Thursday, April 5, 2012

Almost Alcoholic? The Atlantic thinks we all are.

Photo by Michal Sänger, from flickr.
The Atlantic posted an article recently purportedly suggesting a revision in how we classify alcoholics to recognize a spectrum of alcohol abuse. The old, strict definition of alcoholism relied on physical dependence to make its diagnosis. If you didn't need alcohol in your system all the time, you weren't an alcoholic. Later, alcohol abuse was added to the DSM, defined as having had an episode where you suffered serious consequences due to your drinking, such as a DUI or losing a job. Joseph Nowinsky and Robert Doyle suggest that rather than a bi- or trivalent notion of alcoholism, we need to consider it more as a spectrum.
We believe that, as opposed to thinking only those men and women whose drinking has progressed to the point where they need help, that many people in the mid-range may also be suffering as a result of drinking. That suffering may take the form of declining job performance and declining health so that the individual does not yet recognize it as being related to drinking.
Well and good. There's undoubtedly a spectrum of alcohol abuse and dependence, and ill effects can occur long before they become noticeable. So guidance for doctors and psychologists that doesn't rely on an overly simplistic schema can be helpful. But Nowinsky and Doyle's list of symptoms seems over-broad. They list:
  • You drink to relieve stress.
  • You often drink alone.
  • You look forward to drinking.
  • Your drinking may be related to one or more health problems.
  • You drink to relieve boredom or loneliness.
  • You sometimes drive after drinking.
  • You drink to maintain a "buzz."
  • Your performance at work is not what it used to be.
  • You aren't comfortable in social situations without drinking.
  • You find that drinking helps you overcome your shyness. 
This seems excessive to say the least. Most of these are signs, not of alcohol abuse, but of alcohol enjoyment. There's a certain line of thinking that tends to believe that any drinking is pathological; these are the same people that say that splitting a couple bottles of wine with your wife over a five course meal is binge drinking, or that a glass of wine during pregnancy makes you a bad mother. No doubt if drinking is your only stress-reliever or if you're driving after putting down a fifth, you have a problem, but the authors seem to think that if any of these apply to you, you're almost an alcoholic.

The key line is this one: "That research has resulted in a number of strategies that individuals can use to either stop or reduce their drinking." It's a problem if you see the only goal of your research as reducing or stopping drinking, rather than accurately measuring when it's a difficulty rather than a hobby.

Are You Almost Alcoholic? Taking a New Look at an Old Problem - The Atlantic

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