Where is the Line?

In April, The Oprah Show broadcast a episode called Moms Who Drink Too Much. Oprah opened the show with:

It’s estimated that, for millions of moms across the country, the need to escape with a little alcohol has now crossed the line. Have you crossed the line? How many drinks is considered normal? What should have you worried?

The first segment of the show tracked Sarah, a 30-year-old mom who had been filmed at home and created a video diary about her drinking problem. Sarah appears to have worked through the first two stages of change — precontemplation and contemplation — and is now poised to move from preparation into action. The bulk of her ambivalence has been resolved and she is looking forward to life without alcohol. (Oprah says later that the show is going to help Sarah get the help she needs and follow up later on her progress.)

Great stuff. So, Sarah’s frequent heavy drinking, hiding it from her kids, blackouts, and using alcohol to numb her feelings is an example of being way over the line.

Oprah throws out this teaser before going to commercial:

Next, three moms, who like to unwind with cocktails at night, who want to know where they stand. Where is the line? Do they have a drinking problem?

When the show returns, a video montage has the three moms talking briefly about their drinking patterns. One of them is Amber, a 28-year-old mother of two. Her comments include:

I pretty much drink every night, anywhere from on average about 2 glasses of wine a night… I drink because I’m bored. It makes me a better mom, especially when I’m really edgy… I try not to drink before 5, and I try not to drink more than 1-2 glasses when my children are awake.

I am hoping that someone can tell me, if I have 3 drinks, you’re OK, if I have 4 drinks, you’re not OK. I want somebody to tell me exactly where that line is.

Amber is just rephrasing Oprah’s opener — Where’s the line? What is normal, and at what point should a reasonable person worry?

Oprah and the show’s expert for the day, author and interventionist Debra Jay, discuss:

Oprah: OK, Debra says women who don’t have a problem don’t have to make up rules about drinking.

Debra: That’s right. If you don’t have a problem, you never even think about making up a rule, but when you do you start setting up little rules for yourself so it can look like you’re drinking like everybody else, that your drinking is normal. And what happens, is you find that you keep breaking your own rules.

Oprah: OK, and I see you’re frowning because of that. You don’t like that?

Amber: No, I totally disagree. I think anybody who’s going to be responsible, whether it be with prescription drugs or alcohol or anything different, I think that any responsible parent — or person — needs to have a boundary up, or it’s a free-for-all.

Debra: You know, it isn’t really, not with somebody who doesn’t have a problem. They don’t even have to think about it. They just really can use it responsibly. What I’m talking about is internally, inside of yourself. It’s 2 o’clock and I’m thinking, “Boy, I really want that glass of wine,” and I’m looking at my clock, and I’m thinking I’ve got 3 hours until five. And, I’ve got to hold on, I’ve got to hold on. That’s something completely different. Now I’m feeling all this emotional unmanageability inside of myself, trying to keep that rule. Somebody who [doesn’t have a problem], they’re not going to be thinking at 2 o’clock about what they’re going to be drinking at 5 o’clock if they don’t have a problem. That’s what I’m talking about.

OK, so the anwer to “Where’s the line?” seems to be “when we have to set rules for ourselves,” or perhaps more precisely, “when we set rules which we find emotionally unmanageable and end up breaking.”

A little later, Oprah and Debra come back to the five-o-clock-rule issue:

Oprah: You’re saying, the fact that you have to say, “I’m going to only do it after five”…

Debra: Right.

Oprah: …means that it could be a problem.

Debra: Yeah, and usually it’s not just going to be that rule, there are going to be lots of little rules around when I’m with my kids, and this, and that, you know, I’m going to have lots of little rules.

Oprah: Are you an alcoholic…

OK, now we’re getting down to the root of the question, or at least the root of the answers being given to the “Where is the line? question.

Amber is asking whether a problem is occuring at a certain point, and the answers coming back are about the specific problem of alcoholism. Amber seems to be concerned about crossing a line from use of alcohol to abuse, and in response she’s hearing about dependence (alcoholism). But, I’ve interrupted. Let’s hear the rest of the conversation:

Oprah: Are you an alcoholic… You are an alcoholic because your body has a predisposition for the way it handles alcohol.

Debra: Um hmm.

Oprah: Is it alcoholism if it hasn’t hurt anybody yet?

Debra: No, very, very early on, we can’t… it’s probably not going to hurt anybody. It’s progressive and there are certain stages, so as it moves forward it starts hurting people.

Oprah: So, I’m saying, you’re still functioning…

Debra: Yeah. We’re not going to see it, no, we’re not going to see it…

Oprah: OK, everybody’s doing fine…

Debra: No one will know it’s there yet.

Oprah: But you can still be an alcoholic…

Debra: You can still be an alcoholic and usually before anyone notices on the outside, you start having changes in how you feel about it on the inside.

Oprah: Really. Like what?

Debra: Well, again, preoccupation with it. Really thinking about it a lot.

Oprah: Uh huh.

Debra: Most people aren’t preoccupied with alcohol. They’re not thinking about it.

Oprah: Uh huh.

Debra: But people early on, they might look normal on the outside, but boy, they really like those drinking events a lot better than the dry events, for instance. That would be a little bit of a red flag. Does it mean you’re an alcoholic? Not necessarily, but it’s a red flag.

