Alcoholism Facts: Alcoholism Has Never Been What We Thought It Was
Alcoholism Facts – I ran across an interesting article today by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) titled “Alcoholism Isn’t What It Used To Be” (link found broken as of 7/25/12). It isn’t a new article, it was published on the NIAAA’s Spectrum website in 2010. The title could use some work, but I found the article, which involves a study on people who fit the DSM-IV criteria for alcohol dependence, to be quite interesting just the same. It should probably be called, “Alcoholism Has Never Been What We Thought It Was,” since it may shed some light on the mainstream standard of diagnosing alcoholism, a diagnosis that does not line up with reality, and certainly not alcoholism facts of the 77 years of experience of Alcoholics Anonymous. Before you jump to the “AA doesn’t work” bit, hear me out. It does, but that’s a whole other story. The point here is this: AA isn’t the place for some who are coerced to go and the reason it isn’t is because they aren’t actually alcoholics, even though the DSM says they are.
I don’t find the survey article startling, as stated on Dr Stanton Peele’s website where I found the link. I find it interesting because it highlights alcoholism facts that have been known for years, facts which have been distorted over time with the end result being the label of alcoholic stuck on those who may not be, for example someone who gets one DUI. The Big Book “Alcoholics Anonymous”, printed in 1939, describes three classes of drinkers. One of which is characterized by, among other things, having experienced a permanent loss of control over drinking, thus the real alcoholic. In fact, the survey illuminates that the DSM diagnostic criteria is missing two critical indicators of alcoholism – full loss (not impaired) of control over drinking and the abnormal reaction of the alcoholic when he puts alcohol into his system. A proper understanding of the actual characteristics of a real alcoholic could very well turn the “alcoholism is is not a disease” argument on its head.
The articles states, “The NESARC surveyed more than 43,000 individuals representative of the U.S. adult population using questions based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition(DSM-IV) of the American Psychiatric Association (APA). Published in 1994, DSM-IV recognizes alcohol dependence by preoccupation with drinking, impaired control over drinking, compulsive drinking, drinking despite physical or psychological problems caused or made worse by drinking, and tolerance and/or withdrawal symptoms.
The article, located at http://www.spectrum.niaaa.nih.gov/features/alcoholism.aspx (link found broken as of 7/25/12), encapsulates survey data into the following findings:
- Many heavy drinkers do not have alcohol dependence. For example, even in people who have 5 or more drinks a day (the equivalent of a bottle of wine) the rate of developing dependence is less than 7 percent per year.
- Most persons who develop alcohol dependence have mild to moderate disorder, in which they primarily experience impaired control. For example, they set limits and go over them or find it difficult to quit or cut down. In general, these people do not have severe alcohol-related relationship, health, vocational or legal problems.
- About 70 percent of affected persons have a single episode of less than 4 years. The remainder experience an average of five episodes. Thus, it appears that there are two forms of alcohol dependence: time-limited, and recurrent or chronic.
- Although 22 is the average age when alcohol dependence begins, the onset varies from the mid-teens to middle age.
- Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence.
- About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment.
Now, let me begin by saying that as written these findings are at least a bit “squishy.” Some statements made and terms used are ambiguous, and beg questions. Be that as it may, I’m taking them at face value as alcoholism facts for the purposes of making a point that I think, that regardless of this lack, may be made. Also, throw out the people described in the first paragraph, as it is presumed that they don’t meet the DSM criteria for alcohol dependence. Moving on, let’s shift and look at the classes of drinkers as described in the Big Book, a true and lasting account of alcoholism facts, as it breaks them down quite nicely. In the chapter “There Is A Solution,” we find three types of drinker: the moderate drinker, the hard drinker and the real alcoholic. It states, “Moderate drinkers have little trouble giving up liquor entirely if they have good reason for it. They can take it or leave it alone.” “Then we have a certain type of hard drinker. He may have the habit badly enough to gradually impair him physically and mentally. It may cause him to die a few years before his time. If a sufficiently strong reason-ill health, falling in love, change of environment, or the warning of a doctor-becomes operative, this man can also stop or moderate, although he may find it difficult or troublesome and may even need medical attention.” “But what about the real alcoholic? He may start off as a moderate drinker; he may or may not become a continuous hard drinker; but at some stage of his drinking career he begins to lose all control of his liquor consumption, once he starts to drink.” And finally, “We know that no real alcoholic ever recovers control.”
