That statement crossed my lips at least once a week, while I tried to calm the nerves of a client during an initial evaluation in my office. The initial evaluation is administered when someone is trying to determine if clinically they are a drug addict or alcoholic. The results of that evaluation are usually 'yes, addiction is present', mostly because not many people came through my door unless they were aware, on some level, of an addiction.
The qualm most people had with this diagnosis is acknowledging addiction is accepting that you are not in control of your disease; i.e. there is no amount of fanagling you can do to safely continue using. Most people that are seeking help for addiction still want to believe they have just "gotten a little out of control" but once they get treatment and are back in control, they can use again-safely. Unfortunately, that's not how addiction works. Once addicted, never safe. And you can't substitute one substance for another, insert this conversation:
That being said, I am going to focus on alcoholism specifically in this article.
So let's address some of the common questions that cross my desk:
1. So why is alcohol even legal if its so addictive and dangerous?
Because: Drugs are great! (and yes alcohol is a drug). Until they aren't. Yes, some people become addicted, drinking leads to many health issues and contributes to crime, and accidents. BUT, it is also a multi-billion industry that is entrenched in our culture and for some people...is just fun. Alcohol, in and of itself, is not addictive- for everyone. In fact, one of the initial warning signs of alcoholism is a person who feels a strong urge to binge drink and continue drinking following that first drink. The reason is, simply, because alcoholism is based on a genetic predisposition. Hence, why it is viewed as a disease. There is a chemical difference between people who become alcoholics and people who do not. People who are predisposed to alcoholism will react to alcohol differently and indulge in it frequently enough to develop a physical addiction. People who do not have that predisposition are very unlikely to drink enough to ever become physically addicted. Picture smoking a cigarette- the first time you take a puff, you cough, the chemicals are in your system, but you're not hooked- it is not until you have had a few cigarettes that a physical addiction occurs and you feel the withdraw symptoms that make you crave another. Having a drink is the same. Alcoholism occurs in stages and the physical addiction is not present in the early stage. It is not until a larger quantity of alcohol is introduced to your system, over a prolonged period of time that you will actually have physical withdrawal symptoms. Craving the euphoric rush? For an alcoholic, that can happen after the first drink.
For more information regarding the chemical predisposition for alcoholism: a great read is "Beyond the Influence, Understanding and defeating Alcoholism" By: Katherine Ketcham
2. I have some issues with alcohol, but I am a high functioning person! I'm not an alcoholic because I don't need to hide bottles around my house and drink all day. So how can I be an alcoholic?
Unfortunately, I hear that a lot. Despite research that proves that alcoholism is a genetic predisposition (aka you are born with it) many people still carry the shield of the stereotypical late stage alcoholic as their justification that they "aren't that bad" and therefore, can compare out and dismiss their own issues. In early stage alcoholism, a person is usually still enjoying the party. He may have a high tolerance, be able to re cooperate quickly from drinking, maybe drinking has led to an underage or even DUI, but that might be the only consequence he has experienced at this point. It is very hard to see the problem that drinking may become because, for an alcoholic, the buzz is an amazing feeling and it is almost impossible to imagine this thing in your life that makes you feel so good, will be the same thing that destroys you. The goal of current clinicians in the chemical dependency field is to identify the disease before a person becomes a late stage alcoholic.
3. ...Am I an alcoholic?
Well, let's start by providing a copy and paste of the definition of clinical alcohol abuse and dependence from the DSM-IV (the diagnosis guide used by clinicians):
ALCOHOL ABUSE
(A) A maladaptive pattern of drinking, leading to clinically significant impairment or distress, as manifested by at least one of the following occurring within a 12-month period:
- Recurrent use of alcohol resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use; alcohol-related absences, suspensions, or expulsions from school; neglect of children or household)
- Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by alcohol use)
- Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct)
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol (e.g., arguments with spouse about consequences of intoxication).
(B) Never met criteria for alcohol dependence.
ALCOHOL DEPENDENCE
(A) A maladaptive pattern of drinking, leading to clinically significant impairment or distress, as manifested by three or more of the following occurring at any time in the same 12-month period:
- Need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or markedly diminished effect with continued use of the same amount of alcohol
- The characteristic withdrawal syndrome for alcohol; or drinking (or using a closely related substance) to relieve or avoid withdrawal symptoms
- Drinking in larger amounts or over a longer period than intended.
- Persistent desire or one or more unsuccessful efforts to cut down or control drinking
- Important social, occupational, or recreational activities given up or reduced because of drinking
- A great deal of time spent in activities necessary to obtain, to use, or to recover from the effects of drinking
- Continued drinking despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by drinking.
(B) No duration criterion separately specified, but several dependence criteria must occur repeatedly as specified by duration qualifiers associated with criteria (e.g., “persistent,” “continued”).
Source: Adapted from American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC: APA, 2000.
Now, that definition decoded: Ask yourself these 10 questions:
1. Are you unable to stop drinking after having 2-3 drinks?
2. Does your family have a history of alcoholism?
3. Has your health been effected by your drinking? Has your physician advised you cut back?
4. Have you encountered any legal issues due to drinking or drug use?
5. Do you find it hard to control your mood, frequently feeling irritable or frustrated?
6. Have your family members or friends questioned you regarding your drinking habits?
7. Have you ever been involved in a car accident due to drinking?
8. Have you blacked out from drinking or drug use?
9. Have you ever become hostile, belligerent, or been involved in a physical fight while intoxicated?
10. Are you preoccupied with drinking (i.e. is drinking present at all or almost all of your social activities, do you find yourself thinking about happy hour, or the next time you will be able to have a drink when not drinking)?
If you answered yes to more than 3 of these questions OR if you feel that you may have a problem controlling your drinking or drug use, contact a local provider to get an evaluation.
Remember, addiction is a disease- it's not something to be ashamed of or stigmatized by. If a person has diabetes and eats poorly, doesn't monitor his blood sugar, and ignores his symptoms; yes, he is responsible for the decision he made to further the deterioration of his health BUT he is not a bad person for being a diabetic. It is not his fault that he has a medical issue; it is just his responsibility to take action to better his lifestyle and health. Alcoholism is the same.
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