Updated: Dec 31, 2018
When I first identified as alcoholic, I surprised some people -- including myself. I'll be the first to admit: I didn't fit the stereotype. But that's because the stereotype - as is so often the case - is wrong. And it's not just sort of wrong. Among alcoholics, it captures just a tiny minority.
Thanks to shows like Mad Men and movies like A Star is Born, society at least understands that alcoholics are usually not gutter drunks. Alcoholics can be closeted, high-achieving, known only by those in their personal lives - sometimes, known only by themselves. But as a culture, we still have a long way to go before understanding what it truly means - and what it does not mean - to be dependent on alcohol.
For myself, I choose to use the word “Alcoholic.” I know it's distracting, and I use it anyway. I use it even though it prompts a familiar cascade of questions, like whether I routinely drank in the morning, drank at work, drank every day, or suffered withdrawals when I quit. (The answer to all of those is No.)
I earned my Master's in Counseling, so bear with me as I nerd-out for a second on diagnosis. (I use the term "nerd-out" as loosely as possible, given that counseling is the softest of soft sciences - a veritable teddy bear of a field.)
The current Diagnostic & Statistical Manual (DSM-5) has done away with the term “alcoholic” entirely. Rather, it describes a spectrum of alcohol abuse called Alcohol Use Disorder, which can be further classified as “mild,” “moderate,” or “severe."
One practical drawback of this approach is that we we lose the ability to operate heuristically. That is, we lose our mental shortcuts when it comes to alcohol. Identifying as an alcoholic means "I need to stop drinking" or "I need to seek treatment," but noticing that I meet the criteria for mild alcohol use disorder seems to provides no clear direction.
On the other hand, one benefit of this system is that it is more accurate, more nuanced. It allows both providers and laypeople to identify problem drinking in its early stages, and potentially to intervene before drinking gets worse - and all without using the scary label "alcoholic."
So why do I use that label? Why do I call myself an alcoholic? There are a couple of reasons:
1. In the context of twelve-step meetings, identifying as alcoholic helps me to focus on our similarities (our common problem with alcohol), rather than our differences.
2. When I find myself hesitant to use the word "alcoholic," I'm conscious of my own internalized stigma. And to quote the all-knowing Dumbledore (I warned you the science is soft): "fear of the name only increases fear of the thing itself."
3. Most importantly: It's true. It feels true internally, and I also happen to meet diagnostic criteria -- regardless of the classification system.
In a future post, I'll discuss what the diagnostic criteria are. It'll be like a handy how-to guide on how to qualify for alcohol use disorder. In the meantime, I'd challenge you to think about why criteria matter. The purpose of a diagnosis is simply to describe a commonly co-occurring set of symptoms. A diagnosis does not magically capture the breadth of an individual's experience, nor does it provide a plan of action.
So ask yourself -- ask the master of your own experience: How do you experience alcohol? And what, if anything, would you like to be different?