Taking stock thus far, crossing the line can include:

• Daily heavy drinking, hiding it, blackouts, numbing feelings with alcohol.
• Setting rules which are emotionally unmanageable and seldom kept.
• Lots of little rules about, and growing preoccupation with, drinking.

A later segment introduces the audience to Belinda, whose daily drinking is triggering marital tension. Here is part of the ensuing discussion:

Debra: One of the first rules is, if somebody thinks you have a problem with alcohol, you probably do. One of the things we say to people is, “If you don’t know if you have a problem, look around you. Is somebody close to you having a problem [with your drinking]?” It’s the first place it’s going to hit home. It’s not going to hit your job for a long time after it hits your marriage.

Oprah: Can you just have a glass of wine, though, and not have a problem?

Debra: Absolutely.

Oprah: OK.

Debra: Absolutely.

Oprah: If you have to have — this is the thing — if you have to have the glass of wine every night, is that a sign of a problem?

Debra: I think there are people who have a glass of wine every night, and they don’t have a problem, most definitely. It’s never recommended to drink every single day. That is a slippery slope.

Oprah: So, anything you have to do every day, then you should be worrying.

Debra: I’m not saying you’re an alcoholic, but you might be on that slippery slope.

The discussion continues on “After The Show,” a half-hour piece which airs on the Oxygen cable network. Amber sounds less than convinced that her question has been answered when she says:

Amber: I just keep thinking, I’ve never been much of a drinker, was always a good student, always working and being responsible.

Oprah: But the point we made earlier and I think everybody needs to know, [is that] you can …be [not] much of a drinker — as Debra said to Sarah at the very beginning of the show, Sarah had told us that her first drinking experience after graduation, she blacked out — that blacking out is not a normal relationship with alcohol.

Debra: No, no.

Oprah: You don’t have to be much of a drinker if you have the gene.

I recounted what happened next in Oprah Questions Denial. The bottom line from that exchange was that the brains of alcoholics have a malfunction which makes it impossible for them to see their alcoholism developing.

As the end of the “After The Show” show approaches, they take a last stab at answering the question which opened it:

Oprah: Let’s talk about “What is crossing the line?” which I think is a question you guys wanted answered, and I don’t know if you got it answered. What is crossing the line?

Debra: There’s a simple question you can ask: “Is alcohol creating repeated problems in any area of my life, and I continue to drink anyway. If you can answer “yes” to that, you probably have a problem. It’s simple as that. If you can answer “yes” to that question, you probably have a problem, you probably should take a good, hard look, and I would say if you answer “yes” to that and you think, “Well, maybe I don’t have a problem,” you know what? Change your drinking behavior, cut way back … [committing that:]

• I’m going to drink when I’m not around my kids,
• I’m going to only drink with other people,
• I’m going to drink once or twice a week,
• I’m going to have one or two glasses of wine,
• And, it’s a permanent change in my life.

If you can do it, you don’t have a problem. If you can’t, you’ve got a problem.

So, recapping one last time, signs that one has crossed the line may include:

• Daily heavy drinking, hiding it, blackouts, numbing feelings with alcohol.
• Setting rules which are emotionally unmanageable and seldom kept.
• Lots of little rules about, and growing preoccupation with, drinking.
• A loved one believes there is a drinking problem.
• Drinking at all, for those whose bodies are predisposed to alcoholism.
• Inability to cut back dramatically, instantly, and permanently in the face of recurring alcohol-related problems.

Remember Amber’s question?

I am hoping that someone can tell me, if I have 3 drinks, you’re OK, if I have 4 drinks, you’re not OK. I want somebody to tell me exactly where that line is.

Being fair to Oprah and Debra Jay, let’s recognize that:

• An accurate answer in the format Amber asked about — drinking X glasses of wine is OK, but X+1 is over the line — doesn’t exist.
• The answers given were consistent with those that other addiction specialists may have offered.
• The over-the-line characteristics accurately describe folks who have had alcohol dependence.
• Given time and format constraints, producers of the show may have elected to focus on alcohol dependence, to the inadvertant or necessary overshadowing of alcohol abuse issues.

I can’t help but imagine Amber walking away from that show more frustrated than she walked in. She brought valid questions, particularly for folks not having significant problems with or because of their drinking. She repeatedly insisted on taking personal responsibility and asked for guidelines for being proactive about preventing problems.

Had it been me, I might have left the show with a sense of dark foreboding about a cloudy gloom gathering on the horizon, maybe soon, which I probably wouldn’t see coming, nor be able to push back. I might have felt cowed into cutting my drinking back to negligible amounts for a week or two, but fear generally isn’t a good long-term motivator for me. Anyway, since no daily or weekly drink limits were suggested (the one or two drink, once or twice a week thing was for someone with recurring alcohol-related problems, which I honestly don’t have) having 3-5 drinks four or five times a week will probably be fine.

Some line, eh?

(See also: Answers for Amber.)

(p.s., I welcome first-person reflection and responses from Amber, Debra Jay, Oprah producers, or anyone who participated in the show. I’d much rather let y’all speak for yourselves; feel free to contact me here, and I’ll publish your thoughts to whatever extent you choose.)