For this week's excerpt, I'm going back to my 2010 book, What the Early Worm Gets, for an excerpt on the differences between the disease of Alcoholism and behavior disorder Alcohol Abuse, a main theme of that book. This isn't an all-inclusive summary of the differences, but begins a lengthy chapter on how to distinguish the distinctly different alcohol use disorders from one another.
"One of the top researchers, Don Cahalan wrote
Problem Drinkers: A national survey (Jossey-Bass) based on
four studies he authored or co-authored. He said, “Comparing
estimates of Alcoholics and problem drinkers [Alcohol Abusers] is a
rather futile exercise because the concepts of Alcoholism and problem
drinking are not very similar, do not necessarily apply to the same
people and have quite different implications for prevention measures
and treatment.”
If Alcoholism was a
behavioral or emotional or psychological or moral or social or
spiritual failing, lab rats would not get Alcoholism, the
physiological disease. Rats do not even like alcohol to begin with—so
they are incapable of Alcohol Abuse—and haven’t the capacity of
all of those psychological expressions commonly given as causes for
Alcoholism. They are biochemically different when Alcoholism
is present not morally deficient.
Cahalan and others saw the
difference between the Alcoholics and Alcohol Abusers in studies of
drinking behavior in the armed services. There’s a lot of heavy
drinking in the military. You’d expect it in a population
consisting largely of young males away from their families and in a
stressful environment. Many drank so much that they were at a high
risk of developing Alcoholism. Most however only had disciplinary
problems, not telltale changes in body tissues. The medical risks and
physiology of Alcoholism weren’t there.
That’s why many people
leave Alcoholics Anonymous, the mother of all 12-step programs, in
their first year. They walk away saying, “That isn’t me.” They
could be right, too. They could be Alcohol Abusers not Alcoholics.
Controlled drinking may be a
treatment goal for an Abuser. A treatment goal for an Alcoholic
though is abstinence. Only abstinence. Success factors in dealing
with either are variables like the client’s motivation, severity of
drinking, socioeconomic stability and coercion. The largest predictor
of success though is an appropriate match between problem and
solution. Dr. Marc Schuckit, author of "Alcohol
& Sociopathy: Diagnostic Confusion", in the 1973
“Quarterly Journal of Studies on Alcohol,” put it this way. “It
is necessary to distinguish between the Alcoholic who engages in a
limited sphere of antisocial behavior and of the antisocial who
abuses alcohol as part of his behavior. The process and prognosis of
these different varieties are distinct."
To put it another way, an
Alcoholic says, “never again” and they mean it but cannot stick
to it and when an Abuser says, “never again” they usually don’t
mean it and will stick to "never again" only as long as
they choose. Alcohol Abusers actually have three choices. They can
choose not to drink. They can choose to drink moderately. They can
choose to get bombed. Alcoholism is about lack of choice: Once they
take the first drink of alcohol, stopping isn't a choice, and they
can no longer choose the amount. And an Alcoholic certainly didn't
choose the genetics that contribute to their disease."
-- condensed from What the Early Worm Gets, pages 33-35, FIVE STARS on amazon.com
This summer, the
diagnostic manual clinicians use – called the Diagnostic and
Statistical Manual or DSM IV – was replaced by an updated DSM 5.
The update puts both Alcoholism and Alcohol Abuse under the same
"code," however, there will always remain a distinction
between the two and in how the two conditions are best treated.
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