Leonard, PhD, director of the Clinical and Research Institute on Addictions of the University at Buffalo, said these surveys should be taken with a grain of salt, because changes in alcohol consumption varied across the country.
“COVID didn’t really strike everybody in the same way,” he said. “Overall, there was probably some increase in drinking, and [this was] likely among those people who are most at risk of heavy drinking.”
A number of factors could have affected people’s drinking habits during the pandemic.
For example, stay-at-home orders shifted many people’s routines, along with their access to alcohol.
Those working at home might have found it easier to drink alcohol while working online. But even then, they might not have increased their total alcohol consumption.
Similarly, college students doing online school from their parents’ home could have had less access to alcohol than they would at school. Or if they were unsupervised, they might have had greater access.
Not every state imposed stay-at-home orders, though, so people’s lives were disrupted to different degrees. Likewise, economic disruptions varied from state to state.
Stress is another reason given for many people increasing their alcohol consumption. But even this factor varied.
“What was really sort of notable about the pandemic was that some people ended up getting multiple stressors all at the same time,” said Leonard, whether it was a family member dying of COVID-19, job loss, or being confined to their house with limited support.
However, for some people, working at home was less stressful, because they didn’t have to commute long hours or could exercise regularly and get enough sleep.
Stress, though, is not the only reason people drank more.
“Boredom is an important factor,” said Robert Leeman, PhD, an associate professor in the department of health education and behavior at the University of Florida.
“People don’t think of it, because it’s not as salient as stressors, in terms of leading to an increase in someone’s drinking, but it is important,” he said.
While “gray area” drinking may capture how some people feel about their own drinking, Leonard said this term doesn’t correspond with how psychologists talk about alcohol use.
“We think of [alcohol consumption] as being on a continuum,” he said, “where there’s a safe level, there’s a hazardous level, and then there’s a seriously problematic level. And seriously problematic is when you get into the alcohol use disorder categories.”
What these levels look like varies from person to person, based on their life and social networks.
But there are several warning signs of when drinking alcohol might have tipped over into the hazardous level.
Leonard said it’s not just about drinking more alcohol than you planned. It could also be drinking at times you hadn’t planned, or in situations where you wouldn’t normally drink.
“Those sorts of things happen on occasion,” Leonard said. “But if they begin to happen regularly, that’s a sign that you’re not in complete control of your drinking, that you’re responding to social pressures, or you’re responding to a growing tolerance for alcohol.”
Leeman said another warning sign is when drinking alcohol regularly impairs a person’s work performance, personal relationships, or ability to take care of their family or household.
Heavy drinking can also impact a person’s health — and the health of those around them — in other ways.
Alcohol consumption has been linked to
This includes liver problems, heart disease, and certain cancers, as well as domestic violence, suicide, and motor vehicle accidents.
Dr. Christian Hopfer, medical director and attending psychiatrist at UCHealth’s Center for Dependency, Addiction and Rehabilitation (CeDAR) in Colorado, said there is a range of treatment options for people concerned about their drinking.
“There’s not one right path for everyone,” he said, “but a lot of people can do better if they seek out assistance.”
The options include outpatient counseling, inpatient treatment programs, peer support groups such as Alcoholics Anonymous, and prescription medications.
Medications such as naltrexone, acamprosate, and disulfiram can be used alone or with counseling or support groups.
“A lot of people can achieve success by meeting with a counselor, getting some education, or working with their family physician,” Hopfer said. “[The treatment that works best] is a function of how much people are drinking and how hard it is for them to cut down.”
For some people, reducing their alcohol consumption could be a reasonable approach — such as cutting back from five drinks a day to two drinks a day.
That said, if you’re having 15 drinks a day, cutting back to 10 drinks a day still leaves you at a dangerous level.
“Many people try to reduce their drinking,” Hopfer said. “It’s usually only after that hasn’t worked that they consider stopping, which is hard and requires a lot more support.”
While many treatment problems and support groups focus on people who have received a diagnosis of alcohol use disorder, there are also options for people who are at the hazardous drinking level.
Leeman said there are apps that help people track their alcohol consumption, including ones that connect to a breathalyzer. But he said you could even just text yourself every time you have a drink.
These methods can help people identify their drinking patterns: how much they drink, when, and in what situations.
“For those people who are in that hazardous drinking area, they may only need an assessment that shows them that, compared to other people, they’re drinking a little bit heavier,” Leonard said. “That may be all they need to motivate them to reduce their drinking.”