The first two types, the moderate and heavy drinkers, don’t need treatment and/or the program of AA, they are able to stop or moderate on their own, although it may be somewhat difficult, and the second type may need detox. But the third type, he needs serious help. He is the real alcoholic. It really comes down to the definition of alcoholism. Dr. Peele is right in one sense, many people who present as “alcoholics,” according to the DSM, can correct themselves without treatment or even abstinence. They can do this because they aren’t real alcoholics.
Here are my perceptions of the study’s results. Remember, I am taking what they report at face value as alcoholism facts, in spite of numerous questions that would provide vital clarity:
- Many moderate and heavy drinkers are not real alcoholics.
- Most of the people (and I wish there was a number here) who fit the DSM criteria actually have a mild or moderate disorder, experiencing impaired (but not permanent loss) of control, and 70% of them have single episodes of alcohol dependence lasting less then 4 years and therefore are not real alcoholics.
- After 20 years with alcohol dependence, 75% recover (which is comprised of half in abstinence and half in moderate drinking with no symptoms of dependence), and the remaining 25% do not, therefore real alcoholics.
- 62% of the people surveyed recovered (abstinence or moderation with no harm) with no help, because in spite of fitting the DSM criteria they are not real alcoholics, according to the Big Book criteria. 13% recovered with help, therefore the remaining 25% did not recover.
Again, what differentiates the moderate and heavy drinkers from the real alcoholics is the eventual full loss of control of the ability to stop or moderate when presented with sufficient reason to do so (warning from a doctor, relationship or legal troubles). Perhaps Dr Peele uses the diagnosis-lite framework of the DSM, and therefore he interpreted this survey to support his belief that most people recover from alcoholism on their own, many of whom are successful at moderating, because they grow over time into different phases of life. I think he’s half right. The 62% of people in the study who recovered without help from what the DSM-IV calls alcohol dependency were not real alcoholics, and therefore could stop on their own. Perhaps this study and others like it in the future will help reduce the disease concept controversy by revealing that fewer who drink moderately or heavily and who may run into problems are alcoholics than is so widely believed. Perhaps it will also do away with the oxymoron “functional alcoholic.”
I feel the need here for a few important disclaimers. I am not saying that AA is the only way to recover with help. AA was brought into this article because of the veracity of the description of the classes of drinkers. AA is not the only way people who fit the description of a real alcoholic get sober, albeit a very good one. Further, even though the Big Book is clear about what defines an alcoholic, due to delusional thinking, many people will not find themselves in this class when they probably are. Delusion that carries over into their efforts to get help, which they will likely try all sorts of ways to sabotage. This is the subject of another article to be written later, but this emphasizes that diagnosing alcoholism is largely based on self-reporting, and alcoholics like to lie, particularly to themselves and in fact may not be aware they are doing it. They must come to this realization for themselves, if they are to recover. Coercion doesn’t work, although shutting down enabling certainly helps. Yet another article topic.
Suffice it to say, study or no study, there remain hundreds of thousands of real alcoholics and real addicts out there who are untreated. When not drinking or using, they are restless, irritable and discontented, obsessing about the next drink or drug. Once they succumb to that desire, as many will do, they will be in the stage of using they cannot control, only to be stopped by something briefly, arriving back at restless, irritable and discontented, ready to start the whole process over again. It is that space between stopped and started, during the discomfort of no alcohol and no solution, that an opportunity for recovery exists. Treatment, AA and the 12-steps work great when fully pursued wholeheartedly.
♦
Author Unknown. (n.d.). Alcoholism Isn’t What It Used To Be. Retrieved March 12, 2012, from http://www.spectrum.niaaa.nih.gov/features/alcoholism.aspx
Alcoholics Anonymous World Services, Inc.. (1976). Alcoholics Anonymous, The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. Third Edition. New York.
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