“Alcoholic”

As a therapist the word “alcoholic” is bothersome. It is not that I have a problem with alcoholics particularly, but rather I have a problem with how the term—and its associations—interfere with treating alcohol-related problems. The common use of the term, and especially the commonly held definitions or expectations of the label, create an either/or designation for alcohol problems—either one is an alcoholic or one is not, there is no in-between ground . If someone is using alcohol to his or her detriment, but does not drink to messy intoxication regularly (or always), we tend not to label that person an alcoholic and consequently there is (frequently) no attempt to address the problems that are associated with the alcohol use.

“Alcoholic” and “Alcoholism” are not clinical terms and therefore they sometimes have poor operational definitions. If someone drinks every day, but not to the point of apparent (or clinically significant—in psychologist speak) dysfunction, we do not classify that person as an alcoholic—even if his or her drinking is negatively affecting the overall quality of his/her personal life (e.g., relationships, sex life, hobbies). If the drinking causes problems, but does not appear to be an “addiction” (another term that is not clinically defined), then we tend not to label it as something to be treated. We may even talk to the person about how his/her drinking is affecting him, but we do not typically address it in terms of maybe the person should seek help—that would mean he/she was an alcoholic after all, and we do not want to give that stigmatized label to anyone inaccurately.

Furthermore, someone who is experiencing alcohol-related problems but does not experience the symptoms associated with “addiction” is not likely to benefit from Alcoholics Anonymous meetings. Maybe he/she is drinking more frequently, but not substantially more at any one time, or has cravings, but not actually withdrawal. These could, however, qualify someone for a diagnosis of Alcohol Dependence or Alcohol Abuse. But a person is not likely to see himself/herself as an “alcoholic.” “Alcoholism” and “addiction” are the common terms used to describe someone who we perceive as having as having a drinking problem, not “dependence” or “abuse,” which allow for more flexibility in identifying problematic drinking.

Another aspect that is missed with traditional thinking on alcoholism is that someone over 50 may not be drinking more, but is most likely getting more drunk on the same amount of alcohol. Around the age of 50 our bodies become less able to detoxify alcohol, so smaller amounts can actually have more major impacts. But we see a person having two to three drinks a night still—without needing a greater quantity of alcohol, yet his/her body is processing the same amount as if it was in fact more. This can disguise the tolerance a person might be developing.

If we were willing to think of drinking problems in terms other than “alcoholism” or “not alcoholism” we could better address the negative impacts that some people’s alcohol use causes.

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