Why “Alcoholic” Matters.
The medical and scientific community generally eschews the term “alcoholic” these days. Preferring instead terms like alcohol abuse and alcohol dependence, and more recently, “Alcohol Use Disorder“. If you read the link to the NIH’s page just there, you’ll see that this is a set of fairly vague rules designed to identify people who have severe problems with their drinking behavior. They’re not dissimilar from the questions you’ll find in AA’s literature. I don’t know why some words fall in and out of favor. They just do. Generally, soon thereafter, we’re told that the old terms are “offensive”.
I think there’s an important reason to keep the term “alcoholic” around. That doesn’t mean that the newer terms are useless; they just serve a different purpose. They may do harm, or good, or both. I’m not advocating that they not be used. But there’s a fundamental difference between the newer medical terms and “alcoholic” or “alcoholism” and it matters.
Like the institution of AA itself, I subscribe to the disease model of alcoholism. I’m not sure anyone credible doesn’t at this point. We know that people who cannot manage their drinking have some sort of disorder, whether neurological or genetic or both or something, which interferes with their ability to regulate their consumption of alcohol. I’m one of those people. When I drink, I lose the ability to control how much I consume. I have immediate and generally irresistible cravings for more. I behave in ways that I know are wrong but cannot override with moral judgement. It’s a mental illness. There’s no cure.
Alcohol abuse describes a behavior. I also exhibit that behavior when I drink. And I believe firmly (far more firmly than most medical professionals or addiction scientists, I think) that our behavior when we drink – even those of us with this disease – cannot be excused or ameliorated by our condition. When a person commits a crime while drunk, especially if that person is an alcoholic, inebriation is not a mitigating factor. If anything, it is an aggravating factor. Being an abuser of alcohol is not an excuse from participation in society.
Alcohol dependence describes a medical condition. It describes people who suffer from serious withdrawal symptoms (possibly including death) when they stop drinking suddenly. Our bodies come to depend on alcohol to function. Even as it poisons us, we can be physically addicted to the point that sudden cessation is lethal.
Alcohol Use Disorder describes any number of a cluster of symptoms detailed in the link above. It’s deliberately vague, which I can both understand and value, allowing the diagnosis to be a conversation between a physician and a patient. This diagnosis results in many avenues for professional treatment being opened: insurance coverage of inpatient and outpatient treatment, for example. And it also invokes the Americans with Disabilities Act, preventing the patient from being fired so long as they engage with treatment. I have mixed feelings about Alcohol Use Disorder being covered under the ADA.
But “Alcoholic” is different. “Alcoholic” is an identity. It describes a person. I am an alcoholic. I have alcoholism. I was probably born with it. It resides in my genes and my brain and perhaps other important parts of me. Being an alcoholic is part of the structure of my self. It is an inextricable part of me, influencing how I behave from long before my first drink, and long after I stopped drinking. It will persist until I die.
I no longer exhibit alcohol abuse. I am not alcohol dependent. I do not have alcohol use disorder. All of those things depend for their existence on my consumption of alcohol. Because I do not drink, it is impossible for me to suffer from any of those things. However, no sane person with any experience in the workings of alcoholism would presume that that means I am cured. If I drink, I will go back to all of those things. Which is why I believe the expunging of the term “alcoholic” from the medical language is dangerous.
I remain an alcoholic. It’s part of my core identity. It’s part of my brain and my body, and it is not dependent upon my consumption of alcohol. Being so identified makes it clear that I cannot return to the more moderate drinking levels of my early drinking career. The disease is progressive, and does not remit.
Not every problem drinker is an alcoholic the way I am. I know people who have drunk to regretful, problematic levels and returned to normal, socially acceptable drinking. But for those people like me, who drink like I drank, these terms, when used to the exclusion of labeling a person as an alcoholic, can provide us with a dangerous rationalization. We will see the medical terms, see our new behavior, and declare ourselves cured. That gives us permission to return, self-deluded, to drinking.
We can then blame the doctors. We can blame the definitions. We can blame anyone but ourselves. Because we know that changing ourselves is the only way, and that way leads to lifelong sobriety. Which is too terrible to contemplate while we still drink. Easier and safer to tantrum and rail against those who were supposed to cure us but failed. We cannot drink like normal people because the physician was derelict. Let’s raise a drink to his incompetence.
Being an alcoholic matters. Having the identity of an alcoholic matters. The disease being “alcoholism” matters. These terms are not dependent on my use of alcohol. They are simply part of me. And yes, sometimes the term “alcoholic” is offensive. I was offended when it was first used to describe me. Because I didn’t want to accept the truth of myself. And that’s the thing: the truth is sometimes offensive. Being afraid to offend people like me by calling us what we are does no one any good. And can do all of us, me, and my potential victims, a great deal of harm.