Gray Area Drinking: Signs, Diagnose, Risks, and Treatment

Excessive drinking can lead to a wide range of negative effects. Alcohol is a frequent root of social and economic struggles, as well as a frequent cause of physical and mental health problems, the most severe of which is alcohol use disorder (AUD), or alcohol addiction.1,2

Despite obvious detriments, alcohol consumption remains a common practice in societies around the world. Many individuals enjoy drinking, usually in social circumstances, which amounts to what is commonly known as “responsible drinking” or “low-risk drinking”.1,2

However, one issue tied to alcohol use gained significant attention from both the broad public and academic world, especially in recent years. Namely, what happens when a person’s drinking isn’t severe enough to be characterized as AUD but, also, not responsible enough to be categorized as low-risk drinking? This is Gray Area Drinking, and it has become a lot more common in recent years.3

According to a study published in the Journal of Studies on Alcohol and Drugs, approximately 32% of adults in the United States engage in this type of behavior, on a regular or semi-regular basis. That’s almost 66 million US citizens, which makes gray area drinking a prevalent issue that cannot and should not be ignored.4

As such, it is essential to learn to recognize the signs of gray area drinking, its implications, and possible consequences, as well as to familiarize yourself with numerous treatment options available to be able to seek adequate help, whether it is for you or a loved one who is currently combating this problem.3,5

What Is Gray Area Drinking?

Gray area drinking is a term used to describe alcohol consumption that falls between the categories of social drinking and alcohol addiction. It is a pattern of drinking that is not severe enough to be classified as alcoholism but still poses a risk to one’s health and well-being. It is a relatively new concept that the scientific community still hasn’t clearly defined, which makes it difficult to diagnose, as individuals may not display obvious signs of addiction.1,2,5

As such, this gray area drinking is still reliant on related and well-established terms to describe it. The most commonly used one is “low-risk drinking” which The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines as consuming no more than 2 standard drinks per day for men and no more than 1 drink per day for women.2

The definition of low-risk drinking allows us to separate gray area drinkers from social drinkers and individuals suffering from the different stages of AUD, in that they may not drink every day but when they do drink, they often consume significantly more than intended, as well as finding it difficult to stop.1,2,5

What are the Signs of Gray Area Drinking?

Identifying gray area drinking poses a unique challenge since it shares many symptoms with AUD. While not as severe and as physically and mentally damaging as alcoholism, it is still detrimental to a person’s overall well-being and ability to function normally on a daily or periodic basis. Additionally, the signs of gray area drinking are highly individualized and vary from person to person, the most common ones being:5,6,7

• Drinking to cope with stress or negative emotions;
• Drinking alone or in secret;
• Drinking to the point of feeling drunk regularly;
• Difficulty stopping or cutting back on drinking;
• Neglecting responsibilities, such as work or family obligations, due to drinking;
• Feeling guilty or ashamed about drinking habits;
• Experiencing blackouts or memory loss related to drinking;
• Experiencing withdrawal symptoms when not drinking.

These symptoms are very similar to those associated with AUD. However, they do not necessarily indicate alcoholism. Rather, they suggest a problematic relationship with alcohol which can progress into a fully developed AUD if left unchecked. If you notice some of these signs in yourself or someone close to you, it is highly advisable to seek professional help and guidance without delay.6,7

What are the Risks of Gray Area Drinking?

Despite its lack of recognition as a formal diagnosis and the fact that it is not as severe as alcoholism, gray area drinking still poses significant risks to an individual’s physical, mental, and social well-being, as well as their overall quality of life. The most common risks associated with gray area drinking include (but aren’t limited to) are:1,5,8

• Increased risk of accidents and injuries: Consuming alcohol to the point of feeling drunk regularly can impair judgment and coordination, increasing the risk of falls, car accidents, and other injuries.
• Negative impact on mental health: Gray area drinking can contribute to or exacerbate existing mental health issues, such as anxiety and depression. Additionally, using alcohol to cope with negative emotions can create a cycle of dependence that can further harm an individual’s mental health, as well as lead to the formation of AUD.
• Physical health consequences: Excessive alcohol consumption can lead to a range of health problems, including liver disease, high blood pressure, heart disease, and certain types of cancer.
• Relationship problems: Alcohol consumption can strain personal and professional relationships, leading to conflict and misunderstandings. Neglecting responsibilities and engaging in risky behaviors can further exacerbate these issues.
• Legal consequences: Reckless and high-risk behaviors while under the influence of alcohol can result in legal consequences, such as DUIs, public intoxication charges, and criminal offenses.

How to Diagnose Gray Area Drinking?

Due to the ambiguous nature of gray area drinking, it is often necessary to undergo several assessments by medical and mental health specialists in order to clearly discern its nature and underlying factors. Typically, clinicians use various methods to diagnose gray area drinking, some of which include:4,6,9,10

• Medical evaluation: A medical evaluation can help identify physical consequences of alcohol consumption, such as liver damage or high blood pressure. This assessment can also help determine the severity of the individual’s drinking habits.
• Screening tools: Healthcare professionals may use screening tools, such as the Alcohol Use Disorders Identification Test (AUDIT) or the CAGE questionnaire, to assess an individual’s drinking habits and identify potential issues.
• Self-reporting: A medical or mental health specialist may ask an individual to describe their drinking habits, such as the frequency and amount of alcohol consumption, to help identify any potential problems and their extent.
• Mental health evaluation: Mental health professionals may evaluate an individual for underlying mental health conditions that may contribute to their drinking habits, such as anxiety, depression, or bipolar disorder.
• Observation of behaviors: Specialists may observe an individual’s behaviors, such as engaging in risky behaviors while under the influence of alcohol, to help identify potential issues.

