“Gray Area Drinking” Spikes During the Pandemic: The Warning Signs and How to Treat it
Houston, TX
The jarring reality of a COVID-19 pandemic coupled with the stressors of job loss and increasing isolation at home have tipped the scales for many Americans.
Throughout the COVID-19 pandemic, more Americans have turned to heavy drinking and “gray area drinking” simply as a way of coping. “Gray area drinking” refers to the trend of people who drink with regularity, but who do not necessarily meet the clinical criteria of alcohol dependence.
“Gray area drinking” encapsulates a wide spectrum of drinkers, including those individuals who fall in between social drinking and excessive use of alcohol. According to a study conducted by the National Center for Biotechnology Information (NCBI), gray area drinking has been associated with increased risks of alcohol dependence, alcohol-related interpersonal problems and prevalent job loss. Heavy drinking is defined as anything above eight drinks per week for women and 15 drinks per week for men, according to the Center for Disease Control Prevention (CDC).
In fact, a recent NCBI survey suggests that 60 % of people are now drinking more than they did pre-pandemic. The significant rise of alcohol use during the pandemic has its roots in stress management, according to Dr. Ezemenari Obasi, Founder and Director of University of Houston’s HEALTH Center for Addictions Research and Cancer Prevention.
“A large part of this is a function of trying to cope with stress. When COVID-19 happened, people were less able to engage in activities that once brought them pleasure,” Dr. Obasi said. “When you’re stuck at home and managing the stress that comes with being in pandemic, people need coping strategies that work. Alcohol is one of those sources that help people escape negative affect in real time. This can be so effective that we lose sight of the long-term consequences.”
The impact of stress as a trigger for substance use during the pandemic can have so many nuances and layers, according to Diane Arms, Director at the Center for Co-occurring disorders at the Council on Recovery. Arms serves on HEALTH-RCMI's Community Research Advisory Board and is dedicated to working with the Latino population in the interwoven specialties of mental health and substance abuse.
“Generally, I think that society has glamorized drinking in a time where confined to the homes, isolated, changes in their job—even people who were working from home,” Arms said. “They are responsible—not just as the parent, but also as an employee, and a teacher and a daycare, and the list goes on and on. That frustration and overwhelming feeling can lead to people turning to substances to alleviate that stress.”
Instead of using broad determinants to define when drinking becomes problematic, the CDC states that drinking becomes an issue when it interferes with school, work, social activities, and relationships.
According to Arms, the definition for substance use is more complex and profound.
“According to the American Medical Association, American Psychiatric Association and American Society of Addictive Medicine, all three of them acknowledge substance use it is a chronic medical condition,” Arms states. “It’s going to last a long time. It’s not about one treatment or quick fix.”
To delve into the more granular aspect of substance use, there are certain biological reasons why the drinking evolves into a slippery slope—people needing to have “just one more” and drinking more just to get through the day, according to Dr. Obasi.
“When you take a substance like alcohol, the idea is to experience a positive mood. You will get that positive mood, but at some point, your mood will have to come back down. And your body will have to rebalance itself,” Dr. Obasi said. “As you consume more and more alcohol to achieve a sense of euphoria, the strategy becomes less effective and requires you to consume more and more alcohol to reach the desired effect. As you can see, it becomes a vicious cycle whereby people are needing to consume more alcohol to cope with stronger negative affect. This pattern will erode the human stress response, which then has implications for greater health risks.”
Pandemic-induced stress has triggered an increase in heavy drinking among women.
In fact, according to a Jama study, women have increased their heavy drinking episodes—defined as four or more drinks within several hours—by 41% during the pandemic.
“During the pandemic, a lot of the burdens have been unfairly placed on women,” Dr. Obasi said. “Women are asked to be full time workers in addition to helping their children navigate distance learning challenges or providing childcare when those facilities close. Unfortunately, we live in a society that does not always have an equitable way of thinking about how these loads should be shared. This is why you may see more women engaging in heavy drinking during this timeframe. But I would suggest that it is episodic.”
It is crucial to fully recognize the nuanced concept of stress and its sources. As Dr. Obasi emphasizes, not all stressors are deemed negative. In fact, some are quite positive.
“When we talk about stress, we seem to exclusively focus on negative stress. During the pandemic, there are folks who are trying to manage physical abuse, sexual abuse, trauma, unemployment, racism, discrimination, uncertainty, hopelessness, and helplessness,” Dr. Obasi said. “All of that will generate negative stress. Others will get married, have children, get a promotion, become a homeowner—all those things will be positive stressors but stressors, nevertheless. We must have the internal resources that are needed to manage it.”
So, when does alcohol become a concerning issue? It takes a sense of awareness that things have ricocheted out of control, Dr. Obasi states.
“I think at the point you—or loved ones—feel like you are no longer in control,” Dr. Obasi said. “There may be times where you only want to have one drink and you ended up having four. At this point you are no longer in control over your consumption. When you begin to realize that things are falling apart, the drinking becomes more of a coping Band-Aid. We need to have skills and strategies in place to prevent from even getting to this place. We also need to know when we need to seek help from others or a professional.”
It is important to know how to navigate the underlying issue and get the help you need and that’s not always easy to finesse, Dr. Obasi said.
There are five ways to help mitigate heavy drinking, according to Dr. Obasi.
- Understand the deeper issues or stressors behind the craving to drink: “The question is—understanding why do we drink? Drinking could be a symptom of a larger issue. If those other issues are not resolved, you will still have a craving to drink.”
- Have a support system of friends and family to help keep you on course: “You need to have family and friends that will help you execute that plan. So, if you’re going out to dinner with a friend, you might want to say, ‘hey listen, I’m trying to cut back on the alcohol, so make sure I don’t get more than two drinks while we’re out.’ Even if you forget, you have their support around you to help you.”
- Don’t stop cold turkey. Scale back the drinking: “If you quit cold turkey and you are dependent on alcohol consumption, you're going to have an extreme withdrawal reaction.” It is best to scale back the drinking instead of stopping it completely.
- Seek professional help: “If you do become addicted to alcohol and you try to stop, you will experience a lot of negative symptoms that we associate with withdrawal. This includes strong headaches, nausea, sweating, tremors, anxiety, hallucinations, insomnia, and possibly seizures. At this point, you really need to seek professional help. Often, we think of mental illness and addictions as an easy thing you can snap out of, and if you just had a friend to talk to, these things would all go away. But these are serious health conditions that require professional attention. Quitting alcohol while being dependent on it can be a dangerous thing if it is not done in a professional setting.”
- Avoid your triggers and alleviate stress to mitigate long-term health consequences: “For some people, you could be triggered when you just drive by the grocery store where you buy your favorite alcohol...or it could simply come from watching a movie where people are having a drink. There are so many ways in which our days induce a craving to drink. It gets to a point where it becomes hard to see the negative long-term health consequences when drinking is providing immediate relief from current life stressors.”
If you are starting to question yourself about your relationship with alcohol, that is a good indicator and a red flag, Arms said.
“If things are getting messy and you’re not able to function at work—not able to function in your household duties or missing time with your friends, those are all indicators of you potentially having a problem,” Arms said.
The compassionate response to those loved ones who you feel might have a concerning problem with substance use is to address the behavior and not to shame the individual, Arms said.
“It’s about coming from a place of concern, being genuine, and talking about the activity and not the person. Language is very important,” Arms said.
By Alison Medley
Interview Opportunities: Dr. Ezemenari Obasi, Email: emobasi@Central.UH.EDU
If you would like more information about this topic, please contact Alison Medley at 713.320.0933 or email aemedle2@central.uh.edu
