Gray Area Drinking: The Overlooked Struggle with Alcohol
By Dani Saliani
With St. Patrick's Day coming up, many people are going to be spending the evening and the weekend prior at the bars with many alcohol-related festivities around NYC. Many people are those who meet the criteria for an alcohol use disorder and are not yet at the stage where they are willing to come to terms with those problems. There are also many people who engage with alcohol in less-than-healthy ways that do not meet the criteria for an alcohol use disorder. Maybe you engaged in Dry January just to party the first weekend of February. You're thinking about your alcohol use, but because it hasn't had significant dysfunction in your life, making a change to your drinking seems like an extreme measure. Sound familiar?
This is not to shame anyone for habits, but considering this is so common, it can be helpful to explore.
What is Gray Area Drinking?
Gray area drinkers don't have a dependency on alcohol and generally consider themselves to be “social drinkers.” If you relate, you may have wondered what your drinking means "when not in a social setting or when home alone." Gray area drinking is the in-between area of a healthy relationship with alcohol and an alcohol use disorder, so "identifying their drinking as problematic doesn’t happen automatically. For this reason, gray area drinking is not a subject being talked about among friends and family and is often a hidden matter, left to one’s own assessment." (Golden, 2022)
The gray area of consumption was associated with small but significantly increased risks of prevalent and incident alcohol dependence (Dawson, 2011). In Dawson and Grant’s 2011 study, they found that “although the harms associated with this level of consumption reflected low absolute and/or relative risks of harm, their impact was not negligible because of the large proportion of drinkers in the gray area of consumption (29.1%).”
It can be hard to determine what a healthy relationship actually is, so it might be helpful to first understand what is generally considered unhealthy.
When Does Drinking Become a Problem?
Alcohol consumption has a wide range, with moderate consumption considered 2 drinks for men and 1 drink for women in a 24 hour period, according to the Dietary Guidelines for Americans 2020-2025. Binge drinking is generally considered consuming five or more drinks (male), or four or more drinks (female), in about two hours (NIH, 2025). Even there, the difference between what is considered moderate and binge drinking offers a gray area. Depending on a number of biological factors, one can not reach binge numbers on a standard night and still wake up with a hangover or have an embarrassing mishap. This can be considered a personal/interpersonal problem, without being a diagnostically considered problem.
An alcohol use disorder has 3 different levels: mild, moderate and severe and could be assessed with the below graphic:
Based on the DSM-5 (2013) and supported by the DSM-5-TR (2022).
A Confusing Relationship with Alcohol
Let's say you resonate with one of these items, but not more than one (considering that 2-3 items is a mild alcohol use disorder). One item wouldn't qualify you for an alcohol use disorder, but you still might experience distressing impacts from drinking. The term "hangxiety" is the (very real) experience of many individuals after a night of drinking, wherein you can be filled with negative thought patterns and a vague sense of regret, dread, guilt and/or shame, alongside the general physical impacts of a hangover. A question that comes up around hangxiety is 'If I didn't do anything wrong, why do I feel this way?'
For one thing, alcohol changes the chemicals in your brain. It is a depressant after all! Even though you might feel good while under the influence, its depressive effects come along during the restoration process of your brain's baseline chemicals. This process will reduce "the brain’s GABA [the primary inhibitory neurotransmitter in the brain] (reducing calm feelings) and increasing glutamate (making you more anxious)" (Queensland Gov, 2023). There are full-on cognitive distortions that can take over when you're recovering from a night out. These chemical changes can exacerbate a sense of shame that was already in you, since hangxiety is most common in an already anxious population.
But it's important to recognize: it's not you, it's not real. As with most shame and cognitive distortions, they are tricks your mind plays. If you're noticing these tricks primarily around alcohol, you may want to take some precautions for the weekend.
How to Support Yourself
If alcohol isn’t a deterrent to your daily functioning, you don’t have to quit it, though this is always an option. There are other ways that you can be mindful of your alcohol use and keep yourself in a more positive headspace. Here are some tips to support yourself:
“Don’t drink to feel better, drink to feel even better.” This quote is from the 2010 James L Brooks romcom movie, but is a good reminder to think about the circumstances in which you drink and to avoid doing so when you’re in a negative headspace. (I tend to remind myself of this after a bad day.)
Count your drinks— Seems simple, but can be harder to do the more drinks you have and where you’re having them. For example, avoiding 'top ups' at house parties, so you have a more accurate idea of how much you’ve had.
Socialize more often with friends who don't drink/drink infrequently and be aware of social pressures— If you’re going to be shamed for not taking that shot, you may want to take a look at your friends.
Alternate between alcoholic drinks with water or other non-alcoholic drinks— This can reduce the intensity of a hangover.
Hydrate when you get home as much as possible and first thing in the morning— Again, the hangxiety tends to couple with the physical sensations of a hangover.
Eat – Even if you don’t feel hungry, food helps your brain and body to recover.
Be kind to yourself— If you are feeling hangxiety, remember that those negative thoughts are just thoughts and not a comment on your character. Can I scream this one? Can you hear me in the back of the room? This idea is key.
Conclusion
We all have rough nights, do things we’re not proud of, and feel worried about how we’re perceived (some more than others, of course). When someone is in the zone of gray area drinking, abstaining from alcohol isn’t typically the first thought. While this is always an option, especially if things get worse, there are other ways to support yourself through the hangxiety that commonly ensues after a night of drinking. The negative thoughts that spin with hangxiety are common, normal and absolutely not an actual comment on who you are as a person. Maybe you actually did make a mistake when drinking, but one mistake is never the sum of a person. Those are just things to be mindful of the next time you go out. Take care of yourself: hydrate, sleep, eat, and be aware. Stay safe and have a good weekend.
If you’d like to talk about your drinking habits and their impact with a therapist, you can book an appointment with any of our clinicians, you can check out our bios here or make an appointment below. We look forward to working with you!
References
American Psychiatric Association. (2022). Alcohol-Related Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Dawson, Deborah A., and Bridget F. Grant. “The “Gray Area” of Consumption between Moderate and Risk Drinking*.” Journal of Studies on Alcohol and Drugs, vol. 72, no. 3, May 2011, pp. 453–458, https://doi.org/10.15288/jsad.2011.72.453. Accessed 30 Aug. 2019.
Golden, Dana. "What is Gray Area Drinking?" Psychology Today, 26. Apr. 2022, https://www.psychologytoday.com/us/blog/a-fine-line/202204/what-is-gray-area-drinking
Hawaii Island Recovery. “Everything about Alcohol Use Disorder.” Hawaii Island Recovery, 26 Feb. 2020, hawaiianrecovery.com/rehab-blog/everything-about-alcohol-use-disorder.
NIH, National Institute on Alcohol Abuse and Alcoholism. “Understanding Alcohol Drinking Patterns.” NIH.gov, 2024, www.niaaa.nih.gov/alcohols-effects-health/alcohol-drinking-patterns.
Queensland Government. “Hangxiety: Why Alcohol Can Leave You Feeling Anxious.” Queensland Health, 26 July 2023, www.health.qld.gov.au/newsroom/features/hangxiety-why-alcohol-can-leave-you-feeling-anxious.
