How Do We Define Alcoholism?

Universally accepted definitions have been changing over time. Everyone involved in addiction treatment has their private view of the disease. The professionals believe they are entitled to their own opinions about alcoholism because there has been, until now, no clear picture of what alcoholism is, what causes it, how it progresses, and why certain people become addicted while others do not.

And yet, there is a firm basis of research evidence for understanding the disease. The disease itself is understandable and definable; the alcoholic’s behaviour is understandable and definable, and the recovery process is also understandable and definable.

The Rand Report

Opinions must no longer be allowed to overshadow facts. An example of the dangers inherent in allowing researchers to interpret the data according to their personal meanings is a 1976 Rand Report of the USA. This government-funded study assessed the effectiveness of forty-four federal government treatment programs.The term ‘’recovery’’ was replaced with a broader term ‘’remission.’’ ‘’Remission’’ included the category ‘’normal drinking,’’ defined by the authors as drinking less than 3 ounces of pure alcohol every day. An alcoholic was considered in remission, then, if he was drinking the equivalent of 6 ounces or less of 100 proof whiskey every day. Thus, treatment centres that embraced this definition of ‘’remission’’ could claim up to 80 percent success rates – even though most of the alcoholics so labelled were still drinking.

The word ‘’remission’’ by itself is not offensive, but the dangers are genuine when used to describe acceptable ‘’normal drinking’’ in alcoholics. The Rand Report created an uproar in the field of alcoholism when it was published, with some professionals insisting the report provided evidence that some alcoholics could return to regular drinking. Others condemned the study as dangerous and irresponsible since it would encourage alcoholics to believe that they could permanently control their drinking.

Five years later, the Rand researchers backed away from their original conclusions. A follow-up study found that the so-called normal alcoholic drinkers had nearly three times the relapse rate of long long-term abstainers when they tried to stop drinking.

‘’Normal drinking’’ is not possible for the alcoholic. While they can control intake for a few months or even years, their disease will steadily progress until, eventually, the addiction overpowers their best effort to control it.

Another example of the power of words to promote misconceptions is using the term ‘’alcohol abuse’’ as a synonym for ‘’alcoholism.’’ ‘’Alcohol abuse identifies alcoholism as a compulsion like overeating or gambling and puts the onus on the person who allegedly abuses the substance.

Definitions related to alcoholism

The need for precise definitions is obvious. Predominant diagnostic classifications are alcohol use disorder (DSM-5) or alcohol dependence (ICD-11).

Here are some definitions, based on facts already established in the scientific literature and community:

Alcoholism: A chronic, primary, hereditary disease which progresses from an early physiological susceptibility into an addiction characterised by tolerance changes, physiological dependence, and loss of control over drinking. Psychological and social symptoms are secondary to the physiological disease and not relevant to its onset.

Recovery:A return to normal functioning based on total, continuous abstinence from alcohol and substitute drugs, corrective nutrition, and an accurate understanding of the disease. The word ‘’cure’’ should not be used because it implies that the alcoholic can engage in normal drinking after their ‘’problem’’ has been corrected or ‘’treated.’’

Problem Drinker:a person who is not an alcoholic but whose alcohol use creates psychological and social problems for themselves and others.

Heavy Drinker:Anyone who drinks frequently or in large amounts. A heavy drinker may be a problem drinker, an alcoholic, or a regular drinker with a high tolerance for alcohol.

Alcoholic:An alcoholic is a person with the disease of alcoholism regardless of whether they are initially a heavy drinker, a problem drinker, or a moderate drinker. The alcoholic’s increasing problems and heavier drinking stem from their addiction and should not be confused with problem drinking or heavy drinking in the nonalcoholic.

Recovered Alcoholic: The alcoholic who maintains continuous total abstinence from alcohol and substitute drugs and has returned to a normal lifestyle. The term ‘’reformed alcoholic’’ implies that the alcoholic has been ‘’bad’’ and is now being ‘’good’’ – a reflection of the moralistic approach to alcoholism which has no basis in fact. The term ‘’ex-alcoholic’’ should not e used either, for it implies a cure rather than recovery.

Relapse(‘’Slip’’ in AA language):Any intake of alcohol or substitute drug by a recovering alcoholic. Although not usually considered a relapse, the taking of a substitute drug seriously interferes with recovery and almost always leads to a return to drinking.

Bill Wilson, co-founder of Alcoholics Anonymous, defined alcoholism in a rather poetic but apt way: ‘’A soul-sickness.’’

Many clients who come for treatment of alcohol addiction have doubts if they really are alcoholics. Some of these definitions may be of help. However, we must keep in mind that denial is part of the disease so that the person will minimise his or her issue. A skilled addiction therapist will break through the denial mechanism and provide valuable insight to the client.

So, who is an alcoholic? Simple: ask the family! They don’t need any fancy definitions. They know.