This extensive process enables clinicians to provide a comprehensive evaluation and recommend appropriate treatment options.4,6,9,10

Who is More at Risk for Gray Area Drinking?

Gray area drinking can happen to anyone, regardless of age, gender, or socio-economic status. However, some individuals are at higher risk of developing this issue. Here are some factors that increase the chances of gray area drinking:1,7,11,12,13

• Age: According to the NIAAA, young adults between the ages of 18 and 29 are more likely to engage in gray area drinking than any other age group. This is because they are more likely to take part in high-risk behaviors and have a higher tolerance for alcohol than older individuals.
• Social environment: People surrounded by heavy drinkers or those living in an environment where alcohol is easily accessible and/or viewed in a positive light are more likely to start drinking themselves.
• Mental health conditions: Individuals who struggle with mental health conditions (e.g. depression, anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, etc.) often consume alcohol and other substances to cope with the symptoms of their condition, which can lead to dependence and addiction.
• Genetics: Some people may have a genetic predisposition to alcoholism or gray area drinking. Studies have found that children of alcoholics are four times as likely to develop AUD than those without a family history of alcoholism.
• Stress: People who’ve experienced traumatic or stressful life events, such as divorce, job loss, or the death of a loved one, may turn to alcohol as a coping mechanism.

It’s important to note that these factors do not guarantee that someone will engage in gray area drinking, only that they do increase the likelihood.1,7,11

When to Seek Help for Gray Area Drinking?

Gray area drinking can rapidly turn into a serious problem that can negatively impact every aspect of your life and even lead to a fully developed addiction. Here are several signs that indicate it may be time to seek professional treatment:4,14,15,16

• Drinking with greater intensity: If you notice that your alcohol intake has increased, it may be a sign of developing a tolerance to alcohol. This means that you need to drink more to feel the same effects, which can lead to gray area drinking and AUD.
• Experiencing withdrawal symptoms: If you’ve tried to cut back on your drinking, but started experiencing symptoms such as shaking, sweating, and nausea, it may be a sign of withdrawal caused by alcohol dependence.
• Inability to control drinking habits: If you find it difficult to stop drinking once you start, or if you’ve tried to quit (multiple times) without success, it may signify the early stages of alcoholism.
• Drinking is affecting your daily life: If your drinking is interfering with your work, relationships, studies, or other important aspects of your life, it’s a sign that it is time to seek help.
• Experiencing health problems: If you’re experiencing health problems related to drinking (e.g. high blood pressure, liver or heart disease, digestive problems, etc.) it’s important to seek help immediately.

Left unchecked, some of these issues can escalate into chronic diseases which can lead to a whole host of complications and, in the most severe cases, can even have a lethal outcome. Therefore, it is imperative to seek professional help the moment you notice any of the above signs in yourself or your loved one. Timely intervention gives a person the best chance of making a full recovery.14,16

What should I Do if I am a Gray Area Drinker?

While overcoming gray area drinking can be a challenge, it is not impossible. Today, there are multiple treatment options that are widely available and have proven effective in treating Substance Use Disorders (SUD) and, by extension, AUD. The most commonly used today are:17,18,19,20,21 

• Psychotherapy: This can be a highly effective way to address the underlying causes of gray area drinking. It can help you develop healthy coping strategies, identify triggers, and learn how to manage stress and other emotions that may be contributing to your drinking.
• Support groups: Support groups such as Alcoholics Anonymous (AA), together with its alternatives, can provide a safe and supportive environment where you can connect with others who are going through similar experiences. These groups offer a sense of community and accountability, which can be immensely helpful in overcoming SUD.
• Medication: There are several medications available that can help reduce cravings and manage withdrawal symptoms associated with alcohol dependence. These medications can be prescribed by a doctor and are often used in combination with therapy and support groups as a part of a Medication-Assisted Treatment (MAT).
• Inpatient treatment: Inpatient treatment, also known as residential treatment, involves living in a treatment facility for the entire duration of medical detox and treatment. During this time, a person will be receiving intensive therapy and support. Evidence suggests that inpatient treatment is the most effective option for those struggling with any type of SUD.
• Outpatient treatment: Outpatient treatment involves attending therapy and support groups while living at home. This option can be more flexible and less intensive than inpatient treatment, but it may not be appropriate for those with more severe drinking problems.

While all of the above options have proven effective, the results may vary on an individual basis. What works for one person may not work for another, and vice versa. Therefore, it is important to seek treatment that can be tailored to your specific needs and circumstances. The best option is to turn to qualified professionals who have extensive experience in treating alcohol use disorders.17

How To Prevent Gray Area Drinking?

Preventing gray area drinking is possible. However, it requires effort, commitment, and taking several proactive steps to manage one’s alcohol consumption, such as:22,23,24

• Know the risks: Learning about the risks associated with gray area drinking (and drinking in general) can help you make more informed decisions about alcohol consumption. Attend seminars or workshops, read books or articles, or speak to a medical professional to learn more about the dangers.
• Seek support: Surrounding yourself with supportive people who understand your desire to avoid gray area drinking can help keep you on track. Consider joining a support group, speaking to a counselor, or leaning on friends and family members who are supportive of your goals and boast a healthy view of alcohol.
• Identify triggers: Certain situations or people can trigger gray area drinking behavior. Identify these triggers and develop a plan to avoid or manage them. For example, if you tend to drink more when socializing with certain friends, you might consider finding new ways to socialize or limiting your time with those friends.
• Practice self-care: Taking care of yourself physically and emotionally can help prevent gray area drinking. Get enough sleep, maintain a healthy diet, and exercise regularly. You can also practice relaxation techniques like meditation or yoga, as they have proven effective in reducing cravings and developing self-consciousness.

Frequently Asked Questions