What makes an alcoholic an alcoholic?
There was a man who lived near me whom I would see almost every day, wandering the neighborhood shirtless. Sometimes he sat on the sidewalk, asleep against a wall. Other times he drifted through the streets clutching a bottle of vodka. I always assumed he was unhoused. Then one day, I watched a car pull over beside him. A woman stepped out and gently tried to coax him into the passenger seat. It was his daughter, searching for him so she could take him home. He wasn't unhoused. He was an alcoholic.
It's easy to look at someone like this and pass judgment. How could he do this to himself? Why doesn't he just stop drinking? He lacks character. He's weak. We tend to assume that people suffering from alcoholism are choosing their circumstances, when the defining feature of the disease is precisely the loss of choice. What appears from the outside to be a series of bad decisions is often the visible consequence of a struggle that has long since slipped beyond a person's control.
Alcohol Use Disorder (AUD) is a psychiatric condition referenced in the DSM-V that is characterized by a pattern of use or abuse of alcohol that causes social, physical and mental distress to the user. This includes binge-drinkers, people who drink every day, people who have exaggerated amounts of alcohol at once and those who can't go even a few days without drinking. You can learn more about symptoms of AUD here.
It's not how much you drink
One misconception about AUD is that it only applies to people who consume an elevated amount of alcoholic doses per session. This is not always the case. There are many people who may exaggerate their use every once in a while and this does not characterize them as alcoholics. However, if it happens often, it might be a sign.
Alcohol abusers can have different types of consumption patterns that help to characterize AUD. One is the need to drink at least one dose every day or several times a week. Another is constantly binge drinking to the point where you become severely inebriated. One other is when you don't drink constantly, but every time you do, you cannot control your consumption. Some people can go without drinking for several months, but once they start drinking, they can't control themselves.
If you are considering whether you might have AUD, think not only about how often you drink, but what your consumption patterns are like.
The obsession with drinking
Alcoholics are addicts. An addiction is a disorder characterized by compulsive, out-of-control urges to use a substance or engage in a behavior even if it brings mental or physical harm. The drinking becomes an obsession, taking over your entire life.
Addicts cannot control their urges and are constantly thinking about them. They will start the day by thinking about where they will buy their next drink, where they will go to drink, how much they will be able to drink. If something comes between them and their plans and they are unable to have their drink, they become nervous and anxious.
The alcoholic will begin to think about their drinking very strategically. They will count the money that they will need, they will count the amount of drinks that they can have that day, and they will count how many days before they can get their next dose.
They will also negotiate rules with themselves. Is it OK for me to drink tonight? Can I order a drink at the company's after-office party? Is it OK to buy whiskey at the theater? Can I drink at my niece's baptism? When you have to consider the logistics of where and when you will be able to drink, and wonder how socially acceptable it will be, there is a big problem. Alcohol will be on your mind even when you're not drinking.
Another side of this is the set of guidelines that we create to convince ourselves that we don't actually have a problem. You may tell yourself that you only drink on weekends, so it's ok. Or perhaps you only drink beer; that's not a problem, right? You never have more than three drinks, so surely you're not an alcoholic.
The moment we start trying to justify our behavior is the moment we realize that the behavior is no longer normal. We just don't want to admit it.
Addiction as a loss of control
I once went on a date with a first-year psychology student. I told him that I was a recovering alcoholic and he told me: “You're not an alcoholic; you are in complete control of your actions. If you want to drink, you can drink. Just make the decision.” I'm assuming he hadn't studied addiction yet because loss of control is the very definition of addiction. The person that can have one glass of wine and go home has control over their will-power. The addict doesn't have any control over their actions.
This loss of control is exactly the reason why it's not their fault that alcoholics behave the way they behave. It's their responsibility, of course, but not their fault. They cannot control their urges and end up engaging in behavior that is detrimental to their health, relationships and career. They start with honest innocent plans of having one drink, but as soon as the alcohol hits their bloodstream and the dopamine is released, they think it's ok to have just one more drink.
There is a lot of guilt and shame put on the alcoholic because of their behavior. I remember being blamed by the bad decisions I made when really I didn't have any choice or control. I just responded to my urges, despite the consequences. Most people don't understand this and it becomes a taboo that refrains addicts from getting proper treatment.
Back when I attended AA meetings, there were all sorts of recovering alcoholics with all types of life stories: some had become unhoused after losing everything, others were divorced and removed from their families, others lost their careers, others became sick. Alcoholism can generate severe issues in one's relationships, career, finances, and health, and that won't be enough for them to search for help.
A kid learns early on that if they touch a hot stove, they will get burned. An alcoholic will go through repeated embarrassments, lose everything they have, and still continue drinking. The elderly man from the beginning of this article was one drink short of losing his family. After all, how much would his daughter be able to take before she got fed up with his behavior and give up on him? It was the story of many of my AA companions.
The difference between enjoying alcohol and needing it
It's true that alcoholism is the addiction to alcohol, but the way each person drinks and why they drink may differ. My grandpa used to have a glass of whiskey every day after lunch and a glass of wine every night after dinner. He said his doctor had recommended it. I never saw my grandpa get drunk and when he was sick, he had no trouble laying off the alcohol. I don't believe he was an alcohol abuser even though he was a constant drinker. I could be wrong, but there may be a significant difference between enjoying a drink and needing it.
Most alcoholics don't need a reason to drink; it's already part of their routine. Many others relate their drinking to specific events and moments in their lives. They may drink when they're happy, sad, or angry. They may drink because they're feeling anxious and don't know how to deal with their anxiety. Maybe they drink in order to become more sociable or extroverted. They may need a drink to calm down or go to sleep. It's different for everybody.
At one point in my life, I forgot how to deal with problems and ended up using alcohol as a way to cope with my inability to act. The problems kept accumulating as I kept drinking. Only when I quit drinking did I finally have the ability to solve my problems. I thought I needed alcohol to deal with life. The alcohol was actually keeping me from facing it.
What convinced me that I was an alcoholic?
I knew alcohol would be a problem for me since the first time I tried it, when I was seventeen. I immediately knew I was going to enjoy that feeling and would need it constantly. But I had no idea what alcoholism was. Nobody ever explained to me how drinking worked and how to deal with it. I didn't know that alcoholism was genetic in our family. I didn't know it could happen to me.
I finally admitted there was a problem when I caught myself waiting for my son to go to sleep so I could finally have a drink. As this progressed from once a week to daily, I finally started to become concerned. On my next doctor appointment, I told my psychiatrist that I thought I may be an alcoholic.
It still took me three years to figure out how to get rid of the addiction. The first part was admitting there was a problem—that I was indeed an alcoholic. There's a reason why “admitting your powerlessness before alcohol” is the first step on AA's 12-step program. It all starts with understanding what it means to be an alcoholic. So, if you identify with some of the situations presented here, perhaps it's time to ask yourself: are you an alcoholic?
