We are used to thinking of alcohol dependence as black or white: Either someone is or isn’t an alcoholic. Dr. John Mariani , who researches substance abuse at Columbia University, says that the field of psychiatry now recognizes shades of gray between someone who doesn’t drink at all and someone who suffers from an alcohol addiction. At least 38 million adults drink too much. Binge drinking, high weekly use, and any alcohol use by pregnant women or people under the age of 21 are included in this category. In the United States each year, about 88,000 deaths are alcohol related, and alcohol abuse costs the U.S. economy about $224 billion each year. A recent study by the Centers for Disease Control and Prevention (CDC) showed that 90% of excessive drinkers were unlikely to need addiction treatment, and another revealed that only 1 in 6 adults talk with their doctor, nurse, or other health professional about their drinking. Among adults who binge drink 10 times or more a month, only 1 in 3 have discussed drinking. And only 17% of pregnant women have talked about drinking. The CDC recommends that physicians and other health providers include basic alcohol screening and brief counseling as part of routine medical practice by: talking directly with patients about how much and how often they drink; providing information about the health dangers of drinking too much; offering options for patients who may want to stop drinking, cut down, maintain their current level of drinking, or seek further help; and referring patients who need specialized treatment for alcohol dependence. Screening and brief counseling have been proven to work by reducing how much alcohol a person drinks on an occasion by 25% and by improving health and saving money in the same way that blood pressure screening, flu vaccines, and cholesterol or breast cancer screening do. Drinker’s Checkup , an online confidential screening tool, is a good resource to share with clients; it provides detailed, objective feedback for people who aren’t sure whether their drinking is excessive and provides help with making a decision about whether to change drinking habits. An app called Moderate Drinking can be downloaded to help monitor drinking habits; its effectiveness has been demonstrated in a study published in the Journal of Consulting and Clinical Psychology.