Alcoholism or Problem Drinking?
Alcoholism is not the same as problem drinking.
Alcoholism progresses over time and is regularly out of control. Alcoholics have moments they can’t say no to the next drink, creating horrible problems.
All alcoholics are problem drinkers, but not all problem drinkers are alcoholics. There are two types of problem drinkers—alcoholics who can never moderate for long, and problem drinkers who can change their drinking habits. I’m going to show you how I encourage problem drinkers who can moderate and alcoholics who can’t find out which type they are and what to do about it.
So, how do you help someone figure out whether they are an alcoholic or just a problem drinker? The first step is describing the territory.
1st type of problem drinkers—they can change.
Some people like drinking and sometimes drink too much, but they can receive influence and change bad habits. Many of us drank irresponsibly in our teens or twenties and moderated as we matured. This often involved setting personal standards for drinking—sometimes with the help of friends, family, or therapists—and keeping to those standards for years and decades.
2nd type of problem drinkers—alcoholics who can’t moderate.
Alcoholics like drinking and drink too much regularly. They can never consistently moderate drinking. Alcoholics need some kind of recovery process that helps them stay abstinent from alcohol or their lives degrade. Alcoholism kills you slowly, and it’s a painful death.
People fear declaring, “I am an alcoholic.”
When people who like drinking and drink too much enter my office, they want to be problem drinkers who can moderate. Hardly anyone announces, “I am an alcoholic!”
Alcoholics exist in denial with lots of rationalizations like, “It’s not that much of a problem.” If I believe they probably can’t control their drinking, I’ll tell them, “It seems likely to me that you are an alcoholic. What do you think?”
Mostly I what I hear back is some version of, “I can control my drinking.”
This is a crucial moment!
A crack in the denial field.
When I hear, “I can control my drinking,” I lean in and ask, “Do you want to find out if you can moderate?”
“Yes!” They say, relieved that I might change my mind about their alcoholism, hoping they can make an effort and solve the problem—and they may be right! Type one drinkers can moderate.
I begin what has become a familiar conversation over the last 50 years, “The way we find out if you are an alcoholic is simple. Set specific rules for your drinking—say no more than two drinks a day and four when you party—and keep to it for 6 months. Can you do this, without exception, for six months? If you break the rules, you’re probably an alcoholic.”
This is my favorite path into denial systems. Alcoholics usually negotiate, not realizing how such bargaining broadcasts addiction. For example, someone might ask, “What about three drinks a day and no more than five when I party?”
This kind of bargaining often makes me laugh (these conversations don’t have to always be heavy), “Sure, as long as it’s specific, but be aware! The more you drink, the more disinhibited you become. No one I’ve heard of has stuck to three each day and five at parties, but you might be the first!”
Two to four weeks later
· “I almost was perfect I only drank too much on Saturdays.”
· “I only slipped at my cousin’s wedding. It was a wedding!”
· “It was a really social weekend and we started drinking at twelve on the boat.”
Most of the time people break the rules within days or weeks. If this happens twice, they are almost certainly alcoholics, and I’ll tell them. “I believe you’re an alcoholic. What do you want to do about it.”
If I’m lucky, this will be a moment of clarity where this person will feel genuine horror at what it means to them to be an alcoholic.
· “I don’t want people to know!”
· “People will see me as flawed and weak!”
· “What?! I can never taste a great wine ever again?”
· “I hate AA!” (Usually having never given AA a chance).
· I don’t want to be an AA person!”
· “People will find out I’m an alcoholic and despise me!”
Alcoholic shame—facing the consequences.
Fears of horrible social judgments and punishments are core issues in addiction. And these are legitimate fears! People are critical of practicing alcoholics (haven’t you been offended by—or worried about—some intoxicated person acting badly?). Practicing alcoholics experience social condemnation from painful scenes with family, friends, and colleagues.
But the worst shame in alcoholism comes from self-condemnation—the sickening realization, “I’ve hurt lots of people!”
Recovery makes you beautiful.
This shame can point an alcoholic towards love, joy, and health in recovery. We admire alcoholics in recovery! The I-can’t-bear-to-think-I’m-an-alcoholic moment can be transformative.
