What is “gray area” drinking? Exploring 8 signs of the mild alcohol use disorder

When it comes to alcohol, could you fall into a gray area? “Gray area” drinking isn’t a medical diagnosis. But experts say the mild alcohol use disorder can still negatively impact people’s lives — often without them knowing it.

WellTuned spoke with Tracy Terpstra, licensed mental health therapist and behavioral health expert for BlueCross BlueShield of Tennessee, to learn more.

What is gray area drinking?

Terpstra: Gray area drinking is a term for people who fall between being a problem drinker and consuming alcohol responsibly.

According to the National Institute on Alcohol Abuse and Alcoholism, problem drinking is consuming:

4+ drinks on any day or 14+ drinks per week for males
3+ drinks on any day or 7+ drinks per week for females

The reason it’s called “gray area drinking” is because it lacks the formal qualifications for a diagnosis. A person who is drinking in the gray area may not experience specific repercussions, such as work or relationship impairment. Because they don’t have medical, social, work, or academic problems as a result of their drinking, they’re lulled into thinking there’s no alcohol dependence. College-age drinking is a good example of gray area drinking.

Has there been an uptick in drinking since the pandemic started?

Terpstra: Yes. Studies have shown that, during COVID-19, adults reported higher levels of alcohol consumption. This equaled both more days and total drinks — than they did pre-COVID-19.

In the U.S., adults bought more alcohol during most months in 2020 than the previous 3 years.

There’s also been an uptick of admissions to psychiatric or substance use facilities, as well as an increase in opioid overdoses.

What are the signs of problem or gray area drinking?

Terpstra: Signs of problem drinking often include:

Isolation
Withdrawal from events or activities that you typically enjoy
Sneaking off or hiding your behavior
Minimizing or rationalizing your behavior
Drinking more alcohol than you planned
Drinking at times you hadn’t planned, or in situations where you wouldn’t normally drink
Responding to social pressures related to alcohol
Experiencing an increased tolerance to alcohol

In more serious cases, your primary care provider (PCP) may also notice changes in your blood pressure, cholesterol or potassium levels.

Are there any misconceptions about problem drinking you’d like to clear up?

Terpstra: First of all, gray area or problem drinking is hard to identify. In our culture, drinking is accepted and often paired with social engagements, sports and even family events. It’s everywhere, which means it’s especially hard for us to see when we have a problem. This is especially true when the people that surround us are engaged in the same behavior. The sentiment becomes, ‘If everyone’s drinking heavily, then no one has a problem.’

On top of that, there’s the stigma of getting help for substance use. It’s wrongly considered a self-inflicted problem that a person should just be able to stop on their own. That misconception stops people from getting treatment early on, which is actually the most ideal but least accessed time to get help.

How can you assess if you’ve reached a level of drinking that’s unhealthy?

Terpstra: I recommend two ways:

1. MAST self-assessment

MAST stands for The Michigan Alcohol Screening Test, and it’s what doctors use to identify alcohol dependency. Answer 25 questions to get your score.

2. 7-day challenge

Clinically, I often challenge people who are unsure if they have a drinking problem to consider a 7-day challenge.

Try to stop drinking for 7 days and gauge your emotional, mental and physical changes.
Ask yourself: How do you feel when you’re not drinking? Do you see any changes in sleep disruption, appetite, energy level, etc.?
Ask your family and friends how they feel about your abstinence. Are you less irritable? Are you more tolerant/less frustrated? Do they see a change in your anger level or outbursts? Alcohol is one of those things where we simply can’t self-evaluate reliably, so it’s important to get outside perspectives. Feedback from loved ones — the people who know you best — is incredibly valuable.

Terpstra: Once you have those results, talk to your PCP or schedule a virtual behavioral health visit. Alcohol is different from other drugs. Chronic use can take decades to erupt, or to cause physical problems that are serious enough to cause you to get help. That doesn’t mean something is happening now. It’s always better to find out early and ask for the help you need as soon as you can.

10 facts to know about alcohol + how to gauge your alcohol use

Ashley Brantley

Ashley Brantley has been writing about food, culture and health for more than a decade, and has lived in three of Tennessee’s four major cities (Memphis, Nashville and Knoxville).