Q. My husband’s doctor told him to slow down on his drinking. He has slowed down, but he still drinks too much. Over the holidays he had at least three glasses of wine most nights. Some nights, he would consume an entire bottle. Then he would go a couple of days without drinking. He says that he’s not dependent on alcohol, so he doesn’t have a problem. I say he does. What is your opinion?
A. If your husband has been drinking close to a bottle of wine a night, he likely is drinking too much. He may not be an alcoholic, but he seems to be alcohol dependent.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), there is a difference between alcohol dependency and alcohol abuse. Dependency is “characterized by tolerance, signs of withdrawal, diminished control over drinking, and cognitive, behavioral and/or physiological problems.”
Alcohol abuse is a “maladaptive pattern of drinking that leads to clinically significant impairment or distress.” The person who abuses alcohol may not have a consistent pattern of heavy drinking, but the condition is defined by the adverse consequences caused by over-indulging. Someone who abuses alcohol may be abstinent for days or weeks, but when he or she begins to drink, problems with social and/ or occupational functioning emerge.
Your husband drinking’s pattern seems to fall in what the NIAAA terms “risky drinking” category, which focuses on the amount of alcohol consumed each week. If during a week, a man has more than 14 drinks and a woman more than 7 drinks, they are in the risky drinking category. This much drinking is especially problematic for someone who has health problems.
The NIAAA publishes the following guidelines about what constitutes one drink:
• 12 ounces of beer or wine cooler
• 8.5 ounces of malt liquor
• 5 ounces of wine
• 3.5 ounces of dessert wine
• 2.5 ounces of a cordial or liqueur (such as Cognac or Drambuie)
• 1.5 ounces of brandy
• 1.5 ounces of spirits (a single jigger of gin, whisky, vodka, etc.)
Your husband should check out the NIAAA website. Unfortunately, many risky drinkers turn into alcohol abusers over time. Too few people have an understanding of the damage they can do by not following their doctor’s instructions regarding alcohol consumption. I had a patient who continued to drink in spite of his doctor’s warnings. He now has serious health problems that cannot be treated.
As a mental health professional, my concern is that your husband has not been compliant with his doctor’s evaluation. Why has he been unable to do that? Does he not perceive the threat as real? Does he feel that he is invulnerable to the effects of alcohol?
Your husband should schedule another appointment with his doctor to discuss his drinking problem in more depth. I am certain that when his doctor suggested that he cut back, he or she didn’t mean to cut back to a bottle of wine a day. If your husband does not have a drinking problem, he should adhere to the doctor’s recommendations. If he is alcohol dependent, it is time that he gets help to overcome his addiction.
— Nancy Ryburn holds a doctorate degree in psychology from Yeshiva University in New York City. She currently teaches psychology at Southeast Arkansas College. If you have questions, email them to nancyryburn@gmail.com