I want to make this point to help an alcoholic wake up (waking up to being an addict is the purpose of all drug/alcohol interventions, whether it be one person or a dozen people intervening), “You definitely are the object of criticism and contempt, but not primarily from other people! You are contemptuous and critical of yourself for being an alcoholic. You are ashamed of the damage you have done, and you should be ashamed! Shame is our unconscious Shadow-self telling us we are violating our own values. You believe it’s wrong to be a practicing alcoholic, and you’re right! But once you are in recovery, everyone will love you! People love alcoholics in recovery! I admire people who have been sober for months and years, especially if they are in AA benefitting from the 12-step program.”
The taboo words, “I am an alcoholic.”
I’ve found that people who want to be sober but not in AA work to stop drinking without self-identifying as alcoholics. This rarely works. Many people get sober without the help of AA, but few stay sober unless they realize that they can never drink safely.
The first step of AA is, “We admitted we were powerless over alcohol—that our lives had become unmanageable.”
The AA greeting, “Hi. I’m John and I’m an alcoholic,” is a staggeringly powerful intervention. AA meetings support each member’s decision to live and grow, and challenges their denial/rationalization systems. The AA program is transformational. Working a program supports lifelong growth. The first three steps are about acknowledging the chaos, receiving support, and connecting with the sacred. The next nine are about self-inquiry, character development, loving relationships, and spiritual expansion.
People don’t decide they are alcoholics, they discover they are alcoholics.
Willpower has little to do with alcoholism. Different genes predispose people to alcoholism, some of which are shared by cows, chickens, and fruit flies! I don’t think it’s a lack of willpower in fruit flies that makes them turn into drunks!
I tell people, “Alcoholism is like diabetes. You are never cured, but you can manage the condition and have a joyful, healthy life. The part of you that likes drinking will keep suggesting that you’re cured and can drink moderately. This is why we get worried about alcoholics who stop going to meetings. Most everyone in AA has seen members stop attending and relapse.”
The gift of recovery from addiction
When people become sober in the AA program, something magical often happens. Their universe expands beyond selfish cravings into dedication to a better, cleaner life.
AA meetings are beautiful and loving. A community of caring others all trying to save their lives and help others is a beautiful thing. It’s also amazing that an institution as large and long lived as Alcoholics Anonymous has endured so long with so little corruption. The messages and understandings have actually evolved over the years to include modern neuroscience and social research.
Most people recover outside of AA.
One study found that 20% of people who gave up drinking used AA to stop. People yearn to be free of addiction and will find paths to sobriety which work for them.
I’ve found that therapy alone is not enough to help someone get out of denial, face their addiction, and choose life and recovery. Usually, social group support is needed. My parents stopped drinking with their 60s therapy group. The therapist, who was also my therapist, Dr. Joe Ericson, was wild by the day’s standards. The group went on motorcycle trips together and were social in ways that are forbidden by current licensure laws. Joe was a maverick who pushed the limits on supporting human health and joy. He was a wonderful therapist for me and my family.
Any approach an alcoholic makes to stop drinking is the most important first step. It often leads to, “My life has become unmanageable, and I need help!”
Those who keep reaching for recovery will find it—choosing life over death is beautiful and good.
The of seductions alcohol and grieving the losses of Alcohol pleasures.
Controlled drinkers can go to the concert, have four of five beers and smoke a joint with their friends, and an have an ecstatic experience. An alcoholic can never do this without relapsing.
One of clients was a worldly, wealthy, and brilliant alcoholic. He told me once, “It’s a fierce itch!” It feels so good to have a drink when you have that fierce itch. Controlled drinkers can indulge that itch and have an extra drink occasionally, which feels great. Alcoholics can never say “Yes!” to the itch. AA is the king and queen of slogans. Here’s one of my favorites, “One is too many, and a thousand are not enough.”
I do most of my practices sober, but I like meditating, dancing, and martial arts when I use pot or alcohol. These are intense pleasurable states, and often yield insights and downloads (to be reevaluated sober). I wonder how many monks over the eons, feeling these pleasures, became alcoholics.
Alcoholics need to find other paths into transcendence, and there are so many!
Alcohol disinhibits us socially and generates surges of emotions—joy, anger, lust, open-heartedness, genuine interest, and paranoid suspicion all can arise from alcohol altered states. Many of these are intensely gratifying, especially when shared—a party, a bar, a bat mitzva, or a concert with friends.
Abstinence from alcohol can lead to losing (or radically changing) those people, places, and experiences. This can be such a catastrophe! When alcoholics get into recovery, part of the process is grieving all the losses.
Joy while sober is important
Recovery needs to be about creating a life where pleasures and joys happen regularly without alcohol—this can take years, even with hard work.