“I’m not an alcoholic! I can stop any time I want.”

I don’t like the word “alcoholic,” because it’s often considered an insult. Sure, you’ll hear people in Alcoholics Anonymous say, “Hi, I’m Joe, and I’m an alcoholic.” And everybody applauds. But calling someone an alcoholic who isn’t used to the term can be problematic. I usually prefer “problem drinker.”

Spouses and other family members often bring their relative to my office or into a rehab center saying this person needs to quit drinking. The proposed patient denies there’s any problem and he/she just needs to be left alone. “Stop bugging me!”

(Drug addiction works in a very similar fashion. For this whole discussion, just substitute “addict” for “alcoholic,” “using” for “drinking, and “drugs” for “alcohol.”)

So who’s right? How do you know there’s a problem?

The five levels of alcohol consumption

To me, alcohol use falls into five categories:

  1. Teetotaler. This person doesn’t drink at all, ever. Never-drinkers are about 30% of the U.S. population.
  2. Social or occasional drinker. This person drinks occasionally, without regular use, or may have a beer or glass of wine with dinner but never drinks heavily. Social drinkers are about 50% of the people in the U.S.
  3. Heavy drinker. The World Health Organization defines heavy drinking as follows: for men, five or more drinks in 24 hours or fifteen or more drinks a week. For women or anyone over 70 years old: four or more drinks in 24 hours or eight or more drinks a week. If a person frequently drinks more than these amounts, they qualify as a heavy drinker. I exclude from this category people who have had problems due to their drinking.
  4. Problem drinker. This person gets into repeated trouble with their drinking but is able to start and stop without difficulty. An example is a guy who goes to a bar a few times a year but then always gets drunk and winds up being arrested for fighting. Or they’ve been arrested more than once for driving under the influence. Or they’re a heavy drinker and their spouse complains about their drinking because it changes them into a different person. Or they frequently drink so heavily they can’t remember what happened when they were drinking.
  5. Alcohol dependence: This person drinks so heavily and regularly that if they stop, they go into alcohol withdrawal: anxiety, sweats, and tremors if mild. If severe, alcohol withdrawal causes seizures and DTs: “delirium tremens.” Severe alcohol withdrawal can be fatal if not treated.

If you’re a problem drinker or alcohol dependent, you should receive treatment. This is a fatal illness.

For drugs, there are really only three levels: never users, experimental or rare social use, and regular use or dependence.

Recurring problems due to drinking/using

The simplest definition of addiction is you have recurring problems stemming from drug or alcohol use. Here are some examples:

  • You use to such an extent you pass out or often can’t remember what happened while you were drunk. Or, in the case of meth or cocaine, you’re often paranoid or see things that aren’t there or hear voices.
  • You’ve been arrested more than once for an alcohol- or drug-related charge. (Arrested, not necessarily convicted)
  • Your spouse or other family members complain about your drinking. Being unable to see your children or repeated divorces and relationship breakups due to your use are extreme examples of this.
  • Your spouse has to call in sick for you on Monday mornings because you’re too hung over to show up. You’ve lost jobs due to drinking.
  • You’re anxious and depressed much of the time and you can’t sleep.
  • You blame someone else for your drinking problem.
  • Alcohol is affecting your health. Your doctor says your liver tests are abnormal, or your blood pressure is too high. Your memory is failing you.
  • You were too busy drinking/using to finish school and bounce from job to job, never a real career.

The three “C”s of alcoholism/addiction

A more comprehensive definition of addiction is the three “C”s:

  1. Craving or Compulsive use. You think about alcohol or drugs a lot. You dream about using and much of the time all you can think about is getting loaded.
  2. Loss of ControlYou routinely use more than you intend. “One little drinky-poo” turns into ten.
  3. Ongoing use despite Consequences. The problems noted in the previous section keep showing up.

Typically these three come together. More than one of these means you have a problem.

What causes alcoholism/addiction?

The large majority of people with drug or alcohol problems have a positive family history: blood relatives who were themselves addicted. For almost everyone, this is an inherited illness.

When you realize you were born with the tendency to abuse alcohol or drugs, you realize this illness isn’t your fault. But it is your responsibility.

How can you tell? About 70-80% of the population are what we in the business call “normies.” They have a couple of drinks and nothing happens. Alcohol makes them a little relaxed but almost immediately causes sleepiness and an upset stomach. It’s okay but there’s nothing really fun about drinking. More than a little alcohol is really annoying.

It’s completely different if you’ve inherited the risk for alcoholism. A few drinks and you feel really good. A few more and you feel even better. The sky’s the limit! You can drink a lot, more than most of the people you know. And getting drunk is the best yet (never mind the morning after). As one gentleman told me, alcohol “is like a rocket up your butt.” Getting drunk is better than sex, better than anything.

In clinical terms, people who inherit the risk for alcohol are different from “normies” in two ways: they become euphoric with alcohol (normies don’t feel much of anything) and they have a high tolerance (normies become sick).

How do you treat alcoholism/addiction?

I’ll cover this separately. Short version: find someone who specializes in treating addiction and get help. One word of warning: this field is now full of crooks and charlatans. Buyer beware!

Certainly many people get sober just by attending Alcoholics Anonymous meetings in the community. However, attending formal chemical dependency treatment is about three times more effective in achieving a lasting recovery than just AA.